Canadian Fundamentals of Nursing 6th Edition Test Bank PDF

Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter Chapter 42: Nutrition Potter et al: Canadian Fundamentals of Nursing, 6th Edition MULTIPLE CHOICE 1. The energy needed to maintain life-sustaining activities for a specific period of ti...

Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter Chapter 42: Nutrition Potter et al: Canadian Fundamentals of Nursing, 6th Edition MULTIPLE CHOICE 1. The energy needed to maintain life-sustaining activities for a specific period of time at rest is known as which of the following? a. Basal metabolic rate. b. Resting energy expenditure. c. Nutrients. d. Nutrient density. ANS: A The basal metabolic rate (BMR) is the energy needed to maintain life-sustaining activities for a specific period of time at rest. The resting energy expenditure (REE), or resting metabolic rate, is the amount of energy that an individual needs to consume over a 24-hour period for the body to maintain all of its internal working activities while at rest. Nutrients are the elements necessary for body processes and function. Nutrient density is the proportion of essential nutrients to the number of kilocalories. Foods with high nutrient density provide a large number of nutrients in relation to kilocalories. DIF: Remember REF: 1098 OBJ: Explain the importance of maintaining a balance between energy intake and expenditure. TOP: Assessment MSC: NCLEX: Physiological Integrity 2. In general, when energy requirements are completely met by kilocalorie intake in food, what happens? a. Weight increases. b. Weight decreases. c. Weight does not change. d. Kilocalories are not a factor in energy requirements. ANS: C In general, when energy requirements are completely met by kilocalorie intake in food, weight does not change. When kilocalories ingested exceed a person’s energy demands, the individual gains weight. If kilocalories ingested fail to meet a person’s energy requirement, the individual loses weight; therefore, kilocalories are a factor in energy requirements. DIF: Understand REF: 1099 OBJ: Explain the importance of maintaining a balance between energy intake and expenditure. TOP: Assessment MSC: NCLEX: Physiological Integrity 3. In determining kcal expenditure, the nurse knows that carbohydrates and proteins provide 4 kcal of energy per gram ingested. The nurse also knows that fats provide how many kilocalories per gram? a. 3 kcal. b. 4 kcal. c. 6 kcal. d. 9 kcal. 441 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter ANS: D Fats (lipids) are the most calorie-dense nutrient, providing 9 kcal per gram. DIF: Remember REF: 1100 OBJ: List the end products of carbohydrate, protein, and fat metabolism. TOP: Assessment MSC: NCLEX: Physiological Integrity 4. Some proteins are manufactured in the body, and others are not. Those that must be obtained through diet are known as which of the following? a. Amino acids. b. Dispensable amino acids. c. Triglycerides. d. Essential amino acids. ANS: D The simplest form of protein is the amino acid. The body does not synthesize essential amino acids, so these must be provided in the diet. The body synthesizes nonessential (dispensable) amino acids. Triglycerides are made up of three fatty acids attached to a glycerol. DIF: Remember REF: 1099 OBJ: List the end products of carbohydrate, protein, and fat metabolism. TOP: Assessment MSC: NCLEX: Physiological Integrity 5. Knowing that protein is required for tissue growth, maintenance, and repair, the nurse must understand that for optimal tissue healing to occur, the patient must be in which state? a. Negative nitrogen balance. b. Positive nitrogen balance. c. Total dependence on protein for kcal production. d. Neutral nitrogen balance. ANS: B When intake of nitrogen is greater than output, the body is in positive nitrogen balance. Positive nitrogen balance is required for growth, normal pregnancy, maintenance of lean muscle mass and vital organs, and wound healing. In negative nitrogen balance, the body loses more nitrogen than it gains. In neutral nitrogen balance, nitrogen gain equals nitrogen loss; this state is not optimal for tissue healing. Protein can provide energy (4 kcal/g), but because of its essential role in growth, maintenance, and repair, the diet should provide adequate kilocalories from nonprotein sources. Protein is spared as an energy source when carbohydrate in the diet is sufficient to meet the energy needs of the body. DIF: Understand REF: 1100 OBJ: Explain the significance of saturated, unsaturated, polyunsaturated and trans fats. TOP: Assessment MSC: NCLEX: Physiological Integrity 6. In providing diet education for a patient on a low-fat diet, it is important for the nurse to understand which of the following? a. Saturated fats are found mostly in vegetable sources. b. Saturated fats are found mostly in animal sources. c. Unsaturated fats are found mostly in animal sources. 442 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter d. Linoleic acid is a saturated fatty acid. ANS: B Most animal fats have high proportions of saturated fatty acids, whereas vegetable fats have higher amounts of unsaturated and polyunsaturated fatty acids. Linoleic acid, an unsaturated fatty acid, is the only essential fatty acid in humans. DIF: Understand REF: 1100 OBJ: Explain the significance of saturated, unsaturated, polyunsaturated and trans fats. TOP: Assessment MSC: NCLEX: Physiological Integrity 7. Fats are composed of triglycerides and fatty acids. Which of the following statements is true? a. Triglycerides are made up of three fatty acids. b. Triglycerides can be saturated. c. Triglycerides can be monounsaturated. d. Triglycerides can be polyunsaturated. ANS: A Triglycerides circulate in the blood and are made up of three fatty acids attached to a glycerol. Fatty acids (not triglycerides) can be saturated or unsaturated (monounsaturated or polyunsaturated). DIF: Remember REF: 1100 OBJ: Explain the significance of saturated, unsaturated, polyunsaturated and trans fats. TOP: Assessment MSC: NCLEX: Physiological Integrity 8. The patient has been diagnosed with cardiovascular disease and placed on a low-fat diet. The patient asks the nurse, “How much fat should I have? I guess the less fat, the better.” What does the nurse need to explain? a. Fats have no significance in health and the incidence of disease. b. All fats come from external sources and so can be easily controlled. c. Deficiencies occur when fat intake falls below 20% of daily total fat intake. d. Vegetable fats are the major source of saturated fats and should be avoided. ANS: C The acceptable macronutrient distribution range, the range associated with reduced risk of chronic illness while providing essential intakes of total fat, is 20% to 35% for adults. Various types of fatty acids have significance for health and for the incidence of disease and are referred to in dietary guidelines. Linoleic acid and arachidonic acid, which are important for metabolic processes, are manufactured by the body when linoleic acid is available. Most animal fats have high proportions of saturated fatty acids, whereas vegetable fats have higher amounts of unsaturated and polyunsaturated fatty acids. DIF: Understand REF: 1100 OBJ: Explain the significance of saturated, unsaturated, polyunsaturated and trans fats. TOP: Assessment MSC: NCLEX: Physiological Integrity 9. When inserting a nasoenteric tube, the nurse will rotate the tube how much? a. 45 degrees. b. 90 degrees. c. 180 degrees. 443 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter d. 360 degrees. ANS: C The tube is to be rotated 180 degrees while being inserted. DIF: Apply REF: 1138 OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Implementation MSC: NCLEX: Physiological Integrity 10. The patient states that she is a lacto-ovo-vegetarian. Which of the following types of food does a lacto-ovo-vegetarian consume? a. Fish and poultry b. Only plant foods c. Milk and fish d. Eggs and milk ANS: D Ovo-lacto-vegetarians avoid meat, fish, and poultry but consume eggs and milk. Vegans consume only plant food. DIF: Understand REF: 1112 OBJ: Identify the potential nutritional deficits associated with vegetarian diets, with special consideration to vegan and ovo-lactate diets. TOP: Assessment MSC: NCLEX: Physiological Integrity 11. The nurse is providing nutrition teaching to a Korean patient. In doing so, the nurse must understand that the focus of the teaching should be on which of the following? a. Changing the patient’s diet to a more conventional Canadian diet. b. Discouraging the patient’s ethnic food choices. c. Food preferences of the patient, including racial and ethnic choices. d. Comparing the patient’s ethnic preferences with Canadian dietary choices. ANS: C The nurse needs to make sure to consider the food preferences of patients from different racial and ethnic groups, vegetarians, and others when planning diets. Initiation of a balanced diet is more important than conversion to what may be considered a Canadian diet. Ethnic food choices may be just as nutritious as “Canadian” choices. Foods should be chosen for their nutritive value and should not be compared with the “Canadian” diet. DIF: Understand REF: 1111 OBJ: Describe Eating Well with Canada's Food Guide and its value in planning nutritious meals. TOP: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. When teaching a patient about current dietary guidelines for the general population, the nurse explains referenced daily intakes and daily reference values, otherwise known as daily values. In providing this information, the nurse understands what about daily values? a. They have replaced recommended daily allowances (RDAs). b. They have provided a more understandable calculation of RDAs for the public. c. They are based on percentages of a diet consisting of 1200 kcal/day. d. They are not usually easy to find and computer experience is required. 444 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter ANS: B Daily values did not replace RDAs but provide a separate, more understandable calculation for the public. Daily values are based on percentages of a diet consisting of 2000 kcal/day; these values constitute the daily values used on food labels, which are easy for anyone to find. Computer experience is not required. DIF: Understand REF: 1106 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Health Promotion and Maintenance 13. The nurse is teaching the patient about dietary guidelines. In discussing the four components of dietary reference intakes (DRIs), it is important to understand which of the following? a. The estimated average requirement (EAR) is appropriate for 100% of the population. b. The RDA meets the needs of the individual. c. Adequate intake determines the nutrient requirements of the RDA. d. The tolerable upper intake level is not a recommended level of intake. ANS: D The tolerable upper intake level is the highest level that probably poses no risk of adverse health events. It is not a recommended level of intake. The EAR is the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population according to age and gender. The RDA reflects the average needs of 98% of the population, not the exact needs of the individual. Adequate intake is the suggested intake for individuals that is based on observed or experimentally determined estimates of nutrient intakes and is used when evidence is insufficient for setting of the RDA. DIF: Understand REF: 1103 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Health Promotion and Maintenance 14. In teaching mothers-to-be about infant nutrition, what does the nurse instruct patients to do? a. Give cow’s milk during the first year of life. b. Supplement breast milk with corn syrup. c. Add honey to infant formulas for increased energy. d. Remember that breast milk or formula is sufficient for the first 6 months. ANS: D Breast milk or formula provides sufficient nutrition for the first 6 months of life. Infants should not have regular cow’s milk during the first year of life. Cow’s milk causes gastrointestinal bleeding, is too concentrated for the infant’s kidneys to manage, increases the risk for developing milk product allergies, and is a poor source of iron and vitamins C and E. Honey and corn syrup are potential sources of botulism toxin and should not be used in the infant diet. 445 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter DIF: Remember REF: 1107 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Health Promotion and Maintenance 15. To counter obesity in adolescents, increasing physical activity is often more important than curbing intake. Sports and regular, moderate to intense exercise necessitate dietary modifications to meet increased energy needs for adolescents. The nurse understands that these modifications include which of the following? a. Decreasing carbohydrates to 25% to 30% of total intake. b. Decreasing protein intake to 0.75 g/kg/day. c. Drinking water before and after exercise. d. Providing vitamin and mineral supplements. ANS: C Adequate hydration is very important for all athletes. They need to drink water before and after exercise to prevent dehydration, especially in hot, humid environments. Carbohydrates, both simple and complex, are the main source of energy, providing 55% to 60% of total daily kilocalories. Protein needs increase to 1.0 to 1.5 g/kg/day. Vitamin and mineral supplements are not required, but intake of iron-rich foods is necessary to prevent anemia. DIF: Understand REF: 1109 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Physiological Integrity 16. In providing prenatal care to a patient, what does the nurse teach the expectant mother? a. Protein intake needs to decrease to preserve kidney function. b. Calcium intake is especially important in the first trimester. c. Folic acid is needed to help prevent birth defects and anemia. d. The mother should take in as many extra vitamins and minerals as possible. ANS: C Folic acid intake is particularly important for DNA synthesis and growth of red blood cells. Inadequate intake may lead to fetal neural tube defects (such as anencephaly) or maternal megaloblastic anemia. Protein intake throughout pregnancy needs to increase to 60 g daily. Calcium intake is especially critical in the third trimester, when fetal bones are mineralized. Prenatal care usually includes vitamin and mineral supplementation to ensure daily intakes; however, pregnant women should not take additional supplements beyond prescribed amounts. DIF: Understand REF: 1109 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Physiological Integrity 446 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter 17. The patient is an 80-year-old man who is visiting the clinic today for his routine physical examination. The patient’s skin turgor is fair, but he has been complaining of fatigue and weakness. The skin is warm and dry, pulse rate is 126 beats per minute, and urinary sodium level is slightly elevated. After assessment, the nurse should recommend what to the patient? a. Decrease his intake of milk and dairy products to decrease the risk of osteoporosis. b. Drink more grapefruit juice to enhance vitamin C intake and medication absorption. c. Drink more water to prevent further dehydration. d. Eat more meat because meat is the only source of usable protein. ANS: C Thirst sensation diminishes with age, which leads to inadequate fluid intake or dehydration. Symptoms of dehydration in older persons include confusion, weakness, hot dry skin, furrowed tongue, and high urinary sodium. Milk continues to be an important food for older women and men, who need adequate calcium to protect against osteoporosis. After age 70, osteoporosis affects men and women equally. Older persons should be cautioned to avoid grapefruit and grapefruit juice because these will decrease absorption of many drugs. Some older persons avoid meats because of cost or because they are difficult to chew. Cream soups and meat-based vegetable soups are nutrient-dense sources of protein. DIF: Analyze REF: 1111 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Physiological Integrity 18. The nurse is assessing a patient for nutritional status. In doing so, what must the nurse do? a. Choose a single objective tool that fits the patient’s condition. b. Combine multiple objective measures with subjective measures. c. Forego the assessment in the presence of chronic disease. d. Use the Mini Nutritional Assessment for pediatric patients. ANS: B Using a single objective measure is ineffective in predicting risk of nutritional problems. Combine multiple objective measures with subjective measures related to nutrition to adequately screen for nutritional problems. Chronic disease and increased metabolic requirements are risk factors for the development of nutritional problems; these patients may be in critical need of this assessment. The Mini Nutritional Assessment was developed to use for screening older persons in home care programs, nursing homes, and hospitals. DIF: Apply REF: 1113-1116 OBJ: Discuss the major methods of nutritional assessment. TOP: Assessment MSC: NCLEX: Physiological Integrity 19. The patient has a calculated body mass index (BMI) of 34. How would the patient be classified? a. As unclassifiable. b. As being of normal weight. 447 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter c. As being overweight. d. As being obese. ANS: D BMI greater than 30 is defined as obesity. BMI between 25 and 30 is classified as overweight. BMI less than 25 is considered normal or underweight. All BMIs can be classified; they are calculated as weight in kilograms divided by their height in metres squared. DIF: Analyze REF: 1109 (Table 42-2) OBJ: Discuss the major methods of nutritional assessment. TOP: Assessment MSC: NCLEX: Physiological Integrity 20. A patient is seen in the outpatient clinic for follow-up of a nutritional deficiency. In planning for the patient’s dietary intake, the nurse includes a complete protein. Which one of the following is an example of a complete protein? a. Cheese. b. Oats. c. Legumes. d. Vegetables. ANS: A A complete protein contains all essential amino acids in sufficient quantity to support growth and maintain nitrogen balance. Cheese, chicken, fish, and soybeans are examples of complete proteins. Incomplete proteins lack a sufficient quantity of one or more of the nine essential amino acids and include cereals, legumes, and vegetables. DIF: Remember REF: 1100 OBJ: List the end products of carbohydrate, protein, and fat metabolism. TOP: Assessment MSC: NCLEX: Physiological Integrity 21. The patient is an older woman and has been given a nursing diagnosis of Imbalanced nutrition: less than body requirements. What role should the nurse play in her treatment regimen? a. Encourage weight gain as rapidly as possible. b. Encourage large meals three times a day. c. Decrease fluid intake to prevent feeling full. d. Encourage fibre intake. ANS: D Increasing fibre intake deters constipation and enhances appetite. Weight gain should be slow and progressive. The patient should be encouraged to eat frequent small meals to increase dietary intake and to help offset anorexia. Older persons need eight 8-ounce glasses of fluid per day from beverage and food sources. DIF: Remember REF: 1121-1123 OBJ: Identify three major nutritional problems, the patients who are at risk, and related nutrition therapy. TOP: Assessment MSC: NCLEX: Physiological Integrity 22. In determining the nutritional status of a patient and developing a plan of care, it is important to evaluate the patient according to what data? a. Published standards. 448 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter b. Nursing professional standards. c. Absence of family input. d. Patient input only. ANS: A Published standards are based on scientific findings and are important references to use when a plan of care is developed. Nursing standards cannot be used alone. Other health care providers must be consulted to adopt interventions that reflect the patient’s needs. Family should be involved in evaluation and design of interventions. Although patient input is important, synthesis of patient information from multiple sources is necessary for devising an individualized approach to care that is relevant to the patient’s needs. DIF: Apply REF: 1098| 1112 OBJ: Formulate a plan of care to help meet the specific nutritional needs of infants, toddlers, preschoolers, school-aged children, adolescents, adults, and older persons. TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment 23. In creating a plan of care to meet the nutritional needs of the patient, the nurse needs to explore the patient’s feelings about weight and food. Why must the nurse do this? a. To determine which category of plan to use. b. To set realistic goals for the patient. c. To mutually plan goals with patient and team. d. To prevent the need for a dietitian consult. ANS: C Mutually planned goals negotiated by patient, registered dietitian, and nurse ensure success. Individualized planning cannot be overemphasized. Preplanned and categorical care plans are not effective unless they are individualized to meet patient needs. It is important to explore patients’ feelings about weight and food to help them set realistic and achievable goals. The nurse does not set goals for the patient. The plan should reflect the combined effort of patient, nurse, and dietitian, and so a dietitian consult is required. DIF: Apply REF: 1119 OBJ: Formulate a plan of care to help meet the specific nutritional needs of infants, toddlers, preschoolers, school-aged children, adolescents, adults, and older persons. TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment 24. The patient is admitted with facial trauma, including a broken nose, and has a history of esophageal reflux and of aspiration pneumonia. In view of this information, which of the following tubes is appropriate for this patient? a. Nasogastric tube. b. Percutaneous endoscopic gastrostomy (PEG) tube. c. Nasointestinal tube. d. Jejunostomy tube. ANS: D Patients with gastroparesis or esophageal reflux or with a history of aspiration pneumonia may require placement of tubes past the stomach and into the intestine. The nasogastric tube and the PEG tube are placed in the stomach, and placement could lead to aspiration. The nasointestinal tube and the nasogastric tube may be contraindicated by the facial trauma and the broken nose. The jejunostomy tube is the only tube in the list that is placed beyond the stomach and is not contraindicated by facial trauma. 449 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter DIF: Understand REF: 1135 OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Assessment MSC: NCLEX: Physiological Integrity 25. The nurse is preparing to insert a nasogastric tube in a patient who is semiconscious. To determine the length of the tube needed to be inserted, the nurse measures what length? a. From the tip of the nose to the xiphoid process of the sternum. b. From the earlobe to the xiphoid process of the sternum. c. From the tip of the nose to the earlobe. d. From the tip of the nose to the earlobe to the xiphoid process. ANS: D The nurse measures the distance from the tip of the nose to the earlobe to the xiphoid process of the sternum. This approximates the distance from the nose to the stomach in 98% of patients. For duodenal or jejunal placement, an additional 20 to 30 centimetres is required. DIF: Apply REF: 1138 (Skill 42-3) OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Implementation MSC: NCLEX: Physiological Integrity 26. Before giving the patient an intermittent tube feeding, what should the nurse do? a. Make sure that the tube is secured to the gown with a safety pin. b. Have the tube feeding at room temperature. c. Inject air into the stomach via the tube and auscultate. d. Place the patient in a supine position. ANS: B Cold formula causes gastric cramping and discomfort because the mouth and the esophagus cannot warm the liquid. Safety pins should not be used; they can become unfastened and may cause harm to the patient. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus transmits sound similar to that of air entering the stomach. Place the patient in high-Fowler’s position, or elevate the head of the bed at least 30 degrees to help prevent aspiration. DIF: Apply REF: 1142 (Skill 42-4) OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Implementation MSC: NCLEX: Physiological Integrity 27. At present, the most reliable method for verification of placement of small-bore feeding tubes is a. Auscultation. b. Aspiration of contents. c. Radiography. d. pH testing. ANS: C 450 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter At present, the most reliable method for verification of placement of small-bore feeding tubes is x-ray examination. Aspiration of contents and pH testing are not infallible. The nurse would need a more precise indicator to help differentiate the source of tube feeding aspirate. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus transmits sound similar to that of air entering the stomach. DIF: Understand REF: 1148 OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Assessment MSC: NCLEX: Physiological Integrity 28. The nurse is concerned about pulmonary aspiration when providing her patient with tube feedings. What should the nurse do? a. Verify tube placement before the feeding. b. Lower the head of the bed to a supine position. c. Add blue food colouring to the enteral formula. d. Run the formula over 12 hours to decrease volume. ANS: A A major cause of pulmonary aspiration is regurgitation of formula. The nurse needs to verify tube placement and elevate the head of the bed 30 to 45 degrees during feedings and for 2 hours afterward. Blue food colouring is no longer added to enteral formula to assist with detection of aspirate. The formula should not hang longer than 4 to 8 hours. Formula becomes a medium for bacterial growth after that length of time. DIF: Apply REF: 1150-1155 OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Implementation MSC: NCLEX: Physiological Integrity 29. The patient is to receive multiple medications via the nasogastric tube. The nurse is concerned that the tube may become clogged. What can the nurse do to prevent this? a. Irrigate the tube with 60 mL of water after all medications are given. b. Check with the pharmacy to find out whether liquid forms of the medications are available. c. Instill nonliquid medications without diluting. d. Mix all medications together to decrease the number of administrations. ANS: B Crushed medication should be avoided if a liquid formulation is available. Each tube is irrigated with 30 mL of water before and after each medication. Crushed medications, if used, should be diluted. The nurse should read pharmacological information on compatibility of drugs and formula before mixing medications. DIF: Apply REF: 1141 (Skill 42-3) OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Implementation MSC: NCLEX: Physiological Integrity 30. The patient has just started enteral feedings but is complaining of abdominal cramping. What should the nurse do? 451 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter a. Slow the rate of tube feeding. b. Instill cold formula to “numb” the stomach. c. Place the patient in a supine position. d. Change the tube feeding to a high-fat formula. ANS: A One possible cause of abdominal cramping is a rapid increase in rate or volume. Lowering the rate of delivery may increase tolerance. Another possible cause of abdominal cramping is use of cold formula. The nurse should warm the formula to room temperature. The nurse should maintain the head of the bed at least 30 degrees. High-fat formulas are also a cause of abdominal cramping. DIF: Apply REF: 1152 (Table 42-9) OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Implementation MSC: NCLEX: Physiological Integrity 31. The patient has just been started on an enteral feeding and has developed diarrhea after being on the feeding for 2 hours. Which of the following is the most likely cause of the diarrhea? a. Clostridium difficile infection. b. Antibiotic therapy. c. Formula intolerance. d. Bacterial contamination. ANS: C Hyperosmolar formulas can cause diarrhea. If that is the case, the solution is to lower the rate, dilute the formula, or change to an isotonic formula. Antibiotics destroy normal intestinal flora and disturb the internal ecology, allowing for C. difficile toxin buildup. However, this takes time, and the description does not suggest that this patient was taking antibiotics. Proximity to the start of the enteral feedings is more suspicious. Bacterial contamination of the feeding usually occurs when feedings are left hanging for longer than 8 hours. DIF: Apply REF: 1151 (Table 42-9) OBJ: Describe the procedure for initiating and maintaining tube feedings, and avoiding related complications. TOP: Assessment MSC: NCLEX: Physiological Integrity 32. In providing teaching for a patient with type 1 diabetes mellitus, the nurse gives the patient which instruction? a. Insulin is the only consideration that must be taken into account. b. Saturated fat should be limited to less than 30% of total calories. c. Cholesterol intake should be greater than 200 mg/day. d. Nonnutritive sweeteners can be used without restriction. ANS: B The patient with diabetes should limit daily fat to less than 30% of total calories and cholesterol intake to less than 200 mg/day. Patients with type 1 diabetes require both insulin and dietary restrictions for optimal control. Nonnutritive sweeteners can be eaten as long as the recommended daily intake levels are followed. DIF: Apply REF: 1127 (Box 42-9) 452 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter OBJ: Identify three major nutritional problems, the patients who are at risk, and related nutrition therapy. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance 33. The parent of an 8-year-old asks the nurse about any special nutritional needs for children in this age group. The nurse mentions that children in this age group need to do which of the following? a. Increase their intake of B vitamins. b. Significantly increase iron intake. c. Maintain a sufficient intake of protein and vitamins A and C. d. Increase carbohydrate intake to meet increased energy needs. ANS: C School-aged children’s diets should be carefully assessed for adequate protein and vitamins A and C. School-aged children frequently fail to eat a proper breakfast, and their intake at school is unsupervised. An increase in B-complex vitamins is needed to support heightened metabolic activity of the adolescent, but not the school-aged child. The pregnant woman needs to increase iron intake significantly, but the school-aged child does not. Increased energy needs are expected in the adolescent period, not in the school-aged group. Therefore, an 8-year-old child does not need to increase carbohydrates to meet increased energy needs. DIF: Analyze REF: 1108 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Physiological Integrity 34. The nurse is providing home care for a patient who has acquired immune deficiency syndrome (AIDS). In preparing meals for this patient, what should the nurse do? a. Provide small, frequent nutrient-dense meals. b. Encourage intake of fatty foods to increase caloric intake. c. Prepare hot meals because they are more easily tolerated. d. Avoid salty foods and limit liquids to preserve electrolytes. ANS: A Small, frequent, nutrient-dense meals in which fatty foods and overly sweet foods are limited are easier to tolerate. Patients benefit from eating cold foods and drier or saltier foods with fluid in between. DIF: Apply REF: 1128 OBJ: Identify three major nutritional problems, the patients who are at risk, and related nutrition therapy. TOP: Implementation MSC: NCLEX: Physiological Integrity 35. To provide successful nutritional therapies to patients, what must the nurse understand? a. Patients will have to change diet preferences drastically to be successful. b. The patient will tell the nurse when to change the plan of care. c. Expectations of nurses frequently differ from those of the patient. d. Nurses should never alter the plan of care regardless of outcome. ANS: C 453 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter Expectations and health care values held by nurses frequently differ from those held by patients. Successful interventions and outcomes depend on recognition of this fact, in addition to nursing knowledge and skill. If ongoing nutritional therapies are not resulting in successful outcomes, patients expect nurses to recognize this fact and alter the plan of care accordingly. Working closely with patients enables the nurse to redefine expectations that are realistically met within the limits of conditions and treatments and to identify their dietary preferences and cultural beliefs. DIF: Understand REF: 1129 OBJ: Discuss diet counselling and patient teaching in relation to patient expectations. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance 36. In measuring the effectiveness of nutritional interventions, what must the nurse remember? a. To expect results to occur rapidly. b. Not to be concerned with physical measures such as weight. c. To expect to maintain a course of action regardless of changes in condition. d. To evaluate outcomes according to the patient’s expectations and goals. ANS: D The nurse should measure the effectiveness of nutritional interventions by evaluating the patient’s expected outcomes and goals of care. Nutrition therapy does not always produce rapid results. Ongoing comparisons need to be made with baseline measures of weight, serum albumin or prealbumin, and protein and kilocalorie intake. Changes in condition may indicate a need to change the nutritional plan of care. DIF: Apply REF: 1129 OBJ: Discuss diet counselling and patient teaching in relation to patient expectations. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance 37. What action should the nurse take when expected nutritional outcomes are not being met? a. Revise the nursing measures or expected outcomes. b. Alter the outcomes on the basis of nursing standards. c. Ensure that patient expectations are congruent with the nurse’s expectations. d. Readjust the plan to exclude cultural beliefs. ANS: A When expected outcomes are not met, the nurse should revise the nursing measures or expected outcomes according to the patient’s needs or preferences, not solely on the basis of nursing standards. Expectations and health care values held by nurses frequently differ from those held by patients. Working closely with patients enables the nurse to redefine expectations that are realistically met within the limits of conditions and treatments and to identify their dietary preferences and cultural beliefs. DIF: Apply REF: 1129 OBJ: Discuss diet counselling and patient teaching in relation to patient expectations. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 454 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter 1. DRIs are evidence-informed criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age group. Components of DRIs include which of the following? (Select all that apply.) a. EAR. b. RDA. c. The Food Guide Pyramid. d. Adequate intake. e. The tolerable upper intake level. ANS: A, B, D, E DRIs are evidence-informed criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age group. DRIs have four components. The EAR is the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population based on age and gender. The RDA indicates the average needs of 98% of the population, not the exact needs of the individual. Adequate intake is the suggested intake for individuals that is based on observed or experimentally determined estimates of nutrient intakes and is used when evidence is insufficient to allow the RDA to be set. The tolerable upper intake level is the highest level that probably poses no risk of adverse health events. It is not a recommended level of intake. The Food Guide Pyramid is not a component of the DRIs. DIF: Remember REF: 1103 OBJ: Specify recommended dietary intake for age and sex groups in Canada to ensure that patients meet the varied essential vitamins, minerals, and nutritional requirements throughout their growth and development. TOP: Assessment MSC: NCLEX: Physiological Integrity 2. The patient is asking the nurse about the best way to stay healthy. The nurse explains to the patient that from a nutritional point of view, the patient should do which of the following? (Select all that apply.) a. Maintain body weight in a healthy range. b. Increase physical activity. c. Increase intake of meat and other high-protein foods. d. Keep total fat intake to 10% or less. e. Choose and prepare foods with little salt. ANS: A, B, E Canada's Food Guide notes the importance of physical activity in maintaining energy balance and recommends that adults spend 30 to 60 minutes per day carrying out some physical activity and children and youth spend at least 90 minutes per day. The guide provides advice on the use of vitamin and mineral supplementation when the recommended food intake pattern does not ensure adequate amounts and to maintain a healthy body weight. Although not specified in the guide, Canadians are advised to limit salt to “healthy” levels, alcohol to no more than 5% of total energy, and caffeine to no more than 400 mg for the general population. DIF: Apply REF: 1103-1106 OBJ: Describe Eating Well with Canada's Food Guide and its value in planning nutritious meals. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance 455 Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter 3. To create a new nutritional plan of care for a patient, the nurse needs to do which of the following? (Select all that apply.) a. Utilize the characteristics of a normal nutritional status. b. Evaluate previous patient responses to nursing interventions. c. Exclude established expected outcomes to evaluate patient responses. d. Design innovative interventions to meet the patient’s needs. e. Follow through with evaluation and counselling. ANS: A, B, D, E To create a new nutritional plan of care, the nurse must utilize characteristics of a normal nutritional status to gauge effectiveness of the plan. The nurse must be aware of previous patient responses to nursing interventions for altered nutrition to determine the probability of success. The nurse must use established expected outcomes to evaluate the patient’s response to care (e.g., patient’s weight increases by 0.5 kg/week). The nurse must also be creative when designing innovative nursing interventions to meet the patient’s nutritional needs and must demonstrate responsibility by following through with evaluation and counselling to successfully reach goals. DIF: Apply REF: 1119| 1120 OBJ: Discuss diet counselling and patient teaching in relation to patient expectations. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance 456