Deck 3 Module 14 Nutrition Flashcards
(21 cards)
During a health assessment, a client states, “I only eat carbohydrates and low-fat foods. I don’t understand why I am still gaining weight!” Which principles of nutrition should guide the nurse’s response? Select all that apply.
A) Carbohydrates should only be eaten at breakfast.
B) Eating too many carbohydrates leads to excess glucose, which is converted to fat.
C) Excess carbohydrates can lead to obesity.
D) A carbohydrate-limited diet is the only way to not gain weight.
E) Carbohydrates should be high in fiber and low in sugar.
B) Eating too many carbohydrates leads to excess glucose, which is converted to fat.
C) Excess carbohydrates can lead to obesity.
E) Carbohydrates should be high in fiber and low in sugar.
Rationale: Carbohydrates should be eaten throughout the day. Carbohydrates are converted to glucose; when carbohydrates are consumed in excess, the excess glucose is converted to glycogen, or fat, and stored in adipose tissue, which can lead to weight gain and an increased risk for obesity. Carbohydrate deficiencies lead to protein tissue wasting. Carbohydrates should come from the consumption of foods high in fiber and low in added sugars. A carbohydrate-limited diet is not the only way to avoid weight gain.
The nurse is preparing educational materials for a client with hypertension. Which of the following elements should the nurse include when preparing this material? Select all that apply.
A) Advising the client to avoid all sodium in the diet
B) Explaining the effects of sodium on blood pressure
C) Teaching the client how to read nutritional labels
D) Helping the client to recognize foods that are low in sodium
E) Showing the client how to follow the DASH eating plan
B) Explaining the effects of sodium on blood pressure
C) Teaching the client how to read nutritional labels
D) Helping the client to recognize foods that are low in sodium
E) Showing the client how to follow the DASH eating plan
Rationale: Sodium is important in the diet, and not all sodium should be avoided; however, consumption of sodium should be according to the USDA dietary guidelines for recommended intake. In some people, an increase in sodium intake leads to fluid retention and increases blood pressure. The nurse should prepare to teach the client how to read nutritional labels, how to identify foods that are low in sodium, and the DASH eating plan.
The nurse is performing a nutritional assessment of a client who weighs 185 lb and is 5 feet, 3 inches tall. This client’s body mass index, rounded to the nearest hundredth, is ________.
32.77 BMI
Rationale: The nurse should use the formula [Weight in Pounds/(Height in inches × Height in inches)] × 703 for this calculation. The BMI is calculated by dividing weight in pounds (lb) by height in inches (in) squared and multiplying by a conversion factor of 703. The calculation would be
185 / 63 × 63 = 185 / 3969 = 0.0466112 × 703 = 32.77.
The nurse is assessing the nutritional status of an older client. Which finding is most likely to suggest xerostomia?
A) The client refuses food because it is difficult to chew with missing teeth.
B) The client frequently becomes dehydrated due to failure to remember to drink water.
C) The client has a chronically dry mouth despite adequate intake of fluids.
D) The client does not enjoy foods due to diminished taste.
C) The client has a chronically dry mouth despite adequate intake of fluids.
Rationale: Xerostomia is decreased salivation due to decreased function of salivary glands. It may decrease the taste of food, impair chewing, and lead to avoidance of certain foods. The client with a dry mouth most clearly demonstrates xerostomia. Eating patterns may be altered in clients who are missing teeth, have impaired cognition and become dehydrated, or have diminished taste buds, but these are unrelated to xerostomia.
The nurse is assessing a client who has recently had several blood tests done. Which laboratory results would the nurse identify as indicators of malnutrition? Select all that apply.
A) PAB 30 mg/dL B) PAB 100 mg/L C) Cholesterol 120 mg/dL D) Cholesterol 180 mg/dL E) PAB 12 mg/dL
B) PAB 100 mg/L
C) Cholesterol 120 mg/dL
E) PAB 12 mg/dL
Rationale: A normal prealbumin (PAB) level for adult men and women is 15-36 mg/dL or 150-360 mg/L. A 30 mg/dL PAB level would not be a cause for concern, but a 100 mg/L or 12 mg/dL level would be. A normal cholesterol range is between 160 and 200 mg/ dL in adult men and women. A 120 mg/dL cholesterol level would be a possible indicator of malnutrition, but a 180 mg/dL level would not be.
The public health nurse is providing community education aimed at promoting nutritional habits that decrease an individual’s modifiable risk factors for heart disease. Which topics should the nurse include in this teaching session? Select all that apply.
A) Benefits of consuming fruits and vegetables
B) Importance of eliminating all fats
C) Selecting lean protein sources
D) Preparing balanced meals
E) Strategies for maintaining recommended daily caloric intake
A) Benefits of consuming fruits and vegetables
C) Selecting lean protein sources
D) Preparing balanced meals
E) Strategies for maintaining recommended daily caloric intake
Rationale: The primary modifiable risk factors for nutrition alterations are food choice, portion size, and nutritional intake. Learning about the benefits of consuming fruits and vegetables, how to select lean protein sources, how to prepare balanced meals, and how to maintain the recommended daily caloric intake are all strategies for promoting good nutritional habits that decrease the risk for heart disease. In contrast, eliminating all fats should not be included, because some fats are considered “healthy” and need to be included in a heart-healthy diet.
During a home visit, the nurse is assessing an older adult client. Which assessment findings support the nursing diagnosis Imbalanced Nutrition: Less than Body Requirements? Select all that apply.
A) Client reports a problem with dentures slipping while chewing.
B) Client complains of occasional dry mouth and problems with feelings of nausea.
C) Client’s adult children arrive to eat dinner together several times a week.
D) Client is prescribed 15 medications.
E) Client’s Social Security payments have gone down over the last year.
A) Client reports a problem with dentures slipping while chewing.
B) Client complains of occasional dry mouth and problems with feelings of nausea.
D) Client is prescribed 15 medications.
E) Client’s Social Security payments have gone down over the last year.
Rationale: The improperly fitting dentures are causing a problem with chewing, which could lead to decreased protein and fruit and vegetable intake. Polypharmacy could negatively influence taste, and some medications promote nausea and vomiting, cause dry mouth, and suppress appetite, which could explain the dry mouth and nausea the client reports. Low finances could lead to decreased access to food. However, the client’s adult children visiting and sharing a meal with the client would likely improve or support the older client’s nutritional status.
The community health nurse reviews data collected during interviews with community members during a health fair and decides to create a brochure on how to improve iron intake. Which of the following action items might the nurse include that would help vegans and vegetarians increase their iron intake? Select all that apply.
A) Take calcium supplements. B) Consume tofu. C) Consume lentils. D) Increase intake of vitamin C. E) Consume Swiss chard.
B) Consume tofu.
C) Consume lentils.
D) Increase intake of vitamin C.
E) Consume Swiss chard.
Rationale: Vegan diet plans can lead to deficiencies in certain nutrients, including iron. All vegetarians should ensure that they get adequate amounts of iron, and to facilitate the absorption, vitamin C should also be plentiful in the diet. Tofu, lentils, and Swiss chard are all foods that both vegans and vegetarians might eat that can provide needed iron. However, although calcium supplements are good for vegetarians and vegans to take to ensure adequate calcium intake, they do not specifically provide iron
Bariatric surgery is an option for which category of clients?
A) Overweight
B) Pregnant women
C) Adolescents
D) Morbidly obese
D) Morbidly obese
Rationale: For people with morbid obesity, bariatric or lap band surgery is an option. Bariatric surgery may be considered in adolescents in severe cases of obesity resistant to previous weight loss attempts, but not simply adolescents as a group regardless of their obesity. Bariatric surgery would not be considered for clients who are only overweight or for pregnant women.
Which of the following statements best characterizes vitamin use?
A) Clients should be careful not to exceed recommended allowances for daily vitamin intake.
B) Vitamin D is dangerous if taken in large quantities, but there is no upper limit to Vitamin C intake.
C) Generally, two multivitamin pills a day is recommended for all clients regardless of diet.
D) Fat-soluble vitamins in general present the least risk of toxicity to clients who take them in excess.
A) Clients should be careful not to exceed recommended allowances for daily vitamin intake.
Rationale: Excess consumption of some vitamins, especially the fat-soluble vitamins, can lead to significant toxicity. The disorder is referred to as hypervitaminosis. When taken in excess, vitamin D can cause bone destruction, rather than contributing to bone formation. Excess intake of vitamin C can lead to diarrhea, nausea, and stomach cramps. Two multivitamin pills a day is probably excessive because one such vitamin typically contains the recommended intakes of most vitamins and minerals needed on a daily basis, and determinations of vitamin intake should always consider diet.
A nurse working in a community health center is counseling an adolescent regarding a suspected eating disorder. The adolescent is of normal weight but admits to periods of overeating, especially when his parents fight. This client’s eating habits best demonstrate which risk factor for obesity?
A) Cultural and environmental factors
B) Heredity
C) Low socioeconomic status
D) Physical inactivity
A) Cultural and environmental factors
Rationale: This client most often overeats because of stress, which is an environmental risk factor for obesity. The client’s stress comes from the environment, such as problems at school or at home, and not from heredity, low socioeconomic status, or physical inactivity, although these are all risk factors as well.
The nurse is caring for an adult female client who is admitted to the hospital with a possible hip fracture. Following the admission assessment, the nurse determines that the client is obese. The client’s BMI is 33.2 and her waist circumference is 90 cm. How should the nurse classify her obesity and associated disease risk?
A) Class I, high
B) Class II, very high
C) Class III, extremely high
D) Class I, very high
A) Class I, high
Rationale: A BMI of 33.2 would be in the range for Class I obesity (30.0-34.9), which is the same for men and women. However, although a 90 cm waist circumference for a man who is Class I obese would indicate high associated disease risk, for woman a 90 cm waist circumference is above the 88 cm threshold for women, and therefore her associated disease risk is very high. Her BMI would have to be higher to be classified as Class II or Class III.
The nurse is planning a teaching seminar for a group of young adult clients who are at risk for obesity. Which statement by the nurse best addresses their needs?
A) There are drugs that are good to use to reduce weight.
B) Obesity often leads to low self-esteem and depression.
C) Proper diet and exercise programs can not only prevent obesity but also potentially improve the ability to think and the positivity of self-perception.
D) Maternal obesity often leads to menstrual irregularities and higher incidences of infertility.
C) Proper diet and exercise programs can not only prevent obesity but also potentially improve the ability to think and the positivity of self-perception.
Rationale: The young adults who are at risk for obesity need education about changing lifestyles and the importance of preventing obesity as opposed to treating it. Education should include tips on eating healthy and exercising, which can lead to other benefits than preventing obesity. Drugs are used to manage obesity, not prevent it. Information about maternal obesity is not necessarily relevant to all individuals and does not address health promotion. Although obesity is a risk factor for low self-esteem and depression, emphasizing these negative effects does not empower clients to address their risk factors.
The nurse is working with a morbidly obese client who is seeking help to lose weight at a bariatric clinic. When planning this client’s care, which nursing diagnosis is the priority?
A) Activity Intolerance
B) Disturbed Body Image
C) Defensive Coping
D) Constipation
A) Activity Intolerance
Rationale: Along with diet, exercise is an important part of a weight loss program. A client with morbid obesity has a sedentary lifestyle and will have activity intolerance. Disturbed Body Image and Constipation may both be legitimate diagnoses, but Activity Intolerance is a greater priority if the client is to lose weight. There is no evidence that this client exhibits defensive coping.
The nurse is caring for an adult client with a BMI of 26.8 who complains of sleep apnea and gout. The nurse anticipates that treatment of this patient for obesity will consist of which therapies? Select all that apply.
A) Pharmacotherapy B) Diet C) Exercise D) Behavior modification E) Surgery
B) Diet
C) Exercise
D) Behavior modification
Rationale: Clients with a BMI of 25-26.9 with two or more comorbidities–sleep apnea and gout in this case–would be treated with the therapies of diet, exercise, and behavior modification, but likely not pharmacotherapy or surgery.
The nurse is teaching a client scheduled for Roux-en-Y gastric bypass surgery about potential postsurgical complications and how to reduce them. Which client statement best indicates that teaching has been effective?
A) “I need to eat at least one meal a day that is high in simple carbohydrates.”
B) “Complications of this surgery are likely to be limited to mild gastrointestinal issues for several days.”
C) “I need to be alert for the indications of infection or malnutrition.”
D) “I will not continue my exercise program following this surgery.”
C) “I need to be alert for the indications of infection or malnutrition.”
Rationale: Possible postoperative complications for a procedure such as a gastric bypass include anastomosis leak with peritonitis, abdominal wall hernia, gallstones, wound infections, deep venous thrombosis, nutritional deficiencies, and gastrointestinal (GI) symptoms. If the client recognizes a need to be alert to the signs of infection and malnutrition, this shows awareness of some of the complications that might be expected. Mild GI issues are not the only significant complication of this surgery. The client likely should continue the exercise program. Eating meals high in simple carbohydrates can bring on dumping syndrome, a complication in which stomach contents move rapidly through the small intestine, drawing fluid into the intestine by osmosis.
The nurse is providing teaching to a female client about dietary modifications to promote weight loss. Which statement by the nurse is accurate?
A) “Your diet should consist of 1200-1600 calories per day, with calorie consumption increasing toward the end of the day.”
B) “Your diet should consist of 750-1000 calories per day, with just one big meal and then intermittent snacking.”
C) “Your diet should simply cut 500 calories per day from your normal intake, with a special attention to eliminating all fats from your diet.”
D) “Your diet should consist of 1000-1200 calories per day and be low in fat, high in fiber, and include a variety of foods.”
D) “Your diet should consist of 1000-1200 calories per day and be low in fat, high in fiber, and include a variety of foods.”
Rationale: Collaboration with a nutritionist helps clients to identify healthy foods that appeal to them and that can make up a diet plan to create a daily 500- to 1000-kcal deficit. Ideally, the recommended diet should be low in kilocalories and fat, contain adequate nutrients and minerals, and be high in dietary fiber. The client should eat regular meals with small servings. A gradual, slow weight loss of no more than 1-2 lb/week is recommended. For most individuals, this means a diet of 1000-1200 kcal/day for most women and 1200-1600 kcal/day for men. Fewer than 1200 kcal each day may lead to loss of lean tissue and nutritional deficiencies.
A nurse is working with an adolescent client who is attempting to lose weight. The client admits having difficulty being compliant with the diet prescribed by the healthcare provider. Which suggestion by the nurse might assist the client in being compliant with the prescribed diet in a way that is sensitive to the client’s age?
A) “It can be difficult to avoid unhealthy foods if that’s what your friends are eating, but try to choose healthier options when you can.”
B) “Write down the exact foods you eat so that you can see what and how much you are eating.”
C) “Watch the nutrient content and number of calories in everything you eat.”
D) “Eat at the kitchen table so that you eat along with the rest of the family.”
A) “It can be difficult to avoid unhealthy foods if that’s what your friends are eating, but try to choose healthier options when you can.”
Rationale: Adolescence is a time of identity formation, and adolescents align with peers in regard to food selection. Keeping food diaries and monitoring the nutrient content and caloric values of food intake are helpful behavior modification strategies, but these don’t take into account the age of the client, and studies on food consumption show that caloric information or nutrient content is not a major consideration in choice among adolescents. Parental food choices can have a strong impact on adolescents, but some adolescents rebel against these food choices, positively or negatively, and eating with the rest of the family is only beneficial if the family’s habits are healthy.
A nurse is caring for a client who weighs 209 pounds and is 1.67 meters tall. The client eats a high-protein diet and lifts weights to increase muscle mass. The client presents with complications such as sleep apnea, which is often caused by obesity. Which statement regarding this client is true?
A) A body mass index calculation should provide an accurate measure of the client’s amount of fat.
B) A body mass index calculation is the best possible means of measuring this client’s fat if combined with the client’s waist-to-hip ratio.
C) This client’s body mass index calculation might indicate a false positive for obesity.
D) The client should be given a bioelectrical impedance test to most accurately measure the client’s fat.
C) This client’s body mass index calculation might indicate a false positive for obesity.
Rationale: This client’s weight might be at least partially from body building efforts, and so a body mass index calculation, which only uses the parameters of weight and height, might not accurately indicate whether this client is actually obese. Even if combined with the client’s waist-to-hip ratio, a BMI calculation is not the best possible means of measuring a client’s fat, and neither is a bioelectrical impedance test. Underwater weighing is considered the most accurate way to determine body fat.
Which statements regarding upper body obesity are accurate? Select all that apply.
A) Upper body obesity is also called peripheral obesity.
B) Upper body obesity is when the waist-to-hip ratio in men is greater than 0.8 in men or greater than 1 in women.
C) Upper body obesity is associated with a greater risk of hypertension.
D) Young women tend to have more intra-abdominal fat than men.
E) Postmenopausal women tend to have upper body obesity.
C) Upper body obesity is associated with a greater risk of hypertension.
E) Postmenopausal women tend to have upper body obesity.
Rationale: Upper body obesity (also called central obesity) is identified by a waist-to-hip ratio of greater than 1 in men or 0.8 in women. Upper body obesity is associated with a greater risk of complications such as hypertension, abnormal blood lipid levels, heart disease, stroke, and elevated insulin levels. Men tend to have more intra-abdominal fat than women, although women develop a central fat distribution pattern after menopause.
What is the definition of the basal metabolic rate?
A) The amount of energy stored in fat each day
B) The speed of triglyceride breakdown
C) The cost in kilocalories of being alive
D) The speed at which glucose is converted to energy
C) The cost in kilocalories of being alive
Rationale: More than 70% of the energy expended each day goes to maintaining the basal metabolic rate (BMR)–essentially, the “cost” (in kilocalories) of being alive. It is not a measure of triglyceride breakdown, storage of energy in fat, or the conversion of glucose to energy.
