CHAPTER 1: THE RELATIONSHIP OF NUTRITION AND HEALTH

MULTIPLE CHOICE

	1.	Which of the following nutrients helps build and repair body tissues?
a.	protein	c.	fat	
b.	carbohydrates	d.	all of the above	

ANS:	A	PTS:	1	DIF:	A	
TOP:	Nutrients and Their Functions

	2.	Malnutrition can be caused by ____.
a.	eating too much	c.	both a and b	
b.	eating too little	d.	none of the above	

ANS:	C	PTS:	1	DIF:	A	TOP:	Malnutrition

	3.	Which food is considered to have a low nutrient density?
a.	potato chips	c.	apples	
b.	carrots	d.	steak	

ANS:	A	PTS:	1	DIF:	A	
TOP:	Individuals at Risk from Poor Nutritional Intake

	4.	There are many cumulative effects of a poor, unbalanced diet. Which of these disease states may be attributable to a low nutrient density diet?
a.	atherosclerosis	c.	obesity	
b.	hypertension	d.	all of the above	

ANS:	D	PTS:	1	DIF:	B	
TOP:	Cumulative Effects of Nutrition

	5.	Which mineral is needed to prevent osteoporosis from occurring?
a.	iron	c.	zinc	
b.	magnesium	d.	calcium	

ANS:	D	PTS:	1	DIF:	B	TOP:	Deficiency Diseases

	6.	A part of a nutrition assessment involves anthropometric measurements. What is measured during this type of assessment?
a.	percentage of muscle mass	c.	percentage of fat and muscle tissue	
b.	percentage of fat tissue only	d.	percentage of body fluid	

ANS:	C	PTS:	1	DIF:	A	TOP:	Nutrition Assessment

	7.	What biochemical analysis of blood samples may indicate kidney failure?
a.	serum albumin level	c.	creatinine excretion	
b.	serum transferrin level	d.	blood urea nitrogen	

ANS:	D	PTS:	1	DIF:	A	TOP:	Nutrition Assessment

	8.	What is the most common method of assessing a client’s dietary history?
a.	three-day food record	c.	three-day food diary	
b.	24-hour recall	d.	three-day recall	

ANS:	B	PTS:	1	DIF:	A	TOP:	Nutrition Assessment

	9.	Which nutrient deficiency displays lesions at the corners of the mouth?
a.	vitamin B	c.	folic acid	
b.	riboflavin	d.	iron	

ANS:	B	PTS:	1	DIF:	B	TOP:	Deficiency Diseases

	10.	Obesity can increase your risk of developing ____.
a.	iron deficiency anemia	c.	kidney failure	
b.	diabetes	d.	osteoporosis	

ANS:	B	PTS:	1	DIF:	B	
TOP:	Cumulative Effects of Nutrition

	11.	Education in good nutritional health practices would eliminate many health problems that may be caused by malnutrition. Which of the following is the best method for teaching the young child good health habits?
a.	a good health program in kindergarten	
b.	have the physician discuss nutrition with the child	
c.	imitation of adult behavior	
d.	imitation of eating habits of other children	

ANS:	C	PTS:	1	DIF:	C	
TOP:	Health and Nutrition Considerations		

	12.	What is the most common form of nutrient deficiency in the United States?
a.	niacin	c.	protein	
b.	iron	d.	vitamin C	

ANS:	B	PTS:	1	DIF:	B	TOP:	Deficiency Diseases

	13.	Which biochemical test measures protein status?
a.	serum transferrin level	c.	serum albumin level	
b.	creatinine excretion	d.	serum creatinine level	

ANS:	C	PTS:	1	DIF:	B	TOP:	Nutrition Assessment

	14.	Which biochemical test indicates a depleted muscle mass?
a.	serum transferrin level	c.	serum albumin level	
b.	creatinine excretion	d.	serum creatinine level	

ANS:	B	PTS:	1	DIF:	B	TOP:	Nutrition Assessment

	15.	Which blood test can indicate anemia?
a.	hemoglobin test	c.	blood urea nitrogen	
b.	red blood cell test	d.	lipid profile	

ANS:	A	PTS:	1	DIF:	B	TOP:	Nutrition Assessment

	16.	Which biochemical test indicates iron-carrying protein in the blood?
a.	serum transferrin level	c.	serum albumin level	
b.	creatinine excretion	d.	serum creatinine level	

ANS:	A	PTS:	1	DIF:	B	TOP:	Nutrition Assessment

	17.	Which of the following is characteristic of poor nutritional status?
a.	apathy	c.	both a and b	
b.	insomnia	d.	none of the above	

ANS:	C	PTS:	1	DIF:	C	
TOP:	Characteristics of Good Nutrition

	18.	Which of the following diseases is related to vitamin C deficiency?
a.	anemia	c.	scurvy	
b.	goiter	d.	xeropthalmia	

ANS:	C	PTS:	1	DIF:	B	TOP:	Deficiency Diseases

	19.	Which of the following measures is not included in the lipid profile?
a.	glucose	c.	total serum cholesterol	
b.	serum triglycerides	d.	high-density lipoproteins	

ANS:	A	PTS:	1	DIF:	B	TOP:	Nutrition Assessment

	20.	Goiter is a deficiency disease related to deficiency of what nutrient?
a.	iron	c.	calcium	
b.	iodine	d.	folic acid	

ANS:	B	PTS:	1	DIF:	B	TOP:	Deficiency Diseases

	21.	Which of the following are inorganic nutrients?
a.	vitamins	c.	both a and b	
b.	minerals	d.	none of the above	

ANS:	B	PTS:	1	DIF:	B	
TOP:	Nutrients and Their Functions

SHORT ANSWER

	1.	Poorly shaped bones or teeth are a symptom of calcium and vitamin D deficiency. Discuss the relationship between these substances.

ANS:	
Vitamin D is necessary for the utilization of calcium in the body.

PTS:	1	DIF:	B	TOP:	Deficiency Diseases	

	2.	Why is a social history important when doing a nutritional assessment?

ANS:	
To determine whether the client has the financial resources to obtain the needed food and the ability to store and prepare the food.

PTS:	1	DIF:	B	TOP:	Nutrition Assessment	

	3.	List the methods, or means of data collection, used to complete an accurate nutritional assessment that is the framework for a dietary treatment plan.

ANS:	
Social history, 24-hour diet recall, food diary for three to four days, computer analysis of the diet, review for any food–drug interactions, review of medical records, clinical examinations, and review of results of any biochemical tests and anthropometrical measurements.

PTS:	1	DIF:	C	TOP:	Nutrition Assessment	

	4.	The adolescent and the elderly are age groups that are very prone to malnutrition. Discuss the reasons for this.

ANS:	
The adolescent responds to peer pressure to determine the types of foods consumed (chips, colas, candy, etcetera.), and the lifestyle of a teen (always on the go) may result in many skipped meals. The elderly are often alone and mealtimes can be unpleasant and lonely, resulting in skipped meals and in eating poorly-balanced meals. Living conditions often do not encourage a healthy appetite. Financially, some elderly may not be able to afford fresh fruits and vegetables or the protein sources of foods.

PTS:	1	DIF:	C	TOP:	Individuals at Risk from Poor Nutritional Intake

	5.	Describe the appearance of an 18-year-old female who is at the optimal level of nutritional balance.

ANS:	
Shiny hair, clear skin, clear eyes, erect posture, alert expressions, firm flesh on well-developed bone structure, healthy appetite, regular sleep and elimination habits, and positive emotional adjustments.

PTS:	1	DIF:	C	TOP:	Characteristics of Good Nutrition

	6.	Describe the primary function(s) of each of the organic nutrients.

ANS:	
The primary function of carbohydrates and fats is to provide energy. Proteins build and repair body tissues, and vitamins regulate body processes.

PTS:	1	DIF:	B	TOP:	Nutrients and Their Functions

	7.	Wellness is a way of life that integrates mind, body, and spirit. What lifestyle habits will help one achieve wellness?

ANS:	
Wellness can be accomplished through lifestyle habits such as focusing on healthy food choices, not smoking, participating in regular physical activity, and maintaining a healthy weight.

PTS:	1	DIF:	A	TOP:	Introduction

MODIFIED TRUE/FALSE

	1.	Appetite is the physiological need for food. Hunger is a psychological desire for food.
_________________________

ANS:	F, Hunger; Appetite

PTS:	1	DIF:	B	TOP:	Characteristics of Good Nutrition

	2.	The essential nutrient water provides energy. _________________________

ANS:	F, regulates body processes

PTS:	1	DIF:	B	TOP:	Nutrients and Their Functions

	3.	Osteoporosis is a dietary deficiency of calcium and vitamin D that causes bones to soften and may cause the spine to bend. _________________________

ANS:	T			PTS:	1	DIF:	B
TOP:	Deficiency Diseases	

	4.	The body must be provided with nutrients that are necessary for life. These nutrients are only available in food, must be obtained by the body’s nutritional intake, and are known as essential nutrients. _________________________

ANS:	T			PTS:	1	DIF:	A
TOP:	Nutrients and Their Functions

	5.	Primary deficiencies are those an individual is born with, while secondary deficiencies are those caused by a disease condition associated with malabsorption, accelerated excretion, or by destruction of the nutrients. _________________________

ANS:	F, Primary deficiencies are caused by inadequate dietary intake

PTS:	1	DIF:	B	TOP:	Deficiency Diseases	

	6.	Ingestion of megadoses of various vitamins and minerals is one of the major causes of overnutrition in the United States. ______________________

ANS:	T			PTS:	1	DIF:	B
TOP:	Malnutrition

	7.	Biochemical tests include various blood, urine, and stool tests. A deficiency or toxicity can be determined by a visual analysis of the samples.______________________

ANS:	F, laboratory

PTS:	1	DIF:	B	TOP:	Nutrition Assessment	

	8.	The deficiency disease beriberi is caused by inadequate niacin intake.____________________

ANS:	F, thiamin

PTS:	1	DIF:	A	TOP:	Deficiency Diseases	

CASE

Ms. Wooly brought her daughter, Mary, age 16, to the health care center to be seen by the nurse for a referral to the physician. Together, they tell the nurse that Mary has had nausea, vomiting, and headaches for the past two weeks. She has vomited “almost every day.” Ms. Wooly began to cry as she tells the nurse that Mary does not remember the date of her last menstrual period and that she is afraid that Mary is pregnant. During this interchange, Mary appears stoic and does not cry or have any verbalizations. After a blood test confirmed the pregnancy, Ms. Wooly became calmer. A prenatal assessment was begun. Ms. Wooly answered most of the questions even though they were directed at Mary.
Last menstrual period was estimated to be two months ago.
Menses onset began four years ago.
Ht: 5’8”  Wt: 125 lbs
Medium frame size
She described her usual dietary intake as including hamburgers, hot dogs, chips, candy, and colas. Mary denies alcohol, drug, or cigarette use. Mary would not discuss the father of the child, nor did she volunteer any additional information. It is evident that Mary has some urgent needs that must be addressed during this visit. Mary is young and will need time to accept the pregnancy, but she must also begin to eat properly to meet her nutritional needs and those of the infant.

	1.	Problem nutrients for teen pregnancies include calcium, zinc, iron, vitamin A, vitamin C, folate, and protein. What are the nutritional needs for each of these nutrients for a pregnant teenager?

ANS:	
Calcium: (under 18) 1,300 mg per day
Vitamin A: 750 micrograms per day
Zinc: 12 mg per day
Vitamin C: 80 mg
Iron: 27 mg
Folate 600 micrograms per day
Protein: 71 grams per day

http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables

PTS:	1	DIF:	B	TOP:	Individuals at Risk from Poor Nutritional Intake

	2.	State three nursing diagnosis statements from the assessment data.

ANS:	
Altered nutrition: less than body requirements related to adolescent pregnancy, when her own needs for growth and maturation are still high and eating habits are poor. Knowledge deficit related to nutritional requirements during pregnancy. Anxiety related to changes, discomforts, or emotional feelings resulting from pregnancy.

PTS:	1	DIF:	C	TOP:	Individuals at Risk from Poor Nutritional Intake

	3.	List nursing interventions to help Mary achieve an adequate nutritional status.

ANS:	
Using the MyPlate, teach Mary nutritional needs during pregnancy and the characteristics of an adequate diet. Help Mary individualize her diet so that she achieves an adequate intake. Teach Mary strategies for coping with nutrition-related discomforts of pregnancy.

Advise Mary to use nutritional supplements, vitamins, and iron appropriately. Consult with and make referrals to other professionals, dietitian, social services, and other programs developed to aid pregnant women, such as the Special Supplemental Program for Women, Infants, and Children (WIC).

PTS:	1	DIF:	C	TOP:	Care Planning		

	4.	Mary’s age, physical symptoms, and diagnosis will factor into her care. Teen pregnancy is impacted by several life cycle needs, and also covers a broad range of developmental needs based on the pregnancy and the woman’s age. Discuss the factors associated with nutrition and identify goals to help Mary obtain a successful outcome.

ANS:	
Mary is a pregnant teenager. She still has the pressures of being a teenager and the demands of eating nutritionally. In addition to eating properly for the fetus, Mary is still growing and developing with her own nutritional needs. She may also have cravings related to fast foods or empty calories and possibly aversions to meat and eggs. Her list of “usual foods” shows how difficult it may be for her to change her dietary habits and eat healthily. Goal 1: Mary will verbalize understanding of the rationale for eating a nutritious diet. Goal 2: Mary will select foods and make a meal plan that adheres to dietary guidelines for a pregnant teen.

PTS:	1	DIF:	C	TOP:	Individuals at Risk from Poor Nutritional Intake

	5.	Describe the usual weight gain recommended for a pregnant adolescent who is at the recommended weight for her height, for an overweight teen, and for an underweight teen.

ANS:	
The recommended weight gain for a teenager should be at the higher end of the range. A gain of 1 pound (lb) per week in the second and third trimesters of pregnancy is advised. If the adolescent is underweight, a 40lb gain is recommended; for normal weight, 35 lbs; and 25 lbs for an overweight teen. Generally, pregnant adolescents should consume no fewer than 2,000 calories per day. In many cases, higher caloric intakes are needed.

PTS:	1	DIF:	C	TOP:	Care Planning		

	6.	Contact the WIC program in your community. Discuss the benefits and goals and describe the positive outcomes.

ANS:	
An individualized nutritional risk profile is developed for each person and a specific nutritional rehabilitation program is determined. Goals are increased birth weight, decreased preterm delivery, and decreased maternal morbidity and perinatal morbidity and mortality.

PTS:	1	DIF:	C	TOP:	Individuals at Risk from Poor Nutritional Intake

	7.	When Mary hears the nurse tell her she will need to increase her caloric intake, her first response to the nurse was, “More chips, candy, colas.” What is the nurse’s response?

ANS:	
The MyPlate should be used as a basis for daily food choices. The nurse must help Mary understand that the weight gain must be from desirable foods that are nutrient dense, and emphasize the importance of choosing a varied diet. The empty calories that Mary prefers provide no nutritional value for her or the baby.

PTS:	1	DIF:	B	TOP:	Care Planning		

	8.	Before a meaningful exchange of information will occur with Mary, the nurse must first build a trusting relationship and establish good communication lines. Describe the setting that will be most conducive to beginning this dialogue. Who will be present? What will help Mary be relaxed and feel nonthreatened? Describe positive communication techniques that will be useful. How should the session begin?

ANS:	
Development of a trusting relationship should begin with the nurse meeting with Mary alone. Allow her to be in a comfortable position. Sit on a couch next to her, not behind a desk with her facing you. Use open-ended questions, exploratory statements; and body language that is nonthreatening so Mary will feel comfortable. Don’t ask leading questions such as, “You don’t drink or smoke pot, do you?” Begin by talking about daily events to put Mary at ease. As the conversation progresses, use silence to allow Mary to gather her thoughts. Speak with Mary as an adult. Encourage questions from her.

PTS:	1	DIF:	C	TOP:	Care Planning		

Mr. Lew was transported to the emergency room (ER) by emergency transport. City police officers called an ambulance after finding Mr. Lew lying in an alley with apparent unconsciousness. The emergency medical team started an intravenous (IV), and upon arriving at the ER Mr. Lew had regained consciousness but is now unconscious again. Physical data collected included:

Physical appearance is unkempt and dirty.
Odor suggests consumption of alcohol is likely.
T 96, P 124, R 36, B/P 90/40
Very emaciated appearance
Legs and arms very dry and flaky
Mottled purplish areas to lower extremities
Edema 3+ in ankles and lower legs
Abdomen tight and distended
Facial color and nail beds pale
No response to painful or verbal stimuli

After physician examination, Mr. Lew was admitted to the hospital with malnutrition, R/O pancreatitis, and cirrhosis of the liver due to ETOH abuse.

	9.	Mr. Lew has no family or friends present and his level of awareness will greatly restrict data collection. List the data collection methods that are available considering Mr. Lew’s condition. Identify any tools you will need to collect assessment data to begin the planning phase.

ANS:	
Data collection methods include a physical examination, including anthropometric measurements, a nursing history, and biochemical analyses. When Mr. Lew regains complete orientation, a dietary history and dietary recall can be done. Scales, tape measure, and a stethoscope are needed. A dietary history will be difficult to complete; however, the location of his body (in an alley) may indicate the type of lifestyle he has been leading. Tools needed will vary but may include paper, pencil, thermometer, stethoscope, sphygmomanometer, and watch.

PTS:	1	DIF:	C	TOP:	Nutrition Assessment	

	10.	List data that will be assessed.

ANS:	
Eyes should be bright and shiny; assess gums for caries, lesions, missing teeth, gums edematous, and presence of bleeding; face and skin dry, scaly, or smooth and firm; tongue for redness, bumpiness, and roughness; nails firm and pink; posture; wasted appearance; reflexes; vital signs; fat-fold measures; height and weight.

PTS:	1	DIF:	C	TOP:	Nutrition Assessment	

	11.	Identify the biochemical analyses that should be monitored.

ANS:	
Serum albumin, prealbumin, hematocrit, hemoglobin, electrolytes, glucose, BUN, cholesterol including triglycerides, uric acid, calcium, magnesium, enzymes, creatinine, iron, folate and B12

PTS:	1	DIF:	C	TOP:	Nutrition Assessment	

	12.	Identify goals for Mr. Lew, relating to nutrition. Be specific as to protein needs.

ANS:	
Mr. Lew will: stabilize fluid and electrolyte balance within 24–48 hours; receive adequate nutrients to meet nutritional needs (typically 30–35 calories per kg of body weight); gain 0.25–0.5 lb/kg a week. Protein needs are greater in those recovering from alcoholism. Goal would be to consume 1–2 grams per kg of body weight daily. The extra protein is needed for cell growth, and muscle and tissue repair. He will need to have protein added to meals as well as 1–3 snacks per day with added protein.

Resource: Academy of Nutrition and Dietetics Nutrition Care Manual

PTS:	1	DIF:	C	TOP:	Care Planning		

	13.	For each goal, what outcome data will verify that the goals have been met?

ANS:	
Fluid intake and output will be balanced and vital signs normal. Nutritional therapy will be ongoing. Overall physical indicators may not be notable for several weeks, considering the time period it may have taken to reach the level of emaciation. Weight will be fluctuating at first; a stable weight with gain will validate the goal. An adequate diet for Mr. Lew will be necessary for the rest of his life. Laboratory values will be stable, within normal limits, within 48 hours. Mr. Lew will report consuming 3 meals a day with adequate protein as well as snacks between meals. He will report no alcohol consumption. He will also have improved appearance, less dry skin, decreased edema and improved abdominal distention.

PTS:	1	DIF:	C	TOP:	Care Planning		

	14.	Of the goals identified, which is the highest in priority?

ANS:	
Normal laboratory values are the highest priority. In his present condition it is of utmost need to stabilize his body’s fluid and electrolyte balance.

PTS:	1	DIF:	B	TOP:	Care Planning		

	15.	Identify nursing interventions to meet the identified goals.

ANS:	
Weigh daily, monitor I & O hourly, monitor B/P, T, P, R rate, breath sounds, and edema. Monitor lab values: glucose, vitamins, minerals, trace elements, electrolytes, albumin/prealbumin, folate, zinc, and BUN. Mouth care every two hours. Offer small, frequent feedings. Collaborate with dietician for a progressive diet, high in nutrients. Monitor calorie count for three days, closely monitoring protein intake. Assess client’s knowledge of a balanced diet. Provide positive reinforcement for food intake.

PTS:	1	DIF:	C	TOP:	Care Planning		

	16.	Describe the role alcohol has played in Mr. Lew’s nutritional status.

ANS:	
Alcohol produces euphoria that results in depressed appetite and impacts the diet of a drinker. People afflicted in this manner tend to eat very little. The alcohol is rich in calories and energy; however alcohol provides empty calories. The more one drinks, the less food is eaten. Even when food is eaten, the alcohol interferes with the body’s ingestion, digestion, absorption, metabolism, and excretion of nutrients. Nutrient deficiencies are an inevitable result of alcoholism.

PTS:	1	DIF:	C	TOP:	Care Planning