1a- You are working w/a patient who is being discharged from the acute care unit after a heart attack (myocardial infarction). The patient's primary care provider has prescribed medical nutrition therapy, w/a diet that is low in sodium & saturated fat. The patient comes from family where food plays an important role in traditional culture practices.
a. What do you need to know about the patient & the family to assist in dietary planning?

To assist this patient & the family w/dietary planning, it is important to find out the following information:
* Who prepares the food in the home?
* Who buys the food and where is the food purchased?
* What foods are regularly eaten? Are there special foods for the holidays or family occasions?
* What are the patient's food preferences?
In addition, the patient should keep a record of dietary intake (usually recorded for 3 to 7 days).

1b- You are working w/a patient who is being discharged from the acute care unit after a heart attack (myocardial infarction). The patient's primary care provider has prescribed medical nutrition therapy, w/a diet that is low in sodium & saturated fat. The patient comes from family where food plays an important role in traditional culture practices.
b. How can you assist this patient to meet the prescribed dietary requirements?

Teaching about foods that are high in sodium & saturated fat is an important part of the plan for this patient. Reading labels & menus (if patient eats out) will help in the selection of appropriate foods. The pat. & family also may be informed about the possible substitutions for foods, spices, and oils that are high sodium & fat. Alternatives, such as polyunsaturated oils, lean meats & egg substitutes, may be incorporated into meal preparation. A separate meal plan for the patient is usually not necessary because flavorings, such as lemon, can make foods attractive (as well as healthy) for the entire family.

A pregnant woman is at the medical office for a prenatal checkup. What nutritional recommendations should be provided to this patient?

Nutritional recommendations for a pregnant patient included:
* An increase of an additional 30 to 60g of protein daily
* Calcium intake, especially critical in the 3rd trimester
* Supplemental iron
* Folic acid intake increasing to 600 mcg daily during pregnancy.

You are working in a home care agency & have a large older adult patient population. In planning care, what nutritional considerations should be taken into account for these patients?

Nutritional considerations for an older adult patient include:
* Eating a balanced diet that contains a variety of foods; avoiding too much fat, cholesterol, sugar, and sodium or salt
* Eating foods that have adequate amounts of starch & fiber, such as fruits & vegetables & whole-grain cereals and breads.
* Avoiding grapefruit & grapefruit juice
* Drinking adequate fluids
* Consuming cream soups & meat-based vegetable soups as nutrient-dense sources of protein; w/cheese, eggs, and peanut butter as useful high- protein alternatives.
* Drinking milk for calcium & vitamin D; providing calcium supplements if lactose intolerance is present.
* Taking vitamins & nutrient supplements, if necessary, for nutritional deficits

As an occupational health nurse, you are concerned w/positive health behaviors for the employees. You have noticed that some of the workers are overweight. What should you include in a teaching plan to promote nutritional health for the employees?

The teaching plan for these employees should include:
* Guidelines for nutrients & calories
* Avoidance of foods high in fat, cholesterol, sugar, and sodium
* Label reading
* Integration of exercise
* Realistic weight loss goals
* Avoidance of rapid weight loss plans or pills
* Maintenance of the diet within the work environment & schedule

Increase in blood glucose level

Hyperglycemia

Breakdown of food products into smaller particles

Digestion

Production of more complex chemical substances through the synthesis of nutrients

Anabolism

All biochemical & physiological processes by which the body maintains itself

Metabolism

Organic substances in food that are present in small amounts and act as coenzymes in biochemical reactions

Vitamins

Substances necessary for body functioning

Nutrients

Inorganic elements that act as catalysts in biochemical reactions

Minerals

Breakdown of complex body substances into simpler substances

Catabolism

Decrease in blood glucose level

Hypoglycemia

Measurement of size & makeup of body at specific sites

Anthropometry

Identify an example of a nutrition objective from Healthy People 2010.

The goals are for individuals to increase their daily intake of fruits, vegetables, and grain products & decrease their intake of sodium & fat

A vitamin that is synthesized by the body is

Vitamin K is synthesized by the body

Identify whether the following represent carbohydrates, proteins, or fats.
a. Starches
b. Meats
c. Linoleic acid
d. Fiber
e. 9kcal/g of energy
f. Amino acids
g. Fruits

a. Starches = Carbs
b. Meats = Proteins
c. Linoleic acid = Fats
d. Fiber= Carbs
e. 9kcal/g of energy = Fats
f. Amino acids = Protein
g. Fruits = Carb

What information can you provide to an individual at a health fair who is interested in general nutritional guidelines?

Some general nutritional guidelines to share are:
* Eat a variety of foods; consume plenty of grains, fruits & vegetables
* Balance the intake of food w/the amount of physical activity
* Reduce the intake of sugar, sodium, fat/saturated fat & cholesterol
* Moderate the intake of alcoholic beverages
* A copy of MyPyramid may be provided & discussed w/the patient

Provide an example of an alternative dietary pattern.

Examples of alternative dietary patterns include vegetarians, ovolactovegetarians,and lactovegetarians. In addition, patients from diverse sociocultural backgrounds may have dietary patterns that are unique.

For each area of nutritional assessment, identify specific elements to pursue w/the patient.
a. Food & nutrient intake
b. Physical examination
c. Anthropometric measurements

For the nutritional assessment:
a. Food & nutrient intake: 24-hour recall, percentage of meals consumed, food preferences, allergies, dislikes, and physical barriers to eating (oral discomfort, dysphagia)
b. Physical examination: signs & symptoms of nutrients deficiencies, fat deposits, and poor muscle tone & skin turgor
c. Anthropometric measurements: height, weight, and any changes in height or weight

Which of the following are indicators of malnutrition? Select all that apply.

Listlessness, Straight arms & legs, Some fat under the skin, Paresthesia, Loss of ankle reflexes, Rapid heart rate, No palpable masses, Apathy, Dry, scaly skin, Reddish-pink mucous membranes, Spongy gums w/marginal redness, Surface papillae present on the tongue, Pale conjunctivae, Corneal xerosis, Firm, pink nails, Calf tenderness & tingling

1. Listlessness
2. Paresthesia
3. Loss of ankle reflexes
4. Rapid heart rate
5. Apathy
6. Dry, scaly skin
7. Spongy gums w/marginal redness
8. Pale conjunctivae
9. Corneal xerosis
10. Calf tenderness & tingling

A nurse calculates a patient's body mass index (BMI) by dividing the weight in kg by the height in square meters. If the patient weighs 180lbs & is 6 feet tall, what is the BMI

The nurse calculates this individual's BMI as 24.5, within the expected range of 18.5 to 24.9 .
The weight in pounds is rounded to 82 kg & the 6ft height is 3.34 m²

A neurogenic cause of dysphagia is:

Neurogenic causes of dysphagia include stroke, cerebral palsy, Guillan-Barre syndrome, multiple sclerosis, ALS, diabetic neuropathy, and Parkinson disease

A myogenic cause is:

Myogenic causes include myasthenia gravis, aging, muscular dystrophy, polymyositis, and dermatomyositis.

A common sign or symptom of food-borne illnesses is:

A common sign of food-borne illnesses is diarrhea, often accompanied by cramping, nausea & vomiting

A nurse on an acute care unit wishes to promote a patient's appetite. Identify at least 2 interventions that should be implemented by the nurse

To promote a patient's appetite in the acute care setting, the nurse should:
* Enhance food presentation
* Remove food covers from the patient's food tray
* Clean the area & remove odors
* Provide oral care
* Provide for the best temperature & seasoning of the food
* Include food preferences, as appropriate, within the diet

Identify the interventions that a nurse should implement for the patient who is experiencing dysphagia.

The patient w/dysphagia should be:
* Provided w/a rest period before eating
* Positioned upright, w/support as necessary, w/the head flexed to chin down position
* Fed or taught to eat to the stronger side of the mouth
* Given thicker fluids
* Evaluated for the best level of diet
* Fed slowly, provided smaller size bites, and allowed the time to chew thoroughly & swallow the bite before taking another
* Allowed time to empty the mouth after each spoonful

An advantage of enteral nutrition over parenteral nutrition is that enteral nutrition:

Advantages of enteral nutrition include the following: Decreased prevalence of hypoglycemia & electrolyte imbalances, increased utilization of nutrients, maintenance of structure & function of the GI tract, safer & less costly than parenteral nutrition.

Regarding complications of tube feedings:
a. The most serious complication of tube feedings is:
b. To avoid this complication, the nurse should:

The most serious complication associated w/tube feedings is aspiration, and this can be avoided by positioning the patient upright (head of bed elevated at least 30 degrees).

The method of choice for long-term enteral feeding is:

The method of choice for long-term enteral feeding is a gastrostomy

The pH of the gastric aspirate for a patient who has been fasting is:

The pH of gastric aspirate for a fasting patient is usually between 1 & 4

A parenteral nutrition formula that is hyperosmolar (greater than 10% dextrose) should be administered through a(n) __________ venous line.

A central venous line is used for a hyperosmolar solution

A patient will be receiving parenteral nutrition (PN). Identify the following:
a. The main reason for use of PN:
b. A major nursing goal for the patient receiving PN:
c. A nursing intervention to assist the patient in the prevention of metabolic complications related to PN therapy:
d. Guidelines & precautions for lipid infusions

a. PN is used because the patient is unable to ingest or digest enteral feedings.
b. Nursing goals for PN are to prevent infection, maintain the PN system, prevent complications, and promote the patient's well-being.
c. Nursing intervention to prevent complications of PN therapy include weighing the patient daily, monitoring I&O and caloric intake, testing urine or blood for glucose, obtaining blood samples for nutritional assessment, observing for fluid & electrolyte balance, and maintaining the correct infusion rate.
d. The recommended infusion rate for lipids is 1mL/min. Solutions should not be used if there is a separation of contents (oil/creamy layer on top) or if the solution is more than 12 hours old.

Identify a dietary measure that should be implemented for a patient without teeth or with ill-fitting dentures.

For patients without teeth or with ill fitting dentures, a soft diet may be ordered. Patient preferences for foods should be taken into account, as well as consistencies, flavors, and colors.

Identify a nursing diagnosis and goal for patient who is underweight.

*Imbalanced nutrition: less than body requirements is indicated.
A good outcome for this patient is that he/she will achieve optimum weight for age & size

True or False

Infants require more protein that adults.

True

Childhood obesity has doubled in the last 20 years.

True

Unsaturated fatty acids have a minimal effect on blood cholesterol.

True

Identify an example of an antioxidant vitamin.

Vitamins A, C, E & beta-carotene are antioxidants.

What interventions should be implemented for a patient who is receiving enteral feedings?

The correct interventions for the patient receiving enteral feedings are:

a. Keep the head of the bed elevated to 30 to 45○
b. Tube placement is confirmed by monitoring the pH of aspirate.
c. Continuous feedings are administered through an infusion pump.

A nurse is working w/a patient who requires an increase in complete proteins in the diet. The nurse recommends:
1. Milk
2. Cereals
3. Legumes
4. Vegetables

1. Milk

A nurse is talking with a community resident who has gone to the health fair. The resident tells the nurse that he takes a lot of extra vitamins every day. Because of the greater potential for toxicity, the resident is advised not to exceed the dietary guidelines for:
1. Vitamin A
2. Vitamin B3
3. Vitamin B12
4. Folic acid

1 Vitamin A

A nurse is working w/a patient who is a lactovegetarian. The food that is selected as appropriate for this dietary pattern is
1. Fish
2. Milk
3. Eggs
4. Poultry

2. Milk

A patient states that he does not eat fish anymore. An appropriate follow-up question by the nurse is which of the following?
1. "Why don't you like fish?"
2. "What caused you to lose interest in fish?"
3. "Fish makes you feel ill in some way?"
4. "Aren't you aware that fish is a valuable source of nutrients?

2. "What caused you to lose interest in fish?"

A nurse is preparing to insert a nasogastric tube for enteral feedings. The nurse recognizes that this intervention is used when the patient:
1. Has a gag reflex
2. Is not able to chew foods
3. Is slow to eliminate food
4. Is not able to ingest food

4. Is not able to ingest foods

A nurse is preparing the enteral feeding for a patient who has a nasogastric tube in place. The most effective method that the nurse can use to check for placement of a nasogastric tube is to:
1. Perform a pH analysis of aspirated secretions
2. Measure the visible tubing exiting from the nose
3. Inject air into the tube & auscultate over the stomach
4. Place the end of the tube into water & observe for bubbling

1. Perform a pH analysis of aspirated secretions

A female patient who has gone to a family planning center is taking an oral contraceptive. This patient should increase vitamin B6 & niacin intake. The nurse recommends that the patient consume more:
1. Tomatoes
2. Whole grains
3. Citrus fruits
4. Green, leafy vegetables

2. Whole grains

A patient has heard on TV that zinc is an important element in the body's immune response. The patient asks the nurse what foods contain zinc. Because of its zinc content, the nurse recommends:
1. Fish
2. Liver
3. Whole grains
3. Green, leafy vegetables

2. Liver

A nurse is assigned to make home visits to a number of patients. Of the patients that the nurse visits, the patient w/the greatest risk of a nutritional deficiency is the patient with:
1. Decreased metabolic requirements
2. An alteration in dietary schedule
3. A body weight that is 5% over the ideal weight
4. A weight loss of 3% within the past 6 mos

2. An alteration in dietary schedule

After surgery, a patient is having her dietary intake advanced. After a period of NPO, the patient is placed on a clear liquid diet. What food does the nurse request for the patient?
1. Milk
2. Soup
3. Custard
4. Popsicles

4. Popsicles

While completing an assessment during a home visit, a nurse discovers that the patient has a history of congestive heart failure and is taking digoxin 0.25 mg daily. Being aware that medications may influence the patient's dietary patterns, the nurse is alert to the patient experiencing:
1. Anorexia
2. Gastric distress
3. An alteration in taste
4. An alteration in smell

1. Anorexia

A patient on the unit has an enteral tube in place for feedings. When the nurse enters the room, the patient says that he experiencing cramps & nausea. The nurse should:
1. Cool the formula
2. Remove the tube
3. Use more concentrated formula
4. Decrease the administered rate

4. Decrease the administered rate

Which of the following statements made by the parent of an infant indicates the need for additional teaching?
1. "I'll wait to give the baby regular cow's milk until he's a year old."
2. "I'll start w/cereal as the first solid food that I give to the baby after about 4mos."
3. "I'll add a little honey to the baby's bottle to help him digest the formula."
4. "When he can have them, I'll wait a few days in between giving the baby any new foods."

3. "I'll add a little honey to the baby's bottle to help him digest the formula."

A nurse instructs a patient who is a vegan to specifically include which supplement in the diet?
1. Vitamin A
2. Vitamin C
3. Vitamin B12
4. Niacin

3. Vitamin B12

The individual w/the highest percentage of water in the body is a(n):
1. Infant
2. Obese patient
3. Lean patient
4. Older adult

1. Infant

A patient w/a gastrostomy has an excessive residual volume. The nurse should:
1. Request an order for a chest x-ray
2. Alter the type of feeding being given
3. Request an order for a antidiarrheal agent
4. Maintain the patient in high-Fowler's position

4. Maintain the patient in high-Fowler's position

A nurse is monitoring a patient's laboratory reports. Which of the following, if decreased, is indicative of anemia?
1. BUN level
2. Creatinine level
3. Albumin level
4. Hemoglobin level

4. Hemoglobin level

A nurse instructing the family of a patient who is on an National Dysphagia Diet Task Force (NDDTF) dysphagia puree diet to include:
1. Mashed potatoes
2. Moistened breads
3. Well-cooked noodles
4. Soft fruits

1. Mashed potatoes

A nurse recognizes that a patient on a low cholesterol diet requires additional teaching if he indicates that he eats which of the following?
1. Oatmeal
2. Pastries
3. Dried fruits
4. Green peppers

2. Pastries

A realistic weight loss goal for the patient who is overweight is:
1. 1lb per week
2. 3lbs per week
3. 5lbs per week
4. 7lbs per week

1. 1lb per week

To prevent the presence of E. Coli in food, a nurse specifically instructs a patient & family to:
1. Carefully can foods at home
2. Boil shellfish completely
3. Cook ground beef well
4. Keep dairy products refrigerated

3. Cook ground beef well

A nurse is visiting a patient in the home & notes that additional teaching is required if the patient is observed:
1. Cooking poultry to 180°
2. Thawing frozen foods at room temperature
3. Discarding all foods that may be spoiled
4. Cleaning the inside of the refrigerator w/bleach

2. Thawing frozen foods at room temperature

Tube feedings are ordered for a patient w/a nasogastric tube. Unless the agency specifies otherwise, the nurse should:
1. Dilute the feedings w/water
2. Infuse the feedings over the course of 1 to 2hrs
3. Begin w/150 to 250mL at a time
4. Increase feedings by 100 to 150mL per feeding every 8 hours

3. Begin w/150 to 250mL at a time