Nutrition Chapter 26 Flashcards

Question 1

Q

What are the fat soluble vitamins

Question 2

Q

What are the water soluble vitamins

Answer

A

Thiamin
Riboflavin
Niacin
B6 (Pyridoxin)
Panothenic Acid
Folacin (Folate, Folic Acid)
B12 (Cyanocobalamin)

Question 3

Q

Name the minerals

Answer

A

Calcium (Ca)
Magnesium (Mg)
Phosphorus (P)
Potassium (K)
Sodium (Na)

Question 4

Q

Name a trace Mineral

Question 5

Q

Why do we need vitamin A?

Answer

A

For night and Color Vision
For Cellular Growth and Maturity
Maintaining healthy skin and mucus membranes
Growth of skeletal and soft tissues
Reproduction

Question 6

Q

What is the daily reccomended amount of vitamin A for Men and Women

Answer

A

Women: 700mcg/day
Men: 900 Mcg/day

Question 7

Q

What are a few foods that are a good source of vitamin A

Answer

A

Fish liver oil
liver
cream
egg yolk
fruit
green leafy veggies
fortified milk

Question 8

Q

What are the effects of Vitamin A Deficiency

Answer

A

Night Blindness
xerosis
xerophthalmia
keratomalacia
Skin lesions

Question 9

Q

What are some symptoms of too much vitamin A

Answer

A

GI upset
headache
blurred vision
poor muscle coordination
fetal defects

Question 10

Q

Why do we need vitamin D

Answer

A

it regulates blood calcium levels

- it regulates rate of deposit and resorption of calcuim in the bone

Question 11

Q

What is the daily recomended amount of vitamin D

Answer

A

under 50 = 5mcg/day
51-70 = 10 mcg/day
71 + = 15 mcg/day

Question 12

Q

What foods are rich with vitamin D

Answer

A

fish liver oil
fish
fortified milk
sunlight exposure

Question 13

Q

What are the effects of vitamin D deficiency

Answer

A

bone and muscle pain
weakness
softening of bone
fractures
rickets

Question 14

Q

What are the symptoms of too much vitamin D

Answer

A

fatigue
weakness
loss of appetite
headache
mental confusion
mental retardation in infants

Question 15

Q

What is viamin E and why do we need it?

Answer

A

It is an antioxydant

Protects red blood cells and muscle tissue cells

Question 16

Q

What is the daily reccomended amount of vitamin E

Answer

A

15 mg/day for 14+

Question 17

Q

What are some good sources of vitamin E

Answer

A

Veg oils
nuts
milk
eggs
muscle meats
fish
wheat
rice germ
green leafy veggies

Question 18

Q

What are the effects of vitamin E deficiency

Answer

A

Hyporeflexia
ataxia
hemolytic anemia
myopathy

Question 19

Q

What are some symptoms of excess vitamin E

Answer

A

Insufficient blood clotting

impaired immune system

Question 20

Q

Why do we need vitamin K

Answer

A

for synthesis of clotting factors

- bone development

Question 21

Q

What is the daily recommended amount of vitamin K in men and women age 19+

Answer

A

Women= 90mcg/day
Men= 120 mcg/day

Question 22

Q

What are some good sources of vitamin K

Answer

A

Green leafy veggies

liver

Question 23

Q

What are the effects of a vitamin K deficiency

Answer

A

increased bleeding

Question 24

Q

What are some symptoms of too much vitamin k

Answer

A

Jaundice and hemolytic anemia in infants

Question 25

Q

Why is a defieciency of vitamin K unlikely

Answer

A

because intestinal bacteria synthesize a form of vitamin K

Question 26

Q

What are the DRIs?

Answer

A

DRIs are “dietary reference intakes” established by the National Academy of Sciences in a collaborative effort of the United States and Canada to promote the consumption of healthful nutrient levels by all Americans. These guidelines include DRIs for vitamins and minerals, protein, and total energy that are thought to meet the needs of 98% of individuals in a group. For carbohydrates and lipids, the acceptable macronutrient distribution range (AMDR) is used. The DRIs are actually a revision of the older recommended dietary allowances (RDAs). Because the revision is not yet complete for all nutrients, the tables in Chapter 26 of Volume 1 include both RDAs and DRIs.

Question 27

Q

List the current USDA dietary guidelines for Americans.

Answer

A

Current dietary guidelines are as follows:

● Consume a variety of nutrient-rich foods daily.

● Adopt a balanced eating pattern (e.g., the USDA Food Guide) to meet recommended intakes.

● Limit the intake of saturated fats, trans fats, and cholesterol. Keep fat intake below 20% to 35% of total calories. Most fats should come from foods such as fish, nuts, and vegetable oils.

● Limit your intake of added sugars, salt, and alcohol.

● Achieve and maintain a healthy weight.

● Be physically active each day.

● Balance energy (kcal) intake with increase or decrease in activity.

● Choose a variety of fruits and vegetables each day.

● Choose fiber-rich fruit, vegetables and whole grains often. At least half the grains should come from whole grains.

● Cook, chill, and store foods to keep them safe from microorganisms.

● Clean hands, food contact surfaces, and fruits and vegetables. Do not wash or rinse meat and poultry. (Also see Chapter 21 for food safety.)

Question 28

Q

What is the body’s most usable energy source?

Answer

A

Carbohydrates, especially glucose, provide the most usable energy.

Question 29

Q

Which nutrient’s primary function is growth and repair of tissue?

Answer

A

The primary function of dietary protein is the growth and repair of body tissues. Secondarily, proteins attract water in the bloodstream and contribute to regulating fluid-balance in the body. They function as buffers for regulating acid–base balance. Proteins are a secondary energy source. They are also involved in immune defense.

Question 30

Q

Identify five functions of adipose tissue (body fat).

Answer

A

Answers may include any of the following functions of body fat:

● Energy supply

● Thermal insulation

● Vital organ protection

● Nerve impulse transmission

● Tissue membrane structure

● Cell metabolism

● Essential precursor substances

Question 31

Q

Which type of vitamin requires daily consumption to maintain appropriate levels?

Answer

A

Water-soluble vitamins require daily intake because they are eliminated in the urine with little storage in the body.

Question 32

Q

What distinguishes a major mineral from a trace mineral?

Answer

A

Major minerals are those needed in amounts of 100 mg or greater per day. Trace minerals are essential, but needed in lower amounts.

Question 33

Q

Identify at least four functions of water.

Answer

A

Water has the following functions:

● Solvent. Water is the basic solvent for the body’s chemical processes, assisting in the regulation of nerve impulses and muscle contractions.

● Transport. Circulating as blood, water serves a medium for transporting oxygen, nutrients, and metabolic wastes.

● Body structure and form. Water “fills in the spaces” in body tissues (e.g., in muscle) providing structure and form to the body.

● Temperature. Water helps maintain body temperature and creates the necessary environment and temperature for cellular metabolism to occur. When body temperature rises, evaporation of sweat helps cool the body.

Question 34

Q

Imagine that you have just eaten a food consisting of 4 grams of protein, 18 grams of carbohydrate, and 1 gram of fat.

What would your total kcal intake be?

Answer

A

Answer:

97 kcal total

4 g protein X 4 kcal/g = 16 kcal

18 g carbohydrate X 4 kcal/g = 72 kcal

1 g fat X 9 kcal/g = 9 kcal
16 + 72 + 9 = 97 kcal

Question 35

Q

What percent of your kcal are from carbohydrates? Protein? Fat?

Answer

A

To calculate these percentages, divide the kcal for each nutrient by the total kcal in the food (97).

● Carbohydrates. 72 divided by 97 = 0.74 = 74%

● Protein. 16 divided by 97 = 0.16 = 16%

● Fat. 9 divided by 97 = 0.09 = 9%

Question 36

Q

You have already calculated the expected BMR for Mr. Schwartz (“Meet Your Patients”) for a 24-hour period:

Recall that Mr. Schwartz weighs 245 lb. Using the BMR formula in Box 26-3 (Chapter 26 of Volume 1), the BMR for Mr. Schwartz is 2673.6 kcal/day.

● If Mr. Schwartz describes himself as working at a desk 8 to 10 hours per day, lawn mowing manually every other week during the summer, and playing an occasional game of golf, how would you classify his general activity level?

Answer

A

Mr. Schwartz spends a considerable amount of time in sedentary activity. His work at the desk would be considered light activity. His outside activities are limited and extend only up into the light-to-moderate activity level.

Question 37

Q

After interviewing Mr. Schwartz, you estimate his average caloric intake to be approximately 3,000 caloric per day. Determine whether his kcal intake is sufficient or insufficient to maintain his present activity level.

Answer

A

Mr. Schwartz is 69 inches tall and weighs 245 lb, so he is overweight. A general evaluation of the data shows that the BMR for Mr. Schwartz is 2,674 kcal per day—this is the energy required to maintain his weight. Because his activity level is light, he will need a limited number of additional kcal to maintain this weight. If he consumes 3,000 kcal per day, he should have more than enough kcal to maintain his activity level and weight; he may even gain weight on this level of energy (kcal) intake.

To use the more specific energy requirements presented in Volume 1, Table 26-7, a sedentary person who is overweight requires 9 to 11 kcal per pound of body weight per day. Using the midrange, 10, Mr. Schwartz could maintain his present weight with a daily intake of 10 kcal/lb ´ 245 lb—2,450 kcal per day.

Question 38

Q

Why is breast milk an ideal food source for infants?

Answer

A

Breast milk is the ideal food for infants because it is matched to their nutritional requirements. It enhances the maturation of the infant’s immune system and provides passive immunity against a number of infections. Breastfed infants also have a reduced exposure to foreign dietary antigen and believed to have a reduced risk of subsequent allergies.

Question 39

Q

Why are the infant’s nutritional needs per unit of body weight greater than at any other time?

Answer

A

Infants’ nutritional needs are greatest because the most rapid growth occurs during the first year of life. Birth weight triples during the first year and length increases 50%.

Question 40

Q

Why is it sometimes a challenge to meet the nutritional needs of toddlers?

Answer

A

Answers will vary, but may include the following reasons:

● Toddlers may assert their autonomy and manipulate their parents by refusing the foods offered.

● Toddlers may take a long time to eat or refuse to eat at all.

● Toddlers are beginning to form attitudes about food.

● They are mobile and might be distracted during meal times.

Question 41

Q

What is the challenge in meeting the nutritional needs of school-age children?

Answer

A

For school-age children, parental control over food intake declines as the child eats lunch at school and advertising influences his food choices. The child may buy junk food with his lunch money. Even if the child brings lunch from home, he may trade his food or not eat lunch at all.

Question 42

Q

Which age group experiences a growth spurt second only to that of infants?

Answer

A

Adolescents

Question 43

Q

Why are energy (kcal) requirements less for older adults?

Answer

A

For older adults, lean body mass is lost and appetite, physical activity, and BMR decrease, resulting in slightly reduced energy requirements.

Question 44

Q

List at least three nutrients that may be more difficult to supply with a vegetarian diet.

Answer

A

Nutrients more difficult to supply with a vegetarian diet are vitamin B12, protein, calcium, iron, zinc, and vitamin D. Vegans must supplement these nutrients and calcium or consume foods fortified with them.

Question 45

Q

When selecting a program for weight loss, what factors should a person consider?

Answer

A

One should consider whether a diet is nutritionally and scientifically sound. For example, is it recommended by a respected organization, or is it a fad diet? Moderate calorie-restriction diets such as the American Heart Association diet describe food selection and preparation tips and other behavior modifications that can lead to slow, sustained weight loss, promote a diet that includes a variety of food choices and a balance of nutrients, and encourage physical activity as a cornerstone of weight loss. In contrast, fad diets often promise quick and dramatic weight loss, limit the range of foods from which the dieter can select, often recommend consuming supplements and/or specialized packaged meals, or include no practical strategies that help dieters permanently change eating and activity patterns.

Question 46

Q

Why should you encourage clients from various cultures to follow their traditional diets?

Answer

A

Traditional diets of many cultures are healthy and honor and respect family or cultural traditions. Adaptations made to these diets have compromised the nutritional quality.

Question 47

Q

Describe the effects on nutrition of (a) smoking and (b) heavy alcohol use.

Answer

A

The effects on nutrition are as follows:

● Smoking. Smokers use Vitamin C faster than nonsmokers. Even children exposed to secondhand smoke tend to have lower plasma levels of ascorbate than unexposed children (Aghdassi, Royall, & Allard, 1999; Preston, 2003). If the person cannot quit smoking, a vitamin C supplement may help compensate.

● Alcohol. A 12-oz beer contains 150 kcal; a juice-based cocktail contains about 160 kcal. Such drinks can add many unnecessary calories to the regular diet. In addition, alcohol significantly decreases the rate of fat metabolism, contributing to obesity. Excessive alcohol use interferes with adequate nutrition by (a) replacing the food in the person’s diet, (b) depressing the appetite, (c) decreasing the absorption of nutrients by its toxic effects on intestinal mucosa, and (d) impairing the storage of nutrients. People who use alcohol heavily will need multivitamin supplements, especially rich in B vitamins and folic acid.

Question 48

Q

What is the most accurate type of food diary?

Answer

A

The food record is the most accurate food diary. From the detailed information collected, you can analyze the total energy (kcal) and nutrient content for the recorded period.

Question 49

Q

Compare and contrast four nutritional screening approaches.

Answer

A

Answers should include the following aspects of the nutritional screening approaches:

● Cursory screening consists of evaluating height, weight, and BMI, coupled with a brief dietary history. More detailed screening is required when nutritional problems are suspected.

● The subjective global assessment (SGA) method is completed by an experienced clinician who examines subjective and objective parts of a medical history and physical examination to evaluate a client’s nutritional status. It may be used with any type of client. Success with this tool has been mixed because it is largely dependent on the experience of the clinician.

● The Mini Nutritional Assessment (MNA) and Nutrition Screening Initiative (NSI) were developed primarily for use with elderly clients.

● The MNA is a simple and quick method of identifying individuals with nutritional risk or with malnutrition.

● The NSI addresses nutritional concerns associated with chronic diseases that are frequently seen in older adults. The NSI requires collection and evaluation of data in four areas: clinical, dietary, body composition, and biochemical.

Question 50

Q

Identify three nutritional risk factors.

Answer

A

Answers may include any of the following nutritional risk factors:

● Inappropriate food intake

● Poverty

● Social isolation

● Dependency or disability

● Acute or chronic health conditions

● Chronic medication use

● Aging

Question 51

Q

What are the most reliable locations for skinfold measurement?

Answer

A

Answer:

The most reliable locations for skinfold measurement are as follows:

● Triceps for children and women

● Subscapular area in men

Question 52

Q

What are the implications of an increased WHR?

Answer

A

A waist-to-hip ratio (WHR) evaluates obesity by looking at the amount of abdominal fat present. A high level of abdominal fat is associated with increased risk for hypertension, diabetes, hyperlipidemia, and cardiovascular disease. A WHR greater than 1.0 in men and greater than 0.8 in women indicates obesity.

Question 53

Q

Identify at least 10 physical examination findings that would lead you to suspect nutritional problems.

Answer

A

Answers may include any of the following examination findings:

● An increase in temperature

● An elevated BP may be related to fluid volume excess; a low BP may be a sign of dehydration. Heart rate usually responds in an inverse fashion.

● A BMI less than18 or greater than25

● An appearance of illness

● Poor skin turgor

● Poor wound healing

● Constipation

● Any areas of warmth or erythema require investigation

● Red, swollen skin lesions, excessive bleeding and xerosis

● Abnormal nail findings

● Hair that grows slowly, is thin, or easily breaks

● Irritation of the mouth, teeth, and gums

● Facial paralysis or drooping of one side of the face

● An enlarged thyroid gland

● Bounding pulses or a weak, thready pulse

● Edema

● An abdomen that is scaphoid or concave, round to protuberant, or generally enlarged

● Hyperactive or hypoactive bowel sounds

● Thin extremities with excess skinfolds

● Enlarged skinfold measurements

● Joint swelling, deformities, or limitation in range of motion

● Joint pain on palpation or with movement

● Cognitive deficits or severe psychiatric disorders

● Motor or sensory deficits

● Confusion, weakness, or diminished reflexes

Question 54

Q

What factors would lead to poor wound healing?

Answer

A

Factors contributing to diminished healing are insufficient intake of protein, vitamin C, and zinc.

Question 55

Q

What are the likely causes of hyperglycemia?

Answer

A

Elevated glucose levels may develop from excessive carbohydrate intake or emotional or physical stressors. Although it may not have been stated in this chapter in Volume 1, elevated glucose levels can also occur because of insufficient physical activity or insufficient diabetes medication

Question 56

Q

Why is it important to identify the serum albumin level?

Answer

A

Serum albumin levels are useful in identifying chronic nutritional deficiency and malnutrition.

Question 57

Q

When is enteral nutrition the preferred alternative feeding?

Answer

A

Enteral nutrition is the preferred method of feeding for a patient with a functioning intestinal tract who is unable to meet his nutritional needs through oral intake.

Question 58

Q

A nasogastric (NG) tube terminates in the

Question 59

Q

A nasoenteric (NE) tube terminates in the

Answer

A

small intestine.

Question 60

Q

A gastrostomy tube (G-tube), percutaneous gastrostomy tube (PEG) tube, jejunostomy tube, or G-button is inserted into the

Answer

A

stomach or jejunum, respectively, through the skin and abdominal wall.

Question 61

Q

A percutaneous jejunostomy (PEJ) tube is inserted into the

Answer

A

stomach through the abdominal wall and advanced into the jejunum.

Question 62

Q

List four tube placement verification techniques.

Answer

A

Tube placement can be verified by the following techniques:

● Radiography, which is the most reliable method

● Aspiration of contents and inspection for color

● Measuring the pH of the aspirate

● Injecting air into the tube while auscultating the stomach (“whoosh test”)

● Serial observations and assessments. These include observing for respiratory distress, inspecting aspirate for color and consistency, measuring the residual volume of the aspirate, and measuring the tube that extends outside of the body.

● When observing for respiratory distress you might note difficulty breathing, coughing, choking, or cyanosis. Absence of these symptoms is not a reliable indicator of correct placement, but the presence of these symptoms is a strong indicator that the tube is in the respiratory tract.

● Inspecting the aspirate may help distinguish placement through observation of a brown, white, or greenish color and curdled consistency for gastric contents and a more yellow (bile) color with no curdling for intestinal contents.

● When evaluating residual volumes, note that gastric volumes will generally be larger than intestinal or esophageal volumes.

● If the tube is not well secured, it may migrate either up or down, and so a consistent measurement of the external tube may also help verify tube placement (Peter & Gill, 2009).

● Other bedside verification methods. Capnometry and additional tests of gastric juices may also serve as measures to ensure that the tube is correctly placed.

● Capnometry tests for carbon dioxide (CO2). The presence of CO2 with the placement of an NG or NE tube would indicate that the tube has been placed in the respiratory tract. This method is best used at the time of tube placement.
Measuring bilirubin, trypsin, and pepsin in the aspirate provides a positive determination that the tube is placed in the stomach. Test devices for these three gastric components are not yet commercially available (Elpern, Killeen, Talla, Perez, & Gurka, 2007; Peter & Gill, 2009).

Question 63

Q

According to the text calculations, which of the following patients is taking in the correct number of kcal to meet their total energy needs? Choose all that apply.

A. Mr. Jones, who weighs 180 lb, is active, has a normal weight and is taking in 3,240 kcal per day.
B. Mrs. Sanchez, who weighs 220 lb, is sedentary, overweight, and taking in 1,000 kcal per day.
C. Susan, who weighs 100 lb, is slightly underweight, plays soccer three times a week, and is taking in 1500 kcal per day.
D. Mr. Clark, who works a desk job, weighs 190 lb (a normal weight for his height), and is currently taking in 2,800 kcal per day.

Answer

A

Answer:

A. Mr. Jones, who weighs 180 lb, is active, has a normal weight, and is taking in 3,240 kcal per day.

Rationale:

Although Mrs. Sanchez is most likely overweight, her caloric intake may not enable her to meet her daily metabolic needs in terms of maintaining health. Susan’s caloric intake is not enough to meet her active lifestyle, and Mr. Clark’s caloric intake is too large given his sedentary job.

Question 64

Q

Identify the patient with the greatest risk for developing protein-calorie malnutrition. A patient:

A. who is HIV positive
B. with a broken leg and pelvis from trauma who is running a fever of 101.5°F (38.6oC)
C. weighing 300 lb who has entered the hospital for cardiac bypass surgery
D. who is of Hispanic heritage

Answer

A

Answer:

B. A patient with a broken leg and pelvis from trauma who is running a fever of 101.5°F (38.6oC).

Rationale:

There is no information to indicate that the person with HIV is not eating well. Although someone who weighs 300 lb could technically be malnourished, this patient most likely has been eating sufficient nutrients to prevent this type of malnutrition. Being Hispanic is not a risk factor for protein-calorie malnutrition.

Answer 62

A

Answer:

D. 24-hour food recall

Rationale:

Asking the client to recall his food intake for the past 24 hours is an example of obtaining subjective data.

Answer 63

A

Answer:

C. Serum albumin level of 1.8 g/dL

Rationale:

All of the other results are within normal limits.

Answer 64

A

Affects institutionalized elders

Answer 65

A

Provide nearly all the energy for the brain

Answer 66

A

Energy required by resting tissue

Answer 67

A

Fat-soluble vitamins

Answer 68

A

Cycle of binging and purging

Answer 69

A

Increase the risk for cardiovascular disease

Answer 70

A

Only foods of plant origin

Answer 71

A

Tomato soup

Answer 72

A

Answer:

False

Rationale:

Lab results reflective of nutritional status may be skewed by many factors, including hydration status, medications, organ function, and so on.

Answer 73

A

Answer:

False

Rationale:

The nurse aide may obtain height, weight, and document intake and output. An LPN or RN must collect information related to the nutrition history.

Answer 74

A

Answer:

True

Answer 75

A

Answer:

3) Milk

Rationale:

The only animal source of carbohydrate is lactose, the sugar contained in milk. Beef, eggs, and chicken do not provide a source of carbohydrate.

Answer 76

A

Answer:

2) can lead to toxicity.

Rationale:

Vitamins are critical in building and maintaining body tissues, supporting the immune system to fight infection, and ensuring healthy vision. However when fat-soluble vitamins, such as vitamins A, D, E, and K, are supplemented in large doses, toxicity may occur.

Answer 77

A

Answer:

4) Obtain an x-ray of the chest and abdomen.

Rationale:

It is essential to verify that the NG tube is in the stomach and not the airway. The only reliable method among these four is to obtain an x-ray of the chest and abdomen. For subsequent feedings, however, it is not practical to obtain an x-ray each time, and presence of formula in the stomach complicates the pH readings. Therefore, the nurse should use a combination of bedside techniques, including observing appearance and measuring the amount of gastric residual volume, asking the patient to speak, and injecting air (“whoosh” test) while auscultating the stomach.

Answer 78

A

Answer:

1) Aspiration

Rationale:

The head of the bed (HOB) should be elevated to at least 30 to 45 degrees during enteral feeding administration to prevent aspiration. Maintaining an elevated HOB aids in digestion by helping the transit of feeding through the GI tract. Diarrhea, infection, and electrolyte imbalance are all complications associated with enteral feeding, but they cannot be prevented by elevating the head of the bed.

Answer 79

A

Answer:

2) Sepsis

Rationale:

A break in sterile technique places the patient at risk for sepsis. Air embolism can occur when the intravenous tubing is disconnected from the catheter hub. Thrombosis occurs as a result of irritation of the vein from the central venous catheter. Pneumothorax is a complication of central venous catheter insertion.

Answer 80

A

Answer:

3) Hold the feeding for 1 hour, and recheck

Rationale:

The nurse should check enteral feeding residual every 4 to 6 hours. If residual is 10% greater than the formula flow rate for 1 hour (or alternatively, a total of 150 ml), the nurse should hold the feeding for 1 hour and recheck. If residual is still not within normal limits, she should notify the physician.

Answer 81

A

Answer:

2) Flush the tube with 30 ml of water.

Rationale:

The nurse should flush the PEG tube with 30 ml of water before and after administering a medication through the tube. The tube feeding should be held for 1 hour before and 1 hour after administering some medications, such as phenytoin (Dilantin). It is not necessary to hold the feeding for 2 hours. Residual volume should not be checked immediately after administering medications.

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Nutrition Chapter 26 Flashcards

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