Nutrición

The nurse is helping the unlicensed assistive personnel pass meal trays. When providing a meal tray for a client diagnosed with pheochromocytoma, which dietary item should the nurse remove?

• A.Macaroni and cheddar cheese

• B.Watermelon slices

• 
  C.Caffeine free cola
  

• D.Baked chicken

Answer explanation

Choice A is correct. Pheochromocytoma is caused by a tumor on top of the adrenal medulla, causing a surge in catecholamines to be released, thus causing the client to experience headaches, hypertension, hyperglycemia, tremor, and unintentional weight loss. A client with pheochromocytoma is advised to modify their diet so that it does not increase blood pressure. Cheddar cheese contains tyramine and should not be included in the client's diet. Other dietary modifications include limitations of caffeinated beverages, which may also raise blood pressure. This item should be removed from the client's meal tray.

Choice B is incorrect. Watermelon slices are hydrating with no increase in blood pressure. This option is suitable for the client with pheochromocytoma and can be included in the meal.

Choice C is incorrect. If the client were to consume cola, it should be caffeine-free. Caffeine would raise blood pressure, worsening the client's high blood pressure found with pheochromocytoma.

Choice D is incorrect. Baked chicken is a lean protein source. This option is appropriate for the client with pheochromocytoma and can be included in the meal.

The nurse is observing a student nurse feed a client requiring aspiration precautions. The nurse should intervene if the student

• A.asks the client to remain sitting upright for at least 30 to 60 minutes after a meal.

• B.reminds the client to tilt their head backward when eating and drinking.

• C.avoids mixing foods of different textures in the same mouthful.

• D.places salt and pepper on the client's food at their request.

Answer explanation

Choice B is correct. This action by the student nurse requires intervention. The client should assume the chin-down position and be reminded not to tilt backward when eating or drinking. The client should be instructed to have their head turned and chin tucked to reduce the risk of aspiration. Reminding the client to tilt their head backward would increase their risk for aspiration.

Choice A is incorrect. This is an appropriate action by the student and does not require intervention. Remaining upright after meals or snacks reduces the chance of aspiration by allowing food particles remaining in the pharynx to clear.

Choice C is incorrect. This is an appropriate action by the student and does not require intervention. For a client with aspiration precautions, foods should not be mixed with different textures in the same mouthful. Single textures are easier to swallow.

Choice D is incorrect. This is an appropriate action. Condiments on food items are permitted, including salt and pepper. Food should be seasoned to taste.

The nurse is providing patient teaching to the mother of a child with a banana allergy. The nurse would be most correct in informing the mother that this child is at an increased risk of developing an allergy to which of the following?

• A.Penicillin

• 
  B.Cat dander
  

• 
  C.Latex
  

• D.Peanuts

Answer explanation

Choice C is correct. Individuals with allergies to bananas are at an increased risk of developing an allergy to latex. Tropical fruit allergies may also indicate an increased risk. Working in a profession with increased exposure to latex, such as a hairdresser or house cleaner, also places a person at an increased risk for developing this allergy.

Choices A, B, and D are incorrect. Having an allergy to bananas does not increase a person’s risk of developing an allergy to penicillin, cat dander, or peanuts.

The nurse is caring for a client with a feeding tube that has become obstructed.  Which intervention should the nurse implement first to unclog the tube?

•   1. Flush and aspirate the tube with warm water

•   2. Instill a digestive enzyme solution into the tube

•   3. Instill cola or cranberry juice into the tube

•   4. Use a small-barrel syringe to flush the tube

Answer explanation

Enteral feeding tubes are more likely to become obstructed if the tube is not flushed frequently enough, medications are not adequately crushed or diluted before administration, a thick feeding formula is used, or a small-bore feeding tube is required.  Interventions to unclog a feeding tube are more successful if they are initiated immediately.  The nurse should first attempt to dislodge the clogged contents by using a large-barrel syringe to flush and aspirate warm water in a back-and-forth motion through the tube (Option 1).

(Option 2)  If a feeding tube cannot be unclogged with warm water, the nurse may then attempt to use a digestive enzyme solution.  These commercial declogging kits contain prefilled syringes of enzymatic solution that must be added to the tube and dwell in it for a period of time (usually 30 minutes to 1 hour) before flushing and aspiration are attempted.

(Option 3)  Instilling a carbonated beverage (eg, dark cola) or cranberry juice into a clogged feeding tube is not appropriate.  The acidity of either liquid can worsen an obstruction, and the dark color may mask gastrointestinal bleeding. 

(Option 4)  Flushing a feeding tube with a small-barrel syringe can create too much pressure and rupture the tube.

The nurse is planning a meal for a client with Celiac disease.

 It would be appropriate for the nurse to offer the client

• A.macaroni and cheese.

• 
  B.ham sandwich on wheat bread.
  

• 
  C.salmon oven-roasted beets.
  

• 
  D.barley and vegetable soup.

Answer explanation

Choice C is correct. Salmon and beets are both gluten-free. This would be an appropriate offer to the client. Other gluten-free foods include meat, fish, eggs, some dairy, vegetables, corn, fruit, rice, and gluten-free flour.

Choice A is incorrect. Macaroni noodles are generally made of wheat unless otherwise stated. Individuals with Celiac disease must avoid all wheat-containing products. This meal would not be the best choice for this patient.

Choice B is incorrect. Wheat rolls contain gluten and should be avoided in patients with Celiac disease.

Choice D is incorrect. Barley is a rich source of gluten. This would not be an appropriate option. Barley is commonly found in soups, beer, malted milkshakes, and cereals.

The nurse is caring for a client with a body mass index (BMI) of 17.

 The nurse should recommend that the client be prescribed a

• A.fat-restricted diet.

• 
  B.low-protein diet.
  

• 
  C.high-caloric diet.
  

• D.low-sodium diet.

Answer explanation

Choice C is correct. Based on this client's current body mass index (BMI) of 17, this client would most likely be advised to begin a high-caloric diet to gain weight, as the client's current BMI of 17 indicates the client is underweight. A high-caloric diet would allow the client to gain weight, with the goal of the client's BMI being placed within the "normal or healthy weight" range (i.e., between 18.5-24.9). Foods permitted on a high-calorie diet include peanut butter, milkshakes, cereal, and gravies.

Choice A is incorrect. This client is underweight, and a fat-restricted diet would be unhelpful. The nurse should recommend an order for a high-calorie diet to raise the client's BMI.

Choice B is incorrect. The nurse should encourage the client's calorie sources to be high in protein. A low-protein diet would be unhelpful considering the client's current BMI.

Choice D is incorrect. A low-sodium diet would have no relevance to the client's current BMI. The client needs to have dietary choices high in protein and calories to increase their BMI to an average level.

The nurse performs a comprehensive assessment on a client with a body mass index (BMI) of 14.

 The nurse anticipates that the physician will order which dietary modification?

• A.provide the client with two meals a day

• B.reduce total fat and calorie intake for the client

• C.provide additional high protein and calorie shakes

• D.increase the intake of green leafy vegetables

Answer explanation

Choice C is correct. The client is underweight. Body mass index (BMI) is calculated as weight in kilograms divided by height in meters squared. A BMI of 18.5-24.9 is considered healthy. A BMI of less than 18.5 is underweight. A BMI of 25-29 is overweight, and a BMI of 30 or higher is obese. To increase BMI, adding healthy food choices is essential. Foods that are rich in nutrients and high in calories include brown rice, granola, raisin bran cereals, bananas, dried apricots, avocados, sweet potatoes, peas, yogurt, milk, and fatty fish such as salmon and tuna, tofu, beans, lean red meat, nuts, and seeds.

Choice A is incorrect. An underweight client should not be limited to two meals daily. The focus should be on increasing the client's calories.

Choice B is incorrect. Calorie intake should be increased, not decreased. This can be accomplished by offering foods rich in protein and supplemental drinks.

Choice D is incorrect. An increase in green leafy vegetables is not indicated to increase BMI. Instead, the client needs an increase in protein and calories.

The nurse is caring for a client who reports beginning a vegan diet.

 Which of the following vitamins should the nurse recommend?

• A.vitamin C

• 
  B.vitamin B12
  

• 
  C.vitamin A
  

• 
  D.vitamin D

Answer explanation

Choice B is correct. Vitamin B12 is abundantly present in food products of animal origin. These include eggs, poultry, dairy products, fish, and meat. No strict vegetarian source has sufficient vitamin B12 to meet the recommended daily allowance (RDA). Vegans refrain from consuming all animal products, including eggs and dairy. Therefore, vegans are at a very high risk of developing vitamin B12 deficiency. The vegans' highest risk is for vitamin b12 deficiency, and the nurse should prioritize this recommendation. Vegans should be counseled to consume alternative sources of vitamin B12 such as vitamin B12 supplements and foods fortified with vitamin B12 (fortified nutritional yeasts, fortified cereals) to reduce the significant risk of B12 deficiency.

Choice A is incorrect. Vegans are generally not more prone to vitamin C deficiencies than non-vegans. Vegans consume plenty of fruits and vegetables. Vitamin C is present abundantly in fruits (orange, apple, kiwi, etc.) and vegetables (bell peppers, brussels sprouts, broccoli, etc.).

Choice C is incorrect. Vegans are generally not more prone to vitamin A deficiencies than non-vegans. Vegans consume plenty of fruits and vegetables. Vitamin A is present in carrots, apricots, sweet potatoes, and dark green leafy vegetables (such as spinach, kale, and collard greens).

Choice D is incorrect. While vitamin D is not abundant in a vegan diet, there are still some good vegan sources, including mushrooms, spinach, and bananas. Also, vitamin D can be abundantly obtained from sunlight. Vegans may be more prone to vitamin D deficiency than non-vegans.