Diet and Nutrition Final TB 19 & 20

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Nutrition and Diet Therapy
Chapters 19, 20
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1

Compared with renal failure clients who are not on dialysis, clients on continuous ambulatory peritoneal dialysis require:

the same amount of dietary protein

less dietary protein

more dietary protein

a different kind of protein

c

2

Which of the following is a good snack for a client with acute renal failure who is not on dialysis and does not have diabetes?

hard candy

cheese

milk

oranges

a

3

Most renal clients need to avoid salt substitutes because they often contain:

phosphorus

potassium

protein

calcium

b

4

Which of the following are high in potassium?

grapes

apple and cranberry juices

baked potatoes

canned pears

c

5

Mr. S is being treated for renal calculi. The first priority for teaching self-care to this client is to:

increase fluid intake

limit calcium and phosphorus intake

restrict all protein from meat, fish, and poultry sources

restrict high-purine foods, such as anchovies and liver

a

6

When caring for a client with acute glomerulonephritis, the nurse should expect to:

increase his or her calcium and phosphorus intake

restrain his or her energy intake to avoid weight gain

restrict his protein to 20 g/day

meticulously monitor his or her intake and output

d

7

A 56-year-old woman is being treated for acute renal failure. The physician has ordered a 60-g protein diet. When the client's family inquires about the purpose of the diet, the appropriate response is that it is intended to help control the level of ______ in the client's blood.

potassium

sodium

blood urea nitrogen (BUN)

water

c

8

A potassium intake usually is necessary in clients displaying:

periorbital edema

peripheral edema

oliguria

polyuria

c

9

Clients with diabetes and end-stage renal disease must recognize that the need to adjust protein and electrolytes outweighs the need to restrict ______.

complex carbohydrates

simple carbohydrates

saturated fats

vegetable proteins

b

10

Dialysis clients may receive supplemental ______ because of the inability of the diseased kidney to activate this vitamin.

vitamin B12

folic acid

vitamin D

vitamin K

c

11

Clients with kidney stones are usually advised to:

avoid organ meats

drink 3 L of fluid per day

take 8 oz of cranberry juice daily

eliminate calcium-containing foods from their diet

b

12

Ms. M has had four urinary tract infections during the past year. Common appropriate advice is to have her ______.

abstain from sexual intercourse

drink at least 8 cups of fluid daily

avoid milk and meat in excess of the Food Pyramid parameters

drink cranberry juice daily

d

13

Ms. M has had four urinary tract infections during the past year that were treated in a health clinic. Despite compliance with the medication and nutritional program, she has taken longer than average to recover each time and now has a recurrence. Which of the following interventions would help determine the underlying problem?

Test the client's urine for glucose and acetone.

Refer the client to a dietitian for a thorough nutritional assessment.

Recommend that the physician order a white blood cell count and a serum albumin analysis.

Suggest that the client be seen in the sexually transmitted diseases clinic as soon as possible.

a

14

Mr. J is found to have an elevated serum phosphorus level after 6 months on hemodialysis. Mr. J needs help filling out his menu. Which lunch would best meet his needs?

roast beef, noodles, a sliced fresh orange, and milk

baked chicken, rice, fresh grapes, and cranberry juice

macaroni and cheese, a bran muffin, cooked spinach, apricot halves, and lemonade

hamburger on a whole-grain bun, potato chips, a dill pickle, and a cola

b

15

Which of the following interventions is not appropriate for a client with renal disease and anemia?

an iron-rich diet

liberal amounts of foods high in vitamin C

diagnostic studies to identify hidden bleeding

supplementation with water-soluble vitamin K

d

16

Epoetin alfa, a pharmaceutical form of erythropoietin, may be prescribed for clients with renal disease. This drug:

stimulates the liver to liberate stored iron for hemoglobin

binds with ferritin to make it more usable by the bone marrow

replaces a hormone released by the kidney that stimulates red blood cell production

is a special preparation of bioavailable iron

c

17

Dialysis dementia is sometimes seen in clients who have been dialyzed for a number of years. Which of the following interventions is designed to minimize this complication?

control of dietary protein

daily doses of cod liver oil

oral fluid restriction

restriction of dietary phosphate

d

18

Gout is:

a hereditary metabolic disease

caused by an error in fat metabolism

a form of osteodystrophy caused by kidney failure

untreatable except by diet

a

19

Which of the following foods may have precipitated an attack of gout and consequently may need to be avoided by the client?

A)

gravy, liver, and oil-packed sardines

B)

Roquefort cheese, buttermilk, and vegetable soup

C)

chocolate ice cream, chicken-fried steak, and Caesar salad

D)

eggs, pecan rolls, and coffee

a

20

The substances restricted in dietary treatment of gout are:

fatty acids

purines

calcium-rich foods

oxalates

b

21

The toxic condition characterized by retention of nitrogenous substances in the blood is called:

dialysis dementia

oliguria

renal insufficiency

uremia

d

22

When blood is removed from the body and forced over a semipermeable to clean wastes and then replaced back into the body over a 3- to 5-hour period three or more times a week, this is called:

continuous ambulatory peritoneal dialysis

glomerular dialysis

hemodialysis

intermittent peritoneal dialysis

c

23

Ms. T has chronic renal failure. Client teaching should be based on which of the following rationales?

Perhaps the dietary instructions were not well presented or Ms. T was not ready to accept the diet prescription in the past.

Protein should always be restricted in clients with chronic renal failure.

Different nutritional interventions are appropriate at different stages of the disease.

If Ms. T is not more compliant, she will have to undergo dialysis or kidney transplant.

c

24

Mr. F has a chronic kidney disease and has been losing weight. All the following groups of foods except one will probably be given in large amounts to increase his energy intake. Identify the inappropriate foods.

margarine, table sugar, and oil

milk, any kind of nuts, and orange juice

olives, jelly beans, and Popsicles

eggs, suckers, and nondairy creamers

b

25

Mr. F has a chronic kidney disease and has been losing weight. Sufficient energy intake is necessary to:

prevent catabolizing his tissues for fuel

maintain his activities of daily living

provide at least 80% of his resting energy expenditure

utilize all the vitamins he is receiving

a

26

Renal clients may have to control dietary intake of total kilocalories, protein, potassium, sodium, and fluid. The exact diet prescription may change over time because:

of decreased intake as the disease progresses

of increased intake early in the disease

of the client's clinical condition and the treatment approach

types of intake hinge on the client's tolerance and appetite

c

27

Clients with potassium restrictions may be instructed to do all the following procedures except one. Identify the exception.

Cook vegetables in large amounts of water, which is afterward discarded.

Use salt substitutes only after cooking.

Drink carbonated beverages, cranberry juice, or lemonade.

Use any of the permitted foods only in the form specified.

b

28

Clients with potassium restrictions may be instructed to do all the following procedures except one. Identify the exception.

Cook vegetables in large amounts of water, which is afterward discarded.

Use salt substitutes only after cooking.

Drink carbonated beverages, cranberry juice, or lemonade.

Use any of the permitted foods only in the form specified.

a

29

A measurable goal for a client with renal calculi is to drink sufficient water to produce a urinary output of ______ mL/day.

500

1,000

2,000

3,000

c

30

Which of the following interventions for kidney stones has been shown to be ineffective?

a low-oxalate diet

forcing fluids

a low-purine diet

a low-calcium diet

d

31

Sodium is lowest in the following foods:

milk and meat

fat and fruit

starch and milk

fresh fruits and vegetables

d

32

A low-potassium, low-phosphorus alternative to milk is:

monounsaturated liquid nondairy creamer

milk treated with Lact-aid

soy milk

Alterna

a

33

The general dietary protein recommendation for clients with renal insufficiency is:

1 g/kg of actual body weight

0.6 g/kg of actual body weight

1.2 to 1.5 g/kg of healthy body weight

1.2 to 1.5 g/kg of actual body weight

a

34

One-half cup of the following is usually considered 60 cc of fluid:

A)

watermelon

B)

coffee

C)

ice chips

D)

milk

c

35

Which one of the following is low in potassium?

baked beans

chocolate

spinach

gumdrops

d

36

Many clients with renal disease need to be intermittently concerned about the intake of the following:

total kilocalories

fluid

protein

sodium and potassium

all

37

Causes for renal disease include the following:

trauma

excessive fluid intake

infection

medications

abcd

38

Functions of the kidney include:

secretion of ions to maintain acid-base balance

production of erythropoietin

synthesis of bile

production of activated form of vitamin D

acd

39

The following statement(s) is(are) true:

Obesity increases the risk of renal disease.

Normalization of blood pressure and blood glucose are goals for diabetes treatment.

High lipid levels increase the risk of renal disease.

A low-potassium diet minimizes the risk of kidney disease.

abc

40

Significant hypertriglyceridemia is often present in clients with a history of renal disease. The nutritional care of clients with elevated triglycerides includes:

a modified-fat diet

modification of CHO intake

a low-potassium diet

increased intake of monounsaturated fats

abd

41

Clients with ______ should have serum levels of fat-soluble vitamins and vitamin B12 monitored every 6 months.

chronic pancreatitis

gastroesophageal reflux disease (GERD)

peptic ulcer disease

cholelithiasis

a

42

Surgical clients have an increased need for ______ because it helps build connective tissue.

acetic acid

acetylsalicylic acid

ascorbic acid

nicotinic acid

c

43

The client with dumping syndrome should be taught to:

drink plenty of fluids with meals

lie down after meals

limit protein to 30 g/day

eat high-carbohydrate meals

b

44

A client with acute colitis will probably be given a ______ diet.

high-protein

low-fat

low-residue

sodium-restricted

c

45

aFoods thought to be deodorizing, which may help the ostomy client, include:

buttermilk and yogurt

celery and corn

figs and prunes

ham and eggs

a

46

A client complains of constipation. Which of the following habits is likely to contribute the most to the client's constipation?

being a vegetarian

eating the largest meal at noon

limiting fruits and vegetables to cooked ones

using low-calorie foods and beverages for weight control

c

47

Clients with hepatitis and cirrhosis of the liver are likely to consume their best intake at:

breakfast

lunch

dinner

bedtime

a

48

Which of the following is allowed on a low-fat diet?

French fries

goose

peanut butter

sherbet

d

49

A client with which of the following conditions is likely to be given pancreatic enzymes (pancrelipase) before meals?

cholecystitis

cystic fibrosis

diabetes

hiatal hernia

b

50

An alcoholic client with cirrhosis of the liver is admitted following 2 days of vomiting and diarrhea. The physician orders a hydrating solution of 5% dextrose in water intravenously. If thiamin is not included in that order, the nurse should inquire about it because:

thiamin is necessary to predigest the dextrose for immediate absorption

intravenous glucose without thiamin in the cirrhosis client can precipitate the Wernicke-Korsakoff syndrome

thiamin prevents folic acid stores from being diluted by the hydrating solution

deficiency of thiamin causes delirium tremens

b

51

Polymorphisms in the organism and the client are suspected of contributing to the different presentations of:

diverticular disease

gastroduodenal disease

gastroesophageal reflux disease (GERD)

celiac disease

b

52

Which of the following diseases is suspected of having an autoimmune component?

celiac disease

Crohn's disease

ulcerative colitis

all of the above

d

53

Clients who have had resection of the ______ are vulnerable to vitamin B12 deficiency.

duodenum

jejunum

ileum

liver

c

54

The nurse has determined that a client with cirrhosis of the liver has vomited blood. Which of the following diet modifications should the nurse request?

iron rich

high fiber

full liquid to soft

low protein

c

55

Which of the following are least likely to cause the ostomy client problems?

eggs, green pepper, and corn

applesauce, cheese, and tomato juice

beans, fish, and diet soda

broccoli, beer, and peanuts

b

56

Which of the following foods can be valuable in treating constipation?

cheese

milk

prunes

strained orange juice

c

57

In addition to avoiding barley, rye, and wheat, a person with celiac disease (gluten-sensitive enteropathy) has to be very careful about consuming ______ because of frequent contamination of the product with gluten during production.

oats

58

When diet modification is advisable, the client with cholecystitis will probably be given a ______ diet.

low-protein

low-fat

low-residue

low-carbohydrate

b

59

Nutrients especially needed by surgical clients include protein, vitamins C and K, and zinc. Protein is necessary to build scar tissue and to:

control edema in the wound

correct anemia

make antibodies

prevent ketosis

a

60

Davey is a 5-year-old tonsillectomy client on a clear-liquid diet. Which of the following fluids is best to offer him?

apple juice

cranberry juice

orange juice

tea

a

61

The often-prescribed 2 L/day of D5W (5% dextrose in water) for postoperative clients is used to:

administer the Recommended Dietary Allowance for kilocalories

challenge the client's renal system

provide fluids and prevent ketosis

alleviate nausea and prevent vomiting

c

62

Ascites in the client with cirrhosis of the liver is worsened by sodium retention and:

jaundice

diuresis

diaphoresis

hypoalbuminemia

d

63

The “E” in the CAGE questionnaire stands for:

“Have you ever felt guilty about your drinking?”

“Have you ever needed to start the day with a drink?”

“Have you ever had a need to decrease your drinking?”

“Have people irritated you with criticism about your drinking?”

b

64

The systemic effects of the dumping syndrome are:

bradycardia, dyspnea, and polyuria

headache, blurred vision, and hypertension

nausea, vomiting, and diarrhea

weakness, sweating, and hypotension

d

65

To reduce the risk of gallstones, clients could be advised to:

eat breakfast

limit fluid intake after supper

eliminate fats from their diets

add vinegar to cooked vegetables

a

66

The single most important factor in nutrient deficiencies in the United States is:

peptic ulcer disease

celiac disease

cholelithiasis

alcoholism

d

67

Ms. S has been scheduled for a colonoscopy. To facilitate the preparation of the bowel, she is instructed to consume a low-residue diet 2 days before and a clear-liquid diet the day before the procedure. Which of the following foods are appropriate on a low-residue diet?

liquefied carrot juice, fried eggs, and raisin bread

lettuce, boiled ham, and buttered noodles

chili with beans, whole-wheat crackers, and aged cheddar cheese

ripe peach, deep-fried chicken breast, and cornbread

b

68

Ms. P is a 78-year-old resident of a home for the aged where independence is the norm. She is being taught a diet for hiatal hernia. Selection of which of the following foods indicates that she understands the instructions?

chocolate milk, bean soup, and Boston brown bread

decaffeinated coffee, tuna salad, and melon balls

peppermint tea, coleslaw, and fried egg

skim milk, canned carrots, and lean roast pork

d

69

Which of the following foods is safest to include for breakfast for a client with a history of dumping syndrome and lactose intolerance?

orange juice, pecan roll, and coffee

grapefruit half, raisin toast, and cinnamon sugar

plain doughnut, cranberry juice cocktail, and eggnog

bagel, banana, and oatmeal with butter

d

70

The self-treatment for diarrhea in healthy adults includes which of the following?

nothing by mouth for 24 hours

when beginning clear liquids, use milk cautiously

when taking full-liquid diet, include banana for pectin content

avoid very hot, very cold, and caffeine-containing beverages

d

71

Which of the following dietary modifications is suggested for gastroesophageal reflux disease (GERD)?

consuming a small glass of wine with meals

taking mint lozenges after meals

planning small, frequent meals that include protein

substituting decaffeinated coffee for regular

c

72

Which of the following items is associated with tightening the cardiac sphincter?

alcohol

peppermint

chocolate

protein

d

73

Which of the following statements about peptic ulcer treatment is true?

Modern medications are almost always effective without a drastic change in diet.

Avoidance of alcohol and coffee is required to promote healing.

Whole milk is advised to neutralize gastric acid.

Surgery for peptic ulcer cures the disease with no long-term nutritional effects.

a

74

The recommended fiber intake for clients with uncomplicated diverticulosis is ______ grams per day.

30

75

Clients with liver disease may be better able to digest fats in ______ than in other foods.

liquid and soft margarines

milk products and eggs

fish and poultry

quick breads and pastries

b

76

To maintain homeostasis for a client who is NPO (nothing by mouth) with a gastric suctioning device in place, freezing ______ to provide ice chips can be helpful.

sugar solutions

salt solutions

carbonated beverages

electrolyte solutions

d

77

Over the long term, clients with cystic fibrosis need to be monitored for:

cardiovascular disease

diabetes mellitus

kidney disease

osteoporosis

b

78

Clients with cystic fibrosis are particularly susceptible to all but one of the following conditions. Identify the exception.

growth failure

obesity

mineral deficiencies

vitamin deficiencies

b

79

The American Society of Anesthesiologists' guidelines suggest which of the following intakes is permissible for healthy individuals undergoing elective procedures?

white grape juice until 2 hours before the procedure

breast milk until 2 hours before scheduled surgery

infant formula 4 hours before an elective procedure begins

meal containing roast chicken 6 hours before scheduled surgery

a

80

Alcohol education for teenagers should always include:

information about acute poisoning

suggestions to increase vitamin and mineral intake

test data on the length of time it takes to metabolize alcohol

demonstration of intoxicated behavior

a

81

Which of the following factors has not been implicated in the etiology of inflammatory bowel disease?

autoimmune reaction to bacterial flora in the bowel

environmental factors

genetic susceptibility

reactivation of a viral infection

d

82

Which of the following is commonly transmitted by the oral–fecal route?

hepatitis A

hepatitis B

hepatitis C

peritonitis

a

83

Which of the following meals would be best for someone with delayed gastric emptying?

whole-milk eggnog and vanilla wafers

beef stew with dumplings

chicken rice soup and skim milk

split pea soup and wheat crackers

c

84

Which of the following practices should be avoided to prevent traveler's diarrhea?

drinking sealed carbonated beverages without ice

buying foods from street vendors

eating cooked foods piping hot

selecting dry foods such as bread and cereal

b

85

When clients experience a flare in Crohn's disease, which of the following foods may increase diarrhea and cramping?

A)

bananas

B)

carrots

C)

milk

D)

rice

c

86

Which of the following items have not been associated with relapse from remission in clients with ulcerative colitis?

alcohol

potatoes

red meat

sausage

b

87

Which of the following statements about Crohn's disease and ulcerative colitis is false?

Both are local diseases with signs and symptoms confined to the bowel.

About 20% of Inflammatory Bowel Disease (IBD) clients have a first-degree relative (parent, sibling, child) with the disease.

Dietary restrictions are not included as part of therapy.

Common, nonpathogenic microorganisms of intestinal tract are thought to be causally related.

a

88

All but one of the following measures can be helpful in treating postprandial hypotension. Identify the exception.

eating small, frequent meals

limiting carbohydrate intake

resting in a recliner after eating

increasing fiber intake

d