Test Bank for Nutritional Foundations and Clinical Applications A Nursi of your publication

Gridner and Escott-Stump

Test bank Application: A Nursing Approach, 6th Edition Chapter 01: Wellness Nutrition My Nursing Test Banks Chapter 02: Personal and Community Nutrition My Nursing Test Banks Chapter 03: Digestion, Absorption, and Metabolism My Nursing Test Banks Chapter 04: Carbohydrates My Nursing Test Banks Chapter 05: Fats My Nursing Test Banks Chapter 06: Protein My Nursing Test Banks Chapter 07: Vitamins My Nursing Test Banks Chapter 08: Water and Minerals My Nursing Test Banks Chapter 09: Energy, Weight, and Fitness My Nursing Test Banks Chapter 10: Nutrition Across The Life Span My Nursing Test Banks Chapter 11: Nutrition Assessment and Patient Care My Nursing Test Banks Chapter 12: Food-Related Issues My Nursing Test Banks Chapter 13: Nutrition for Disorders of the Gastrointestinal Tract My Nursing Test Banks Chapter 14: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas My Nursing Test Banks Chapter 15: Nutrition for Diabetes Mellitus My Nursing Test Banks Chapter 16: Nutrition in Metabolic Stress: Burns, Trauma and Surgery My Nursing Test Banks Chapter 17: Nutrition for Cardiopulmonary Diseases My Nursing Test Banks Chapter 18: Nutrition for Diseases of the Kidneys My Nursing Test Banks Chapter 19: Nutrition for Neuro-Psychiatric Disorders My Nursing Test Banks Chapter 20: Nutrition in Cancer and HIV/AIDS My Nursing Test Banks

Chapter 01: Wellness Nutrition My Nursing Test Banks Chapter 01: Wellness Nutrition Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. Examples of informal education include attending a workshop on coronary artery disease sponsored by the American Heart a. Association. b. watching a television show about diabetes. c. learning about food safety techniques in a high school economics course. d. joining a support group to help overcome an eating disorder. ANS: B Watching a television show about diabetes is an example of informal education because it is an experience that occurs through a daily activity. Attending a workshop or joining a support group would be considered nonformal education; a high school course would be considered formal education. DIF:Cognitive Level: ApplyingREFage 6 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 2. A college student exercises regularly and generally eats a healthy variety of foods, is taking a course in general nutrition, buys locally produced food whenever possible, is an active member of an on-campus faith-based organization, and keeps a journal to help process her emotions. What else could be important for her to include in her life in order to develop her overall wellness? a. Growing some of her own food b. Keeping a food record to help evaluate what she eats c. Eating meals with friends throughout the week d. Meeting with a registered dietitian to review her food choices ANS: C Wellness enhances a persons level of health through development of each of the six dimensions of health: physical health, intellectual health, emotional health, social health, spiritual health, and environmental health. Exercise and eating a health variety of foods help develop physical health; taking a course in general nutrition helps develop intellectual health; buying locally produced food helps develop environmental health; being part of a faith-based organization helps develop spiritual health; and keeping a journal helps develop emotional health. The missing dimension in this example is development of social health; eating meals with friends throughout the week would add this dimension. Growing her own food would be another example of environmental health; keeping a food record would be another contributor to physical health; and meeting with a registered dietitian may contribute to physical, intellectual, and emotional health. DIF:Cognitive Level: AnalyzingREFages 1-3 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. For a client who is missing meals because of poor planning or is too busy to eat, emotional health can be affected by _____, which can cause confusion or anxiety. a. low blood sugar levels b. high blood sugar levels c. high blood pressure

d. extremely low blood pressure ANS: D Poor eating habits affect emotional health. Missing meals may cause blood sugar levels to decrease, which can cause anxiety or confusion or make it difficult to control emotions. Late night binges on snack food are likely to result in excessive energy intake but would have a less direct effect on emotional health. Eating small meals throughout the day is likely to maintain more constant blood sugar levels, which would actually have a positive effect on emotional health. Excessive caffeine consumption may contribute to anxiety, but 2 cups of caffeinated coffee is not considered excessive. DIF:Cognitive Level: AnalyzingREFage 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 4. The best example of the type of concern that is likely to be addressed by the U.S. Department of Health and Human Services when target goals for Healthy People 2030 are updated is a. preference for vegetarian eating patterns among white women. b. low intake of fruits and vegetables by African American children. c. widespread use of bottled water in higher socioeconomic groups. d. common use of protein and vitamin supplements in athletes. ANS: B Healthy People is used to set targets for health promotion to improve the health of all individuals. It addresses environmental and social issues that affect health outcomes. Low intake of fruits and vegetables by African American children is likely to have an adverse effect on their health and so may be addressed when target goals are set. Vegetarian eating patterns, use of bottled water, and use of protein and vitamin supplements do not necessarily have an adverse effect on nutritional health and so are less likely to be addressed. DIF: Cognitive Level: Applying REF: Pages 4-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. An example of community support for health promotion is a. teaching a young mother skills in safe food preparation. b. watching a television documentary about industry errors in food processing. c. labeling fresh poultry packages with information about proper food storage. d. being aware that Salmonella can be transmitted because of inadequate food preparation. ANS: C Food labeling information is an example of community support because it is a regulatory measure that supports new health-promoting behaviors within a social context. Teaching, watching television and awareness may increase knowledge, but they do not alter the social context by regulation or environmental change. DIF:Cognitive Level: ApplyingREFage 4 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 6. An example of a technique for health promotion is a. exercising five times a week. b. local supermarkets expanding the availability of fresh fruits and vegetables. c. teaching a teenager how to choose healthier foods at fast-food restaurants. d. information about the relationship of dietary intake and diet-related disorders. ANS: C Health promotion consists of strategies that are designed improve the health of individuals, families, groups, and communities, such as teaching a teenager how to choose healthier fast foods. Exercising

regularly contributes to wellness, but it is not bringing about a change in health unless this is a change in behavior. Stocking a wider availability of fresh produce does not promote health, unless the supermarket uses specific strategies to encourage consumption. Information about the relationship between nutrients and disease is simply information unless it is used to promote behavior change. DIF:Cognitive Level: ApplyingREFage 4 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 7. For the efficient functioning and maintenance of the body, a person needs to consume sufficient amounts of a. fiber. b. nutrients. c. minerals. d. supplements. ANS: B The body needs sufficient amounts of all nutrients for efficient functioning and maintenance. Both fiber and minerals are needed, but each represents only one type of nutrient. Supplements are not always necessary because sufficient nutrients can often be obtained from food. DIF:Cognitive Level: UnderstandingREFages 8-10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. A nurse has just been assigned to a community health program for older adults. She should check the document Healthy People 2020 to become familiar with a. nutrition priorities and goals for older American adults. b. dietary standards for Americans older than 50 years. c. dietary guidelines recommended for older adults. d. MyPlate recommendations for older adults. ANS: A Healthy People 2020 focuses on targets and goals for improving the health of the nation. The nurse would check the Dietary Reference Intakes for information about dietary standards. The Dietary Guidelines for Americans and MyPlate are separate documents from Healthy People 2020 and focus on specific advice and guidelines for healthy eating. DIF:Cognitive Level: ApplyingREFages 4-5 | Page 10 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. A healthy female middle-aged client asks what she can do to prevent the development of type 2 diabetes. Weight control and nutrition strategies discussed are considered a. primary treatment. b. primary prevention. c. secondary prevention. d. tertiary prevention. ANS: B Action to prevent the development of type 2 diabetes is considered primary prevention. Secondary prevention involves early detection to halt and minimize the effects of the disease, and tertiary prevention minimizes complications and helps restore health after the disorder has developed. Primary treatment is not a recognized term. DIF: Cognitive Level: Applying REF: Pages 5-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

10. As a home health care nurse, you are visiting a 70-year-old client who has just returned home from the hospital after being treated for coronary artery disease. The medical nutrition therapy developed for him by the hospital dietitian is considered a. palliative care. b. primary prevention. c. secondary prevention. d. tertiary prevention. ANS: D This is an example of tertiary prevention, which entails minimizing complications and helping restore health after heart disease has developed. Primary prevention would occur before the disease developed, and secondary prevention would involve early detection to minimize the effects of the disease. Palliative care is intended only to minimize symptoms. DIF: Cognitive Level: Applying REF: Pages 5-6 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 11. A nutrient that can be made by the body is called a. essential. b. complete. c. incomplete. d. nonessential. ANS: D Nonessential nutrients can be made by the body. Essential nutrients cannot be made by the body and must be consumed. The terms complete and incomplete refer to proteins. Complete proteins contain all the essential amino acids; incomplete proteins are lacking one or more essential amino acids. DIF:Cognitive Level: RememberingREFages 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. A client exercises regularly and wants to make sure he has sufficient energy for his workouts. The type of nutrient that will be most helpful in providing the energy he needs is a. carbohydrates. b. water. c. minerals. d. protein. ANS: A Carbohydrates are the best source of fuel to provide energy for the body. Protein can also provide fuel for energy, but its primary purpose is important structural and functional roles. Water and minerals are important for health but do not provide fuel for energy. DIF: Cognitive Level: Applying REF: Pages 8-10 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 13. A 45-year-old man tells you that he drinks 3 oz of Scotch whiskey most evenings. His alcohol intake is considered a. insignificant. b. moderate. c. higher than is recommended. d. dangerously high. ANS: B

Moderate alcohol intake is two servings or fewer per day for men. One serving of spirits, such as whiskey, is 1.5 ounces. Therefore, 3 oz of whiskey per day is considered moderate alcohol intake. DIF:Cognitive Level: AnalyzingREFage 9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. A dessert contains 4 g of protein, 30 g of carbohydrate, 15 g of fat, and 5 g of alcohol. The nutrient that provides the most kilocalories in the dessert is a. protein. b. carbohydrate. c. fat. d. alcohol. ANS: C Fat provides the highest number of kilocalories: At 9 kcal per gram, 15 g of fat provides 135 kcal. At 4 kcal per gram, 4 g of protein provides 16 kcals. At 4 kcal per gram, 30 g of carbohydrate provides 120 kcal. At 7 kcal per gram, 5 g of alcohol provides 35 kcal. DIF:Cognitive Level: ApplyingREFage 9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 15. A cup of frozen yogurt contains 24 g of carbohydrate, 2 g of fat, and 4 g of protein. The total number of kilocalories in the frozen yogurt is a. 110. b. 130. c. 140. d. 162. ANS: B At 4 kcal per gram, 24 g of carbohydrate provides 96 kcal. At 9 kcal per gram, 2 g of fat provides 18 kcal. At 4 kcal per gram, 4 g of protein provides 16 kcal. Therefore, the total kilocalories in the frozen yogurt is 130 kcal (96 + 18 + 16). DIF:Cognitive Level: ApplyingREFages 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. Combinations of amino acids link together to form a. protein. b. carbohydrates. c. dietary fiber. d. lipids. ANS: A Proteins are made up of various combinations of amino acids, linked together. Carbohydrates are made up of one or more units of simple sugars. Dietary fiber consists mostly of carbohydrate that cannot be digested. Lipids are made up of glycerol and triglycerides or sterols. DIF:Cognitive Level: RememberingREFages 8-9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. A bodybuilder tells you that all of his meals and snacks include high-protein foods such as eggs, canned tuna, chicken, milk, and cheese. Most of the extra protein is probably used by his body to form a. strong bones and joints. b. body fat stores. c. healthy brain tissue.

d. increased muscle mass. ANS: B Excess protein is broken down to amino acids and then used for energy or stored as body fat. This mans body will use some of this protein to increase muscle mass, but increasing protein intake beyond the amount needed does not increase muscle formation. Excess protein intake does not improve bone, joint, or brain health. DIF:Cognitive Level: ApplyingREFage 9 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. When clients have a strong family history of both heart disease and cancer, the nurse should encourage them to reduce their intake of a. dietary fiber. b. protein. c. monounsaturated fat. d. saturated fat. ANS: D Saturated fat intake is related to risk of heart disease and certain types of cancer. Monounsaturated fat intake has less effect on risk of these diseases. Dietary fiber intake should be increased to help reduce risk of cardiovascular disease and cancer. The effects of protein intake on risk of these diseases are much less significant. DIF: Cognitive Level: Applying REF: Page 9 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 19. The National Health and Nutrition Examination Survey (NHANES) is able to assess the overall nutritional and health status of Americans because a. the populations surveyed are representative of the total population. b. it focuses on ethnic and socioeconomic groups at greatest risk. c. it collects large volumes of survey data from all over the nation. d. survey methods and standards are consistent from year to year. ANS: A Data from NHANES represent America overall because the survey populations are carefully selected to represent the total population. Their data therefore provide a better indication of the nations overall health than do large amounts of data from all over the country. It does not focus specifically on populations at high risk for disease. Standardization over time provides useful data on trends and changes but does not reveal the overall health of the nation. DIF:Cognitive Level: ApplyingREFages 4-5 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. In working with a ethnic minority population, a helpful way to increase health literacy could be to a. invite members of the community to help identify needs and teaching strategies. b. encourage acculturation and adoption of healthful American eating patterns. c. set up a feeding program to provide healthy food for members of the community. d. use visual aids rather than written materials during health education encounters. ANS: A Members of an ethnic minority population can be very helpful in identifying needs and effective teaching strategies for people in their community and in encouraging people in the community to accept advice from nurses or other health professionals. They do not necessarily need to adopt

American eating patterns; often these are less healthful than their traditional eating patterns. Setting up feeding programs does not promote positive self-efficacy. Visual aids may be helpful, but their use is not necessarily the best educational strategy. DIF: Cognitive Level: Applying REF: Pages 6-7 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 21. A client has heard that nutrients can be converted to other nutrients in the body. He takes highdose vitamin C supplements because he believes this will supply his bodys need for other vitamins. What would you tell him? a. He should switch to a multivitamin supplement instead of just vitamin C. b. Each vitamin has a specific function and needs to be supplied through a variety of foods. Vitamin C can provide only water-soluble vitamins, and he still needs to consume fatc. soluble vitamins. Vitamin C supplements should be taken only when he has symptoms of a cold or d. influenza. ANS: B Vitamins cannot be converted into other vitamins; each has a specific function, and the best way to consume adequate amounts of each vitamin is to eat a variety of foods. Vitamin C is water soluble, but it cannot be converted to other water-soluble vitamins. Vitamin C is needed by the body at all times, not just when someone is ill. A multivitamin supplement would provide a better range of vitamins than just vitamin C, but it is still better to consume vitamins from food, rather than from supplements. DIF:Cognitive Level: ApplyingREFages 9-10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. For a mother with two children who works in health care management 60 to 70 hours a week, the biggest barrier to healthy eating is likely to be a. lack of concern for her own or her childrens health. b. inadequate income to purchase healthy foods. c. insufficient time to plan and prepare healthful meals. d. lack of knowledge about healthy eating. ANS: C For busy professionals and families, the biggest barrier to healthy eating is usually hectic schedules and lack of time to plan and prepare healthy meals. Most mothers, especially those who work in a health care field, are concerned about their familys health. Many professional women have at least some understanding of healthy eating. With a professional job, lack of income is not very likely to be a barrier to healthy eating. DIF: Cognitive Level: Applying REF: Page 7 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 23. A class of nutrients that is important in body structure and influences the function of muscles and the central nervous system is a. proteins. b. minerals. c. vitamins. d. carbohydrates. ANS: B

Minerals are important in body structures and influence the function of muscles and the central nervous system. Proteins are structural components and form part of muscles but are less influential in the central nervous system. Vitamins and carbohydrates do not have structural functions. DIF:Cognitive Level: UnderstandingREFage 10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. If mine workers were trapped in a mine and it took several days for a rescue team to reach them, the nutrient that they would need most in order to survive is a. protein. b. carbohydrates. c. water. d. vitamins. ANS: C The body can survive only a few days without water. The body may not function optimally without other nutrients, but it can survive many days and even weeks without them. DIF:Cognitive Level: ApplyingREFages 8-10 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. The client who would benefit most from an increase in dietary fiber intake is one with a. fatigue. b. constipation. c. dehydration. d. coronary heart disease. ANS: B Adequate dietary fiber and fluid intake can help alleviate constipation. It has a small but less significant effect in helping reduce risk of coronary heart disease. Dietary fiber intake does not affect fatigue or hydration status. DIF: Cognitive Level: Applying REF: Page 9 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 26. To provide adequate amounts of vitamins and minerals, the best course of action is to a. lose weight to achieve ideal body weight. b. eat a variety of foods from each food group. c. follow the same general food pattern each day. d. consume foods high in fiber and low in saturated fat. ANS: B Including a variety of foods from each food group increases the likelihood of obtaining adequate amounts of vitamins and minerals. Achieving ideal body weight does not guarantee adequate nutrient intake. Following the same general food pattern each day could actually limit vitamin and mineral intake because the assortment of foods is likely to be limited. Choosing foods high in fiber and low in saturated fat diet does not necessarily result in intake of adequate levels of vitamins and minerals. DIF: Cognitive Level: Applying REF: Page 12 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 27. If a nurse wants to evaluate whether a clients vitamin or mineral supplement contains too much of a specific nutrient, the nurse should a. check the manufacturers recommendations about intake for that nutrient. b. request blood and urine tests to determine the clients body stores of that nutrient.

c.

compare the amount in the supplement to the tolerable upper intake level (UL) for that nutrient. compare the amount in the supplement to the Recommended Dietary Allowance (RDA) for that nutrient.

d. ANS: C The UL is the maximum intake that should not be exceeded to prevent adverse health risks; this should be compared to the amount in the supplement. The Recommended Dietary Allowance is the amount that meets the needs of most health individuals in a life-stage and gender group, but it is not the upper level for safety. Manufacturers do not necessarily provide reliable information about safety of supplements they are marketing. Blood and urine tests may or may not show whether the body is accumulating unsafe levels of a nutrient, depending on the nutrient and how long the supplement has been taken. DIF:Cognitive Level: ApplyingREFage 11 TOP:Nursing Process: Assessment| Nursing Process: Evaluation MSC:Client Needs: Physiological integrity 28. Why is it difficult to specify the number of grams of protein that he or she should eat each day? More research studies are needed to help determine ideal levels of protein intake for a. various age and gender groups. b. Health care professionals should not give specific advice to clients, to avoid lawsuits. c. It is unrealistic to expect clients to meet precise levels of protein intake. Recommended protein intakes are expressed as a range and are based on a percentage of d. energy intake, which varies between individuals. ANS: D Protein intake does not need to be precise and can be within an acceptable range, expressed as a percentage of energy intake. Health care professionals should not give unnecessarily precise advice, but they can give scientifically based advice without concern for lawsuits. A reasonable amount of research has been conducted to be able to give at least general advice about protein intake. The likelihood that clients will achieve a specific protein intake is not related to the difficulty in identifying what their intake level should be. DIF:Cognitive Level: AnalyzingREFages 8-9 | Page 11 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. If a college student is eating only one small meal per day in an attempt to lose weight and is taking high doses of vitamin and mineral supplements to try to make up for the lack of food, the student would be described as having a. malnutrition. b. disordered nutrition. c. overnutrition. d. undernutrition. ANS: A An imbalance of intake of nutrients, energy, or both (in this case, high intake of some nutrients and low intake of energy) is called malnutrition. Overnutrition refers only to excessive intake, excessive nutrients, or excessive energy. Undernutrition refers only to inadequate intakes of nutrients, energy, or both. Disordered nutrition is not a recognized term. DIF:Cognitive Level: ApplyingREFage 12 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

30. An overweight client has been trying to lose weight for years. She tells you that she believes she is genetically designed to be overweight and that the foods available in supermarkets today make weight loss impossible. The clients attitude shows a. positive self-efficacy. b. negative self-efficacy. c. poor environmental health. d. poor emotional health. ANS: B The clients attitude demonstrates negative self-efficacy. She does not perceive that she has power over her life and behaviors. A belief that she could change her personal behaviors would reflect positive self-efficacy. She is able to express her feelings, and so she does not necessarily have poor emotional health. Her belief about healthy food choices in her environment is not necessarily accurate. DIF:Cognitive Level: ApplyingREFages 1-2 | Page 12 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity Chapter 02: Personal and Community Nutrition My Nursing Test Banks Chapter 02: Personal and Community Nutrition Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. A client tells you that he cannot eat most green vegetables because they taste too bitter. What is the most likely explanation? a. He has certain genetic taste markers that make him a super taster. b. He associates eating green vegetables with unpleasant childhood memories. c. He needs to train himself to enjoy the acquired taste of bitter vegetables. d. He is making an excuse to avoid making healthful changes in his eating habits. ANS: A Some people have variations in genetic taste markers that make them super tasters. These people often experience the taste of certain vegetables as being bitter. Environmental factors such as childhood memories may also influence food choices but are not usually associated with tasting vegetables as bitter. Tastes can be acquired and sometimes people make excuses to avoid making changes, but these are less likely explanations for this particular problem DIF:Cognitive Level: ApplyingREFage 18 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 2. A teenaged client is hungry and goes to the refrigerator for a snack. A holiday has just been celebrated at her home, and many of her favorite foods are available. She selects some slices of roast turkey and a cup of her aunts special fruit salad. This is an example of a. bingeing. b. abundance. c. food choice. d. food preference. ANS: D

This teenager is able to select foods according to her preferences. Food choices are restricted by convenience, but many of her favorite foods are available, and so her choices are not limited. The food is abundant, and she may choose to binge and overeat, but her selections are made according to her food preference. DIF:Cognitive Level: AnalyzingREFage 18 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 3. A mother tells you that she does not allow her young children to eat while they watch television, even though her husband often eats high-fat, sugary foods while they watch television as a family. The most important thing to discuss with her is the a. genetic factor of preference for sweet and salty tastes. b. influence of ethnicity on preference for sour tastes. c. childrens weights when they were born and their weights now. d. environmental effects of parental food choices and television watching. ANS: D Because young children spend so much time with their families, their parents food choices have a major effect on their own future food choices. Preventing young children from eating while watching television will have only a short-term effect, and they are likely to imitate their father in eating high-fat, high-sugar snacks. The fathers food preferences are probably influenced by genetics and ethnicity, and it may be interesting to find out whether the childrens current weights are healthy for their heights (although their birth weight is probably not relevant), but this information has less immediate effect on the nutritional health of this family. DIF:Cognitive Level: ApplyingREFage 18 | Page 35 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial integrity 4. If a middle-aged couple with two teenage children has insufficient income to purchase food, the most helpful program for them would be the a. MyPlate food guidance system. b. National School Lunch and School Breakfast Programs. c. federal governments Supplemental Nutrition Assistance Program (SNAP). d. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). ANS: C SNAP provides financial assistance to buy nutritious foods for individuals and families with incomes below certain levels. WIC provides assistance only to women who are pregnant or breastfeeding and to infants and children up to the age of 5 who are at nutritional risk. School meal programs would benefit the children but not the adults. MyPlate would help the family make healthy food choices but would not help with their financial problems. DIF:Cognitive Level: ApplyingREFages 18-19 | Page 21 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. For most Americans, the most significant nutrition concerns are a. lack of interest in making healthy food choices. b. poor availability of fruits and vegetables in many areas. c. excessive intake of saturated fats, cholesterol, sodium, and sugars. d. inadequate intake of key vitamins, minerals, and phytochemicals. ANS: C Most Americans have high intake of saturated fats, cholesterol, sodium, and sugars, which is associated with increased prevalence of chronic disease. Many people have inadequate intake of

micronutrients, but this has a lesser overall effect than excessive intakes of fats, sodium, and sugars. Some areas of the country have poor availability of fruits and vegetables, but this is not a widespread problem in the country as a whole. Many Americans express at least some concern about making healthy food choices. DIF:Cognitive Level: UnderstandingREFages 18-20 | Page 30 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 6. Excessive intake of high-sodium, high-fat foods can lead to diet-related illnesses such as a. genetic disorders, hypertension, and diabetes. b. hypertension and sickle cell anemia. c. viral infections that necessitate antibiotics. d. coronary artery disease and hypertension. ANS: D Coronary artery disease and hypertension are more common in individuals who consume highsodium, high-fat diets. The risk for genetic disorders, sickle cell anemia, and viral infections is not affected by dietary fat and sodium intake. DIF:Cognitive Level: ApplyingREFage 19 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. Of the following, the most important overall dietary modification to help reduce the risk of chronic disease is a. eating fewer foods that contain preservatives. b. buying mostly locally grown foods. c. eating more plant-based foods. d. eating more animal-based foods. ANS: C Scientific evidence from the nutrition literature shows that shifting to a more plant-based diet is one of four significant modifications to dietary intake patterns that will improve the overall health of Americans. Preservatives per se have not been associated with health status (although foods that contain preservatives may be more highly processed and may have higher levels of fat, sugar, and sodium and lower levels of nutrients than do foods without preservatives). Buying locally grown foods may be a good agricultural and economic practice, but it does not affect health status. Eating more animal-based foods would be the opposite of what is recommended. DIF: Cognitive Level: Applying REF: Page 20 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 8. One way to help clients follow the Dietary Guidelines for Americans is to encourage them to use a. Healthy People 2020. b. the MyPlate food guidance system. c. the Supplemental Nutrition Assistance Program (SNAP). d. the Exchange Lists for Meal Planning. ANS: B MyPlate is designed to help clients implement the recommendations of the Dietary Guidelines for Americans. Healthy People 2020 sets national targets for health promotion. SNAP provides funds for individuals and families with low incomes to buy nutritious foods. The Exchange Lists for Meal Planning is intended primarily for patients with diabetes and those who need to lose weight; the system helps patients choose appropriate portion sizes to control their intake of fat, protein, carbohydrate, and energy.

DIF: Cognitive Level: Understanding REF: Pages 18-23 | Pages 27-28 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. For a client who follows a vegan diet, the most helpful meal planning tool would be a. the Healthy Eating Plate, produced by the Harvard School of Public Health. b. the Mediterranean Diet Pyramid, from Oldways Preservation and Exchange Trust. c. the Power Plate, created by the Physicians Committee for Responsible Medicine. Exchange Lists for Meal Planning, from the American Diabetes Association and d. the American Dietetic Association ANS: C The Power Plate is a vegan food planning guide that eliminates all sources of animal foods. The Healthy Eating Plate and Mediterranean Diet Pyramid could be adapted for a vegan diet, but they include meat and dairy options. The Exchange Lists for Meal Planning is intended to help design eating patterns for clients who need to monitor their intake of energy and specific macronutrients, such as clients with diabetes. DIF: Cognitive Level: Applying REF: Pages 22-25 | Pages 27-28 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 10. An indirect benefit of the Fruits & VeggiesMore Matters program is a. better understanding of fruit and vegetable preparation techniques. b. increased availability of fruits and vegetables in food deserts. c. eating more fresh produce in season. d. decreasing dietary fat intake. ANS: D Fruits & VeggiesMore Matters is designed to increase intake of fruits and vegetables. Fruits and vegetables are naturally low in fat; they would replace higher fat foods in the diet and thus would indirectly decrease dietary fat intake. The program does not address fruit and vegetable preparation techniques, does not target availability of produce in food desert areas, and does not address eating fruits and vegetables in season versus out of season. DIF: Cognitive Level: Applying REF: Page 23 | Page 26 | Page 30 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 11. A meal planning guide that would be helpful for a patient who needs to closely monitor their intake of calories, carbohydrates, protein, and fat is the a. National Fruit and Vegetable Program. b. MyPlate food guidance system. c. Dietary Guidelines for Americans. d. Exchange Lists for Meal Planning. ANS: D In the Exchange Lists for Meal Planning, foods are grouped according to their kilocalorie, carbohydrate, protein, and fat content, and serving sizes that contain specific amounts of each of these are listed. Therefore, this guide can help clients monitor their intake. The National Fruit and Vegetable Program simply encourages increased intake of fruits and vegetables. The Dietary Guidelines for Americans gives general advice but does not translate this into specific amounts of foods. MyPlate would help patients achieve healthy intake of kilocalories, carbohydrate, protein, and fat, but it would not be specific enough for them to monitor their intake closely. DIF: Cognitive Level: Applying REF: Pages 19-23 | Pages 26-28 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

12. One reason that increasing fruit and vegetable consumption helps decrease dietary fat intake is that fruits and vegetables a. are natural appetite suppressants. b. replace high-fat foods in the diet. c. are rich in antioxidants and phytochemicals. d. decrease absorption of fat from foods. ANS: B Fruits and vegetables replace high-fat foods in the diet because they are high in fiber and water; they cause satiety so that clients have less desire for high-fat foods. Fruits and vegetables are not, and do not contain, natural appetite suppressants and do not hinder absorption of fat from foods. They are rich in antioxidants and phytochemicals, but increased intake of these substances does not affect fat intake. DIF:Cognitive Level: UnderstandingREFage 23 | Pages 26-27 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. Why are health professionals concerned about the trend toward eating more food away from home? a. Larger portion sizes often contribute to excessive caloric intake. b. Eating away from home means less social interaction. c. Eating out tends to decrease the variety of foods eaten. d. Restaurant meals are associated with more sedentary lifestyles. ANS: A Restaurants and fast food outlets often serve large portions that increase caloric intake. Eating away from home does not necessarily decrease social interaction, inasmuch as families or friends may eat away from home in groups. Eating out does not necessarily decrease the variety of foods eaten, depending on individual food choices. Eating out has not been related to physical activity levels. DIF:Cognitive Level: UnderstandingREFage 21 | Page 29 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 14. If clients want to use the food label to check the number of kilocalories in a product, they should also check the a. calories from fat. b. servings per container. c. Percent Daily Value. d. ingredient list. ANS: B The number of calories in a product is stated for a standard serving size of that food. Clients need to multiply the calories per serving by the number of servings in the container to know how many calories are in the container. The calories from fat are not related to the total number of calories in the food. The Percent Daily Value refers to the nutrient content of the food rather than its caloric value. The ingredient list does not give any information about calories. DIF:Cognitive Level: AnalyzingREFage 32 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 15. The most useful part of the food label for clients who want to make sure they choose foods high in nutrients is the a. Percent Daily Value. b. health claims.

c. organic seal. d. amount of nutrients per serving. ANS: A The Percent Daily Value shows how a food fits into the overall daily diet and would therefore show whether it makes a high or low contribution to nutrient intake. Health claims may indicate that a food has high or low amounts of specific nutrient related to that particular health claim, but they would not indicate overall nutrient content of the food. The organic seal, if present, indicates the farming methods used to grow the food but does not give any information about nutrient content. The amount of nutrients per serving is listed for only some nutrients; the listing would not give any information about vitamins and minerals in the food because these are listed only as Percent Daily Values. DIF:Cognitive Level: ApplyingREFages 31-35 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 16. If a client is trying to increase intake of dietary fiber, a useful symbol to look for on the food label would be the a. MyPlate food guidance graphic. b. U.S. Department of Agriculture (USDA) 100% Organic seal. c. Fruits & VeggiesMore Matters logo. d. 100% Whole Grain stamp. ANS: D Whole grains are an important source of dietary fiber, and so the 100% Whole Grain stamp would help a client select high-fiber foods. Fruits and vegetables also contain high amounts of dietary fiber, but the Fruits & VeggiesMore Matters logo is not used in labeling individual foods. MyPlate is also not used on food labels. The organic status of a food does not reveal any information about its dietary fiber content. DIF: Cognitive Level: Understanding REF: Pages 21-23 | Page 27 | Pages 33-34 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 17. The Nutrition Facts panel on a food label is useful for a. determining the ingredients in a product. b. determining the ease of preparing a product. c. comparing the price value of two or more products. d. comparing the nutritional value of two or more products. ANS: D The Nutrition Facts panel on a food label lists the quantities of specific key nutrients in the food and can therefore be used to compare the nutritional value of two or more products. The ingredients are listed elsewhere on the package, rather than in the Nutrition Facts panel. The Nutrition Facts panel does not indicate how easy the food is to prepare and does not include any information about cost or price. DIF:Cognitive Level: UnderstandingREFages 32-33 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 18. A pregnant woman may look for a health claim on food labels that links a. sodium intake and risk of stroke. b. calcium intake and risk of osteoporosis. c. folic acid intake and risk of neural tube defects. d. fruit and vegetable intake and risk of heart disease.

ANS: C The U.S. Food and Drug Administration has approved use of a health claim stating the relationship between folic acid intake during pregnancy and decreased risk of neural tube defects in infants. It has also approved use of a health claim stating the relationships between (1) calcium intake and (2) decreased risk of osteoporosis, between (1) a diet rich in fiber-containing grain products, fruits, and vegetables and (2) reduced risk of coronary heart disease, and between (1) a diet low in sodium and (2) reduced risk of high blood pressure (not specifically stroke); however, this information is not directly relevant to a pregnant women. DIF:Cognitive Level: ApplyingREFage 35 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 19. An eating behavior that is most likely to have a negative long-term effect on health is a. a monthly meal out at an expensive restaurant. b. eating French fries with lunch once a week. c. avoiding a specific fruit or vegetable. d. drinking one can of sugar-sweetened beverage every day. ANS: D Small daily practices have a cumulative effect on nutritional health. Eating a rich meal once a month or even ordering French fries once a week will have less overall effect on health than daily habits. It is possible to avoid a specific fruit or vegetable and still make healthy food choices by including other fruits and vegetables. DIF:Cognitive Level: ApplyingREFage 18 | Page 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. The most helpful general recommendation for making healthy food choices would be to a. focus on organic and natural foods. b. learn to use the Nutrition Facts Panel on food labels. c. eat more food from plant sources and less food from animal sources. d. replace refined grain products with whole grain foods. ANS: C The most helpful overall recommendation would be a shift to a more plant-based diet, which automatically decreases intake of saturated fat and cholesterol. Replacing refined grains with whole grains is a good choice, but it is only one aspect of healthy eating. Organic and natural foods do not necessarily improve nutrient intake. Learning to use the Nutrition Facts Panel is helpful, but not all foods have these labels (fruits, vegetables, and meats do not have to carry these labels). DIF:Cognitive Level: AnalyzingREFage 20 | Pages 32-34 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 21. A client works at a fast food restaurant and usually orders a cheeseburger and regular soda at lunchtime. What would be the most simple recommendation to make this a healthier choice? a. Eat the meat patty and cheese without the bun, and drink juice. b. Do not add ketchup or mustard, and drink cappuccino. c. Skip this meal and fast until dinner. d. Omit the cheese from the burger, and drink skim milk. ANS: D Omitting the cheese from the hamburger would decrease intake of saturated fat and calories; replacing the soda with skim milk would replace the calcium without added fat and sodium. Removing the bun would decrease calories but would not decrease the fat content; drinking juice

would provide some nutrients but also an amount of sugar similar to that of regular soda. Ketchup and mustard add sodium and a relatively small number of calories, but their impact is less significant than the cheese; fast-food cappuccino is high in sugar and fat. Missing meals does not usually help improve overall dietary intake; regular intake of nutrients throughout the day helps body metabolism function well. DIF: Cognitive Level: Analyzing REF: Pages 19-21 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 22. A male client is 38 years old. He is married with two children, aged 7 and 9 years. Both he and his wife work full time. What other information would be important to know when showing him how to use MyPlate to develop a personalized food plan? a. His wife enjoys cooking home-made meals. b. He is currently training to run a marathon. c. Both his father and mother both have type 2 diabetes. d. He has an allergy to nuts. ANS: B MyPlate recommendations are based on age, sex, and activity level. Therefore, the most important information would be that he is training for a marathon. MyPlate gives recommendations for numbers of servings from each food group each day; it does not recommend specific foods, and so allergy information not important because other foods within the food group could be selected. His parents health problems may help motivate him to make healthy food choices, but this information is not needed to use MyPlate. The number of foods from each food group is not affected by whether foods are home cooked or preprepared. DIF:Cognitive Level: ApplyingREFage 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 23. For a busy client who works 50 hours a week, a helpful strategy for making healthy food choices is a. eating several small meals throughout the day. b. planning meals and snacks in advance. c. buying fruits and vegetables in season. d. using the Dietary Guidelines for Americans as a guide. ANS: B Planning ahead for meals and snacks can be very helpful for busy clients so that they do not rely on impulsive food choices. It allows them to make decisions ahead of time instead of waiting until they are tired and hungry. Eating several small meals throughout the day may help maintain energy in a long workday but does not help make healthier food choices. Buying fruits and vegetables in season helps to save money on groceries but is not necessarily related to making healthy food choices. The Dietary Guidelines for Americans provides general advice but does not help with specific food choices. DIF:Cognitive Level: ApplyingREFage 31 | Page 35 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 24. A single mother has epilepsy and does not drive. She works full time from home, and her three children take the bus to school. She generally rides her bike or walks wherever she needs to go. What would be your greatest concern related to the familys nutritional well-being? a. It is not safe for someone with epilepsy to prepare food with sharp knives and a hot stove. b. She is unlikely to be able to afford healthy food for three children as a single mother. c. Because she does not drive, she may not have access to affordable and high-quality food.

d.

Working full time would not leave her enough time to prepare nutritious food for her family.

ANS: C The greatest concern is that because she does not drive, she may not have access to affordable and quality food. Depending on her job, she may have sufficient income to purchase nutritious food, and many women are able to work full time and make time to prepare food for their families. She may need to be careful in the kitchen and perhaps cook only when other family members are home in case she has a seizure, but if her epilepsy is well controlled, there is no reason why she should not cook. DIF:Cognitive Level: AnalyzingREFages 29-31 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and effective care environment 25. For someone who is able to shop for food only once a month, the most nutritious fruits and vegetables would be _____ fruits and vegetables. a. fresh seasonal b. frozen c. canned d. dried ANS: B When they have to be stored for longer than a few days, the most nutritious type of fruits and vegetables would be frozen. Many fresh fruits and vegetables lose some vitamins and may start to rot after a few days. Canned and dried fruits and vegetables are better than none at all, but they contain lower levels of vitamins and may contain added salt or sugar. DIF:Cognitive Level: ApplyingREFages 30-31 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 26. In choosing between two types of canned soup with regard to the best source of calcium, what information would you look for? a. Dairy products in the ingredient list b. The Percent Daily Value for calcium c. Health claims related to calcium content d. A Good source of calcium description ANS: B The most helpful comparison would be the Percent Daily Value for calcium in the two products. The presence of dairy products in the ingredient list does not indicate the amount of calcium in the product. Similarly, health claims and Good source of calcium descriptions would not help you compare the two products. DIF:Cognitive Level: ApplyingREFages 32-33 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 27. In a comparison of food products, the description that means the lowest fat content per serving is a. lean. b. very lean. c. light. d. low fat. ANS: D

Low fat means no more than 3 g of fat per serving. Lean means no more than 10 g of fat per serving. Extra lean means no more than 5 g of fat per serving. Light means that the food contains one third fewer calories, or half the fat, of the original, which does not give any specific information about the fat content. DIF:Cognitive Level: AnalyzingREFage 33 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 28. The main reason for choosing organic foods is a. to support the local economy. b. concern for the environment. c. to improve nutrient intake. d. better taste and quality. ANS: B The main reason for choosing organic foods is concern for the environment. Many organic foods are grown and sold locally, but this is not a primary concern. Organic foods are not necessarily better in terms of nutritional value, taste, and quality. DIF: Cognitive Level: Applying REF: Pages 33-34 TOP: Nursing Process: Planning MSC: Client Needs: Safe and effective care environment 29. An individual would be described as having an external locus of control if he or she a. writes out a shopping list each week and generally buys only foods on the list. b. tries to eat mostly foods produced through organic and sustainable farming practices. c. has decided to eat a turkey sandwich but ends up ordering pizza with friends. d. tries to influence friends and family to help them make healthier food choices. ANS: C Individuals with an external locus of control do not feel they are able to control outside forces that have power over their experiences, so they may be easily influenced to eat pizza instead of a sandwich. Individuals who write and buy foods from a shopping list would be described as having an internal locus of control because they have an inner sense of their ability to guide life events. Use of organic foods and a desire to influence other peoples food choices are not related to locus of control. DIF:Cognitive Level: ApplyingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 30. In a research study, subjects in one group decrease their intake of saturated fat and cholesterol, and those in a control group maintain their current level of intake for 2 years, with regular monitoring of risk factors for cardiovascular disease. This type of research study is called a(n) a. case study. b. epidemiologic study. c. monitoring study. d. experimental study. ANS: D In experimental studies, researchers compare health outcomes of subjects who receive treatment or intervention with those of subjects in a control group, who receive no treatment or intervention. In epidemiologic studies, researchers track the occurrence of health or disease processes among populations to determine possible causative factors. In case studies, researchers examine individual cases of disease or health problems. Monitoring studies is not a recognized research term. DIF:Cognitive Level: RememberingREFage 29

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance Chapter 03: Digestion, Absorption, and Metabolism My Nursing Test Banks Chapter 03: Digestion, Absorption, and Metabolism Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. Peristalsis is necessary to make it possible for people to _____ food. a. chew b. digest c. swallow d. smell and taste ANS: C Peristalsis makes swallowing possible as involuntary movements of circular and longitudinal muscles move food along the esophagus from the mouth to the stomach. Chewing is accomplished by jaw muscles and is not related to peristalsis. Peristalsis helps move food along the gastrointestinal tract to the places where digestion of each nutrient takes place, but it does not make digestion itself possible. Smell and taste are not related to peristalsis. DIF:Cognitive Level: ApplyingREFage 42 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. Examples of mechanical digestion include a. activity of salivary amylase in the mouth. b. churning and mixing of food in the stomach. c. action of bile breaking fats into smaller droplets. d. effects of secretin in stimulating the pancreas to release bicarbonate. ANS: B Churning and mixing of food in the stomach is an example of mechanical digestion because it causes physical breakdown of the food. Salivary amylase is an enzyme that causes chemical breakdown of food; bile causes emulsification of fats. Secretin is a hormone that stimulates release of bicarbonate from the pancreas; this buffers stomach acid so that intestinal enzymes can work. DIF:Cognitive Level: UnderstandingREFages 42-43 | Page 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 3. An example of a problem caused by a sphincter muscle not operating properly is a. constipation. b. gallbladder disease. c. heartburn. d. peptic ulcer. ANS: C Heartburn is caused by reflux of acidic stomach contents into the esophagus when the sphincter muscle between these two parts of the digestive tract does not operate properly. Constipation is usually caused by slow peristalsis, often in relation to inadequate intake of dietary fiber and fluid. Gallbladder disease is unrelated to gastrointestinal sphincters. Peptic ulcer is usually caused by Helicobacter pylori infection. DIF: Cognitive Level: Applying REF: Pages 42-43 | Page 46 | Pages 49-50

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. The best description of an enzyme is a(n) a. chemical messenger. b. acid and alkali buffer. c. emulsifier. d. organic catalyst. ANS: D Enzymes are organic catalysts that work on specific classes of nutrients to change them from one form to a simpler form. The description chemical messenger applies to hormones. The emulsifier in the intestines is bile. The pancreas secretes alkaline bicarbonate to buffer stomach acid so that intestinal enzymes can work properly. DIF:Cognitive Level: RememberingREFage 40 | Pages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Chemicals that act as messengers are called a. proteins. b. hormones. c. enzymes. d. nerve impulses. ANS: B Hormones act as messengers between organs to cause release of needed secretions. Some, but not all, hormones are proteins. Enzymes work locally on specific classes of nutrients to change them from one form to a simpler form. Nerve impulses send messages in the body but via electrical impulses rather than via chemicals. DIF:Cognitive Level: RememberingREFages 43-44 | Page 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. The action of salivary amylase in the mouth is an example of a. chemical digestion. b. chewing. c. mechanical digestion. d. peristalsis and segmentation. ANS: A Salivary amylase is an enzyme that chemically digests starch in the mouth. It does not contribute to mechanical digestion. Chewing is an example of mechanical digestion. Peristalsis and segmentation help propel food along the gastrointestinal tract and mix food with intestinal secretions. DIF: Cognitive Level: Understanding REF: Page 40 | Page 42 | Page 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Most mechanical breakdown of food occurs in the a. large intestine. b. liver and pancreas. c. mouth and stomach. d. esophagus and mouth. ANS: C Mechanical breakdown of food occurs in the mouth during chewing and in the stomach as the food is mixed by muscular action. By the time food reaches the large intestine, it is already broken down,

and most of the nutrients have been absorbed. The liver and pancreas produce secretions that help with chemical but not mechanical breakdown of food. Food passes through the esophagus largely unchanged, and so the esophagus is not involved in breakdown. DIF:Cognitive Level: UnderstandingREFage 40 | Pages 42-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. The body process over which people have most conscious control is a. ingestion. b. digestion. c. metabolism. d. excretion. ANS: A People can choose the foods and fluids they ingest. Digestion, metabolism, and excretion are largely automatic processes. A persons actions may affect those processes indirectly (e.g., exercise affects metabolism, stress may affect digestion), but people have less control over them than over ingestion. DIF: Cognitive Level: Applying REF: Page 48 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 9. When someone walks by a bakery and smells the fresh bread, his or her mouth starts to water. As the person thinks about eating the fresh bread, another digestive function that starts to occur is a. peristalsis in the small intestine. b. stimulation of pancreatic secretions. c. increased blood flow to the gut and liver. d. release of the hormone gastrin in the stomach. ANS: D Release of the hormone gastrin from the stomach may be caused by the cephalic phase of gastric secretions when someone thinks about eating food. Thinking about food does not stimulate peristalsis, pancreatic secretions, or blood flow to the gut and liver. DIF:Cognitive Level: ApplyingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. The most important functions of the small intestine are a. digestion and denaturation. b. segmentation and excretion. c. digestion and absorption. d. peristalsis and mechanical digestion. ANS: C Most digestion and absorption occurs in the small intestine. Denaturation is not part of the digestive process. Segmentation occurs in the small intestine, but excretion does not. Peristalsis occurs throughout the digestive tract, and mechanical digestion occurs in the mouth and stomach. DIF:Cognitive Level: ApplyingREFages 43-45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. The most important function of the villi of the small intestine is to a. increase the secretion of enzymes for digestion. b. increase the surface area for absorption of nutrients. c. excrete waste into the intestines. d. secrete hormones in response to nutrients in the gut.

ANS: B Villi increase the surface area of the small intestine, which makes it possible for it to absorb more nutrients. Digestion occurs in the small intestine but is not a function of the villi. Excretion does not occur in the small intestine. The villi do not secrete hormones. DIF:Cognitive Level: RememberingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. The layer of the gastrointestinal tract that contributes most to mechanical digestion of food is the a. mucosa. b. submucosa. c. muscularis. d. serosa. ANS: C The muscularis is a layer of muscle tissue that causes churning, peristalsis, and segmentation of food, which contribute to mechanical digestion. The mucosa is the inside layer that releases enzymes and digestive juices. The submucosa is a layer of connective tissue that contains blood vessels and nerves that regulate digestion. The serosa is the outermost layer of the gastrointestinal wall and connects to the peritoneum lining. DIF:Cognitive Level: UnderstandingREFage 42 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. If pancreatic secretions were absent, a. there would be no bicarbonate to buffer the acid in chyme entering the duodenum. b. mechanical digestion in the stomach would be inhibited. c. the hormone secretin would not be secreted by the small intestine. d. the gallbladder would not contract to release bile into the small intestine. ANS: A Pancreatic secretions contain bicarbonate, which is important in buffering the acidity of chyme from the stomach. Pancreatic secretions enter the small intestine, below the stomach, and so have no effect on the stomachs mechanical digestion. The hormone secretin causes release of pancreatic secretions; pancreatic secretions do not affect its release. Bile release is initiated by the hormone cholecystokinin (CCK), not by pancreatic secretions. DIF:Cognitive Level: ApplyingREFages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. Release of digestive secretions into the small intestine is caused by _____ that are released when _____. a. enzymes; food enters the stomach b. enzymes; food enters the small intestine c. hormones; food enters the stomach d. hormones; enters the small intestine ANS: D Hormones that are released when chyme enters the small intestine cause the release of digestive secretions into the small intestine. The causative agents are hormones, not enzymes. The digestive secretions contain enzymes; enzymes do not trigger their release. If hormones were released when food entered the stomach, digestive secretions would be released into the small intestine too early and could cause damage. DIF:Cognitive Level: UnderstandingREFages 43-44

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. If the large intestine did not carry out its main function, feces would be a. alkaline. b. acidic. c. liquid. d. very dry. ANS: C A major function of the large intestine is absorption of water, and so if the large intestine were dysfunctional, feces would be liquid. Feces would not be dry if the large intestine did not remove water. The large intestine does not have a significant effect on the acidity or alkalinity of feces. DIF:Cognitive Level: ApplyingREFage 44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. If the speed of peristalsis were to increase, the result would be a. heartburn. b. vomiting. c. diarrhea. d. constipation. ANS: C If peristalsis were to speed up, food would move quickly through the gastrointestinal tract, and time for absorption of nutrients and water would be insufficient, which would result in diarrhea. Constipation can be related to decreased peristalsis. Heartburn is caused by reflux of stomach contents in the esophagus and is not related to peristalsis. Vomiting is caused by a reverse in the direction of peristalsis. DIF:Cognitive Level: ApplyingREFages 42-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. The part of the digestive system that is easiest to live without is the a. taste buds. b. gallbladder. c. large intestine. d. appendix. ANS: D The least vital part of the intestine is the appendix; it does not have any known function in humans. The taste buds are important for the enjoyment of food and to stimulate food intake. The gall bladder is not essential, but it allows for storage of bile to be released as needed for optimal digestion. The large intestine is important for absorption of water and a few other nutrients; it is possible to live without it, but intake must be adapted to compensate for unabsorbed fluid, electrolytes, and other substances. DIF:Cognitive Level: ApplyingREFage 40 | Pages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. What is the main difference between passive diffusion and active transport? a. In active transport, the villi membrane surrounds the substance. b. Active transport requires energy; passive diffusion does not. c. Passive diffusion is involuntary; active transport is voluntary. d. Active transport requires enzymes; passive diffusion does not.

ANS: B Active transport requires energy to absorb nutrients against a concentration gradient; passive diffusion does not require energy because nutrients travel with the concentration gradient. The absorptive process by which the villi membrane surrounds the substance is pinocytosis. Neither passive diffusion nor active transport is under voluntary control, and neither process involves enzymes. DIF:Cognitive Level: ApplyingREFage 45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Nutrients are considered to have become part of the body only once they have a. been placed inside the mouth. b. been swallowed. c. passed through the microvilli cells. d. been stored throughout the body. ANS: C Nutrients are considered to be truly inside the body once they have been absorbed from the intestines through the microvilli cells. When food is in the mouth or swallowed, it is still outside the body in that the nutrients are not available for metabolism and storage. Stored nutrients are inside the body, but that is not the point at which they are first considered to be inside. DIF:Cognitive Level: RememberingREFage 45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. People tend to feel full for longer after eating a high-fat meal rather than a low-fat meal because a. ingestion of fat causes release of hormones that signal a feeling of fullness to the brain. food stays in the stomach for longer to allow emulsification by bile and digestion by b. gastric enzymes. fat in the duodenum causes release of gastric inhibitory polypeptide, which decreases c. peristalsis of the stomach. metabolism of the products of fat metabolism by the liver takes longer than metabolism of d. other nutrients. ANS: C As fat inters the duodenum after a high-fat meal, it causes release of gastric inhibitory polypeptide, which decreases peristalsis in the stomach. Food stays in the stomach longer, and so the person feels full longer. People feel full after a high-fat meal is because the stomach is full for longer, not because the brain is told by hormone messengers that it is full. Emulsification of fat by bile and digestion of fat by enzymes occurs in the small intestine, not in the stomach. Metabolism of nutrients is not related to a feeling of fullness. DIF:Cognitive Level: ApplyingREFage 43 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. The bloodstream carries nutrients to the liver soon after absorption because the liver a. produces hormones that regulate blood glucose level. b. is an important site of metabolism and production of vital substances. c. is able to determine which substances should be stored and eliminated. d. has functions similar to those of the stomach in relation to the digestive process. ANS: B After absorption, the bloodstream carries nutrients to the liver because it has so many important metabolic functions in the body, and so its nutrient needs take priority. Hormones that regulate

blood glucose level are produced by the islets of Langerhans in the pancreas. The liver stores some substances and eliminates others, but this is not the primary reason that blood travels there directly from the intestines. The functions of the liver are very different from those of the stomach. DIF:Cognitive Level: RememberingREFage 46 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. An example of catabolism is the a. building of new muscle tissue during growth. b. breakdown of glucose to provide energy. c. synthesis of protein from amino acids. d. use of enzymes to digest protein and release amino acids. ANS: B Catabolism is the breakdown of absorbed and stored nutrients into small particles, which causes the release of energy as heat and chemical energy. An example of this is the breakdown of glucose to provide energy. Building new muscle tissue during growth and synthesis of protein from amino acids are examples of anabolism. Use of enzymes to digest protein is a function of digestion, not related to anabolism and catabolism, which are metabolic functions. DIF:Cognitive Level: UnderstandingREFage 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 23. Healing of a broken bone is an example of a. anabolism. b. catabolism. c. absorption. d. metabolism. ANS: A Healing of a broken bone is an anabolic process because it involves use of nutrients and substrates to form new body tissue. Catabolism is the breakdown of body tissues to release energy or release nutrients for other body processes. Metabolism comprises both anabolism and catabolism. Absorption is the process by which nutrients are taken into the body from the gut. DIF:Cognitive Level: ApplyingREFage 47 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. A busy and stressed person who eats very few fruits and vegetables and does not take time to exercise is likely to experience a. vomiting. b. diarrhea. c. constipation. d. lactose intolerance. ANS: C Busy lifestyles, stress that causes muscle tension, lack of exercise to maintain tone in gastrointestinal muscles, and lack of dietary fiber (from fruits, vegetables, and whole grains) are likely to result in constipation. Diarrhea may be caused by stress, not by lack of fruits and vegetables or lack of exercise. Vomiting is caused by motion sickness or by ingestion of a virus or toxin. Lactose intolerance is caused by an inability to digest lactose, the sugar in milk. DIF: Cognitive Level: Applying REF: Page 39 | Page 46 | Pages 48-49 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Dehydration may occur after

a. vomiting and diarrhea. b. constipation and heartburn. c. esophagitis and anemia. d. gastroesophageal reflux and hiatal hernia. ANS: A Both vomiting and diarrhea cause abnormal loss of fluid, which can lead to dehydration. Constipation, heartburn, esophagitis, anemia, gastroesophageal reflux, and hiatal hernia do not affect hydration status. DIF:Cognitive Level: ApplyingREFage 44 | Page 48 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 26. A person who complains of problems with gas, bloating, and diarrhea if he or she eats breakfast cereal with milk, but not if he or she eats pancakes or waffles, may have a. milk allergy. b. gluten intolerance. c. irritable bowel syndrome. d. lactose intolerance. ANS: D These symptoms are likely to be caused by lactose intolerance. Patients with lactose intolerance cannot digest lactose, the sugar in milk, and so it ferments in the intestines, causing gas, bloating, and diarrhea. Milk allergy may also cause diarrhea, but it would probably also cause skin rash, asthma, or both. Gluten intolerance would not be affected by milk intake. Symptoms of irritable bowel syndrome would probably not be related to eating foods with milk. DIF: Cognitive Level: Applying REF: Page 46 TOP: Nursing Process: Diagnosis MSC:Client Needs: Physiological integrity 27. The adjectives mechanical and chemical describe two a. actions needed to cook food. b. ways to move substances in the body. c. types of action that result in digestion. d. ways in which molecules are transported into and out of cells. ANS: C Mechanical and chemical describe two types of action that take place in digestion. These adjectives describe processes that may be used to cook food, but they are not needed for this description. Substances are moved in the body and into and out of cells by mechanical and chemical means, but these adjectives are not generally used for these processes. DIF:Cognitive Level: ApplyingREFage 40 | Pages 42-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. If a meal is eaten at noon, by 8 PM that evening, the food would probably be in the a. stomach. b. small intestine. c. large intestine. d. colon. ANS: B Food stays in the stomach for 2 to 6 hours. It then takes about 5 hours to pass through the small intestine and another 9 to 16 hours to pass through the large intestine, which includes the colon. Therefore, 8 hours after a meal, the food would be in the small intestine.

DIF:Cognitive Level: ApplyingREFages 43-44 | Page 46 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. If the small intestine did not release secretin, the result would be that the stomach would not release gastric juices to moisten and begin digestion of swallowed a. food. b. the gallbladder would not release bile to help the process of fat breakdown. c. peristalsis would slow down, and food would move very slowly through the intestines. d. the chyme entering the small intestine would be too acidic for digestive enzymes to work. ANS: D Secretin causes the pancreas to release bicarbonate into the small intestine to reduce the acidity of the chyme being released by the stomach; this ensures the correct pH for the digestive enzymes in the small intestine to digest the food. Release of bile by the gallbladder and peristalsis are affected by the hormone cholecystokinin (CCK), rather than by secretin. Secretion of gastric juices is controlled by gastrin. DIF:Cognitive Level: ApplyingREFages 43-44 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 30. If peristalsis were to reverse direction, the result would be a. vomiting. b. diarrhea. c. constipation. d. intestinal failure. ANS: A Reverse peristalsis causes vomiting; instead of food moving from the mouth to the stomach and then the small intestine, it flows backwards and is regurgitated out of the mouth. Diarrhea may be caused by increased peristalsis, so that waste is eliminated before the water can be reabsorbed. Constipation may be caused by slow peristalsis, so that food moves to the rectum very slowly. Reverse peristalsis does not cause intestinal failure, although ongoing vomiting prevents ingestion, digestion, and absorption of food. DIF:Cognitive Level: ApplyingREFages 42-43 | Page 48 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity Chapter 04: Carbohydrates My Nursing Test Banks Chapter 04: Carbohydrates Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. The primary function of carbohydrates in the body is to provide a. sweetness. b. satiety. c. energy. d. dietary fiber. ANS: C The most important function of carbohydrates in the body is to provide energy. Unrefined sources of carbohydrate do provide dietary fiber, but refined carbohydrates do not. Similarly, unrefined

carbohydrates may add to satiety, but refined carbohydrates contribute less to satiety than do protein and fat. Simple carbohydrates provide sweetness; this is pleasant but not essential to the body. DIF: Cognitive Level: Remembering REF: Page 51 | Page 54 | Pages 58-59 | Pages 64-66 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 2. Fructose, galactose, and glucose are examples of a. disaccharides. b. polysaccharides. c. monosaccharides. d. complex carbohydrates. ANS: C Fructose, galactose, and glucose each consist of a single unit of carbohydrate and are therefore monosaccharides. Disaccharides consist of two carbohydrate units; polysaccharides and complex carbohydrates consist of several carbohydrate units. DIF:Cognitive Level: RememberingREFages 53-54 | Page 58 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. The sweetness in a banana comes mostly from a. fructose and sucrose. b. fructose and glucose. c. glucose and maltose. d. maltose and sucrose. ANS: A The most common sugars found naturally in fruits such as a banana are fructose and sucrose. It may also contain some glucose, but this contributes less to the sweetness. Fructose is the sweetest of the sugars, and so it contributes most to the sweetness. Maltose is found only in germinating grains or as a product of partial starch digestion in the gut. DIF: Cognitive Level: Applying REF: Pages 53-54 | Pages 58-59 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. A blood glucose level of 60 mg/dL is considered to be a. inconclusive. b. representative of hypoglycemia. c. representative of normoglycemia. d. representative of hyperglycemia. ANS: B The normal range for blood glucose level is 70 to 100 mg/dL. Therefore, 60 mg/dL is considered to represent hypoglycemia. DIF:Cognitive Level: ApplyingREFage 57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. In comparison with table sugar (sucrose), honey tastes _____ because it contains _____. a. sweeter; fructose b. sweeter; maltose c. less sweet; fructose d. less sweet; maltose ANS: A

Honey is sweeter than table sugar because it contains fructose, the sweetest of all the sugars. Maltose is less sweet than table sugar and is not found in honey; it is found only in germinating grains and as a product of partial starch digestion. DIF:Cognitive Level: ApplyingREFages 54-56 | Page 58 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 6. Someone who follows a strict vegetarian (vegan) diet and eats very few refined foods is likely to have _____ intake of _____ carbohydrates and dietary fiber. a. low; complex b. high; complex c. low; simple d. high; simple ANS: B Strict vegetarian diets contain only plant foods that have high levels of carbohydrates. Refined foods contain more simple sugars and some starch. Unrefined foods contain mostly complex carbohydrates and fiber. Therefore, someone who follows a strict vegetarian diet and eats very few refined foods is likely to have a high intake of complex carbohydrates and dietary fiber. DIF: Cognitive Level: Applying REF: Pages 52-53 | Page 62 | Pages 64-65 | Page 68 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 7. A person would be most likely to produce excessive ketones if his or her food intake that day consisted only of a. green salad with oil and vinegar dressing. b. refried pinto beans and rice. c. cheeseburgers and French fries. d. fried eggs with bacon and hash brown potatoes. ANS: A Ketones are produced when insufficient carbohydrate is available and the body has to metabolize fat for energy. A green salad with oil and vinegar dressing provides energy from fat but minimal amounts of carbohydrate. In the other meals, carbohydrate is provided by beans, rice, the bun for the burger, and the potatoes used to make the fries and hash browns. DIF: Cognitive Level: Applying REF: Page 54 | Page 57 | Page 63 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. Since the 1970s, consumption of refined white sugar has decreased, mostly because a. health-conscious consumers are using less of it. b. use of high-fructose corn syrup has increased. c. use of artificial sweeteners has increased. d. use of honey and other natural sweeteners has increased. ANS: B Use of refined white sugar has decreased because use of high-fructose corn syrup has increased. High-fructose corn syrup is used because it is cheaper to produce and sweeter than white table sugar. Unfortunately, consumers are not using less sugar; in fact, they are consuming more sugar overall. Use of artificial sweeteners, honey, and other natural sweeteners has increased, but this is not the main contributor to decreased refined white sugar consumption. DIF: Cognitive Level: Remembering REF: Page 59 TOP: Nursing Process: Evaluation MSC: Client Needs: Health promotion and maintenance 9. The person who is most likely to develop dental caries is one who

a. eats dessert after each meal. b. drinks two or three regular soft drinks every day. c. snacks on candy bars between meals. d. chews gum throughout the day. ANS: C Dental caries is mostly likely to be caused by snacking on sweet, sticky foods (like candy bars) between meals. When desserts are eaten with meals, the teeth are exposed to carbohydrates for less time each day, so bacteria have less time to ferment the carbohydrate and cause caries. Soft drinks do not stick to the teeth like more sticky sweet foods and so are less likely to contribute to caries. Chewing gum may stimulate saliva production, which washes the teeth, and so it does not usually contribute to dental caries. DIF:Cognitive Level: UnderstandingREFages 59-61 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. The most significant effect of bacteria in the mouth is fermentation of a. dietary fiber, which promotes formation of beneficial short-chain fatty acids. b. dietary fiber, which increases intestinal gas production. c. simple carbohydrates, which promotes production of sugar alcohols and causes halitosis. d. simple carbohydrates, which promotes formation of plaque and tooth decay. ANS: D Bacteria cause fermentation of sugars in the mouth and promote formation of plaque, which causes tooth decay. Bacteria are not capable of producing sugar alcohols, although their action on food may contribute to halitosis. Fermentation of dietary fiber occurs in the large intestine, not in the mouth. DIF: Cognitive Level: Remembering REF: Page 59 | Page 61 | Page 65 | Page 67 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 11. The primary reason for chewing sugar-free gum instead of sugar-sweetened gum is that sugarfree gum a. is calorie-free and helps with weight control. b. contains sugar alcohols that do not promote dental caries. c. contains gums that provide soluble dietary fiber. d. is sweeter than sugar-sweetened gum because it contains artificial sweeteners. ANS: B Sugar-free gum is usually made with sugar alcohols, which are not fermented by bacteria in the mouth and so do not promote dental caries. Sugar alcohols contain fewer kilocalories than other sugars but nonetheless contain 2 to 3 kcal per gram, and so they are not calorie-free. Chewing gum is not usually swallowed and so would not contribute to dietary fiber; in addition, this is not different with sugar-sweetened versus sugar-free gum. Sugar-free gum is usually sweetened with sugar alcohols, which are actually less sweet than other sugars. DIF: Cognitive Level: Remembering REF: Pages 60-62 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 12. Aspartame should not be consumed by a. infants and school-aged children. b. individuals who suffer from arthritis. c. individuals who have phenylketonuria (PKU). d. anyone who is underweight or trying to gain weight. ANS: C

Aspartame contains phenylalanine, and so it should not be consumed by individuals who have phenylketonuria. There is no evidence that moderate intake of aspartame is harmful for infants and school-aged children, although there may be no reason for them to consume it. Claims that aspartame causes arthritis have not be verified. Food sweetened with aspartame rather than sugar will provide fewer kilocalories and so will not help individuals gain weight, but this does not mean that underweight people should avoid aspartame. DIF: Cognitive Level: Remembering REF: Pages 60-62 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 13. John wants to increase his dietary fiber intake. The best breakfast choice to help him achieve this goal would be a. pancakes and orange juice. b. oatmeal with raisins. c. scrambled egg and toast. d. blueberry muffin and jam. ANS: B The best sources of dietary fiber are whole grains, fruits, and vegetables. Therefore, the breakfast with the highest amount of dietary fiber would be oatmeal with raisins. Pancakes, toast, and the muffin could contribute dietary fiber if they are made with whole wheat flour, but this was not specified. Orange juice is basically oranges with the fiber removed. Jam made with whole fruit may be high in fiber, but relatively small amounts are eaten. Animal foods such as eggs do not contain dietary fiber. DIF: Cognitive Level: Applying REF: Pages 64-66 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 14. Colon cancer runs in Janes family. She may be able to decrease her risk of developing this cancer if she increases her intake of a. fish and bran. b. apples, strawberries and citrus fruit. c. oatmeal, barley and legumes. d. whole grains and vegetables. ANS: D High intake of insoluble fiber helps decrease risk of colon cancer because it is fermented to produce short-chain fatty acids that decrease risk of tumor formation. The best sources of insoluble fiber are whole grains and vegetables. Oatmeal, barley, legumes, apples, strawberries, and citrus fruit contain more soluble than insoluble fiber. Bran has high amounts of insoluble fiber, but fish does not contain dietary fiber. DIF: Cognitive Level: Applying REF: Pages 64-66 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 15. Eating a bowl of oatmeal for breakfast every day may help prevent a. heart disease because it contains soluble fiber. b. high blood pressure because it contains potassium. c. hypoglycemia because it contains complex carbohydrate. d. osteoporosis because it contains calcium and vitamin D. ANS: A Oatmeal helps prevent heart disease because it contains soluble fiber, which helps decrease blood cholesterol levels. It is not a significant source of potassium and is unlikely to affect blood pressure,

except by displacing other foods with high levels of sodium. Hypoglycemia is prevented by consuming foods that contain protein and carbohydrate throughout the day, rather than eating a specific food at one meal. Oatmeal would contain a significant amount of calcium and vitamin D only if it is made or eaten with milk, and so it would not necessarily help prevent osteoporosis. DIF: Cognitive Level: Applying REF: Pages 57-58 | Pages 65-67 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 16. Athletes use physical training and dietary manipulation to increase their body stores of energy in the form of a. glucose. b. glycogen. c. amino acids. d. short-chain fatty acids. ANS: B Athletes use these methods to increase their body stores of energy in the form of glycogen. Glycogen is the form of carbohydrate stored in the liver and muscles. Glucose and amino acids are not stored in the body. Also, the primary function of amino acids is tissue building, not energy production. Short-chain fatty acids are produced when bacteria cause fermentation of dietary fiber in the colon. They are used as an energy source only by epithelial cells in the colon. DIF:Cognitive Level: UnderstandingREFages 56-57 | Page 65 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 17. After a high-carbohydrate meal, the dominant process would be a. glycogenesis. b. glycogenolysis. c. gluconeogenesis. d. glucagon production. ANS: A After a high-carbohydrate meal, the carbohydrate is digested and absorbed as glucose. Excess glucose is converted to glycogen; this process is called glycogenesis. The other three processes occur a long time after a meal, after a fast, or after exercise, when glucose stores are low. In glycogenolysis, glycogen is converted back to glucose. Gluconeogenesis is conversion of fat and protein to glucose. Production of the hormone glucagon increases blood glucose levels by stimulating glycogenolysis and gluconeogenesis. DIF: Cognitive Level: Applying REF: Pages 56-57 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. A dietary fiber intake of 18 g daily is considered a. the minimum recommended. b. below the optimal range of intake. c. within the optimal range of intake. d. above the optimal range of intake. ANS: B A fiber intake of 18 g is below the optimal range of daily intake for dietary fiber. The recommended range is 25 to 38 g/day. DIF:Cognitive Level: RememberingREFages 67-69 TOP:Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity

19. A beneficial effect of bacterial fermentation of dietary fiber in the colon is a. production of intestinal gas. b. providing monosaccharides for energy. c. production of short-chain fatty acids. d. production of long-chain fatty acids. ANS: C Bacteria cause fermentation of dietary fiber in the colon to produce short-chain fatty acids, which provide energy for mucosal cells and inhibit tumor formation. DIF:Cognitive Level: RememberingREFages 64-67 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20. Increased consumption of fruits and vegetables would be most beneficial to someone with a. arthritis. b. diarrhea. c. constipation. d. osteoporosis. ANS: C Foods with high amounts of dietary fiber, such as fruits and vegetables, can help relieve constipation by increasing fecal bulk. Arthritis is not related to intake of fruits and vegetables. High intake of fruits and vegetables may exacerbate diarrhea. Osteoporosis is related to intake of calcium and vitamin D; fruits and vegetables are not good sources of these nutrients. DIF: Cognitive Level: Applying REF: Pages 66-67 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 21. Peter has been very ill and has not eaten for 3 days. In order to provide carbohydrate for his brain and other cells, his body will break down a. body fat. b. liver glycogen. c. blood glucose. d. muscle protein. ANS: D The body needs a minimum of about 100 g carbohydrate daily, so after 3 days Peters body will have used up his bodys glucose and glycogen stores (about 150 g in muscles and about 90 g in liver). Body fat cannot be converted to glucose, and so his body must break down muscle protein to produce glucose by gluconeogenesis. DIF:Cognitive Level: AnalyzingREFages 56-57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. An example of a food with a low glycemic index is a. lentil soup. b. a bagel. c. a sports drink. d. cornflakes cereal. ANS: A Lentil soup has a low glycemic index. Foods with a low glycemic index produce a relatively small increase in blood glucose level. Lentils have high amounts of fiber, which tends to decrease glycemic index. Bagels, sports drinks, and cornflakes have relatively low amounts of fiber.

DIF: Cognitive Level: Applying REF: Pages 57-58 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 23. If someones stomach is removed, his or her ability to digest carbohydrate would be a. limited to only disaccharides and monosaccharides. b. limited to only polysaccharides. c. largely unaffected. d. lost completely. ANS: C Most carbohydrate digestion occurs in the small intestine. Salivary amylase begins some carbohydrate digestion in the mouth, but this stops in the acid environment of the stomach. The stomach is the main site of protein digestion. Therefore, removal of the stomach has little effect on carbohydrate digestion. DIF:Cognitive Level: ApplyingREFages 55-56 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. If someone chewed a piece of bread for a long time, its taste would become a. unchanged. b. salty. c. sweeter. d. bitter. ANS: C Saliva in the mouth contains salivary amylase, or ptyalin, which begins starch digestion. If a starchy food such as bread stays in the mouth long enough, the amylase will break down the starch to produce monosaccharides and disaccharides, which taste sweet. DIF:Cognitive Level: ApplyingREFage 55 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. If a healthy persons blood glucose level is 120 mg/dL, his or her body would respond by releasing a. glucagon. b. somatostatin. c. insulin. d. epinephrine. ANS: C The normal range for blood glucose level is 70 to 100 mg/dL. Therefore, a blood glucose level of 120 mg/dL is high, and the body would release insulin to promote storage of blood glucose to remove the excess from the blood. Glucagon, somatostatin, and epinephrine all increase blood glucose levels, and so they would have the opposite of the desired effect. DIF:Cognitive Level: ApplyingREFage 57 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 26. The main concern with increasing intake of high-fructose corn syrup is that it a. provides mostly fructose, which is poorly metabolized. b. provides energy but no nutrients. c. promotes storage of body fat. d. cultivates an increased desire for sweet foods and beverages. ANS: B

The main concern with high intake of high-fructose corn syrup in processed foods and beverages is that it provides energy but no nutrients. Fructose is easily metabolized by the body and converted to glucose, which may be used for energy or stored as body fat. It does not promote storage of body fat more than any other excess energy. A taste for sweet foods is largely innate, and even though a desire for sweet foods may be cultivated, it is not necessarily related to intake of this specific sweetener. DIF:Cognitive Level: UnderstandingREFage 59 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 27. The best way to ensure adequate nutrient intake is to eat plenty of a. refined grains. b. enriched grains. c. whole grains. d. fiber supplements. ANS: C Whole grains supply the most nutrients. When grains are refined, the bran and germ are removed, and many nutrients are fiber are lost. Enrichment replaces some, but not all, of the nutrients that are removed when grains are refined. Fiber supplements contain dietary fiber but do not contain all the other vitamins and minerals found in whole grains. DIF: Cognitive Level: Applying REF: Pages 68-69 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 28. For someone with diabetes mellitus, high blood glucose levels may be caused by high intakes of a. refined carbohydrates. b. any type of food. c. any type of sugar. d. any type of carbohydrate. ANS: D Any type of carbohydrate can cause an increase in blood glucose level in people with diabetes. Refined carbohydrates and sugars tend to increase blood glucose level more quickly, but high intake of any carbohydrate causes blood glucose level to rise. Fats and proteins have less effect on blood glucose level than do foods that contain carbohydrate. DIF:Cognitive Level: UnderstandingREFages 57-58 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. A client experiences bloating, gas, and diarrhea after eating ice cream or drinking milk. These symptoms are probably related to a. hypoglycemia. b. lactose intolerance. c. inadequate fiber intake. d. diverticulitis. ANS: B Some adults develop lactose intolerance because they lose the ability to produce lactase, the enzyme that digests lactose, the disaccharide in milk. Undigested lactose is fermented in the colon, which causes bloating, gas, and diarrhea. Hypoglycemia is a low level of blood glucose and is unrelated to intake of dairy products. Inadequate fiber intake is likely to cause constipation, not diarrhea. Diverticulitis is also often related to low fiber intake and is unrelated to intake of dairy products. DIF: Cognitive Level: Applying REF: Pages 54-55 TOP: Nursing Process: Diagnosis

MSC:Client Needs: Physiological integrity 30. The end product of starch digestion in the body is a. sucrose. b. maltose. c. glycogen. d. glucose. ANS: D Starch is ultimately broken down to individual monosaccharide glucose units. Starch consists of chains of only glucose and so contains no fructose. Sucrose is a disaccharide that contains glucose and fructose and so cannot be formed from starch. Glycogen may be formed from glucose in the body but is not formed during digestion. DIF:Cognitive Level: RememberingREFages 54-56 | Page 58 TOP:Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance Chapter 05: Fats My Nursing Test Banks Chapter 05: Fats Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. Of the following, the food that would provide the most energy per ounce is a. butter. b. tuna. c. pasta. d. hard candy. ANS: A Butter would provide the most energy per ounce because fat is the densest energy source. Fat provides 9 kcal/g; protein and carbohydrate each provide 4 kcal/g. Tuna is mostly protein with just a small amount of fat, pasta is mostly carbohydrate, and hard candy is only carbohydrate, and so all of these would provide fewer calories per ounce than would butter. DIF:Cognitive Level: ApplyingREFage 74 | Page 81 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity 2. The most beneficial function of cholesterol in the body is a. formation of sex hormones, bile, and vitamin D. b. depositing plaques in arteries. c. being part of cell membrane structure. d. solubility in both water and fat. ANS: A The body uses sterols such as cholesterol to make sex hormones, bile, and vitamin D. Cholesterol does contribute to deposition of arterial plaques, but this is not beneficial to the body. Cell membrane structure and solubility in both water and fat are functions of phospholipids; cholesterol is a sterol, not a phospholipid. DIF:Cognitive Level: ApplyingREFages 77-78 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

3. If a patient receiving parenteral nutrition develops eczema, the patient probably has a. vitamin C deficiency. b. essential fatty acid deficiency. c. protein-energy malnutrition. d. phospholipid and sterol deficiency. ANS: B In a patient receiving fat-free parenteral nutrition, eczema may be a sign of essential fatty acid deficiency. Eczema is not caused by vitamin C deficiency; symptoms of vitamin C deficiency include bleeding gums and breakdown of scar tissue. Eczema is not a sign of protein-energy malnutrition. The body makes phospholipids and sterol, and so deficiency does not occur. DIF: Cognitive Level: Applying REF: Page 74 TOP: Nursing Process: Diagnosis MSC:Client Needs: Physiological integrity 4. If a food that is usually made with hydrogenated oil is made with vegetable oil instead, one potential concern is that the a. flavor will be significantly different. b. food will feel oily to the touch. c. food will contribute more to cardiovascular risk. d. food will have a shorter shelf life. ANS: D Hydrogenation of vegetable oils increases their shelf life because the double bonds are removed, which renders the fatty acids less vulnerable to oxidation; therefore, a food made with vegetable oil may have a shorter shelf life. Use of vegetable oil does not necessarily result in a different flavor from use of hydrogenated fat and does not make the food feel more oily. Foods made with vegetable oils are less likely to contribute to cardiovascular disease than those made with hydrogenated fats, which contain saturated and trans fatty acids. DIF:Cognitive Level: UnderstandingREFage 82 | Page 84 TOP:Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment 5. A triglyceride is a compound composed of a. glycerol with two fatty acids attached. b. glycerol with three amino acids attached. c. glycerol with three fatty acids attached. d. organic molecules formed in triangular chains. ANS: C Triglycerides are compounds made up of glycerol and three fatty acids. The compound of glycerol plus two fatty acids is a diglyceride. Glycerol does not combine with amino acids. Triglycerides do not form in triangular chains. DIF:Cognitive Level: RememberingREFage 75 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. To decrease intake of saturated fatty acids and increase intake of polyunsaturated fatty acid, one dietary change would be from using _____ to using _____ oil. a. shortening; coconut b. margarine; olive c. soybean oil; canola

d. butter; sunflower ANS: D Sunflower oil is rich in polyunsaturated fatty acids, and butter is rich in saturated fatty acids; therefore, this switch would have the best effect. Shortening actually has higher amounts of polyunsaturated fatty acids and lower amounts of saturated fatty acids than does coconut oil. Olive oil contains lower amounts of saturated fatty acids than does margarine, but it is rich in monounsaturated fatty acids, not polyunsaturated fatty acids. Both canola oil and soybean oil have relatively low amounts of saturated fatty acids; canola oil contains mostly monounsaturated fatty acids, whereas soybean oil is rich in polyunsaturated fatty acids. DIF: Cognitive Level: Applying REF: Page 76 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 7. If a client wants to lose 1 lb of body fat each week, he or she would need to make sure that the daily calorie intake was lower than the daily energy needs by _____ kcal/day. a. 350 b. 500 c. 900 d. 3500 ANS: B One pound of body fat contains 3500 kcal. To create a weekly deficit of 3500 kcal, daily energy intake would need to be less than daily energy expenditure by 500 kcal (3500 7). DIF: Cognitive Level: Applying REF: Page 74 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 8. Of the following fats, the one that is most likely to be liquid is a. milk fat. b. beef drippings. c. coconut oil. d. peanut oil. ANS: D In general, plant oils are more liquid and animal fats tend to be solid. Both milk fat (butter) and beef drippings (lard) have high amounts of saturated fatty acids and tend to be solid fats. Coconut oil is a plant oil, but it has high amounts of saturated fatty acids, and so it is usually solid. Peanut oil has high amounts of unsaturated fatty acids and is a liquid oil. DIF: Cognitive Level: Understanding REF: Pages 75-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. The number of double bonds present in the fatty acid chain determines the a. number of fatty acids attached to the glycerol molecule. b. number of glycerol molecules attached to a fatty acid. c. degree of saturation or unsaturation of a fatty acid. d. degree of saturation or unsaturation of the glycerol molecule. ANS: C The number of double bonds in a fatty acid chain determines the degree of saturation or unsaturation of a fatty acid. The number of fatty acids attached to the glycerol molecule determines whether it is a monoglyceride (one fatty acid), a diglyceride (two fatty acids), or a triglyceride (three fatty acids). There is never more than one glycerol molecule attached to a fatty acid, and glycerol molecules do not vary in the degree of saturation or unsaturation.

DIF:Cognitive Level: UnderstandingREFages 75-77 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 10. A client who wishes to avoid blood clots may benefit from regular intake of a. fish oil capsules. b. salmon. c. lecithin. d. olives and olive oil. ANS: B Omega-3 fatty acids help decrease risk of blood clots. The best source of omega-3 fatty acids is fatty fish, such as salmon; fish oil capsules are not recommended because large doses may decrease immunity. Lecithin and the monounsaturated fatty acids found in olive oil do not decrease risk of blood clotting. DIF: Cognitive Level: Applying REF: Pages 75-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 11. Overall energy intake can be greatly affected by relatively small changes in intake of a. protein. b. carbohydrate. c. fat. d. alcohol. ANS: C Fat contains more energy per gram than any other nutrient (9 kcal/g versus 4 kcal/g for protein and carbohydrate and 9 kcal/g for alcohol). Therefore, relative small increases or decreases in fat intake can result in significant increases or decreases in energy intake. DIF: Cognitive Level: Understanding REF: Page 74 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 12. The number of kilocalories provided by 23 g of fat is a. 92. b. 161. c. 207. d. 230. ANS: C Fat contains 9 kcal/g. Therefore, 23 g fat contain 207 kcals (23 9). DIF:Cognitive Level: ApplyingREFage 74 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. If dietary analysis shows that fat provides 31% of an individuals energy intake, their fat intake would be a. considered below the recommended range. b. considered within the recommended range. c. considered above the recommended range. d. generally recognized as safe. ANS: B The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of kilocalories; therefore, 31% is within the recommended range. Generally recognized as safe is a term used for food additives.

DIF:Cognitive Level: ApplyingREFage 80 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 14. Sources of invisible fat include a. pastries and pies. b. bacon and chicken with skin. c. butter and sour cream. d. oil and vinegar salad dressing. ANS: A In baked goods such as pastries and pies, the fat cannot be seen; it is absorbed into the flour, which makes it invisible. Bacon has visible strips of white fat, chicken skin is visibly fatty, butter and sour cream can be seen unless they are melted into toast or potatoes, and oil can be seen floating on top of the vinegar in salad dressing. DIF:Cognitive Level: ApplyingREFages 81-83 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 15. An example of emulsification is a. chewing of food in the mouth. b. use of egg yolk to make mayonnaise. c. commercial hydrogenation of liquid oils. d. digestion of fat in the small intestine. ANS: B The lecithin in egg yolk acts as an emulsifier in the making of mayonnaise. Chewing of food is mastication. Hydrogenation of liquid oils does not emulsify them. In the small intestine, bile emulsifies fat to increase the surface area for digestion, but the fat is not actually digested there. DIF:Cognitive Level: ApplyingREFage 78 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 16. For someone with coronary heart disease, what would be the most helpful piece of information on a food label? a. Total calories per serving b. Milligrams of cholesterol per serving c. Grams of saturated fat per serving d. Grams of total fat per serving ANS: C Saturated fat intake has the greatest influence on blood cholesterol levels and coronary heart disease. Intakes of total fat and total energy are important, but not as important as saturated fat. Intake of cholesterol is less important because most cholesterol is made by the body, and dietary sources contribute relatively little. DIF: Cognitive Level: Applying REF: Page 82 | Pages 84-86 | Page 88 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 17. If a salad dressing is made with olive oil, it would contain mostly _____ fatty acids. a. trans b. saturated c. polyunsaturated d. monounsaturated ANS: D

Olive oil is rich in monounsaturated fatty acids. Trans fatty acids are found in hydrogenated fats. Polyunsaturated fatty acids are found mostly in other liquid vegetable oils. Saturated fatty acids are found in dairy, meat fats, and coconut and palm oil. DIF: Cognitive Level: Applying REF: Page 76 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. The best description of a fat with high amounts of trans fatty acids is that it is a. liquid at room temperature. b. found naturally in tropical oils. c. easily transformed from one state to another. d. produced by hydrogenation of plant oils. ANS: D Trans fatty acids are formed when liquid plant oils are hydrogenated to form a hard fat, such as margarine or shortening. Trans fatty acids are not naturally present in any fats or oils, and fats with high amounts of trans fatty acids tend to form solid, rather than liquid, fats at room temperature. Trans fatty acids are shelf stable and so are not easily transformed. DIF:Cognitive Level: RememberingREFage 82 | Page 84 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 19. An alternative to hydrogenation to increase the shelf life of polyunsaturated fat is the addition of a. vitamin E. b. vitamin D. c. hydrogen. d. zinc. ANS: A Antioxidants provide a way to preserve unsaturated fats without hydrogenation. Vitamin E is an example of an antioxidant that may be added to unsaturated fats. Vitamin D and zinc do not have antioxidant properties. Hydrogen is added during hydrogenation. DIF:Cognitive Level: ApplyingREFages 84-85 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 20. The most important property of phospholipids that makes them valuable both in foods and in the body is that they a. carry fat-soluble vitamins. b. are useful as low-energy fat substitutes. c. are soluble in water and fat at the same time. d. function as natural antioxidants. ANS: C Phospholipids are valuable in foods and in the body because they are soluble in water and fat at the same time. This makes them useful emulsifiers and important components of cell membranes. Phospholipids have no particular role in carrying fat-soluble vitamins. They are not used as fat substitutes. They do not function as antioxidants. DIF: Cognitive Level: Understanding REF: Pages 77-78 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 21. Most fat enters the lymphatic system after a. absorption. b. circulation. c. metabolism.

d. hydrogenation. ANS: A Most fat is absorbed into the lymphatic system from the small intestine. It then passes into the circulation. Therefore, circulation and metabolism occur after, not before, fat enters the lymphatic system. Hydrogenation occurs during food production and is not connected to processing of fat in the body. DIF:Cognitive Level: ApplyingREFage 78 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 22. Jacob usually eats a sandwich with salami, mayonnaise, lettuce, and tomato on wheat bread for lunch. What change would be most helpful in decreasing his risk of cardiovascular disease? a. Add sprouts instead of tomato. b. Switch to whole-wheat bread. c. Omit the mayonnaise. d. Replace the salami with turkey. ANS: D Replacing the salami with turkey would be most beneficial because salami has high amounts of saturated fatty acids, which tend to increase blood cholesterol levels. Turkey also contains saturated fatty acids but has low amounts of fat overall. Switching the whole-wheat bread would increase dietary fiber intake, which would also help decrease blood cholesterol level, but the effect would not be as great as a decrease in saturated fat. Omitting the mayonnaise would help decrease overall fat intake, but the fat in mayonnaise is mostly unsaturated and so it would be less beneficial than using a lower fat meat. Both sprouts and tomatoes add vitamin C and other nutrients, and so this change would make very little difference nutritionally. DIF:Cognitive Level: ApplyingREFage 76 | Pages 80-83 TOP:Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 23. High levels of low-density lipoprotein cholesterol (LDLc) are associated with an increased risk of a. diabetes mellitus. b. high levels of high-density lipoprotein cholesterol (HDLc). c. coronary artery disease. d. high blood pressure and stroke. ANS: C High levels of low-density lipoprotein cholesterol are associated with increased risk of coronary artery disease. They do not have a direct effect on risk for diabetes mellitus or high blood pressure and stroke. LDLc and HDLc levels are not necessarily related. DIF:Cognitive Level: RememberingREFage 82 | Pages 84-85 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 24. A client who is trying to follow a low-fat eating pattern tells you that he or she has experienced diarrhea. You may want to find out whether he or she has a. eaten foods made with the fat substitute carrageenan. b. eaten foods made with the fat substitute olestra. c. greatly increased intake of fish and seafood. d. developed essential fatty acid deficiency. ANS: B

Olestra is a fat substitute that is not digested or absorbed and may cause diarrhea if eaten in large quantities. Carrageenan is a carbohydrate that is digested and does not cause diarrhea. Fish and seafood consumption and essential fatty acid deficiency are not associated with diarrhea. DIF: Cognitive Level: Applying REF: Page 74 | Page 77 | Page 86 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 25. The client most likely to benefit from use of medium-chain triglycerides is one who a. has essential fatty acid deficiency. b. has malabsorption because of removal of part of the small intestine. c. needs to gain weight after surgery and chemotherapy to treat bowel cancer. d. has high levels of both serum total cholesterol and low-density lipoprotein cholesterol. ANS: B Medium-chain triglycerides are beneficial for patients with malabsorption because they are relatively easily absorbed. They do not contain essential fatty acids. They contain the same amount of energy as other fatty acids, and so they would not be especially beneficial for a client who needs to gain weight. They do not influence serum cholesterol levels. DIF: Cognitive Level: Applying REF: Page 74 | Page 78 | Pages 85-86 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 26. A good lunch choice for someone who wants to increase intake of omega-3 fatty acids would be a. peanut butter and jelly sandwich. b. lentil soup. c. salad with olive oil dressing. d. grilled tuna sandwich. ANS: D Fatty fish, such as tuna, are an excellent source of omega-3 fatty acids, and so the grilled tuna sandwich would be the best choice. Peanut butter and olive oil have high amounts of monounsaturated fatty acids but are not good sources of omega-3 fatty acids. Lentil soup is likely to have low amounts of fat. DIF: Cognitive Level: Applying REF: Pages 76-77 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 27. If a person did not produce bile, a. fats would pass through the intestines undigested. b. fats would be digested and absorbed too quickly. c. fat digestion may occur more slowly. d. digestion of fat would be unaffected. ANS: C Bile emulsifies dietary fats to increase their surface area for action of digestive enzymes. Therefore, without bile, digestion of fat would occur more slowly. Because of mixing and churning of chyle with digestive secretions and enzymes in the small intestine through peristalsis and segmentation, digestion would still occur, but more slowly. DIF:Cognitive Level: ApplyingREFages 78-79 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. A client who is a bodybuilder eats large quantities of tuna, chicken, and lean meats every day. Any extra energy from these foods that the clients body does not need will be stored as a. adipose tissue. b. essential body fat.

c. muscle tissue. d. glycogen. ANS: A Extra energy from any source is stored as fat in adipose tissue. Muscle is developed in response to exercise; it requires some protein, but extra protein cannot be stored as muscle tissue. Glycogen stores in the body are limited. Essential body fat is the fat that protects organs and nerve cells; its amount does not increase with dietary excess. DIF: Cognitive Level: Applying REF: Pages 75-76 | Pages 79-80 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. A healthy daily fat intake for someone who eats 3000 kcal per day is _____ g. a. 100 b. 33 to 83 c. 67 to 117 d. 600 to 1050 ANS: C The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of energy intake. Of 3000 kcal, 20% to 35% is 600 to 1050 kcal. Fat contains 9 kcal per gram, and so this represents approximately 67 to 117 g (600/9 to 1050/9 g) of fat daily. DIF:Cognitive Level: ApplyingREFage 80 TOP:Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity 30. A client grew up on a farm and learned to prepare foods with butter and lard produced by the farm animals. She is now in her 60s and has just learned that she has coronary artery disease. To best meet her physical needs, as well as psychological needs, the health practitioner should a. suggest that she adopt a low-fat vegetarian dietary pattern. b. ask how she usually prepares foods and suggest ways to reduce the use of animal fat. advise her to eat more fruits and vegetables and to replace some of the animal fat with c. palm and coconut oil. d. advise her to avoid adding fat to foods and eat only very lean poultry and fish. ANS: B The health practitioner should start with the ways the client usually prepares food and suggest ways in which she can use less animal fat and more heart-healthy unsaturated fats without making dramatic or arbitrary changes. A low-fat vegetarian dietary pattern is not necessary and may be unacceptable to the client. Eating more fruits and vegetables may be beneficial, but palm and coconut oil are high in saturated fat, which would not be helpful. It is probably not necessary for her to avoid adding any fat to foods and to eat only very lean poultry and fish; such drastic changes might not be maintained by the client. DIF: Cognitive Level: Analyzing REF: Page 76 | Pages 81-84 | Pages 87-88 TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance Chapter 06: Protein My Nursing Test Banks Chapter 06: Protein Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE

1. If a person were to eat a diet that provided carbohydrate, fat, and micronutrients, but very little protein, for example if he or she ate only whole-wheat pita bread with olive oil, the body would manufacture amino acids to make essential proteins from fatty acids and a. glycogen. body metabolism would decrease to conserve amino acids until protein intake was b. resumed. c. the liver would recirculate amino acids instead of breaking them down and excreting urea. the body would break down muscle tissue to provide amino acids to make essential d. proteins. ANS: D The body needs regular dietary protein to provide amino acids. If no protein is eaten in the diet, the body uses muscle tissue to provide amino acids to make essential body proteins. The liver cannot recirculate amino acids; some are always broken down, and the nitrogen portion is excreted as urea. Body metabolism may decrease slightly, but it would not be sufficient to conserve amino acids for any length of time. The body cannot manufacture amino acids from fatty acids and glycogen. DIF:Cognitive Level: ApplyingREFages 90-92 | Page 94 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. If a man weighs 190 lb and eats 150 g protein per day, his protein intake is _____ of the Recommended Dietary Allowance (RDA). a. less than 100% b. between 100% and 150% c. between 150% and 200% d. greater than 200% ANS: D The RDA for protein is 0.8 g per kilogram of body weight. This mans weight is 190 lb, or 86 kg; 86 kg 0.8 = 69.1 g protein per day. Thus, an intake of 150 g is more than twice his RDA of 69.1 g of protein per day. DIF:Cognitive Level: ApplyingREFage 97 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Some proteins contain an alpha helix, which is part of their _____ structure. a. primary b. secondary c. tertiary d. quaternary ANS: B The alpha helix structure is an example of the secondary structure of proteins. The primary structure is the amino acid sequence. The tertiary structure comprises bonds that form within chains in loops or folds. Quaternary structure is formed by combinations of more than one polypeptide. DIF:Cognitive Level: UnderstandingREFage 92 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. The most accurate statement about amino acids is that a. most amino acids contain sulfur. b. they are stored in the liver for use when needed. c. essential amino acids cannot be manufactured by body cells. d. nonessential amino acids cannot be manufactured body cells.

ANS: C Body cells cannot manufacture essential amino acids. Cells can make nonessential amino acids from essential amino acids. The liver is not able to store significant amounts of amino acids. Some but not most amino acids contain sulfur. DIF:Cognitive Level: ApplyingREFage 90 | Page 96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. Nonessential amino acids can be made by the liver from a. glucose and urea. b. other amino acids. c. fatty acids and glycerol. d. enzymes and hormones. ANS: B The body can make nonessential amino acids from other amino acids. Once the amino group has been removed from an amino acid and has been formed into urea, the body cannot turn it back into an amino acid. Fatty acids and glycerol cannot be used to make amino acids. Enzymes and hormones may help control the manufacture of nonessential amino acids but are not themselves used to make them. DIF:Cognitive Level: UnderstandingREFages 90-91 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. If a person usually ate 2 ounces of lean meat at lunchtime and decided to substitute cooked lentils instead, how much of the lentils would the person need to eat? a. 2 tablespoons b. cup c. cup d. 1 cup ANS: B Each ounce of meat is equivalent to cup cooked dry peas or lentils. Therefore, 2 oz of meat would be equivalent to cup. DIF:Cognitive Level: ApplyingREFage 91 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. Body proteins may become denatured in the presence of a a. drug overdose. b. very high fever. c. vitamin deficiency. d. high stress level. ANS: B Very high fever may denature body proteins because the extreme heat changes the shape of the protein. Drug overdoses, vitamin deficiencies, and high stress levels do not cause proteins to become denatured. DIF:Cognitive Level: ApplyingREFage 92 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. The most important function of hydrochloric acid in the stomach is to a. convert pepsinogen to its active enzyme form, pepsin. b. denature dietary proteins to allow digestion. c. kill bacteria in food and prevent foodborne illness.

d. stop the action of salivary amylase. ANS: A Hydrochloric acid is essential in the stomach for activating pepsinogen to pepsin in order to begin protein digestion. The acid does denature some proteins, but this is not essential to digestion. Stomach acid may play a role in killing pathogenic bacteria and does stop the action of salivary amylase, but these effects are less important. DIF:Cognitive Level: RememberingREFage 93 | Page 95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. A patient fell off a bicycle and broke one arm and one leg. Immediately after the accident, the patients body will be in a state of a. anabolism. b. catabolism. c. deamination. d. hypermetabolism. ANS: B Immediately after a serious accident, the physical stress, immobility, and need to break down damaged tissues cause loss of tissue through catabolism. Anabolism occurs when new protein is being formed during growth or healing. Deamination is one part of catabolism; it involves removal of the amino group when amino acids are broken down. Hypermetabolism is a term that describes an increased state of metabolism in general. DIF:Cognitive Level: ApplyingREFages 94-95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. Without vitamin B6, the body would be unable to a. absorb amino acids. b. digest proteins. c. convert ammonia to urea. d. regulate acid-base balance. ANS: A Vitamin B6 (pyridoxine) is needed as a carrier for absorption of amino acids. It has several roles in protein metabolism, but it is not needed for protein digestion or for conversion of ammonia from protein breakdown to urea in the liver. Pyridoxine is not involved in regulation of acid-base balance. DIF:Cognitive Level: UnderstandingREFage 94 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 11. An example of a situation in which nitrogen balance is positive is a. aging. b. infection. c. starvation. d. pregnancy. ANS: D Positive nitrogen balance means that more nitrogen is retained in the body than is excreted. This would be the situation in pregnancy, when new tissue is being formed in the mother and fetus. Aging, infection, and starvation are all times when the nitrogen balance would be negative. DIF:Cognitive Level: ApplyingREFages 94-95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

12. If a patient has a torn ligament, then during healing and recovery, the patients body would need to manufacture a. fibrin. b. albumin. c. collagen. d. hemoglobin. ANS: C Collagen is the main structural protein found in ligaments and other connective tissues, bone, and teeth. Fibrin is an important protein in blood clots. Albumin is an important blood plasma protein. Hemoglobin is the main protein that carries oxygen in the blood. DIF:Cognitive Level: ApplyingREFage 95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 13. During acute bacterial infections, patients need extra protein to manufacture a. hormones. b. antibodies. c. antibiotics. d. enzymes. ANS: B During bouts of infection, the immune system uses protein to produce antibodies. Hormones are chemical messengers in the body that are sometimes proteins but are not directly involved in fighting infection. Antibiotics help recover from bacterial infections but are administered to the patient and are not produced by the body. Enzymes are protein catalysts in the body and are also not involved in fighting infection. DIF:Cognitive Level: ApplyingREFages 95-96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. The property of protein that is most important to its buffering properties is a. its ability to create osmotic pressure in intravascular, intracellular, and interstitial fluids. b. the fact that amino acids include both an acid carboxyl group and an amine base group. c. its ability to pump nutrients and other vital substances across cell membranes. its communication (hormones) and catalytic (enzyme) functions that help regulate body d. functions. ANS: B All of these statements are true of proteins, but the condition that allows it to act as a buffer is the composition of amino acids that includes both an acid carboxyl group and an amine base group. DIF:Cognitive Level: RememberingREFage 95 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. The protein found in muscles whose function is similar to that of hemoglobin in blood is a. collagen. b. oxyglobin. c. myoglobin. d. myosin. ANS: C Hemoglobin carries oxygen in blood; the protein that carries oxygen in muscles is myoglobin. Myosin is a contractile protein found in muscles, and collagen is a structural protein found in

ligaments and tendons. Oxyglobin does not exist. DIF:Cognitive Level: RememberingREFages 95-96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. For clients with phenylketonuria the most important part of treatment is to a. not eat any foods that contain phenylalanine. b. limit their phenylalanine intake to the amount their bodies need. c. take enzyme supplements to help digest phenylalanine. d. take penicillin to prevent complications. ANS: B People with phenylketonuria do need some phenylalanine to make essential proteins, but they should not take in more than they need because they will be unable to break down the excess. Phenylalanine is an amino acid, the smallest product of protein digestion, and so it is not digested by enzymes. Penicillin is used to prevent secondary infections in people with sickle cell anemia but is not used to treat phenylketonuria. DIF:Cognitive Level: UnderstandingREFage 96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 17. An example of a food that contains complete protein is a. oatmeal. b. lentil soup. c. peanut butter. d. hard-boiled egg. ANS: D Eggs and most other animal foods contain complete protein. Grains, legumes, and nuts contain incomplete proteins. DIF:Cognitive Level: ApplyingREFages 96-98 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 18. High levels of glucocorticoid hormones are likely to be produced by someone who a. participates in a weight-training program. b. consumes excessive amounts of protein. c. is pregnant. d. has a large infected wound. ANS: D Glucocorticoid hormones are produced by the adrenal cortex and have a major role in protein catabolism. For an infected wound, catabolism is necessary to break down damaged tissue. Weight training and pregnancy are anabolic conditions. Consuming excessive amounts of protein places a burden on the kidneys for excretion of nitrogenous waste but does not affect glucocorticoid hormone levels. DIF:Cognitive Level: ApplyingREFage 94 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 19. An example of a meal that contains complementary proteins is a. pasta and tomato sauce. b. split pea soup with crackers. c. oatmeal and buttered toast. d. fruit yogurt with strawberries.

ANS: B Split pea soup with crackers contains complementary proteins: The incomplete legume protein in the split pea soup complements the incomplete grain protein in the crackers. Vegetables such as tomato sauce and fruit such as strawberries do not contain sufficient protein to complement another incomplete protein in a meal. Both oatmeal and toast are grains, and so their incomplete proteins are not complementary. Fruit yogurt contains complete protein and does not need to be combined with an incomplete protein. DIF:Cognitive Level: ApplyingREFages 96-98 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 20. High urinary urea excretion may be caused by a. high protein intake. b. phenylketonuria. c. kidney failure. d. administration of growth hormone. ANS: A High levels of urinary urea excretion may be caused by protein intake in excess of the bodys need; excess protein is deaminated and used to provide energy; and the ammonia is converted to urea by the liver and excreted by the kidneys. Kidney failure causes high blood levels of urea because the kidneys are unable to excrete it; urinary urea levels would be low. Phenylketonuria is an inability to break down excess phenylalanine and would have very little effect on urea excretion. Administration of growth hormone would cause anabolism, which would result in greater use of amino acids and less urea excretion. DIF:Cognitive Level: ApplyingREFage 94 | Page 96 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. The sports coaches at a university are designing training diets for their teams. Why do they need to provide more protein for the mens rowing team than for the womens rowing team? a. The mens team is more active than is the womens team. b. The mens team has more lean body mass than does the womens team. c. The mens team has a higher metabolic rate than does the womens team. d. The mens team uses dietary protein less efficiently than does the womens team. ANS: B Men generally require more protein than do women because they have more lean body mass than do women; lean body mass requires more protein to maintain. Men are not necessarily more active than women when they compete in the same sport. They do have a higher metabolic rate, but this is because they have more lean body mass; their higher metabolic rate affects their energy needs, not their protein needs. Men do not use protein less efficiently than do women. DIF:Cognitive Level: ApplyingREFage 97 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 22. Most physically active adults in America do not need to eat more protein than inactive adults because a. exercise does not increase protein needs as long as energy needs are met. exercise increases the efficiency of recycling amino acids so that extra needs are met b. endogenously. c. most people have high enough protein intake to provide the extra protein needed for active

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

d. ANS: C Athletes have higher protein needs than nonathletes (1.2 to 1.7 g/kg versus 0.8 g/kg, respectively). However, most Americans consume the amount of protein recommended for athletes, and so most American athletes do not need to increase their protein intake. Exercise does not increase the efficiency of protein turnover. DIF: Cognitive Level: Applying REF: Page 97 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 23. The RDA of protein for a healthy adult who weighs 60 kg is _____ g/day. a. 36 b. 48 c. 60 d. 72 ANS: B The RDA of protein for a healthy adult is 0.8 g/kg per day. Therefore, the RDA for an adult who weighs 60 kg is 48 g/day (0.8 60). DIF:Cognitive Level: ApplyingREFage 97 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 24. Janet eats beans, grains, fruits, and vegetables, and milk. Her diet is considered a. lactovegetarian. b. ovolactovegetarian. c. flexitarian. d. vegan. ANS: A Diets than contain plant foods plus milk are lactovegetarian diets; ovolactovegetarian diets include milk and eggs. Vegan diets contain only plant foods. Diets that contain plant foods plus dairy, eggs, and occasional meat, fowl, or fish are flexitarian. DIF:Cognitive Level: ApplyingREFages 98-99 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 25. Eric follows a vegetarian eating pattern, and he wants to know whether he needs to take any vitamin and mineral supplements. What would be most important to find out? a. Whether he includes complementary vegetable proteins b. Whether he follows a vegan eating pattern or eats some animal foods c. Whether his skin has regular exposure to sunlight d. Whether he relies on mostly natural or mostly processed foods ANS: B It would be important to find out whether Eric follows a vegan diet; strict vegan diets do not contain any vitamin B12 (found only in animal products) and vitamin D (obtained mostly from fortified milk). Including complementary vegetable proteins would improve the overall quality of his protein intake but would not affect his vitamin and mineral intake. Regular skin exposure to sunlight would help manufacture some vitamin D, but would not help with vitamin B12 status, and so the question

of sun exposure is less important. Processed food may contain fewer micronutrients that natural foods, but this is less critical than whether he includes any animal foods in his diet. DIF:Cognitive Level: AnalyzingREFages 98-99 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 26. A person who follows a strict kosher diet would not eat a. macaroni and cheese. b. a cheeseburger and fries. c. a bean-and-cheese burrito. d. roast beef with mashed potatoes. ANS: B A strict kosher diet would not include a cheeseburger because meat and dairy may not be eaten together. Both macaroni with cheese and a bean-and-cheese burrito contain only dairy. Roast beef with mashed potatoes is acceptable as long as the beef has been slaughtered appropriately. DIF:Cognitive Level: ApplyingREFage 100 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC:Client Needs: Psychosocial integrity 27. An appropriate size serving of meat, poultry, or fish is about the size of a. your fist. b. a dollar bill. c. the palm of your hand. d. one fourth of a dinner plate. ANS: C An appropriate size serving of meat, poultry, or fish is about the size of the palm of your hand. This represents about 3 ounces. A serving the size of a fist or one fourth of most dinner plates would be too large. A dollar bill is flat and therefore does not indicate a three-dimensional serving size. DIF:Cognitive Level: RememberingREFages 99-100 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 28. A small child has normal weight, but his arms and legs are thin, whereas his belly and face appear swollen. His mother tells you that the only food they have had in the house for the past 3 weeks is noodles and some bread. The child probably has a. malabsorption syndrome. b. acute infection. c. marasmus. d. kwashiorkor. ANS: D The child probably has kwashiorkor caused by inadequate protein intake with adequate energy intake (noodles and bread provide carbohydrate but little protein). Marasmus is caused by inadequate intakes of both energy and protein and is characterized by extreme wasting in the entire body. Acute infection or malabsorption syndromes may exacerbate malnutrition but are not the primary cause. DIF:Cognitive Level: ApplyingREFages 101-102 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 29. Examples of individuals who may have an increased risk for malnutrition include

a. inactive middle-aged men. b. sleep-deprived adolescents. c. children with chronic infections. d. breastfed infants. ANS: C Chronic infection at any age and especially in childhood increases the risk of malnutrition because nutrient needs may be higher and nutrients may not be so well absorbed. Also, appetite may be lower. Inactivity in middle-aged men is likely to lead to overnutrition, not undernutrition. Sleepdeprivation in adolescents is not associated with malnutrition. Breast-fed infants are usually well nourished and are not at high risk for malnutrition. DIF:Cognitive Level: ApplyingREFages 101-102 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 30. An example of the lifestyle habit of chaining is a. gradually reducing intake of sugar-sweetened beverages. b. eating a piece of fruit with breakfast every day. c. keeping a record of all food and beverages eaten. d. involving all family members in choosing healthy foods. ANS: B Eating a piece of fruit with breakfast every day is an example of chaining. Chaining involves linking two behaviors; soon the individual will always want to eat a piece of fruit whenever he or she eats breakfast. Gradually reducing intake of sugar-sweetened beverages, keeping a record of all food and beverages eaten, and involving all family members in choosing healthy foods are other good strategies to help improve eating habits. DIF:Cognitive Level: ApplyingREFage 102 | Page 104 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC:Client Needs: Psychosocial integrity Chapter 07: Vitamins My Nursing Test Banks Chapter 07: Vitamins Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. A patient is admitted to the hospital with confusion, memory loss, and ataxia. What other information would lead you to suspect that his symptoms may be caused by secondary thiamin deficiency? a. The patient has very limited funds and has been eating mainly rice and beans. b. The patient admits that he struggles with alcoholism. c. The patient is recovering from a minor stroke. d. The patient has a family history of Alzheimers disease. ANS: B Alcoholism may be associated with a secondary thiamin deficiency because the liver needs increased amounts of thiamin to detoxify alcohol. Limited food intake may cause primary deficiency (although legumes are a good source of thiamin, and so primary deficiency is unlikely). Strokes and Alzheimers disease may cause confusion, memory loss, and ataxia, but not in relation to a secondary vitamin deficiency.

DIF: Cognitive Level: Analyzing REF: Page 107 | Pages 111-112 | Page 119 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. An example of someone who has a relatively high risk for vitamin deficiencies is a(n) a. 45-year-old half marathon runner. b. 85-year-old man living independently. c. college-age woman living with roommates. d. breastfed newborn. ANS: B Subgroups of the population at risk for vitamin deficiencies include older adults because of decreased vitamin absorption and limited physical and economic resources to purchase and prepare food. Active middle-aged adults and college students usually consume enough food to ensure adequate vitamin intake. Vitamin deficiencies are rare among breastfed newborns. DIF:Cognitive Level: ApplyingREFage 106 | Page 124 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Deficiencies are likely to develop most rapidly with low intake of vitamin a. A. b. C. c. D. d. E. ANS: B Vitamin C is water soluble; vitamins A, D, and E are fat soluble. Deficiencies of water-soluble vitamins develop more rapidly because they are not stored in the body. DIF:Cognitive Level: ApplyingREFages 108-109 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 4. The best way to ensure intake of a variety of phytochemicals is to a. take a daily multivitamin supplement that includes phytochemicals. b. increase intake of soy-based foods, such as soy milk, tofu, and soy flour. c. choose whole grains and include at least five servings of fruits and vegetables daily. d. include at least three servings of dairy products daily and use a variety of herbs and spices. ANS: C The best way to ensure intake of a variety of phytochemicals is to eat a variety of plant-based foods, including whole grains, fruits, and vegetables. Multivitamin supplements do not necessarily contain phytochemicals. Soy-based foods contain only a limited selection of phytochemicals. Dairy products do not contain phytochemicals; herbs and spices may provide some but are used in small quantities and so would not provide significant amounts. DIF:Cognitive Level: ApplyingREFage 109 | Page 111 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 5. The person who would have the highest need for thiamin is a. someone who lifts weights to maintain health. b. a pregnant woman. c. a professional cyclist. d. an older adult who walks 2 miles daily. ANS: C

Thiamine needs are related to metabolic rate (i.e., energy expenditure) because thiamine is a coenzyme in energy metabolism. Therefore, the professional cyclist needs the most thiamin because he or she has the greatest energy needs. Pregnancy, walking, and weightlifting all increase energy needs, but less so than professional athletic training. DIF: Cognitive Level: Analyzing REF: Page 111 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 6. A homeless man is brought into the emergency room with muscle weakness, loss of coordination, and tachycardia. He has alcohol on his breath. He may be suffering from a deficiency of a. thiamin. b. riboflavin. c. niacin. d. folate. ANS: A Symptoms of thiamine deficiency include muscle weakness, loss of coordination, and tachycardia. Alcoholism increases the bodys need for thiamin and may contribute to a secondary thiamin deficiency. Symptoms of riboflavin deficiency include cheilosis, glossitis, and dermatitis. Niacin deficiency causes pellagra, characterized by dermatitis, dementia, and diarrhea. Symptoms of folate deficiency include megaloblastic anemia, glossitis, diarrhea, irritability, absent-mindedness, depression, and anxiety. DIF:Cognitive Level: ApplyingREFages 111-116 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. If whole milk is stored in a clear bottle in a refrigerator with a glass front, a. the milk fat may separate and rise to the top of the bottle. b. some of the protein in the milk may become denatured. c. the ultraviolet light exposure may destroy the vitamin D. d. the ultraviolet light exposure may destroy the riboflavin. ANS: D Riboflavin is destroyed by ultraviolet light, and so storage of milk in a clear bottle and a glass-front refrigerator may cause loss of riboflavin. Vitamin D is not affected by ultraviolet light. Ultraviolet light does not cause milk fat to separate out and does not denature protein. DIF: Cognitive Level: Remembering REF: Page 92 | Page 112 | Page 121 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 8. A good way to increase intake of riboflavin would be to a. eat cereal with skim milk for breakfast instead of toast and juice. b. replace romaine lettuce salad with spinach salad. c. drink orange juice instead of apple juice. d. make sandwiches with whole grain bread instead of white bread. ANS: A The most significant source of riboflavin in the United States is milk, and so switching to cereal with milk for breakfast would increase riboflavin intake. Replacing romaine lettuce with spinach would increase intake of folate. Replacing apple juice with orange juice would increase vitamin C intake. Eggs, meats, and whole grains are all good but lesser sources of riboflavin. Using whole grains would increase intake of several vitamins and would increase riboflavin intake slightly, but less than by drinking extra milk. DIF: Cognitive Level: Applying REF: Pages 112-113 | Page 115 | Pages 118-119

TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 9. In a very poor country where the subsistence crop is corn and intake of animal protein is very limited, the population has a high risk for developing a. scurvy. b. pellagra. c. spina bifida. d. pernicious anemia. ANS: B Corn has low levels of niacin, and low intake of animal protein would mean that relatively little tryptophan would be available to be converted to niacin; therefore, the population would be at risk for developing pellagra, the niacin deficiency disorder. Scurvy is caused by deficiency of vitamin C. Lack of folate during early pregnancy can lead to spina bifida. Pernicious anemia is caused by lack of intrinsic factor in the stomach to facilitate absorption of vitamin B12. DIF:Cognitive Level: ApplyingREFages 113 -117 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 10. Niacin can be manufactured by the body from the amino acid a. alanine. b. arginine. c. tryptophan. d. phenylalanine. ANS: C Niacin can be manufactured by the body from tryptophan, but not from alanine, arginine, or phenylalanine. DIF:Cognitive Level: RememberingREFage 129 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 11. A young woman recently married tells you that she is excited to have children. She should be especially careful to consume adequate amounts of a. folic acid. vitamin B12. b. c. pyridoxine. d. vitamin E. ANS: A Women who may become pregnant need to ensure adequate intake of folic acid to prevent neural tube defects. The neural tube forms before many women know they are pregnant, and so it is important to ensure adequate intake of folic acid before pregnancy. Vitamin B12, pyridoxine, and vitamin E are all important vitamins, but the need for them is not especially associated with pregnancy. DIF: Cognitive Level: Understanding REF: Pages 114-116 | Page 119 | Page 123 TOP:Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 12. An example of a high-folate meal is a. fish, French fries, and coleslaw. b. spinach salad with orange segments.

c. oatmeal with brown sugar and raisins. d. pork chops with applesauce. ANS: B Good sources of folate include leafy green vegetables (including spinach), legumes, ready-to-eat cereals, and some fruits and juices (including orange). Fish, oatmeal, raisins, pork, and applesauce are not good sources of folate. DIF:Cognitive Level: ApplyingREFage 115 | Page 119 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 13. The type of anemia associated with folate deficiency is _____ anemia. a. microcytic b. pernicious c. megaloblastic d. iron deficiency ANS: C The type of anemia associated with folate deficiency is megaloblastic anemia. Microcytic anemia is associated with iron deficiency. Pernicious anemia is associated with vitamin B12 deficiency. Iron deficiency anemia is (as its name suggests) associated with deficiency of iron, not of folate. DIF:Cognitive Level: RememberingREFages 114-116 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 14. If an older adult develops delusions and hallucinations, it is important to check his or her blood levels of vitamin B12. a. b. intrinsic factor. c. folic acid. d. thiamin. ANS: A Delusions and hallucinations may be signs of vitamin B12 deficiency, even before development of anemia. Intrinsic factor is produced by the stomach and is vital for absorption of vitamin B12; it is not found in the blood. Loss of intrinsic factor in older adults contributes to vitamin B12 deficiency. Folic acid deficiency may cause irritability, absent-mindedness, depression, and anxiety, and thiamin deficiency causes memory loss and confusion, but neither of these is associated with delusions and hallucinations. DIF:Cognitive Level: ApplyingREFage 112 | Page 116 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 15. If a patient needs regular injections of vitamin B12, the most likely explanation is that a. he or she follows a vegan eating pattern. b. he or she struggles with alcoholism. c. he or she has a malabsorption syndrome. d. his or her stomach does not produce intrinsic factor. ANS: D Vitamin B12 injections are necessary for patients who do not produce intrinsic factor, which is essential for absorption of vitamin B12 from the gut. Patients who follow a vegan eating pattern need vitamin B12 supplements because this vitamin is found only in animal foods. However, they can use

oral supplements because they are still able to absorb the vitamin; they do not need injections. Alcoholism does not affect absorption of vitamin B12. Malabsorption syndromes may decrease absorption of vitamin B12, but with adequate dietary intake and supplements, affected patients may still be able to absorb sufficient amounts from the gut. DIF:Cognitive Level: ApplyingREFage 116 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 16. An example of a meal with high levels of biotin is a a. cheese-and-tomato sandwich. b. roast beef and mustard sandwich. c. peanut butter and jelly sandwich. d. vegetarian sandwich with avocado and alfalfa sprouts. ANS: C The richest sources of biotin include liver, kidney, peanut butter, egg yolks, and yeast. DIF:Cognitive Level: ApplyingREFage 117 | Page 119 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 17. Some choline can be synthesized by the body from a. glycerol. b. cholesterol. c. tryptophan. d. methionine. ANS: D The body can synthesize some choline from methionine, but not enough to meet the needs of the body. The body cannot synthesize choline from glycerol, cholesterol, or tryptophan. DIF:Cognitive Level: RememberingREFage 117 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 18. Scurvy would be most likely to occur in someone who lives in a a. remote village in northern Minnesota. b. farming community in Florida. c. city in central California. d. fishing community on the coast of Maine. ANS: A Scurvy is caused by vitamin C deficiency. Both Florida and California produce abundant citrus fruit, other fruits, and vegetables, which are excellent sources of vitamin C. A community on the coast of Maine does not necessarily produce good sources of vitamin C locally, but it is connected to commercial transportation, and so a variety of foods are probably available. A remote village in northern Minnesota may not have good access to fresh fruits and vegetables during the winter months, and so scurvy could potentially develop. DIF:Cognitive Level: ApplyingREFages 117-119 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. If a registered dietitian is concerned about the adequacy of a clients vitamin C intake, he or she would want to find out whether the client a. drinks milk. b. follows a vegan diet. c. has regular exposure to sunlight.

d. smokes cigarettes. ANS: D The dietitian would need to know whether the client smokes cigarettes because smokers require more vitamin C than nonsmokers. A vegan diet raises concerns about intake of vitamin B12 (found only in animal foods) but does not necessarily affect vitamin C intake. Regular exposure to sunlight and milk intake affect vitamin D status but not vitamin C status. DIF: Cognitive Level: Applying REF: Pages 116-119 | Pages 121-123 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 20. Vegetables are likely to be highest in vitamin C if they are a. boiled. b. canned. c. stir-fried. d. oven roasted. ANS: C Vegetables are likely to be highest in vitamin C if they are stir-fried. Heat destroys vitamin C, and so cooking for the minimum amount of time preserves vitamin C. Oven roasting is a slow cooking method, and so more vitamin C is lost. Vitamin C is also water soluble, and so cooking methods that use water, such as boiling and canning, cause loss of vitamin C into the cooking liquid. In stirfrying, vegetables are cooked quickly without water. DIF:Cognitive Level: UnderstandingREFage 118 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 21. Foods that are good sources of preformed vitamin A include a. sweet potatoes. b. egg yolk. c. tomatoes. d. carrots. ANS: B Preformed vitamin A is found only in the fat of animal foods; egg yolk is a good source. Sweet potatoes, tomatoes, and carrots are all good sources of carotenoids, which can be converted to retinoids (vitamin A) in the body. DIF:Cognitive Level: ApplyingREFage 120 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 22. The best description of blindness caused by vitamin A deficiency in developing countries is that it is a. temporary and treatable. b. infectious and often fatal. c. limited to night blindness. d. permanent but preventable. ANS: D The blindness caused by vitamin A deficiency is permanent once it occurs, but it can be prevented by administration of periodic supplements. Vitamin deficiencies may be exacerbated by infections that increase nutrient needs, but the deficiencies themselves are not infectious. Blindness may cause

early death but is itself not fatal. Vitamin A deficiency may cause both night blindness and complete blindness. DIF:Cognitive Level: UnderstandingREFage 120 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 23. Foods rich in antioxidant vitamins include a. oranges and vegetable oils. b. apples and butter. c. carrots and olive oil. d. mushrooms and milk. ANS: A The two vitamins that function as antioxidants in the body are vitamins C and E. Citrus fruits such as oranges are excellent sources of vitamin C; vegetable oils are excellent sources of vitamin E. DIF: Cognitive Level: Understanding REF: Pages 117-118 | Page 123 TOP:Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 24. The main reason that the adequate intake (AI) for vitamin D increases in older adults is that a. their ability to absorb dietary vitamin D is diminished. b. conversion of vitamin D to its active forms is less efficient. c. their skin is less efficient in synthesizing vitamin D during sun exposure. d. they require more vitamin D than do younger adults to maintain bone health. ANS: C Older adults need more dietary vitamin D because their skin is less efficient in synthesizing vitamin D during sun exposure. Their ability to absorb vitamin D and convert vitamin D to its active form has less effect on vitamin D needs. They do not necessarily require more total vitamin D than do younger adults for bone health; they need more from foods because their skin manufactures less. DIF:Cognitive Level: UnderstandingREFages 121-122 TOP:Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 25. Rickets would be most likely to develop in a(n) a. elderly frail adult who lives alone. b. Asian college student who does not drink milk. c. white toddler who has been weaned from breast milk. d. 9-month-old breastfed African American baby. ANS: D Rickets is caused by vitamin D deficiency in infants and toddlers; those who are breast-fed and have dark skin are at higher risk because breast milk is low in vitamin D and dark skin is less efficient at forming vitamin D when exposed to sun. In response to low intake of vitamin D and calcium, elderly adults may develop osteoporosis and younger adults may develop osteomalacia. DIF:Cognitive Level: ApplyingREFage 122 TOP:Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective care environment 26. The most likely cause of vitamin toxicity is a. high intake of fortified foods. b. increased absorption as a result of medications.

c. long-term use of megadose supplements. d. high intake of nutrient-dense foods. ANS: C Vitamin toxicity is usually caused by use of high-dose supplements over a long period of time. Levels of vitamins in fortified foods are unlikely to be toxic, and very few foods contain high enough levels to cause toxicity. Medications do not cause significant increases in vitamin absorption. DIF: Cognitive Level: Understanding REF: Page 106 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 27. An example of a meal with high levels of vitamin K is a. grilled shrimp with rice and green beans. b. eggs, bacon, and hash browns. c. stir-fried beef with broccoli. d. bacon, lettuce, and tomato sandwich. ANS: C The best source of vitamin K is green leafy vegetables, such as broccoli. Dairy products, meats, cereals, and fruits provide smaller amounts. DIF:Cognitive Level: ApplyingREFage 124 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 28. Vitamin K deficiency could be a problem in someone who a. does not produce intrinsic factor. b. uses antibiotics for several months. c. struggles with alcoholism. d. has limited skin exposure to sunlight. ANS: B Antibiotics kill gut bacteria that synthesize vitamin K, and so long-term use of antibiotics may cause vitamin K deficiency. Intrinsic factor is required for absorption of vitamin B12, not vitamin K. Alcoholism is associated with secondary deficiencies of several B vitamins. Skin exposure to sunlight stimulates production of vitamin D. DIF:Cognitive Level: ApplyingREFage 124 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 29. The first step to ensure adequate intake of vitamins is to a. use a daily multivitamin supplement. b. increase fortification of key foods in the food supply. c. target specific supplements for specific subgroups of the population. d. ensure that the diet includes a variety of foods from all of the food groups. ANS: D The best way to ensure adequate intake of vitamins is to start with a diet that includes a variety of foods from all the food groups. Reliance on supplements and food fortification do not result in an overall optimal diet. Use of supplements by specific subgroups of the population may be a second step in ensuring dietary adequacy, but it would not be the first step. DIF: Cognitive Level: Applying REF: Page 106 | Pages 124-125 TOP:Nursing Process: Planning| Nursing Process: Implementation

MSC: Client Needs: Health promotion and maintenance 30. The primary reason that many Americans use vitamin supplements on a regular basis is that a. supplements taste better than food. b. this practice is necessary for good health. c. it is cheaper than consuming an adequate diet. d. it is easier than making dietary and behavioral modifications. ANS: D It is often easier to take vitamin supplements than to make dietary and behavioral modifications to ensure that the diet provides adequate nutrients. Supplements do not necessarily taste good, and supplements are not necessary for good health for most people. Supplements are also not necessarily cheaper than foods containing a variety of nutrients. DIF: Cognitive Level: Applying REF: Page 124 TOP: Nursing Process: Planning MSC:Client Needs: Psychosocial integrity Chapter 08: Water and Minerals My Nursing Test Banks Chapter 08: Water and Minerals Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. If a woman who drinks a cup of decaffeinated coffee in the morning, a cup of fruit juice with lunch, 6 cups of water throughout the day and a cup of tea at bedtime, her fluid intake would be considered a. dangerously low. b. below optimal. c. optimal. d. too high. ANS: C This womans total fluid intake for the day is 9 cups, the recommended amount for women. Minimum fluid intake for health is around 4 cups; intake below this would be considered dangerously low. Fluid intake can be too high, but the specific amount that causes water intoxication is unknown. DIF:Cognitive Level: ApplyingREFage 130 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 2. Having only softened tap water at home would be of most concern to a(n) a. pregnant woman. b. full-time student who also works part-time. c. elderly woman with osteoporosis. d. retired man with hypertension. ANS: D Softened water has relatively high levels of sodium, which exacerbates hypertension in saltsensitive individuals. It is not ideal for anyone to drink softened water on a regular basis, but it is of special concern for someone with hypertension. Someone who is retired is more likely to drink beverages made with tap water at home. An elderly woman with osteoporosis would benefit from the calcium in hard water, but this is less of a concern. A student who is gone at work or school

most of the day would not consume much of the softened tap water. Sodium intake is not a specific concern in pregnancy. DIF:Cognitive Level: ApplyingREFage 130 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 3. Interstitial fluid is the body fluid a. within the cells. b. outside the cells. c. between the cells. d. in the bloodstream. ANS: C Interstitial fluid is the body fluid between the cells. The fluid within the cells is intracellular fluid; the fluid outside the cells is extracellular fluid; the fluid in the bloodstream is blood plasma. DIF:Cognitive Level: RememberingREFage 131 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 4. Dehydration is most likely to have a negative effect on a. digestion of food. b. storage of excess energy. c. nerve impulse conduction. d. body temperature regulation. ANS: D Within the body, water helps to regulate body temperature by absorbing and distributing heat throughout the body and through perspiration. Digestion of food requires secretion of digestive fluids, but this is less immediately affected by dehydration. Water is not needed to store excess energy in adipose tissue. Water is not important for this conduction of nerve impulses. DIF:Cognitive Level: ApplyingREFages 131-132 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 5. It would be most difficult for the body to maintain homeostasis if over several days someone had an inadequate intake of a. calcium. b. sodium. c. iron. d. fluoride. ANS: B Homeostasis is maintenance of physiologic equilibrium within the body. All of these minerals help maintain homeostasis, but inadequate intake of sodium over just a few days would have the most effect. Sodium is an electrolyte and is important for maintaining fluid balance in the body. If calcium intake is inadequate, the body can draw on reserves in bone; if iron intake is inadequate, the body has some reserves in the spleen, and so body homeostasis would not be affected unless the deficiency continued long term. Fluoride deficiency may cause dental caries and may affect bone density, but this is also a long-term effect and would not affect the body over a few days. DIF:Cognitive Level: Applying REFage 133 | Page 138 | Page 142 | Page 147 | Page 151 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 6. If an athlete ran a marathon, sweated profusely, and drank only water with some sugar to replace fluids and carbohydrate, his or her body would increase secretion of

a. adrenaline. b. aldosterone. c. alanine. d. antidiuretic hormone (ADH). ANS: B The body would respond to loss of sodium in sweat by releasing the hormone aldosterone; this would prompt the kidney to decrease sodium excretion. During a marathon, the body may produce adrenaline in response to stress, but this would not address the problem of fluid and energy replacement without sodium replacement. Alanine is an amino acid and has no effect on sodium balance. ADH causes the kidneys to decrease water excretion but does not affect sodium excretion. DIF:Cognitive Level: AnalyzingREFage 133 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 7. If a patient complained of muscle weakness, confusion, decreased appetite, and irregular heartbeat, it would be important to check blood levels of a. sodium. b. calcium. c. potassium. d. magnesium. ANS: C These symptoms are typical of a possible blood potassium level that is either too low or too high; both conditions can be very dangerous. Low sodium levels cause headache, muscle cramps, weakness, reduced ability to concentrate, and loss of memory and appetite; high sodium levels may cause edema and hypertension. High calcium levels cause weakness, lack of energy, poor appetite, nausea and vomiting, constipation, or bone pain; low blood calcium levels cause muscle cramps, spasms, and twitching and tingling in the fingers and around the mouth. Symptoms of magnesium deficiency include twitching of muscles, muscle weakness, and convulsions; symptoms of magnesium overload are long-term diarrhea and dehydration. DIF: Cognitive Level: Applying REF: Page 143 | Pages 145-146 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 8. In an older adult who is usually very alert, disorientation may be a sign of a. iron deficiency. b. malnutrition. c. edema. d. dehydration. ANS: D Disorientation may be a sign of dehydration, which is common in older adults, partly because their thirst mechanism is diminished. Iron deficiency anemia causes fatigue but not disorientation. Severe malnutrition may affect mental acuity but is less likely than dehydration to cause acute disorientation. Edema causes swelling but does not usually affect orientation. DIF: Cognitive Level: Applying REF: Pages 133-134 | Pages 148-149 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 9. If an elderly client who lives alone and has a limited income has edema, it would be important to evaluate his or her dietary intake of sodium and a. protein. b. calcium.

c. chloride. d. potassium. ANS: A Edema may be caused by high intake of sodium or inadequate intake of protein if protein levels in the body become so low that cellular fluid levels become imbalanced. Edema is not related to dietary intake of calcium, chloride, or potassium. DIF:Cognitive Level: ApplyingREFage 144 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 10. The term bioavailability means the a. total amount of a mineral in a food. b. ratio of free mineral to bound mineral in a food. c. amount of a mineral that is excreted by the body. d. amount of a mineral that can be absorbed by the body from a food. ANS: D Bioavailability is the amount of a mineral that can be absorbed by the body from a food. It is generally lower than the total amount of the mineral in a food. It may be related to the ratio of free mineral to bound mineral in a food, but that is only one of many factors affecting bioavailability. It is not related to the amount excreted by the body. DIF: Cognitive Level: Understanding REF: Page 136 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 11. Long-term dietary calcium intake has the greatest effect on a. body temperature. b. muscular strength. c. bone calcium levels. d. blood calcium levels. ANS: C Long-term dietary calcium intake affects bone calcium levels. Calcium does not affect body temperature. The body maintains steady levels of calcium in the blood and muscles, using calcium from bone if dietary intake is insufficient. DIF:Cognitive Level: UnderstandingREFages 138-142 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 12. If people want to maximize their absorption of calcium, they should avoid drinking a. tea. b. milk. c. orange juice. d. bottled water. ANS: A Tea contains oxalic acid and tannins, both of which decrease absorption of calcium. Milk contains lactose and vitamin D, which increase calcium absorption. Orange juice and bottled water do not have a significant positive or negative effect on calcium absorption. DIF:Cognitive Level: ApplyingREFages 140-142 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 13. Lifestyle changes that may help prevent development of osteoporosis include a. reducing intake of animal protein. b. eating a piece of fruit with lunch every day.

c. taking a daily multivitamin supplement with adequate amounts of calcium and vitamin D. d. taking a 30-minute walk most days. ANS: D Taking a 30-minute walk most days may help prevent development of osteoporosis because regular exercise stimulates an increase in bone density. Eating vegetable versus animal protein, increasing intake of fruit, and use of multivitamin supplements with adequate amounts of calcium and vitamin D are unlikely to prevent osteoporosis (although they may have other health benefits). DIF:Cognitive Level: ApplyingREFages 140-142 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 14. An example of a food with high levels of phosphorus is a. rice. b. carrots. c. cheese. d. bananas. ANS: C Foods high in phosphorus include dairy foods (such as cheese). Many processed convenience foods and soft drinks also contain phosphorus as additives. Fruits, vegetables, and rice are not good sources of phosphorus. DIF: Cognitive Level: Applying REF: Pages 142-143 | Page 147 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 15. A good source of calcium for someone who follows a strict vegetarian (i.e., vegan) diet would be a. coconut milk. b. a bean burrito. c. skim milk. d. pasta salad. ANS: B A good vegan source of calcium is a bean burrito because legumes contain calcium. Coconut milk and pasta salad are not good sources of calcium. Skim milk is not included in a vegan diet. DIF: Cognitive Level: Applying REF: Pages 138-142 | Page 147 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 16. Secondary magnesium deficiency is most likely to occur in a. areas where access to fresh fruits and vegetables is limited. b. clients with type 1 diabetes mellitus. c. association with excessive vomiting and diarrhea. d. association with dehydration attributable to heat exposure. ANS: C Secondary magnesium deficiency may occur with excessive vomiting and diarrhea. Primary magnesium deficiency is rare; deficiency is not usually related to poor intake, and fruits and vegetables are not the only good sources of magnesium. Type 1 diabetes and dehydration due to heat exposure do not cause magnesium deficiency. DIF: Cognitive Level: Applying REF: Pages 133-134 | Page 143 | Page 147 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

17. Of the following, the food choice that contains the least sodium is a. cornbread. b. corn tortilla. c. corn on the cob. d. buttered popcorn. ANS: C The food choice that contains the least sodium is corn on the cob. Of all these forms of corn, this is the least processed. Food processing usually involves addition of sodium. DIF:Cognitive Level: ApplyingREFages 144-145 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 18. A sodium intake of 2100 mg daily by a healthy adult would be considered a. below the adequate intake (AI). b. within the recommended range. c. below the maximum recommended level. d. above the maximum recommended level. ANS: C A sodium intake of 2100 mg daily is below the maximum level recommended by the National Research Council (2400 mg/day) and the American Heart Association (2300 mg/day). The AI is 1500 mg. There is no recommended range for sodium intake, just the AI and upper limits. DIF:Cognitive Level: ApplyingREFages 144-145 TOP:Nursing Process: Assessment| Nursing Process: Evaluation MSC: Client Needs: Health promotion and maintenance 19. A family with three young children has limited income, relies on public transportation, and has just moved into a very old apartment complex with old plumbing and lead pipes. The best recommendation to minimize lead exposure would be to a. use only bottled water. b. run the tap water for 2 minutes before using it. c. boil the tap water for 2 minutes before using it. d. use only hot water for drinking, cooking, and preparing food. ANS: B The best recommendation would be to run the tap water for 2 minutes before using it, so that any water sitting in the pipes that may have absorbed lead would not be used. Using bottled water is not practical for a family with limited income who uses public transportation. Boiling the water would not remove the lead and would actually concentrate it. Hot water would dissolve more lead; in fact, only cold water should be used. DIF:Cognitive Level: AnalyzingREFage 130 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 20. If someone took a 6-hour car ride in an air-conditioned vehicle without making any bathroom stops, they weigh less at the end of the trip than at the beginning because a. of insensible fluid losses from the skin and lungs. b. body fat stores would be metabolized for energy. c. muscle mass would be lost. d. fluid would be lost through sweating.

ANS: A Even in an air-conditioned vehicle, the body still loses fluid through the skin and lungs. The person would not lose significant amounts of sweat in an air-conditioned vehicle. A small but fairly insignificant amount of body fat would be metabolized. Muscle mass would be lost only if the driver were inactive or had low protein or carbohydrate intake over several days. DIF:Cognitive Level: ApplyingREFage 132 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 21. The main reason that young women require more dietary iron than young men is a. that they absorb iron less efficiently. b. to compensate for their lower muscle mass. c. to replace blood losses during menstruation. d. that they recycle hemoglobin more rapidly. ANS: C Young women require more dietary iron than young men to replace blood losses during menstruation. There is no difference between iron absorption or hemoglobin recycling in young men versus young women. Higher iron intake does not compensate for lower muscle mass in women. DIF:Cognitive Level: UnderstandingREFages 148-149 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 22. The most easily absorbed form of iron is found in a. a grilled pork chop. b. tomatoes cooked in an iron skillet. c. collard greens cooked with bacon. d. spinach salad with strawberries. ANS: A Heme iron is absorbed most easily; it is found in animal foods, such as pork. Cooking an acidic food such as tomatoes in an iron skillet would increase the iron content, but the iron would be nonheme, which is less well absorbed than heme iron. Similarly, the vitamin C in the strawberries would increase the absorption of the iron in the spinach, but it is still the nonheme form that is less well absorbed. Bacon may contribute a very small amount of heme iron to the collard greens, but it would be much less than the pork chop. DIF:Cognitive Level: ApplyingREFage 148 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 23. The first signal that the body needs fluid is a. dark, concentrated urine. b. the sensation of hunger. c. the sensation of thirst. d. headache. ANS: C The body signals its need for fluid via the sensation of thirst, a dryness in the mouth. Dark, concentrated urine also indicates a need for fluid, and headache may also be caused by dehydration, but these symptoms occur later than thirst, at a time when the bodys need for fluid is much greater. Hunger is a signal that the body needs food, not fluid.

DIF:Cognitive Level: ApplyingREFage 133 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 24. Hemosiderosis, storage of too much iron in the body, is most likely to occur in a(n) a. man who drinks five or more alcoholic beverages every night. b. adolescent who drinks four or more soft drinks daily. c. toddler who prefers drinking milk to eating meals. d. pregnant woman who takes iron supplements. ANS: A Hemosiderosis is most likely to occur in a man with high alcohol intake. Adolescents who have high intake of soft drinks are likely to have high intake of phosphorus. Toddlers who prefer to drink milk rather than eating meals may develop iron deficiency. Pregnant women who take iron supplements are unlikely to store too much iron because iron needs are very high during pregnancy. DIF: Cognitive Level: Applying REF: Page 143 | Pages 148-150 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. In countries where the staple food source is unleavened bread made from whole grains, zinc deficiency may be prevented by eating a. refined grains. b. breads with yeast. c. fortified grains. d. bread in which the grains were soaked before being baked. ANS: B Zinc deficiency may be prevented by making breads with yeast; the yeast breaks the bond between the zinc and phytic acid, which prevents zinc from being absorbed. Eating refined grains would result in even lower zinc intake; fortification of grains does not include adding zinc; and soaking grains before making bread does not release the zinc from the phytic acid. DIF:Cognitive Level: ApplyingREFage 150 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 26. The most reliable source of iodine in the United States is a. seafood. b. dairy products. c. fortified table salt. d. residues of cleaning products. ANS: C The main source of iodine in the United States is fortified table salt. Seafood is a good source, but most Americans do not eat it often enough for it to be their main source of iodine. Dairy products may contain some iodine, depending on the animal that produced them, but they are not reliable sources. Residues of cleaning products may provide some dietary iodine, but the amount is not usually enough to be significant. DIF:Cognitive Level: ApplyingREFages 150-151 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 27. A client feels constantly tired even though she is getting 8 hours of sleep each night, and she is gaining about 2 lbs a month even though she has not changed her eating habits. You discover that

she eats only organic and natural foods and avoids anything that is fortified. She may have a deficiency of a. iron. b. zinc. c. potassium. d. iodine. ANS: D Deficiency of iodine causes lethargy and weight gain; the most reliable source of iodine is iodized salt, but if the client avoids fortified foods, she may be avoiding this valuable source. Iron deficiency would cause anemia and tiredness, but not weight gain. Deficiency of zinc impairs growth, reduces appetite, and causes immunologic disorders. Deficiency of potassium causes muscle weakness, confusion, decreased appetite, and, in severe cases, cardiac dysrhythmias. Foods are not usually fortified with iron, zinc, and potassium, and so avoiding fortified foods would not necessarily affect intake of these nutrients. DIF: Cognitive Level: Analyzing REF: Page 146 | Pages 148-150 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 28. Dietary fluoride is important for a. decreasing staining of teeth. b. decreasing sensitivity of teeth. c. stimulating production of saliva. d. increasing the strength of tooth enamel. ANS: D Dietary fluoride is important for the strength of tooth enamel. It does not decrease staining or sensitivity of teeth or stimulate production of saliva. DIF:Cognitive Level: RememberingREFage 173 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC:Client Needs: Physiological integrity 29. Measuring the amount of a mineral in a plant food may not necessarily indicate whether it is a valuable dietary source of that mineral because a. plant foods contain phytates, oxalates, and binders that reduce bioavailability. b. plant foods require cooking or processing to make minerals bioavailable. c. plants often contain inactive forms of minerals. d. the amount of minerals in plants varies widely, depending on growing conditions. ANS: A Plant foods contain phytates, oxalates, and binders that may limit the amount of a mineral that is available to the body, even if it is present in the food. Minerals may become more bioavailable with cooking or processing, but this is not necessarily true. Most minerals do not exist in different forms; they are generally either present or absent. The amount of minerals in plants may vary somewhat depending on the growing conditions, but this is less of a factor than bioavailability. DIF: Cognitive Level: Applying REF: Page 136 TOP: Nursing Process: Planning MSC:Client Needs: Physiological integrity 30. Wilsons disease is an inherited disorder that causes excessive accumulation of a. iron. b. zinc. c. copper.

d. chromium. ANS: C Wilsons disease causes excessive accumulation of copper. Excessive accumulation of iron is called hemosiderosis. Excessive accumulations of zinc and chromium do not have specific names. DIF: Cognitive Level: Remembering REF: Page 149 | Pages 152-153 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 31. A good dietary source of chromium is a. pasta. b. grapes. c. oatmeal. d. cauliflower. ANS: C Oatmeal is a good dietary source of chromium because it is a whole grain. Good sources do not include refined grains (such as pasta), fruits, and vegetables. DIF:Cognitive Level: ApplyingREFage 152 TOP:Nursing Process: Planning| Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 32. Apart from lowering dietary sodium intake, a dietary change that is most likely to help decrease high blood pressure levels is a. decreasing intake of dairy products. b. increasing intake of vegetable protein. c. increasing intake of calcium and potassium. d. replacing saturated fats with polyunsaturated fats. ANS: C Dietary changes that may help decrease high blood pressure include increasing intake of calcium and potassium. This could be accomplished by increasing, rather than decreasing, intake of dairy products. Intake of vegetable versus animal protein and replacing saturated fats with polyunsaturated fats do not decrease blood pressure, although these changes may have other health benefits. DIF: Cognitive Level: Analyzing REF: Page 138 | Pages 146-147 TOP:Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 33. A wife who blames her high blood pressure on her husbands preference for salty foods is an example of a. denial. b. chaining. c. reframing. d. projection. ANS: D A wife who blames her high blood pressure on her husbands preference for salty foods is an example of projection. She is projecting her unhealthy behaviors on her husband instead of taking responsibility for her own health. Denial would be ignoring the problem. Chaining would be associating one behavior with another. Reframing would be replacing negative expectations and associations with positive ones. DIF:Cognitive Level: ApplyingREFages 153-154

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity Chapter 09: Energy, Weight, and Fitness My Nursing Test Banks Chapter 09: Energy, Weight, and Fitness Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. A good example of living in an obesogenic environment is a. working for an employer who gives employees free membership at a health club. b. being a former high school athlete who now works in a sedentary job. living in an apartment complex where it is unsafe for children to play outside c. unsupervised. d. a physicians recommendation not to exercise during recovery from surgery. ANS: C Obesogenic environments limit peoples ability to stay active while surrounding them with inexpensive high-energy foods. Living in an apartment complex in an unsafe area would be considered obesogenic because it limits the ability to be active. Being given a free health club membership is antiobesogenic because it encourages physical activity. A high school athlete who becomes sedentary is not necessarily prohibited from engaging in active leisure-time activities. Needing to remain inactive during recovery from surgery is only temporary and so has less effect on long-term weight. DIF:Cognitive Level: ApplyingREFage 159 | Page 171 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 2. The total amount of energy in a bowl of soup that contains 5 g of protein, 2 g of fat, and 20 g of carbohydrate is _____ kcal. a. 27 b. 108 c. 118 d. 133 ANS: C Protein provides 4 kcal/g; fat provides 9 kcal/g; carbohydrate provides 4 kcal/g. Therefore, the soup contains 118 kcal ([5 4] + [2 9] + [20 4] = 20 + 18 + 80). DIF:Cognitive Level: ApplyingREFage 160 TOP:Nursing Process: Assessment| Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 3. The fuel for all body processes that traps energy released from food is a. electrons. b. acetyl coenzyme A. c. glucose-6-phosphate. d. adenosine triphosphate. ANS: D The body catabolizes nutrients, and their energy is trapped in adenosine triphosphate (ATP), the fuel for all processes that require energy in the body. Electrons do not store energy. Acetyl coenzyme A is a substance that is produced in the sequence of reactions as nutrients are metabolized in the