NR 228 Nutrition Exam 2 Questions and Verified Answers Latest 2026 Already Graded A -Chamberlain| ASSURED SUCCESS

Pregnancy weight gain for normal weight

25-35 lbs

*due to breast feeding and amniotic fluid

Dietary Guidelines for pregnant women

-Avoid foods such as raw eggs, raw meats, excessive amounts of coffee (only one cup per day)

Vitamins that should not increase during pregnancy are

-Vitamin C (hypercalcemia)

-Vitamin E (fetal heart defect)

-Vitamin K (prolong jaundice)

Preeclampsia nutrition related concerns

-Patient will be put on the DASH diet (hypertension diet) to help lower BP

-Limit and avoid trans fats, sat. fats, sugar, salt, no fast food, no coffee

-Increase foods rich in potassium, magnesium, and vitamins, fruits and vegetables, whole grain, protein

Gestational Diabetes Mellitus

Recommended foods to prevent GDM include carbohydrates, iron, calcium, protein, and fat sources. (simple carbs, fruits and veggies)

Maternal PKU

Lack of proper dietary therapy during pregnancy. Findings in infant: microcephaly, mental retardation, growth retardation, congenital heart defects.

-Pregnant women should not eat foods high in phenylalanine (should only consume 1-4 mg per day)

-Avoid fish, meat, diet soda, eggs, wheat

-Fruit, vegetables, and low protein foods are okay to eat

Lactation

750-1000mL of breast milk daily

-500 kcal for producing breast milk daily

*avoid foods such as garlic, citrus (lemon/limes), broccoli, spices, and cauliflower because it may alter taste of breast milk

Infancy birth weight and breast feeding

-first 6 months of life infant should consume breast milk.

-second 6 months of life infant should consume a combination of breast milk and baby food

Infant Dietary Guidelines

-Solid foods at 4-5 months

-if exclusively breastfeeding, baby should be taking in an iron supplement at 4 months old to avoid iron deficiency anemia.

Infancy and Fat Consumption

-Fat and cholesterol consumption is important in brain growth and development and nerve tissue

-If infant is overweight, do not restrict fats

Baby Bottle Tooth Decay

occurs when baby goes to bed with a bottle

-bottle before bed should only contain water

Nutrition-Related Concerns: Infancy

-Premature/low-weight = failure to thrive

-if child has PKU, phenyl-free formula should be used

-If baby has galactosemia (lactose intolerant) baby should consume soy formula

Toddlers: 1-3 years old diet

-limit 100% juice: 4-6oz per day

-consume snack foods such as graham crackers, apple slices, and cheese cubes

-Limit milk intake to 24oz per day due to lack of iron

-child should try food product 7-10 times before deciding not to like something

Preschoolers: 4-6 years old diet

-environmental influencer eaters

-avoid eating sugary foods while watching tv

-healthy plate contains: veggies, fruits, whole grain, healthy protein, water, healthy oils

School age children: 7-12 years old diet

-Concerns are: 10% skipping breakfast and type of diet they are consuming

-Risk for diabetes and obesity

Adolescence: 13-19 years old diet

- iron, fiber, calcium, protein, and vitamins are important nutrients to consume

-Calcium intake = 1300 mg daily (3 to 4 servings of dairy products)

-Adolescents reach maximum bone density levels during this time

-Foods high in CA: milk, sardines, cheese, yogurt

Adulthood diet

-important to exercise and eat a balanced diet to avoid cardiovascular diseases

-calcium is an important vitamin to consume due to bone health

Older adult diet concerns

-arthritis is the most common factor of prevention of eating well

-decrease in calorie needs

-decrease in nutrient absorption(vitamin B12, B9 (folic acid), and calcium)

-decrease in mass and tone

-oral problems caused by dentures

-medical conditions

Nutritional Guidelines for balanced diet (eldery)

-40-55% carbohydrates

-10-20% fat

-consume whole grains such as brown rice, oat meal, and whole wheat bread

-avoid added sugars especially in fruits

-avoid coconut oil due to high in sat. fat

Elderly Population prevention

-exercise and strength training

-increase water intake for hydration

-weight bearing exercises, increase sun exposure, and consumption of vitamin D reduces risk for osteoporosis

Primary nutritional deficiency

inadequate intake of nutrients

secondary nutritional deficiency

caused by illness, disease, and iatrogenic (ex: patient is NPO for procedure and it's causing nutritional deficiency)

Malnutrition side effects

- weight loss

-dry skin

-brittle, thin hair

-loss of muscle mass

-brittle nails

-weakness

-bone and joint pain

-fatigue

Nutrition Assessment Tools

-ht/wt

-bi/triceps skin fold measurements

Calculate % of wt change overtime:

Usual wt - present wt / usual wt X 100

- 1-2% in 1 week = moderate wt loss

- >2% in 1 week = severe wt loss

- 5 in 1 month = moderate wt loss

- >5 in 1 month = severe wt loss

Normal BMI

18.5-24.9

Overweight BMI

25-29.9

Obese BMI

30-39.9

Severely Obese BMI

35-39.9

Morbidly Obese BMI

greater than 40

Males that are high risk for cardiovascular disease and diabetes have a waist circumference of

greater than 102 cm

Females that are high risk for cardiovascular disease and diabetes have a waist circumference of

greater than 88 cm

Clinical values that measure adequate nutrition intake are

- fluid intake and output

-calorie count = most accurate measure

-hemoglobin levels: low levels = patient is not eating enough nutrients such as protein

Albumin Levels

3.5-5 g/dL

monitors long term protein consumption

-good for patients who are going in for a scheduled surgery

Prealbumin Levels

16-40 mg/dL

-short term indicator of protein consumption from the last two days

-Drawn for patients with traumas, infection, and stress

-low levels require supplementation

Food-Drug interactions

may cause: increase absorption, decrease absorption, irritation of digestive tract, or no effect

Who is at risk for drug interactions

Elderly, due to:

-polypharmacy

-chronic conditions

-metabolism decrease

Common foods that can cause drug interactions are

dairy products, coffee, grapefruit juice, coke or sodas, alcohols, tea, green leafy vegetables, licorice, ginseng, and charcoal boiled foods

grapefruit juice interaction

can cause Lipitor or atorvastatin to increase effect and cause toxicity leading to liver injury or liver failure

Vitamin K rich food interactions

increase in vitamin k and warfarin cause clot formation effect. decrease in vitamin k and warfarin cause prolong bleeding.

Foods high in vitamin k include: broccoli, squash, peppers, parsley, tomatoes, olive oil, kale, swiss chard

Consuming foods high in protein, amino acids, and vitamin B6 can cause effect on

Levodopa (Parkinson's Disease Med)

- interaction with protein and vitamin B6

-energy drinks and supplements that contain B6 may decrease levodopa effects and cause exacerbation in Parkinson's causing tremors and balance problems

Tyramine rich foods interact with

MAOI's: hypertensive crisis

- age cheese, bleu cheese, smoked meats, wine, and dark chocolate contain tyramine.

clear liquid diet

provides rest for GI, see through liquids

-water, coffee, tea, broth

full liquid diet

careful planning provides adequate nutrition

-yogurt, ice cream, pudding,

Blenderized (pureed) diet

blending food into liquid form for patients who cannot chew. Good for patients with fractured/wired jaws

mechanical soft diet

is recommended for people with difficulty in chewing or swallowing.

-soft and easy to eat: ground meats, smashed carrots, and soft cheese.

-good for mouth sores from radiation therapy on head/neck cancer patients

soft diet

low in fiber (easy to chew & digest), used for GI tract getting back to normal because unable to digest. no raw vegetables, no beef

diet as tolerated

Ordered when the client's appetite, ability to eat, and tolerance for certain foods may change

-gradual progression to normal eating or dietary pattern

Nursing Measurements to take before determining correct diet plan are:

-assess bowel function before advancing diet

-ongoing assessment parameters

-document nutritional intake (I's and O's)

-education and support for diet therapy

Enteral nutrition (EN)

Provision of nutrients through the gastrointestinal tract when the client cannot ingest, chew, or swallow food but can digest and absorb nutrients.

-feeding pump and feeding tube is used

- initial placement is checked by chest xray

-if pH levels are greater than 7 it is in the lungs

EN: Polymeric/Intact/Standard formulas

contains whole proteins and complete nutrition

-normal GI function is required

EN: Elemental formula

used when there is partial function of GI tract due to illness or short bowel syndrome

EN: modular formula

used for an add in supplement

EN: specialty formula

used for patients with disorders

EN administration methods

-head of bed is raised to 30-45 degrees to help reduce aspiration

-placement of feeding tube should be check before feeds by checking apirating gastric contents in a syringe and testing pH levels. Contents should be between levels of 1-4.

gastric residual volume

the volume of formula and GI secretions remaining in the stomach after a previous feeding

-checked Q4H - first 48 hrs for all patients and critical

-routinely Q6-8hr for noncritical patients

-250-500mL notify physician

Phenytoin and Theophylline

medication interactions with tube feedings. May decrease or increase effects.

*stop feeding 2 hours before administration and for 2 hours after medication is recieved

Most common complication of EN is

diarrhea

-decrease infusion rate if this occurs

Prevention of food poisoning for EN patients

-frequently washing hands before, during, and after handling tube

-refrigerate unused portion for up to 24 hr

-change ET tube/equipment Q24H

Transition to tube feeding to regular feeding

-stop feeding 1 hour before and after meals

-full liquid diet initially follow by purred to soft diet

Weaning occurs as oral intake increases:

-decrease tube feeding vol. until 6 meals/day are eaten

-oral intake is 500-750kcal/day

-cyclic feeding at nighttime

Discontinue tube feeding:

-consumes 2/3 of protein and calorie needs for 3-5 days

Home Enteral Nutrition

-Homemade blenderized formulas is strongly discourage because it can clog the tube

-recommended to stay on a feeding schedule

Parenteral Nutrition (PN)

method of supplying nutrients to the body by an intravenous route.

-1200-1500kcal/day

-Protein = 150g/day

-postivie nitrogen balance

PN Therapeutic Outcomes

-daily wt gain: up to 1kg/day

-increase in albumin levels (3.5-5.0)

-increase in prealnumin levels (15-36)

PN Solution Components

-Commerically prepared PN based solution

-carbs: 5-70% dextrose

-protein: amino acids: 3.5-15%

PN Fat/Lipid Emulsion

-additional calories and essential fatty acid

-"three-in-one" solution

-soy bean oil allergy, unless they have an allergy to soil

Peripheral PN (PPN)

-no need for high protein and caloric requirements

-solution is isotonic: 5-10% dextrose and 3-5% amino acids

-used for short term

Central PN (TPN)

-high protein and caloric requirement

-HYPERtonice soluction

-used for long term care of supplment support

TPN care/nursing management

-keep solution in the fridge until 1 hr before use

-DONT interrupt existing TPN infusion: it will cause hypoglycemia

-Glycosuria: first few days of TPN

-infuse 10-20% dextrose if need to

-catheter site dressing change with strict aseptic technique

Complications of TPN are

hyperglycemia

hypoglycemia

septicemia

fluid overload

clogged tubing

infection r/t catheter

Q6 accu checks

home parenteral nutrition

cyclic infusion

Transition: oral/tube feeding

-reduce infusion rate 50% for 1-2 hours before stopping

-provide sips of diluted fruit juice to maintain GI function

-stop TPN if oral intake is >60% of total energy and protein requirements

signs and symptoms of dysphagia

choking, drooling, decrease food intake, coughing, watery eyes, clearly throat, excessive tongue movement

-elderly = at risk

- complications: aspiration pneumonia, dehydrations, malnutrition

nutrition therapy to decrease aspiration

-using thicken agencies (foods such as apple sauce, mash potatoes, chocolate pudding)

-minimize distractions

-encourage dry swallows and coughing

-sit upright with chin to chest

-dont rush

-use spoons when dealing with fluids to decrease liquid amount

-encourage small bites

GERD (gastroesophageal reflux disease)

Risk factor: obesity

-most common cause is a hiatal hernia (found on chest xray)

-chocolate, coffee, doxycycline, spicy foods, alcohol, smoking can increase risk for GERD

common symptoms of GERD are

chest pains

belching

tooth erosion

excessively swallowing

painful chest/heart burn (pyrosis)

developing a sour taste

**dietary modifications can help treat these symptoms

Dietary and lifestyle modifications of GERD

watch your weight

limit caffeine, peppermint, fatty foods, and alcohol

quit smoking

don't eat 2-3 hours before bed

raise HOB 4-6 inches(30 degrees)

don't lay down after meals

small frequent meals are encouraged

avoid tight clothing and belts

Peptic Ulcer Disease (PUD)

-Risk factor: increase use in NSAIDS and ibuprofen

common in elderly

-h.pylori is 80% of cases and treated with antibiotic and antacids

-main concern is bleeding, pain

causes: stress, alcohol, family hx, excessive use of meds

Nutrition Therapy for PUD

-individualize diet plan: consume foods as tolerated

avoid foods: coffee, soda, spicy food, high sugar foods, fried foods

consume: raw honey. avocados, spinach, kale, cabbage, celery, and Brussel sprouts

Dumping syndrome

common in gastric bypass patients

cause: consuming contents too fast

Dumping syndrome S/S

-Can occur 15-30 mins after consumption of food:

Fullness, faintness, diaphoresis, tachycardia, palpitations, hypotension, nausea, abdominal distinction, cramping, diarrhea, weakness, and syncope.

**Concern = hypoglycemia

Nutrition therapy for dumping syndrome is

-avoid drinking fluids during meals

-lie down for 30 min after meal

intake more complex carbs(peas, beans, whole grains, vegetables) and avoid simple carbs

celiac disease symptoms

gas

diarrhea

stomach pain

fatigue

joint pain

weight loss

itchy skin

celiac disease diet

Consume:

fruits

vegetables

eggs

quinoa

rice

unprocessed meats

**reduces digestive issues, increases energy, and decreases inflammation

Do not consume: wheat, rye, barley, milk, cheese, yogurt, butter

lactose intolerance

The inability to completely digest the milk sugar lactose

-add lactase enzyme to milk 24 hours before consumption

-milk and dairy are important for bone health which is a big concern for lactose intolerant patients.

inflammatory bowel disease (IBD)

Inflammation of the colon and small intestine.

- Crohn disease and ulcerative colitis.

-exacerbation due to stress: can be painful, can damage or destroy intestines

Nutrition Therapy for IBD

-adjunct to drug therapy and surgery (immunosuppressants and colostomy)

-TPN

-Elemental formula

=high calorie, high vitamin, low residue foods

ACUTE STAGE = high protein and low fiber (can cause diarrhea)

REMISSION STAGE = high fiber intake

Short Bowel Syndrome (SBS)

decreased digestion and absorption that result from a large resection of the small intestine

Nutrition Therapy = MCT oil containing formula

Should consume complex carbs and avoid simple carbs (soda, fried food, sugary foods)

- worried about malabsorption and diarrhea (fatty stools)

Ostomy

Biggest concern is fluid and electrolyte imbalances of NA and K

- supplement fat-soluble vitamins

-avoid high fiber and hard to digest food and foods that can cause gas and diarrhea

-consume strained fruits and veggies

Colostomy

Create an eating pattern of eating the largest meal in the middle of the day and the smallest meal in the evening to avoid a bag blow out during the night

-consume low fiber foods

-consume 8-10 cups of water

-avoid eggs, garlic, onions, fish, asparagus, cabbage, broccoli, and alcohol--> these foods are odor producing

Diverticulosis/diverticulitis Risk Factors are

age

low fiber diet

high refined CHOs

sedentary lifestyle

Treatment= diverticulitis is antibiotics

diverticulosis is increasing fiber intake

Nutrition therapy for diverticulosis and diverticulitis is

-high fiber diet of 25-38 g/day

> 5 cups/servings of fruits and vegetables

6 ounces/servings of whole grain breads and cereals

-fluid intake of 8-12 cups daily