MISSED CONCEPTS

Chapter 37 — Nutrition Review Sheet

1. Nutrition calculations

BMI example — Question 41

Weight = 84 kg, Height = 1.65 m

\frac{84}{1.65\times1.65}=\boxed{30.9}

Multiply height × height first, then divide the weight. Do not calculate from left to right without parentheses.

Adult BMI classifications

BMI can be less accurate in highly muscular individuals, patients with edema or dehydration, and older adults with reduced muscle mass.

Food label example: A container has 180 kcal per serving and 2.5 servings. Total = 180 × 2.5 = 450 kcal.

2. Metabolism and cholesterol

Cholesterol and dietary fats

• Cholesterol is nonessential as a dietary nutrient. Your body can produce enough cholesterol even though it is needed for normal functions.

• Trans fats increase LDL and decrease HDL.

• Saturated fats tend to increase serum cholesterol.

• Unsaturated fats generally help lower serum cholesterol.

• Fiber can help lower cholesterol by increasing its fecal excretion.

Memory trick

LDL = “bad”; HDL = “good.” Trans fats make the combination worse: LDL up, HDL down.

3. Vitamins, pregnancy, and lactation

Fat-soluble versus water-soluble

Remember: ADEK needs fat. Conditions that impair fat absorption can cause deficiencies of vitamins A, D, E, and K. Vitamin E is fat-soluble; vitamin C is not.

Additional calorie needs in Chapter 37

These are the approximate additional calorie requirements presented in your assigned textbook, not the person’s total daily calories.

4. Enteral versus parenteral nutrition

This showed up as a missed concept twice, so it deserves extra attention.

PPN = Peripheral Parenteral Nutrition.

• Administered through a peripheral IV.

• Uses less concentrated solutions than highly concentrated central PN.

• Does not use an NG tube, PEG tube, or any other gastrointestinal feeding tube.

Central PN: Highly concentrated, hypertonic nutrients administered through central venous access. Monitor for infection, blood glucose abnormalities, and other metabolic or mechanical complications.

Memory trick: Enteral = enter the gut. Parenteral = bypass the gut.

5. Dietary guidelines and mineral interactions

The sodium guideline refers to the 2020–2025 dietary guidelines printed in your assigned textbook.

Your 60-second memorization checklist

Check off each fact you can recall without looking

0/9

4 / 4 / 9 — carbohydrates, protein, fat

BMI = kg ÷ (height in meters)²

Catabolism breaks down; anabolism builds up; absorption takes in

Trans fats: LDL up, HDL down

ADEK = fat-soluble vitamins

340 / 450 / 500 = second trimester, third trimester, lactation

PPN = peripheral IV, NOT an NG tube

Sodium: less than 2,300 mg/day in your textbook

Excess zinc can cause copper deficiency

How I would study this sheet: Review the tables once, cover the right-hand columns, and try to recall the answers aloud. Then practice two BMI problems and two calorie calculations without notes.

You don’t need to relearn the whole Nutrition chapter. Concentrate on turning these specific missed concepts into things you can answer automatically.

Source material: Taylor’s Fundamentals of Nursing, Chapter 37, and your NUR 134 Nutrition lecture.Chapter 37 — Nutrition Review Sheet

NUR 134 · Based on your missed questions from all 60 questions

You scored 46/60 (76.7%) across your three Nutrition quizzes. This review focuses specifically on the concepts you missed, so you don’t have to restudy everything you already know.

Your biggest areas to strengthen are calculations, vitamin classifications, nutrition terminology, and enteral versus parenteral feeding.

1. Nutrition calculations

BMI example — Question 41

Weight = 84 kg, Height = 1.65 m

\frac{84}{1.65\times1.65}=\boxed{30.9}

Multiply height × height first, then divide the weight. Do not calculate from left to right without parentheses.

Adult BMI classifications

BMI can be less accurate in highly muscular individuals, patients with edema or dehydration, and older adults with reduced muscle mass.

Food label example: A container has 180 kcal per serving and 2.5 servings. Total = 180 × 2.5 = 450 kcal.

2. Metabolism and cholesterol

Cholesterol and dietary fats

• Cholesterol is nonessential as a dietary nutrient. Your body can produce enough cholesterol even though it is needed for normal functions.

• Trans fats increase LDL and decrease HDL.

• Saturated fats tend to increase serum cholesterol.

• Unsaturated fats generally help lower serum cholesterol.

• Fiber can help lower cholesterol by increasing its fecal excretion.

Memory trick

LDL = “bad”; HDL = “good.” Trans fats make the combination worse: LDL up, HDL down.

3. Vitamins, pregnancy, and lactation

Fat-soluble versus water-soluble

Remember: ADEK needs fat. Conditions that impair fat absorption can cause deficiencies of vitamins A, D, E, and K. Vitamin E is fat-soluble; vitamin C is not.

Additional calorie needs in Chapter 37

These are the approximate additional calorie requirements presented in your assigned textbook, not the person’s total daily calories.

4. Enteral versus parenteral nutrition

This showed up as a missed concept twice, so it deserves extra attention.

PPN = Peripheral Parenteral Nutrition.

• Administered through a peripheral IV.

• Uses less concentrated solutions than highly concentrated central PN.

• Does not use an NG tube, PEG tube, or any other gastrointestinal feeding tube.

Central PN: Highly concentrated, hypertonic nutrients administered through central venous access. Monitor for infection, blood glucose abnormalities, and other metabolic or mechanical complications.

Memory trick: Enteral = enter the gut. Parenteral = bypass the gut.

5. Dietary guidelines and mineral interactions

The sodium guideline refers to the 2020–2025 dietary guidelines printed in your assigned textbook.

Your 60-second memorization checklist

Check off each fact you can recall without looking

0/9

4 / 4 / 9 — carbohydrates, protein, fat

BMI = kg ÷ (height in meters)²

Catabolism breaks down; anabolism builds up; absorption takes in

Trans fats: LDL up, HDL down

ADEK = fat-soluble vitamins

340 / 450 / 500 = second trimester, third trimester, lactation

PPN = peripheral IV, NOT an NG tube

Sodium: less than 2,300 mg/day in your textbook

Excess zinc can cause copper deficiency

Chapter 40 — Oxygenation & Perfusion Review Sheet

1. Ventilation vs. diffusion vs. perfusion

You missed the distinction between perfusion and diffusion in Question 7.

Clinical distinction: If oxygen is crossing the alveolar membrane normally but cardiac pumping is insufficient, the primary issue is inadequate perfusion—not diffusion.

Memory trick: Ventilation = air, diffusion = gas exchange, perfusion = blood flow.

2. Recognizing increased work of breathing

On Question 16, you correctly identified retractions and accessory-muscle use, but missed nasal flaring.

Nasal flaring

Widening of the nostrils during breathing, associated with increased respiratory effort.

Retractions

Visible pulling inward of tissues between or around the ribs during inspiration.

Accessory-muscle use

Recruitment of the neck, shoulder, or other accessory respiratory muscles to assist breathing.

Also assess respiratory rate, rhythm, depth, effort, lung sounds, oxygen saturation, and dyspnea.

3. Oxygen delivery devices and flow rates

You missed the minimum simple-mask flow rate in Question 22.

CRITICAL FACT

Simple face mask = minimum 5 L/min

Never operate a simple face mask below 5 L/min because inadequate flow can cause exhaled CO₂ to accumulate inside the mask.

Oxygen device comparison

Figures reflect textbook Table 40-4, except partial-rebreather FiO₂ from your lecture. The lecture gives nasal cannula 23–42% and simple mask 5–10 L/min; Chapter 40’s narrative also lists simple mask 5–10 L/min. For actual Venturi use, follow the prescribed FiO₂ and device-specific barrel settings.

Key device distinctions

• Nasal cannula: Common low-flow device that allows eating and talking.

• Simple face mask: Must have at least 5 L/min to prevent CO₂ rebreathing.

• Partial rebreather: Has a reservoir bag and allows rebreathing of some exhaled air.

• Nonrebreather: Uses one-way valves and delivers a high concentration of oxygen.

• Venturi mask: Provides the most precise, fixed oxygen concentration.

4. Oxygen saturation goals

Question 28 showed that you need to review COPD oxygen targets.

Do not memorize 88–92% as the target for every COPD patient. The nurse follows the prescribed oxygen range and assesses respiratory status, not just the pulse oximeter.

An SpO₂ of 75–80% is not an appropriate routine target; it requires prompt evaluation and intervention.

Memory trick: Most = 94–98; at risk of CO₂ retention = often 88–92.

5. Incentive spirometry vs. suctioning

On Question 31, you confused the time needed for an incentive-spirometry breath hold with the maximum suctioning time.

Incentive spirometry

3–5 sec

Hold the breath after maximal inhalation.

Approximately 5–10 breathing exercises every 1–2 hours, if able.

Tracheal suctioning

10–15 sec

Maximum duration of suction application per pass.

Hyperoxygenate as indicated to reduce suction-induced hypoxemia.

Remember: Incentive spirometry helps promote lung expansion. Suctioning removes secretions when the patient cannot clear the airway effectively.

6. Arterial blood gas (ABG) values

You missed the normal values for both PaCO₂ and PaO₂ in Questions 36 and 37.

How to interpret your missed concepts

• PaCO₂ above 45 mm Hg: Increased arterial carbon dioxide.

• PaCO₂ below 35 mm Hg: Decreased arterial carbon dioxide.

• PaO₂ below 80 mm Hg: Below the textbook’s normal reference range, indicating reduced arterial oxygenation.

• PaO₂ and SpO₂ are not interchangeable: PaO₂ measures oxygen pressure, while SpO₂ estimates the percentage of available hemoglobin saturated with oxygen.

Example

A patient has a PaCO₂ of 52 mm Hg and a PaO₂ of 75 mm Hg.

PaCO₂ is elevated, and PaO₂ is decreased.

You answered a similar question correctly on your follow-up quiz, so you’ve already demonstrated improvement here.

Final high-yield recall checklist

Check off each fact once you can recall it

0/10

Ventilation = air movement; diffusion = gas movement; perfusion = blood flow

Nasal flaring, retractions, and accessory muscles all indicate increased work of breathing

Simple face mask must be at least 5 L/min

Nonrebreather = 10–15 L/min in Chapter 40

Venturi provides the most precise fixed FiO₂

Most oxygen targets = 94–98%; selected COPD/hypercapnia-risk targets = 88–92%

Incentive spirometry breath hold = 3–5 seconds

Maximum suction duration = 10–15 seconds

PaCO₂ = 35–45 mm Hg

PaO₂ = 80–100 mm Hg

What I would prioritize for your exam

Your strongest opportunity for improvement is memorizing ABG reference values, oxygen flow rates, and respiratory procedure timing. You already demonstrated a better understanding of perfusion and device selection by scoring 5/5 on your follow-up.

Review the tables, cover the answers, and recite them from memory. These are the specific details I would make automatic before your Test 3.

Elimination Exam Results

Your strongest section was Part 2, where you scored 95%. You demonstrated a good grasp of urinary terminology, incontinence types, specimen collection, catheter safety, and common diagnostic procedures.

The clearest pattern is intake/output calculations, especially deciding whether a net balance is positive or negative. You also missed a few exact textbook facts and two nursing safety/care concepts.

1. Review of all 10 missed questions

These rationales match your assigned urinary and bowel elimination chapters.

2. Your highest-priority review: Intake and output

The formula you need to memorize

\boxed{\text{Net fluid balance}=\text{Intake}-\text{Output}}

Intake greater than output

Positive (+)

More fluid entered than left.

Output greater than intake

Negative (−)

More fluid left than entered.

Your three missed calculations, worked out

Question 40

Intake = 240 + 120 + 180 + 500 = 1,040 mL

Output = 300 + 450 + 100 + 50 = 900 mL

1040-900=\boxed{+140\text{ mL}}

Question 57

Intake = (8 × 30) + (6 × 30) + 360 + 250 = 1,030 mL

Output = 625 + 120 + 85 = 830 mL

1030-830=\boxed{+200\text{ mL}}

Question 58

Remember that IV fluids and enteral feedings count toward intake, not just fluids consumed by mouth.

Test-taking strategy: Write I − O at the top of your scratch paper. Total intake first, total output second, and then subtract in that order. Don’t decide whether the result is positive or negative until you’ve compared the totals.

3. Elimination review sheet — facts to memorize

Urinary elimination

The developmental ages distinguish initial sphincter control from later achievement of toileting independence.

Bowel elimination

Chapter 39 specifically cautions against enemas when there is intestinal obstruction or paralytic ileus. It also distinguishes cleansing enemas, intended to evacuate stool, from oil-retention enemas, intended to soften and lubricate stool.

4. What your results tell me

Priority 1 — Fluid calculations

Three missed questions involved intake/output. Two were sign errors, and one involved forgetting a fluid source. This is your clearest recurring weakness.

Priority 2 — Enema administration and safety

Review retention times, the difference between cleansing and retention enemas, and contraindications. Question 59 is especially important because it involves patient safety.

Priority 3 — Exact textbook facts

Memorize specific gravity, developmental ages, definitions, and timing of mass peristalsis.

Priority 4 — Complete nursing assessments

On SATA questions, consider every assessment obligation separately. In urostomy care, monitoring the stoma is just as important as protecting the skin and measuring output.

5. Your final study checklist

Recall these without looking

0/9

I can distinguish micturition from diuresis.

I know urinary developmental ages.

I know normal urine specific gravity.

I know when mass peristalsis occurs.

I can calculate net fluid balance correctly.

I include every relevant fluid source in intake.

I know the three important urostomy assessments.

I know oil-retention enema timing.

I know when enemas are contraindicated.

My recommendation for your next study session

You’re already demonstrating strong comprehension of the Elimination material, particularly the urinary disorders and nursing procedures. Rather than another full 60-question exam, I’d concentrate on fluid balance problems, enema safety, and exact numerical facts.

To reach 90% on a 60-question practice exam, you need 54 correct answers. That means improving just four of the ten concepts you missed would have gotten you there. The three calculation questions are a particularly useful place to start.

NUR 134 — Rest and Sleep: Final Exam Results

Chapter 35 · Completed 60-Question Knowledge Assessment

FINAL SCORE

53/60

88.3%

Part 1

15/20

75%

Part 2

18/20

90%

Part 3

20/20

100%

You answered all 20 questions correctly in the final section, including both SATA questions.

You missed only 7 questions across the entire exam: 4, 5, 8, 13, 20, 21, and 29. All seven relate to sleep physiology, stages, or terminology. Your performance on sleep disorders, sleep hygiene, nursing assessments, medication safety, and nursing interventions was particularly strong.

You were one correct answer away from 90% (54/60). Your results also show substantial improvement across the three sections.

Your 7 missed questions — with explanations

These distinctions are supported by the uploaded textbook and lecture.

Targeted review sheet

1. NREM versus REM sleep

This is your highest-priority area because three of your missed questions involved sleep stages or sleep architecture.

Sleep stages in your assigned textbook

These are the percentages and four-stage NREM terminology used in Taylor’s Chapter 35.

Memorize the nighttime pattern:

Early night

Longer periods of deep sleep

Toward morning

Longer periods of REM sleep

Memory connection: Stage II takes the biggest share of normal sleep. REM is associated with vivid dream recall, and REM periods lengthen later in the night.

2. Sleep regulation: anatomy and hormones

Your textbook treats these as different parts of the physiology of sleep, so avoid mixing the brain structure with the hormone.

3. Sleep-disorder terminology

Dyssomnias

Your lecture’s category for disturbed sleep quantity, including insomnia and excessive daytime sleepiness.

Parasomnias

Patterns of unusual waking-like behavior during sleep.

The dyssomnia/parasomnia distinction here follows your NUR 134 lecture terminology, while the textbook also discusses more specific diagnostic categories.

Where I recommend focusing your studying

First: NREM and REM characteristics

Spend the most review time on Stage II, Stage IV, vivid dreams, and the way sleep stages change toward morning.

Second: Vocabulary

Focus on distinguishing dyssomnias, parasomnias, somnambulism, and enuresis.

Third: Sleep physiology

Revisit the roles of the hypothalamus, melatonin, and RAS.

Your results show that nursing interventions and patient teaching are strengths: you answered all 20 questions correctly in the final section, including medication precautions, environmental interventions, assessments, and therapeutic approaches.

The remaining opportunity is mostly memorization of specific terminology and physiology rather than gaps in applying nursing care. A focused review of these seven concepts would be more useful than rereading the entire chapter.

Final takeaway: You finished at 88.3%, only one question below a 90% result. Your last two sections were 90% and 100%, which is encouraging progress going into your actual exam.