A
Which foods high in vitamin A should the nurse recommend to a client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Eggs
2. Butter
3. Whole milk
4. Dark leafy vegetables
5. Lean red meat
Answer: 1, 2, 3, 4
Explanation:
1. Foods high in vitamin A include eggs, butter, whole milk, and dark leafy vegetables.
2. Foods high in vitamin A include eggs, butter, whole milk, and dark leafy vegetables.
3. Foods high in vitamin A include eggs, butter, whole milk, and dark leafy vegetables.
4. Foods high in vitamin A include eggs, butter, whole milk, and dark leafy vegetables.
5. Lean red meat is not high in vitamin A.
Which deficiencies should the nurse understand occur after bariatric surgery? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. B-complex vitamins
2. Copper
3. Iron
4. Fat-soluble vitamins
5. Potassium
Answer: 1, 2, 3, 4
Explanation:
1. The client is at risk for B-complex vitamin deficiency.
2. The client is at risk for a copper deficiency.
3. The client is at risk for iron deficiency.
4. The client is at risk for fat-soluble vitamin deficiency.
5. The client who has had bariatric surgery is at risk for a calcium deficiency.
Which information should the nurse include in the dietary discussion with a client that consumes a vegetarian diet?
1. "You are not at risk for vitamin deficiencies."
2. "Seek out dietary sources which include vitamin B12."
3. "Increase fluids and fiber to promote the absorption of vitamins."
4. "You may be at risk for a vitamin C deficiency."
Answer: 2
Explanation:
1. Based on the choices of food, a vegetarian diet may not adequately supply the necessary vitamins.
2. Vitamin B12 is found only in animal sources but may also be added to other food sources. It is important to encourage the client to seek those sources out.
3. Increasing fluids and fiber does not promote the absorption of vitamins.
4. A vegetarian diet is almost never deficient in vitamin C as this vitamin is plentiful in fruits and vegetables
Which describes a function of Vitamin C?
1. Maintains vision
2. Regulates digestion
3. Promotes development of bones and teeth
4. Promotes the manufacturing of platelets
Answer: 3
Explanation:
1. Vision is maintained by vitamin A.
2. Vitamin B helps with metabolic processes, such as digestion.
3. Vitamin C is necessary for development of bones, teeth, and blood vessels.
4. Vitamin C is not essential for the manufacturing of platelets.
Which priority intervention should the nurse implement for a client that is experiencing magnesium toxicity?
1. Monitor the client's breathing
2. Assess the client's reflexes
3. Administer IV calcium gluconate
4. Administer an IV bolus of NS
Answer: 3
Explanation:
1. Administering calcium gluconate is the priority intervention to reverse the effects of the magnesium.
2. Administering calcium gluconate is the priority intervention to reverse the effects of the magnesium.
3. Serious respiratory and cardiac suppression may result from overdose. Calcium gluconate or gluceptate may be administered IV as an antidote.
4. Normal saline cannot reverse the toxicity of magnesium.
A client asks the nurse why they are prescribed a multivitamin. Which information should the nurse include in the discussion?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Small amounts of vitamins are needed for health.
2. Vitamins will heal many illnesses.
3. Vitamins are inorganic compounds that are not always stored in the body.
4. Your body cannot synthesize most vitamins.
5. Vitamins are needed for growth and maintenance of normal metabolic processes.
Answer: 1, 4, 5
Explanation:
1. Vitamins are organic compounds. They are needed for health.
2. Vitamins are great nutritional support, but there are very few illnesses that vitamins will heal.
3. Vitamins are organic compounds and many are stored in the body.
4. Only vitamin D can be synthesized.
5. Vitamins are needed for growth and maintenance of normal metabolic processes.
Which laboratory tests should the nurse evaluate for the client receiving topical vitamin A? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Serum calcium level
2. Hemoglobin level
3. Blood urea nitrogen
4. Serum potassium level
5. Serum cholesterol
Answer: 1, 3, 5
Explanation:
1. Vitamin A may increase serum calcium.
2. Vitamin A does not affect the hemoglobin level.
3. Vitamin A may increase the blood urea nitrogen.
4. Vitamin A does not affect the potassium level.
5. Vitamin A may increase the serum cholesterol.
A client asks the nurse how much vitamin C should be taken to prevent a cold. Which information should the nurse discuss with the client?
1. "Increase your dietary intake of Vitamin C as well as add an oral supplement." 2. "There is no proof that vitamin C prevents the common cold."
3. "Vitamin C is effective if you take the recommended daily allowance."
4. "Vitamin C must be taken prior to the onset of the cold to be most effective."
Answer: 2
Explanation:
1. The ability of vitamin C to prevent the common cold has not been proven.
2. The ability of vitamin C to prevent the common cold has not been proven.
3. The ability of vitamin C to prevent the common cold has not been proven.
4. There is no evidence to support that vitamin C must be taken before a cold in order to be effective.
Which describes an important function of vitamin A?
1. Promotes visual pigment of the eye
2. Antioxidant properties
3. Promotes blood clotting
4. Facilitates bile excretion
Answer: 1
Explanation:
1. Vitamin A is needed for the precursor retinol for normal vision.
2. Vitamin C and E are antioxidants.
3. Vitamin K is important in the clotting of blood.
4. Vitamin B helps with metabolic processes.
Which is a priority nursing assessment for the client who is receiving a parenteral feeding?
1. Fluid overload
2. Overnutrition
3. Electrolyte imbalance
4. Weight loss
Answer: 1
Explanation:
1. A priority nursing assessment for the client receiving a parenteral feeding is to monitor for signs of fluid overload. Solutions are hypertonic and may create fluid shifting with resulting changes in intravascular fluid. Monitoring for increased pulse rate and quality, increasing blood pressure, dyspnea, or edema will assist in quickly noting adverse effects.
2. Monitoring the client for overnutrition is important but not a priority assessment for the client receiving a parenteral feeding. Overnutrition occurs over a period of time.
3. Monitoring the client for an electrolyte imbalance is important but not a priority assessment for the client receiving a parenteral feeding. An electrolyte imbalance may occur over a period of time.
4. Monitoring the client for weight loss is important but not a priority assessment for the client receiving a parenteral feeding. Weight loss occurs over a period of time.
The nurse notes a client is prescribed Orlistat (Alli). Which condition should the nurse recognize the prescription is treating?
1. Obesity
2. Malnutrition
3. Malabsorption syndrome
4. Overnutrition
Answer: 1
Explanation:
1. Orlistat is prescribed for the treatment of obesity in combination with a reduced-calorie diet and exercise.
2. Orlistat is not used to treat malnutrition.
3. Orlistat is not used to treat malabsorption syndrome.
4. Orlistat is not used to treat overnutrition.
Which clinical conditions would the nurse most likely associate with a client who has a documented history of alcoholism?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Carbohydrate deficiency
2. Thiamine deficiency
3. Scurvy
4. Vitamin A deficiency
5. Pellagra
Answer: 2, 3, 4, 5
Explanation:
1. Alcohol is high in carbohydrates.
2. Thiamine deficiency is commonly seen in alcoholic clients.
3. Alcoholics are among those at highest risk for vitamin C deficiency or scurvy.
4. Vitamin A deficiency is caused by prolonged dietary deprivation that may occur in alcoholism.
5. Pellagra is a niacin deficiency that is commonly seen in alcoholic clients.
Which vitamin should the nurse encourage a female to take prior to becoming pregnant to help prevent neural tube defects?
1. Thiamine
2. Niacin
3. Riboflavin
4. Folic acid
Answer: 4
Explanation:
1. Folic acid, not thiamine, is the vitamin that is essential for the prevention of neural tube defects in a fetus.
2. Folic acid, not niacin, is the vitamin that is essential for the prevention of neural tube defects in a fetus.
3. Folic acid, not riboflavin, is the vitamin that is essential for the prevention of neural tube defects in a fetus.
4. Folic acid is the vitamin that is essential for the prevention of neural tube defects in a fetus.
Which vitamin can be toxic if consumed in large amounts?
1. Niacin
2. Vitamin C
3. Vitamin A
4. Folic acid
Answer: 3
Explanation:
1. Niacin is vitamin B and therefore water soluble.
2. Vitamin C is a water-soluble vitamin and cannot be toxic.
3. Vitamin A is lipid soluble and can be toxic in large amounts.
4. Folic acid is a B vitamin and is water soluble.
Which information should the nurse provide a client who will receive enteral nutrition?
1. "Nutrition can be administered continuously."
2. "Your nutrition will be administered through your veins."
3. "Enteral feedings allow natural digestion to occur."
4. "Most enteral feeding consists of thinned pureed food."
Answer: 3
Explanation:
1. Enteral products can be given intermittently by bolus or by continuous drip.
2. Parenteral nutrition is administered through the venous system. Enteral nutrition is delivered into the gastrointestinal tract.
3. Since enteral feedings are administered into the gastrointestinal tract, it allows for natural digestion to occur
4. Most enteral feeding is formula based.
Which client is at greatest risk for developing vitamin deficiencies?
1. A client newly prescribed phenytoin (Dilantin) for the treatment of epilepsy
2. A client prescribed oral contraceptives for birth control
3. A client who eats a well-balanced diet and does not take a vitamin supplement
4. A pregnant client that is receiving prenatal vitamins
Answer: 2
Explanation:
1. Certain anticonvulsants can be associated with B complex deficiencies, but the client is just starting therapy so he is not at great risk.
2. The use of oral contraceptives is associated with deficiencies of B complex vitamins.
3. Most nutritional demands can be met with a well-balanced diet.
4. The prenatal vitamins will meet all the vitamin requirements of the pregnant female.
Which is the priority nursing assessment for the client with preeclampsia receiving magnesium sulfate experiencing muscle weakness?
1. Oxygen saturation
2. Deep tendon reflexes
3. Peripheral edema
4. Breath sounds
Answer: 2
Explanation:
1. The oxygen saturation is not the priority assessment.
2. Trace or absent deep tendon reflexes indicates the client is experiencing a magnesium toxicity. Toxic levels will cause a neuromuscular blockade with resultant respiratory paralysis, heart block, and circulatory collapse.
3. Peripheral edema is not the priority assessment.
4. Breath sounds are important but not as important as the respiratory rate due to the muscular weakness associated with magnesium sulfate toxicity.
Which should the nurse monitor to prevent complications of a client receiving total parenteral nutrition (TPN)?
1. Potassium levels
2. Blood glucose levels
3. Liver enzymes
4. Thyroid function
Answer: 2
Explanation:
1. The client's potassium levels are not as likely to be affected by total parenteral nutrition (TPN).
2. Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose.
3. Total parenteral nutrition does not have an adverse effect on the liver.
4. Total parenteral nutrition does not have an adverse effect on the thyroid function.
Which condition is associated with a cyanocobalamin (B12) deficiency? 1. Pellagra
2. Pernicious anemia
3. Rickets
4. Scurvy
Answer: 2
Explanation:
1. A deficiency of niacin results in pellagra.
2. A cyanocobalamin (B12) deficiency can result in pernicious anemia, which may require pharmacotherapy.
3. A vitamin D deficiency results in rickets.
4. A vitamin C deficiency results in scurvy.
Which enteral formula should the nurse anticipate for a client with a functioning GI tract experiencing undernourishment?
1. Modular
2. Polymeric
3. Semi-elemental
4. Elemental
Answer: 2
Explanation:
1. Modular formulas are disease-specific supplements. For example, protein modules can be used to meet the extra nitrogen needs of patients with burns or severe trauma. Other conditions include CKD, liver failure, pulmonary disease, or a specific genetic enzyme deficiency.
2. A polymeric formula is used in patients who are generally undernourished but have a fully functioning GI tract.
3. Semi-elemental formulas require little or no digestion and are easily absorbed. Indications include malabsorption syndrome, partial bowel obstruction, IBD, radiation enteritis, bowel fistulas, and short-bowel syndrome.
4. An elemental formula is used for clients who have malabsorption disorders.
Which information should the nurse provide a parent of a newborn prescribed a vitamin K injection?
1. "Vitamin K is administered if there is observed bleeding."
2. "Vitamin K is only administered to infants that are bottle fed."
3. "Newborns do not have enough intestinal bacteria to synthesize vitamin K."
4. "Newborns are unable to store vitamin K in their body."
Answer: 3
Explanation:
1. Vitamin K is administered prior to waiting for active bleeding to promote clotting of the blood.
2. Vitamin K is not transferred through the breastmilk. All newborns will need to receive vitamin K to promote clotting.
3. The newborn's small intestine is sterile so there is inadequate bacteria to synthesize vitamin K, which is essential to promote blood clotting.
4. The newborn has not synthesized vitamin K because their small intestine is sterile.
Which should the nurse include in the plan of care when administering total parenteral nutrition?
1. Check the feeding tube for residual prior to initiating feedings.
2. Remove the solution from the refrigerator 30 minutes prior to hanging.
3. Withhold oral medications while the total parenteral nutrition (TPN) is hanging.
4. Maintain a dedicated percutaneous endoscopic gastrostomy (PEG) tube for the solution.
Answer: 2
Explanation:
1. Checking the tube for residual is performed with enteral feedings, not parenteral feedings.
2. A cold infusion could cause irritation to the intravenous (IV) site.
3. The client can continue to receive oral medications while the total parenteral nutrition is infusing.
4. Parenteral infusions are done through an intravenous (IV) line, not a percutaneous endoscopic gastrostomy (PEG) tube.
Which describes the body's need for vitamins?
1. They are needed in large amounts to support metabolic processes.
2. They are needed in large amounts to promote health.
3. They are needed in small amounts to promote growth.
4. They are needed in small amounts to detoxify chemicals.
Answer: 3
Explanation:
1. Vitamins are organic compounds required by the body in small amounts for growth and for the maintenance of normal metabolic processes.
2. Vitamins are organic compounds required by the body in small amounts for growth and for the maintenance of normal metabolic processes.
3. Vitamins are organic compounds required by the body in small amounts for growth and for the maintenance of normal metabolic processes.
4. Vitamins are organic compounds required by the body in small amounts for growth and for the maintenance of normal metabolic processes. They do not specifically detoxify chemicals.
Which substance assists with the efficient absorption of calcium?
1. Intrinsic factor
2. Coenzymes
3. Phosphorus
4. Vitamin D
Answer: 4
Explanation:
1. Efficient absorption of calcium is not associated with intrinsic factor.
2. Efficient absorption of calcium is not associated with coenzymes.
3. Efficient absorption of calcium is not associated with phosphorus.
4. Efficient absorption of calcium is assisted by vitamin D.
Which information should the nurse include in the teaching for a client that will be receiving intermittent enteral nutrition at home?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "Clean the equipment between each feeding administration."
2. "Once mixed, the enteral feeding should hang no more than 8 hours."
3. "Refrigerate any feeding that is not needed for a feeding."
4. "You may use plain tap water for scheduled tubing flushes."
5. "Keep the area around the insertion site clean."
Answer: 1, 3, 4, 5
Explanation:
1. The equipment used to provide enteral feedings should be kept clean.
2. Enteral feedings should hang no more than 4 hours.
3. Unused feeding should be refrigerated to prevent spoilage.
4. Plain water is acceptable for tubing flushes.
5. The area around the insertion site should be kept clean.