Description
Nutrition and Diet Therapy for Nurses 1st Edition Tucker Dauffenback Test Bank
ISBN-13: 978-0131722163
ISBN-10: 0131722166
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Tucker and Dauffenbach
Chapter 7
Learning Outcome 1
To examine the role of water in maintaining health.
- The nurse is caring for Mr. H, a 47-year-old client admitted to the hospital for fever of unknown origin. His temperature at the last vital check was 102 degrees F, and he was sweating profusely. The provider ordered I&O on the client to monitor for dehydration. This measurement will include: (Select all that apply.)
- Indeterminate water loss.
- Insensible water loss.
- Sensible water loss.
- Indiscriminate water loss.
- Uncompensated water loss.
Answers: 2, 3
Rationale: Water lost from the body by sweating is referred to as insensible water loss because it is difficult to measure. Sensible water loss refers to water loss which is measurable such as water eliminated in urine. Both types of water lost are calculated to monitor for dehydration. Indeterminate, uncompensated, and indiscriminate are not terms used to define water loss.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
- The ICU patient is NPO. Upon noting that the client’s order for intravenous fluids expired with his last infusion several hours ago, the ICU nurse called to obtain a new order. The nurse is aware that maintaining adequate levels of hydration in a client is essential because in the human body water has many roles including:
- Transport of nutrients and other substances.
- Elimination of fecal material.
- Weight stabilization.
Answer: 1
Rationale: Water has many important roles in the human body including transportation of nutrients and other substances; regulation of the core body temperature; removal of waste products; and lubricant for joints, eyes, and mucous membranes. Water is lost during fecal elimination, but does not cause the process. Weight is affected by the amount of water in the body, but is not stabilized by it. Euhydration refers to a state of water balance.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
- The nurse in charge of the Alzheimer’s unit reminds the nursing assistants several times each shift to offer all the clients a drink and snack. She understands adequate hydration is essential because an even core temperature in the body is maintained as heat from metabolism and physical activity is absorbed by:
Answer: 4
Rationale: Heat produced by metabolism and physical activity are absorbed by water in the body and dissipated to maintain an even core body temperature. This type of water loss is referred to as insensible since it is difficult to measure.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
Learning Outcome 2
To relate sources of water, caffeine, and alcohol in the diet.
- When discussing nutritional needs with the caretaker of an elderly client, the nurse should explain that there are many sources of water in foods which can be included when assessing the daily water intake. An example of this is adding about 100 ml water to the total daily intake that is contained in:
- An apple.
- One slice of bread.
- One cup of pasta.
- Ten French fries.
Answer: 1
Rationale: Many foods in a regular diet contribute to the daily fluid intake. A whole medium size apple contains 118 ml water. Other fruits and vegetables can also be a source of dietary water including: baked potatoes, oranges, green beans, and melons. Considering other sources of water can be especially important with the elderly because of a blunted response to poor hydration.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
- A 16-year-old student came to see the school nurse because she felt “nervous and shaky.” They reviewed her diet history, and the student admitted that she drank 5–6 cups of coffee every morning before school and caffeinated soda during the day despite the fact that her parents asked her to decrease her caffeine intake. The best response for the nurse would be:
- “Caffeine is a form of drug and can cause serious health problems if overused.”
- “You are probably not feeling well because you did not eat breakfast and have low blood sugar.”
- “Many adults drink more caffeine that that in a day.”
- “ Caffeine is a central nervous depressant and can cause you to feel funny.”
Answer: 1
Rationale: Caffeine can be found in coffee, tea, soft drinks, chocolate, energy drinks, and medicine. Caffeine content on these products will be listed on the ingredient list or content label and should be checked prior to use. Overuse of caffeine can cause serious health problems. Caffeine is a central nervous system stimulant and can cause people to feel irritable and/or shaky. Medications containing caffeine include (but are not limited to) analgesics, cold remedies, and stimulants.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
- Mr. D. frequently drinks 3–4 martinis before dinner every night. He does not see himself as an alcoholic. He feels that drinking liquor and beer are very different, and that alcoholics are people who drink beer in excess because only a small amount of liquor is used to make a martini. When discussing sources of alcohol, the best response for the nurse would be:
- “The alcohol in 4 martinis is equal to about 11 cans of regular beer.”
- “People who drink martinis may consume a smaller amount of alcohol but can still be considered alcoholics.”
- “Beer and martinis have the same alcohol and calorie content.”
- “Only beer drinkers are considered alcoholics if they overindulge.”
Answer: 1
Rationale: The average 12-ounce serving of regular beer contains about 14 gm of alcohol. A martini contains about 38 gm of alcohol, almost 11 times more than a can of beer. Anyone who drinks to excess and can’t control their desire for alcohol can be considered an alcoholic. It does not make a difference what type of alcohol they consume.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
Learning Outcome 3
To illustrate methods of assessing fluid requirements.
- A client with Alzheimer’s disease in an assisted living complex has been treated for dehydration twice this year, mostly because he does not drink unless someone offers him water. The best way to monitor hydration status would be to:
- Monitor weight daily.
- Monitor input and output (I&O).
- Offer him coffee several times a day.
- Provide a pitcher of water and track how much he drinks.
Answer: 2
Rationale: Clients with Alzheimer’s disease often have a blunted response to thirst and need to be monitored closely to avoid dehydration. Keeping a record of the daily I&O will provide a tool for determining fluid needs. Coffee has been linked with water loss and may exacerbate the situation. Dependency on others for fluids is always a risk for dehydration, and frequent reminders and coaching is needed even if fluids are in the proximity.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
- The nurse is reviewing labs for her adolescent client who is in the ICU. He had been receiving intravascular fluids until yesterday. She notices that the client has hypernatremia. Her next action should be to:
- Assess the client for skin tenting.
- Obtain a reading on the pulse oximeter.
- Check the client’s temperature.
- Evaluate for edema.
Answer: 1
Rationale: Assessing a client for skin turgor or “tenting” can be used to screen for the hydration status of a client. Although this may not be useful in older adults due to subcutaneous tissue loss and changes in skin elasticity related to aging, it may be a good indicator in an adolescent. Hypernatremia refers to elevated serum sodium levels and signals the loss of water from the extracellular fluid. The condition of hypernatremia does not impact the client’s oxygenation status, temperature or result in edema.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
- The nurse practitioner orders a urine specific gravity for an athlete brought to the emergency department following a marathon for complaints of fatigue, elevated temperature, and confusion. When it returns, the report shows the urine specific gravity to be 1.039. She interprets this as a sign of:
- Hyper hydration.
- Water toxicity.
Answer: 3
Rationale: Normal specific gravity values are 1.002–1.028. A urine specific gravity of 1.030 or greater is a sign of dehydration. This diagnosis is supported by complaints of confusion, fatigue, and elevated temperature. Hyper hydration and water toxicity are terms used to describe an excessive intake of water, a condition usually found in clients with schizophrenia and other mental illnesses. Euhydration is a state of balanced body fluids.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
Learning Outcome 4
To translate the current consensus regarding the role of caffeine and alcohol in overall health.
- Mr. D, a 62-year-old retired client has poorly controlled hypertension. Today his blood pressure was 191/96 mmHG. After the nurse reviewed his diet history she identified several foods that could affect his blood pressure including: (Select all that apply.)
- Ham sandwich with potato chips.
- Ice cream.
- Bacon and eggs.
Answers: 1, 2, 4
Rationale: Caffeine is the most widely used central nervous stimulant in the world and can adversely affect blood pressure. Foods with a high sodium content such as ham, potato chips, and bacon also cause an elevated blood pressure by decreasing the amount of water eliminated in urine. Ice cream and bananas would not affect blood pressure.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
- Which of the following statements about caffeine are true? (Select all that apply.)
- Caffeine can cause toxic side effects in large doses.
- Women and adolescents consume the most caffeine in the United States.
- The amount of caffeine found in coffee and tea varies by brand.
- Caffeine increases gastric acid.
- Soda contains more caffeine than either coffee or tea.
Answers: 1, 3, 4
Rationale: A high intake of caffeine can cause toxic side effects that include vomiting, seizures, tachyarrhythmias, and even death. An estimated 87% of the U.S. population consumes caffeine, with adults and male adolescents the top consumers. The amount of caffeine in coffee and tea is affected by the brand, brewing method, and steeping time. Caffeine increases gastric acid production and lowers the esophageal sphincter pressure which can lead to gastroesophageal reflux and gastritis. The amount of caffeine varies between products and can be determined on the ingredient label.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Comprehension
- Mrs. K is a 35-year-old client who is pregnant with her first child. She works as a consultant, and part of her job involves taking clients to dinner to discuss marketing options for their products. The company she works for expects her to order wine with dinner for herself and her guests. Recently she noticed that if she does not drink the wine her guests seem to feel hesitant to drink theirs as well, making the gesture awkward and wasteful. During her clinic visit she asks the nurse what the “rule” is for drinking during pregnancy. The best response for the nurse would be:
- “One or two glasses of wine with dinner should not be harmful, but avoid liquor and beer.”
- “If having wine with dinner is an expectation for your job you should do it.”
- “To keep your baby as safe as possible, alcohol should be avoided during pregnancy.”
- “Consider ordering beer instead because it contains more nutrients.”
Answer: 3
Rationale: Current recommendations advise women and small men to limit alcohol intake to one drink per day. Children, pregnant and lactating females, individuals with medical conditions or who are taking medications that interact with alcohol should avoid alcohol completely. Adverse events related to excess alcohol in plasma crossing the blood brain barrier is more common in women because of lower body water levels than men. Alcohol ingested by pregnant females acts as a direct toxin on the developing fetal brain and can lead to permanent damage.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
Learning Outcome 5
To summarize signs and symptoms of altered fluid status that can be found when conducting a nursing assessment.
- The nurse is performing an assessment on an elderly client admitted for altered mental status. After assessing the client’s vital signs, the nurse notices which of the following signs that might indicate altered fluid balance? (Select all that apply.)
- Dry oral mucosa
- Lower extremity edema
- Dark colored urine
- Increased heart rate
- Increased respiratory rate
Answers: 1, 3, 4
Rationale: Elderly clients with an altered mental status are at risk for dehydration. When performing a physical assessment there are several signs that may indicate that the client has an altered fluid status including: dry oral mucosa, dark colored urine, and increased heart rate. Lower extremity edema is linked to excess fluid volume and increased respiratory rate is not affected by hydration status.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
- A client is admitted to the emergency department after being found sick at home by the visiting nurse. The visiting nurse’s assessment indicates the client was confused, tachycardic bradycardic, and febrile with a temperature of 102 degrees F. The most appropriate nursing diagnosis is:
- Altered fluid status.
- Viral infection.
- Increased heart rate.
Answer: 1
Rationale: The nursing diagnosis for this client was altered fluid status. Although a viral infection may be the cause of the symptoms she observed, it would be a medical diagnosis. Increased heart rate and fever are two signs of an altered fluid status.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
- An 80-year-old woman who lives alone in a rural area was brought to the clinic by a neighbor after reporting several recent falls. When talking with the nurse she denied any injuries, but said that she recently began to feel dizzy when she gets out of bed or a chair. The nurse is concerned that she may be dehydrated when she notices that the client: (Select all that apply.)
- Has lost over 8 pounds since last month.
- Has an increased heart rate.
- Appears to be slightly confused.
- Has a lower blood pressure than normal.
- Has lower extremity edema.
Answers: 1, 2, 3, 4
Rationale: Symptoms of dehydration can include sudden weight loss, increased heart rate, confusion, tachycardia, and hypotension. The elderly are at an increased risk for dehydration due to blunted thirst perceptions. The recommended fluid intake for females is 2.7 L/day. Edema results from a fluid overload rather than dehydration.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
Learning Outcome 6
To evaluate the role of the nurse in identifying individuals at risk for altered health related to poor fluid status or excessive intake of caffeine or alcohol.
- Nurse F. works at a high school in a small rural town. Her son is a member of the school cross country team. Several times after training he has come home and complained of muscle weakness, dizziness, and increased heart rate. Each time she encouraged him to drink extra fluids and rest and the symptoms resolved. Now that she identified this as a problem, her next course of action would be to: (Select all that apply.)
- Include information about the symptoms and effects of altered fluid status in her health class which is mandatory for all students.
- Arrange a special class for athletes to discuss good hydration and symptoms of dehydration.
- Discuss the need for athletes to have extra fluids with the physical education staff.
- The is no need to do anything else since her son now drinks extra fluids.
- Be present at all sports events to ensure students are adequately hydrated.
Answers: 1, 2, 3
Rationale: Dehydration is a risk for athletes who participate in sports which include strenuous physical activity. Arranging a class for school athletes, including information for all students, and discussing fluid needs with the physical education staff would all be good interventions for the nurse. The nurse should not have to be present at all sports events.
Nursing Process: Implementation
Client Need: Physiological Integrity
Cognitive Level: Application
- A 16-year-old client is seen at the clinic for her monthly prenatal visit. During the visit, the nurse is concerned that she has not been gaining weight. The nurse asks about her daily diet, and also asks about any drug use or alcohol consumption. Initially, the client denied any drug or alcohol use. During the interaction, the nurse explained that drinking during pregnancy can lead to serious problems. Finally the client admits to drinking “a few beers” at parties, but says that her friends said it would not hurt. Appropriate responses by the nurse would be: (Select all that apply.)
- Alcohol use during pregnancy is toxic to the fetus and can affect normal development.
- No amount of alcohol has been proven safe to consume during pregnancy.
- An occasional beer may be safe, but why take a chance with your baby’s health?
- Alcohol can prevent the absorption of nutrients that are important for fetal development.
- This just shows what kind of a mother you will be.
Answers: 1, 2, 4
Rationale: The intake of any amount of alcohol is not recommended during pregnancy. Alcohol acts as a direct toxin on the developing fetal brain and can cause permanent neurocognitive damage. Alcohol constricts blood vessels and limits the amount of blood flowing to the placenta. Any alcohol ingested during pregnancy can lead to fetal alcohol spectrum disorder which causes physical defects and mental and behavioral disabilities. Binge drinking places the fetus at greatest risk. Criticizing the young woman will close the doors of communication.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
- Mr. S is a 60-year-old obese client in for a yearly clinic visit. The nurse assesses his vital signs, and asks him about his current medical problems. He tells her that he feels fine, plays golf several times a week, and has stopped smoking cigarettes. When she asks about his alcohol intake he tells her that he has started to drink two glasses of wine each night because he heard it is good for his heart. The best response for the nurse would be:
- “Two glasses of wine would be considered drinking in moderation, but any more could cause problems such as hypertension or liver disease.”
- “Any amount of alcohol is bad for your health.”
- “Wine is low in calories so should not cause weight gain.”
- “Wine has definitely been linked with liver cancer and should be avoided.”
Answer: 1
Rationale: The current recommendation for alcohol intake is one drink per day for small men and women, whereas two drinks would be considered drinking in moderation for larger men. Moderate intake of alcohol can have some health benefits, but in excess has been linked to cancers, hypertension, depression, insomnia, and disorders of the gastrointestinal tract. Wine contains about 125 calories per 5-oz glass.
Nursing Process: Assessment
Client Need: Physiological Integrity
Cognitive Level: Application
