nutrition final

After surgical removal of the gallbladder (cholecystectomy), the nurse should counsel patients to \n a. follow a low-fat, low-cholesterol diet. \n b. ensure high intake of protein and fluid. \n c. eat a well-balanced diet as tolerated. \n d. avoid snacking between meals.

c

If a nurse is beginning an enteral feedings for a patient with pancreatitis, the only appropriate type of formula is \n a. modular. \n b. hydrolyzed. \n c. intact. \n d. hypercaloric.

b

At the beginning of an acute episode of pancreatitis, the nutrition priority is to provide \n a. a clear liquid diet. \n b. jejunal enteral feedings. \n c. parenteral nutrition. \n d. intravenous fluids.

d

The only appropriate diet order for a patient with pancreatitis is to begin feedings via \n a. nasogastric tube. \n b. percutaneous endoscopic gastrostomy (PEG) tube. \n c. nasoduodenal tube. \n d. percutaneous endoscopic gastrojejunostomy.

d

If a patient with cirrhosis of the liver has a soft diet order, he or she probably has \n a. lethargy. \n b. cholelithiasis. \n c. esophageal varices. \n d. hepatic encephalopathy.

c

The most beneficial dietary change for a patient with cholelithiasis and cholecystitis would be to \n a. avoid fried foods and creamy sauces. \n b. abstain from drinking alcohol. \n c. refrain from eating 4 hours before bedtime. \n d. avoid eggs, shrimp, and high-cholesterol foods.

a

If an otherwise healthy patient with normal body weight develops fatty liver disease, it would be especially important to evaluate their \n a. blood glucose level. \n b. alcohol intake. \n c. total fat intake. \n d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).

b

If an obese postmenopausal woman who does not drink alcohol develops fatty liver disease and wants to avoid progression to cirrhosis or liver cancer, the best recommendation is to \n a. decrease intake of saturated fats. \n b. decrease intake of carbohydrate. \n c. lose 3 to 4 lb per week. \n d. lose 1 to 2 lb per week.

d

If a client will be visiting an area where hepatitis E virus (HEV) is endemic, the best way to prevent becoming infected is to \n a. eat only cooked fruits and vegetables and drink only commercially bottled water. \n b. eat only at internationally recognized establishments. \n c. obtain a vaccination before entering that area. \n d. avoid and raw or unpasteurized dairy products.

a

A symptom that is common to all types of hepatitis is \n a. jaundice. \n b. headache. \n c. dehydration. \n d. muscle aches.

a

In treating patients with hepatitis, it is important for nurses to help patients cope with the challenge of \n a. difficulty sleeping. \n b. risk of bleeding. \n c. sodium restriction. \n d. fluid restrictions.

c

An individual may be at risk for HEV infection if they travel to India and eat \n a. curried shrimp. \n b. fresh fruit salad. \n c. Tandoori chicken. \n d. cooked foods from street vendors.

b

For patients with hepatitis, an important way to minimize loss of muscle mass is to \n a. participate in daily aerobic exercise. \n b. participate in daily strength exercise. \n c. maintain an adequate protein intake. \n d. maintain an adequate micronutrient intake

c

The person at greatest risk for developing cirrhosis or liver cancer is a(n) \n a. young woman who drinks a glass of wine every day. \n b. young man who travels extensively to tropical countries. \n c. middle-aged overweight man with gallstones. \n d. older adult infected with hepatitis C virus (HCV).

d

A good meal for a patient with ascites would be \n a. canned minestrone soup with saltine crackers. \n b. baked chicken with a roll and steamed green beans. \n c. bacon, sausage, eggs, and toast. \n d. tortilla chips with nacho cheese and salsa.

b

If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing \n a. fatty liver disease. \n b. hepatitis D. \n c. secondary depression. \n d. hepatic encephalopathy.

d

f a patient with cirrhosis of the liver is treated with lactulose and neomycin, he or she probably has \n a. a secondary infection. \n b. ascites. \n c. esophageal varices. \n d. hepatic encephalopathy.

d

Someone who drinks one glass of wine every night with dinner plus an occasional beer when watching a football game would be considered to be \n a. alcoholic. \n b. an alcohol addict. \n c. a moderate drinker. \n d. a heavy drinker.

c

If a person has no history of liver disease but does have a strong family history of cardiovascular disease, the person may help decrease the overall risk for chronic disease by \n a. following a lacto-ovovegetarian diet. \n b. avoiding use of NSAIDs. \n c. abstaining from drinking any alcoholic beverages. \n d. drinking one or two servings of alcoholic beverages daily.

d

If a malnourished patient with cirrhosis of the liver seems to be vulnerable to development of hepatic encephalopathy, the best food to give them would be \n a. scrambled eggs. \n b. roast beef with gravy. \n c. a hamburger. \n d. a bean burrito.

d

If a patient with end-stage liver disease gains 5 lb in 1 week, the most likely explanation is \n a. development of ascites. \n b. restoration of muscle mass. \n c. high energy intake. \n d. edema in the extremities.

a

A patient with end-stage liver disease may lose fat stores and muscle mass, but this may not be evident from measurements of body weight because of \n a. dehydration. \n b. fat redistribution. \n c. ascites and edema. \n d. electrolyte imbalances.

c

After liver transplantation, long-term nutrition recommendations most closely resemble those for patients with \n a. hepatitis. \n b. gallstones. \n c. peptic ulcer disease. \n d. metabolic syndrome.

d

An example of an individual who may be at high risk for gallstones is a(n) \n a. underweight woman who runs 3 miles four times a week. \n b. overweight man who smokes and has a sedentary job. \n c. overweight man who has recently begun an exercise program. \n d. mother with four children who has lost 25 pounds in the past 3 months.

d

Cholecystitis is caused by \n a. blockage of the bile duct by gallstones, bacterial infection, or ischemia. \n b. concentration of bile in the gallbladder that favors formation of gallstones. \n c. failure of the gallbladder to contract and release bile into the small intestine. \n d. intake of excessive amounts of cholesterol and fat, in combination with bacterial infection.

a

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For patients with any kind of liver disease, the most important dietary modification is \n a. abstaining from alcohol. \n b. decreasing fat intake. \n c. increasing protein intake. \n d. avoiding dietary fructose.

a

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If a patient is infected with HCV, he or she may \n a. have consumed contaminated food or water. \n b. be co-infected with hepatitis B virus (HBV). \n c. have had sexual contact with an infected person. \n d. have recently gotten a tattoo.

d

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For patients who are infected with hepatitis and have a poor appetite, the best way to increase protein and energy intake would be \n a. adding peanut butter to toast, soups, or smoothies. \n b. tossing salads and pasta with olive oil. \n c. mixing powdered milk into mashed potatoes and soups. \n d. adding sugar to coffee and tea.

a

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As a patient who has undergone liver transplantation heals, a necessary transition is \n a. increasing protein intake to replace pretransplantation losses. \n b. restricting fluid and sodium intakes to prevent ascites. \n c. generally eating less to avoid weight gain and chronic disease. \n d. generally eating more to maintain body weight and muscle mass.

c

A bottle of beer that contains 13 g of carbohydrates and 16 g of alcohol provides _____ kcal. \n a. 116 \n b. 155 \n c. 164 \n d. 203

c

If a 75-year-old woman needs hip replacement surgery but reports that she has lost 15 lb since her husband died 3 months ago because she has had very little appetite, the best approach would be to \n a. provide enteral feedings immediately after surgery. \n b. delay surgery until the patient returns to usual body weight. \n c. recommend using a multivitamin or multimineral supplement. \n d. ensure at least 2 weeks of good nutritional intake before surgery.

d

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If a patient is healing more slowly than expected after surgery, he or she may benefit from \n a. enteral feedings. \n b. supplemental zinc and vitamins A and C \n c. supplemental iron and vitamins B12 and D  \n d. additional branched-chain amino acids.

b

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Of the following, the most stressful physical traumas would be \n a. a single bone fracture. \n b. a low-grade fever \n c. minor surgery. \n d. a large third-degree burn

d

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If someone has been fasting for 36 hours, his or her body is meeting its glucose needs by breaking down \n a. glycogen. \n b. keto acids. \n c. amino acids. \n d. fatty acids.

c

If a malnourished patient has a poor appetite, the nurses first priority should be to recommend \n a. enteral feedings. \n b. increasing intake of fruits and vegetables. \n c. several small meals and snacks each day. \n d. limiting between-meal snacks to promote hunger

… (c or d?)

\
Once patients have completely recovered from gastric bypass surgery for treatment of obesity, an appropriate meal would be \n a. a large green salad with chopped turkey and vinaigrette dressing. \n b. a medium vanilla shake. \n c. half a small chicken breast and cup of green beans. \n d. a cup of bean soup with vegetable sticks.

c

If a student group goes on hunger strike and drinks water but does not eat any food for 4 days, they are likely to \n a. feel colder than usual. \n b. have increased mental acuity. \n c. sleep for shorter periods of time. \n d. develop fluid overload.

a

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A major difference between starvation and stress is that metabolic rate _____ during starvation and _____ during recovery from injury. \n a. increases; decreases \n b. decreases; increases \n c. is unaffected; increases \n d. decreases; is unaffected

b

If a patient who has fallen down a flight of steps has a low body temperature, low blood pressure, and high blood glucose levels, he or she is probably \n a. in the initial injury (ebb) phase. \n b. in the recovery (flow) phase. \n c. developing a serious infection. \n d. developing multiple organ dysfunction syndrome (MODS).

a

Four day after a major accident involving multiple broken bones, the patient would be expected to be in the _____ phase. \n a. critical \n b. stress \n c. ebb \n d. flow

d

During starvation or fasting, the body adapts so that it can obtain as much energy as possible from \n a. glycogen. \n b. glucose. \n c. protein. \n d. fat.

d

If a man who weighs 80 kg is recovering from surgery and has an average protein intake of 105 g/day, his protein intake is \n a. inadequate. \n b. deficient. \n c. appropriate. \n d. excessive.

c

If a 40-year-old, woman weighing 60 kg breaks both ankles while hiking and is hospitalized, her fluid needs would be _____ mL. \n a. 1800 to 2100 \n b. 2100 to 2400 \n c. 2400 to 2700 \n d. 2700 to 3000

b

The amino acid that plays an important role in the gastrointestinal tract during stress is \n a. arginine. \n b. glutamine. \n c. methionine. \n d. phenylalanine.

b

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When refeeding a malnourished patient, it is especially important to monitor blood levels of \n a. phosphorus. \n b. iron. \n c. zinc. \n d. vitamin C.

a

During the initial injury (ebb) phase, the main nutritional priority is \n a. normalizing blood glucose levels. \n b. normalizing fluid status. \n c. providing adequate protein. \n d. avoiding overfeeding.

b

The best way to determine energy needs of stressed patients is to use \n a. indirect calorimetry. \n b. the Ireton-Jones formula. \n c. the Dietary Reference Intakes. \n d. patient hunger and appetite cues.

a

If a malnourished patient undergoes an emergency appendectomy and develops pneumonia during the recovery, he or she probably \n a. has a history of smoking. \n b. used protein from the intercostal muscles for energy. \n c. had bronchitis before undergoing surgery. \n d. needs evaluation for dysphagia.

b

If a severely burned patient has been unable to eat more than a few bites each day for a week, he or she should be fed by means of \n a. enteral feedings into the stomach. \n b. enteral feedings into the jejunum. \n c. central parenteral nutrition. \n d. peripheral parenteral nutrition.

a

In a critically ill patient receiving parenteral nutrition, a blood glucose level of 145 mg/dL is considered \n a. too low. \n b. acceptable. \n c. slightly elevated. \n d. seriously elevated

b

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If a patient has significant fluid losses from perspiration and wound dressings that cannot be measured easily, the best way to monitor fluid balance is to \n a. measure serum sodium levels. \n b. weigh the patient daily. \n c. use formulas to calculate losses. \n d. check urine concentration.

b

After surgery, once bowel sounds return, the most appropriate first meal should be \n a. clear liquids. \n b. soft and low in fiber. \n c. chosen by the physician. \n d. chosen by the patient

d

If a patient undergoes resection of 6 inches of the colon, they are likely to have the best outcome if they \n a. gave the bowel complete rest for 7 to 14 days. \n b. begin oral or enteral feedings the day after surgery. \n c. follow a soft, low-fiber diet. \n d. follow a high-fiber diet to promote laxation.

b

Presurgical nutritional status would be most important for a(n) \n a. middle-aged man undergoing open heart surgery to replace a heart valve. \n b. young woman undergoing a mastectomy for treatment of breast cancer. \n c. older adult undergoing cholecystectomy. \n d. child undergoing tonsillectomy.

a

The factor that contributes most to development of MODS is \n a. blood glucose level. \n b. inflammatory response. \n c. fever. \n d. malnutrition

b

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The best indicator that it is safe for a patient to begin to resume oral intake after surgery is \n a. presence of bowel sounds. \n b. return of appetite. \n c. ability to sit upright. \n d. normal blood glucose level.

a

The staff member best equipped to determine the nutrient needs of patients with severe burns is the \n a. physician. \n b. registered nurse. \n c. pharmacist. \n d. registered dietitian.

d

If a patient is seriously burned and the muscle tissue is visible, the patient has a _____ burn. \n a. first-degree \n b. second-degree \n c. third-degree \n d. nonthermal

c

If a patient experiences a third-degree burn over 30% of the body surface area, the first priority would be \n a. provision of adequate protein. \n b. prevention of nausea and vomiting. \n c. replacement of fluids and electrolytes. \n d. provision of adequate energy

c

The factor that would have the greatest influence on the energy needs of a burned patient is the \n a. patients activity level. \n b. patients emotional stress level. \n c. percentage of total body surface area burned. \n d. type of burn (thermal, chemical, electrical, or radioactive).

c

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Kidney disease affects the bodys ability to maintain \n a. body temperature. \n b. body weight. \n c. bone health. \n d. bowel function.

c

If a patient is losing significant amounts of protein in urine, he or she probably has \n a. acute renal failure. \n b. chronic renal failure \n c. nephrotic syndrome. \n d. renal calculi.

c

One of the nurses important roles in care of patients with nephrotic syndrome is \n a. monitoring serum sodium level. \n b. monitoring fluid intake and output. \n c. ordering a high-protein, low-sodium diet. \n d. monitoring serum phosphorus level.

b

The best way to ensure that patients with nephrotic syndrome are able to use their dietary protein to maintain lean body tissue is to \n a. provide 1.5 to 2.0 g protein per kilogram of body weight per day. \n b. encourage daily exercise. \n c. ensure adequate energy intake. \n d. provide adequate dietary potassium.

c

An example of a source of hidden sodium is \n a. mouthwash. \n b. saltine crackers. \n c. opaque salt shakers. \n d. raw fruits and vegetables.

a

If a patient with acute renal failure gains 2 lb in 24 hours, the cause is likely to be \n a. urea retention. \n b. fluid retention. \n c. increased fat stores. \n d. increased muscle mass.

b

If a patient with third-degree burns covering 40% of the body surface area suddenly exhibits high blood pressure and edema and is not producing urine, he or she has probably developed \n a. severe malnutrition. \n b. nephrotic syndrome. \n c. chronic renal failure. \n d. acute renal failure.

d

It would be most challenging to design a diet for chronic renal failure for \n a. a patient with elevated levels of serum low-density lipoprotein (LDL) cholesterol. \n b. a patient with hypertension. \n c. someone who follows a vegan eating pattern. \n d. someone who adheres to strict kosher food laws.

c

Protein needs of patients with acute renal failure who do not need dialysis are \n a. lower than those of patients receiving hemodialysis. \n b. the same as those of patients receiving hemodialysis. \n c higher than those of patients receiving hemodialysis. \n d. dependent on the volume of urine produced.

a

In order to calculate fluid needs for a patients in the oliguric phase of acute renal failure, it is important to know the patients \n a. body weight. \n b. energy intake. \n c. serum sodium level. \n d. amount of output.

d

The person who is most likely to develop chronic kidney disease is a(n) \n a. obese woman with elevated levels of LDL cholesterol. \n b. man with type 2 diabetes and hypertension. \n c. man who drinks two alcoholic beverages a day and smokes cigarettes. \n d. woman with tuberculosis and acquired immunodeficiency syndrome (AIDS).

b

Before development of end-stage renal disease, the primary focus of nutrition therapy for patients with chronic renal failure is \n a. limiting intake of sodium and fluid. \n b. limiting foods that produce toxic metabolic byproducts. \n c. providing sufficient protein to prevent secondary complications. \n d. providing adequate energy, protein, and nutrients to promote recovery.

b

The National Renal Diet \n a. provides carefully calculated menus for patients with chronic renal failure. \n b. provides flexible meal planning tools for patients with chronic renal failure. \n c. provides lists of foods that are acceptable for patients with chronic renal failure. \n d. allows patients with chronic renal failure to select foods without the help of a registered dietitian.

b

Of the following, the meal that would be best to include as part of a renal diet plan is \n a. cheese omelet with biscuits. \n b. baked chicken with rice and green beans. \n c. bean burrito with tortilla chips and salsa. \n d. peanut butter sandwich on whole wheat bread.

b

A food that is restricted in patients who are receiving hemodialysis and taking phosphate binders is \n a. banana. \n b. potato. \n c. egg.

d. milk

d

It is most appropriate to take medications to reduce serum phosphorus levels \n a. with fluids. \n b. with meals. \n c. between meals. \n d. one hour after meals.

b

Patients with chronic renal failure often need supplements that contain an active form of vitamin \n a. A. \n b. C. \n c. D. \n d. K.

c

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If a patient with chronic renal failure develops anemia, he or she probably needs to be given \n a. erythropoietin. \n b. vitamin B12 supplements. \n c. folate supplements. \n d. red blood cells.

a

The nurse would be most concerned if a family member visited a patient during hemodialysis treatment and brought the patient \n a. a salad with olive oil dressing and chopped egg. \n b. a bagel with homemade jam. \n c. unsalted pretzel sticks and honey. \n d. a chocolate 

d

If a patient with chronic renal failure begins peritoneal dialysis, his or her protein intake should \n a. be calculated on the basis of the degree of malnutrition. \n b. be determined by the patients blood urea nitrogen level. \n c. decrease because the patient is not losing protein in urine. \n d. increase because protein is lost into the dialysate.

d

If a patient wishes to continue working and be active during the day, the best kind of peritoneal dialysis would be \n a. intermittent. \n b. manual. \n c. mechanical. \n d. continuous ambulatory.

d

In comparison with patients treated with hemodialysis, patients treated with peritoneal dialysis have _____ dietary protein needs. \n a. slightly higher \n b. slightly lower \n c. much higher \n d. much lower

a

In comparison with patients treated with hemodialysis, patients treated with peritoneal dialysis have \n a. similar energy needs. \n b. higher energy needs. \n c. lower energy needs. \n d. more variable energy needs, depending on activity level.

c

For bone health, it is very important for patients with chronic renal failurewhether they are receiving hemodialysis, peritoneal dialysis, or no dialysisto restrict their intake of \n a. potassium. \n b. oxalates. \n c. fluid. \n d. phosphorus.

d

The most significant challenge for patients with diabetes mellitus and chronic renal failure who are treated with peritoneal dialysis is that \n a. insulin is lost into the dialysate. \n b. glucose is absorbed from the dialysate. \n c. the combined food restrictions are complex. \n d. peritoneal dialysis causes taste changes and food aversions.

b

In a patient who is receiving steroids after renal transplantation, it is important to monitor _____ levels. \n a. hemoglobin \n b. blood glucose \n c. blood urea nitrogen \n d. serum phosphorus

b

Two weeks after a patient has undergone renal transplantation, his or her energy needs \n a. are lower than normal. \n b. are higher than normal. \n c. fluctuate from day to day. \n d. depend on nutritional status before surgery.

b

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A patient who has calcium oxalate kidney stones should \n a. limit foods with high levels of calcium. \n b. avoid calcium supplements. \n c. limit foods with high levels of oxalate. \n d. avoid lower quality vegetable proteins.

c

The most important advice for preventing kidney stones is to \n a. restrict dietary calcium intake. \n b. increase dietary protein intake. \n c. drink at least 10 to 12 cups of fluid daily. \n d. achieve and maintain a healthy body weight.

c

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An example of a food that may increase urinary oxalate levels is \n a. a ginger cookie. \n b. a cinnamon roll. \n c. a blueberry muffin. \n d. strawberry shortcake.

d

When someone smokes cigarettes and drinks three alcoholic beverages a day, he or she is contributing to his or her cancer risk via \n a. initiation. \n b. metastasis. \n c. promotion. \n d. progression.

c

Someone who uses sunscreen and wears UV protective clothing and hats to prevent development of skin cancer may need to \n a. use light therapy to prevent seasonal affective disorder. \n b. consume extra vitamins C and E and other dietary antioxidants. \n c. ensure adequate intake of vitamin D from fortified foods and supplements. \n d. consume additional fluids to replace sweat losses caused by additional clothing.

c

Fruits and vegetables help prevent cancer because they have high amounts of \n a. phytosterols. \n b. vitamins. \n c. antineoplastics. \n d. antioxidants.

d

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A dietary change that would help prevent cancer, according to the National Cancer Institute recommendations, is \n a. eating vegetarian meals two or more times a week. \n b. choosing organic, pesticide-free fruits and vegetables. \n c. eating five or more daily servings of fruits and vegetables. \n d. consuming three or more daily servings of low-fat dairy products.

c

Factors that contribute to loss of lean body mass in many patients with cancer that are outside the patients control include \n a. hypermetabolism. \n b. inadequate protein intake. \n c. inadequate energy intake. \n d. drug noncompliance.

a

A patient in whom cancer has been newly diagnosed is about to begin intense chemotherapy. She tells you that the only good thing about this diagnosis is that she will now be able to lose weight without even trying. The most appropriate nursing response would be to \n a. encourage the patient to celebrate the positive aspects of the disease. \n b. encourage adequate nutrient intake to maximize tolerance of chemotherapy. \n c. reinforce the need to achieve and maintain ideal body weight. \n d. emphasize eating the right types of foods rather than an amount of food.

b

If a patient is going to have surgery to remove cancer of the esophagus, it is important to \n a. prevent poor food intake as a result of depression by warning the patient that the surgery may be disfiguring. \n b. emphasize complete abstinence from cigarette smoking and use of alcoholic beverages. \n c. provide nutrition support to reverse malnutrition caused by difficulty eating during the disease progression. \n d. encourage the patient to enjoy favorite foods to maximize intake.

c

If a patient has dumping syndrome after surgery to remove a tumor, he or she has probably had a \n a. vagotomy. \n b. gastrectomy. \n c. pancreatectomy. \n d. small bowel resection.

b

Bone marrow cells and cells lining the gastrointestinal tract are more susceptible than other cells to damage caused by chemotherapy because they \n a. are target cells for drugs. \n b. have a rapid turnover rate. \n c. are exposed to higher doses of the drugs. \n d. absorb more of the drugs than they excrete.

b

If a patient with cancer is receiving a combination of chemotherapeutic agents that is known to interfere with bone marrow, they should give special attention to prevention of \n a. dehydration. \n b. foodborne illness. \n c. nausea and vomiting. \n d. loss of bone mass.

b