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Nutrition and Diet Therapy for Nurses

University of Ottawa
Uploaded: 2 years ago
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Category: Nursing
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Filename:   tucker_ch01_tif.doc (78 kB)
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Description
Chapter 1
Transcript
Tucker and Dauffenbach Chapter 1 Learning Outcome 1 To examine the role of the nurse in individual, family, and community nutrition. The nurse has been invited to speak about nutritional needs to a community group. Prior to planning the content of the presentation, the nurse should determine: How expenses for handouts will be reimbursed. The target audience. What equipment is available. Dietary needs of participants. Answer: 2 Rationale: The nurse who is going to do a presentation needs to know about the group, including such things as ages, cultural considerations, community needs. The learning needs of a group can be determined, but one cannot know dietary needs of participants. Expense reimbursement and equipment availability are relevant, but they will not determine the content of the presentation. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application The nurse is planning a program for a preschool group at a day care center. What should the nurse plan to include for an effective presentation for this age group? Activities to keep children busy for about an hour An interactive computer game Have another nurse available to answer questions Colorful pictures of foods Answer: 4 Rationale: The nurse has a responsibility to plan activities that are age-appropriate. Pre-school age children have a short attention span and like bright colors. The nurse can be an effective teacher in this setting by having colorful pictures of healthy foods that children can readily identify. A computer game is not an effective strategy for this age group, nor should it be necessary to have another nurse. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application The clinic nurse expects to meet with an elderly couple, one of whom is diabetic. Without knowing any other details, what should the nurse do to prepare? Assemble a folder of materials that is given to all new diabetics Ask other staff what they know about this couple Review a list of questions that can be asked to assess learning needs Develop a teaching plan Answer: 3 Rationale: The nurse must know about the learning needs of individuals, families, and groups to develop plans for individualized needs. The nurse cannot assume this is a new diabetic, nor is it appropriate to seek information from other staff. The nurse cannot develop a teaching plan until the learning needs are carefully assessed. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 2 To understand nutrition as an aspect of total health care. The nurse knows teaching about nutrient needs to an adult client has been effective when the client states: “If I don’t take a multi-vitamin supplement, I will be unable to meet all nutrition needs.” “There are some insignificant nutrients that I don’t really need.” “A good diet is hard work.” “The nutrients I need come from foods.” Answer: 4 Rationale: The nurse needs to understand the role of macro- and micronutrients in maintaining health and preventing disease. A client who understands that nutrients come from foods has beginning knowledge of nutrition. There are no insignificant nutrients, nor is a vitamin supplement required for good health. A good diet should not be hard work; it can be implemented with careful planning. Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analysis A client tells the nurse that “a good diet is the key to a long life.” The nurse responds that: “It is one aspect of healthy living.” “Good genes are a better predictor of long life.” “A good diet is most important early in life.” “You are well on your way to a long life.” Answer: 1 Rationale: It is important that a good diet is one aspect of healthy living. Other aspects may include safety, interpersonal relations, coping mechanisms, etc. Good genes may play a role; however, a client cannot ignore the role of nutrition in promoting a healthy life. A good diet is important throughout the lifespan, and it is never too late to make changes. A nurse ignores teaching opportunities when dismissing a client by suggesting that a long life is likely. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application A client who is obese tells the nurse that malnutrition is definitely not a problem. The nurse responds by telling the client that: Malnutrition can be an excess or deficiency of nutrients. Nutrient deficiency is the best indicator of malnutrition. This is correct information. A lot of research about malnutrition is being conducted. Answer: 1 Rationale: The nurse must be aware that malnutrition is an excess, deficit, or imbalance of nutrients. The obese client may, therefore, be malnourished. The client holds an incorrect assumption about malnutrition. Research is being conducted about all nutrients, but that response is not addressing the client’s lack of knowledge. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 3 To use the nursing process as the approach to nutritional care of clients. Which of the following information about a client would the nurse record as subjective data? Select all that apply. 60 years old History of diabetes Nausea after eating fatty foods Mother died of colon cancer Pain with chewing Answer: 3, Nausea after eating fatty foods; 5, Pain with chewing Rationale: Age is a statement of fact that can be easily verified, therefore it is objective data. Diabetes is a statement of fact that can be easily verified; therefore, it is objective data. Nausea is a client’s subjective experience, described in the client’s own words. The nurse cannot objectively verify the data. Cause of death is a statement of fact that can easily be verified; therefore, it is objective data. Pain is a client’s subjective experience, described in the client’s own words. The nurse cannot objectively verify the data. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analysis The nurse is meeting with a client who wants to do “something” about weight loss. The first thing the nurse should do is: Weigh the client. Find out how much weight the client wants to lose. Discuss the importance of good nutrition as part of the weight loss plan. Ask about the client’s reasons for wanting to lose weight. Answer: 1 Rationale: The first assessment measure the nurse will obtain is the client’s weight. The nurse can then explore reasons for wanting to lose weight and determine realistic expectations. The role of good nutrition will be part of the teaching implemented by the nurse. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application A client asks the nurse why it is important to fill out a food frequency questionnaire. The nurse responds that a food frequency record is used to: Determine nutrient excesses and deficiencies. Provide baseline data for dietary planning. Find out which supplements the client is taking. Determine which foods have been consumed during the past 24 hours. Answer: 2 Rationale: The food frequency record asks clients to reveal how often they consume specific foods and beverages, along with portion sizes. This data serves as part of the baseline data for determining nutrient excesses or deficiencies and will then lead to dietary planning. Supplements are not part of the food frequency questionnaire, nor does it include the 24-hour recall. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 4 To formulate relevant nursing diagnoses for individuals with actual or potential nutritional problems. The nurse calculates an elderly client’s body mass index as 19. Which of the following NANDA diagnoses would be appropriate? Knowledge deficit Fluid volume deficit Altered nutrition: less than body requirements Impaired metabolism Answer: 3 Rationale: A client with a BMI of < 20 is considered underweight, so the client is has a nutrient deficit. There is nothing to conclude that the client has a knowledge or fluid volume deficit, merely because the client is underweight. Impaired metabolism is not an accepted NANDA diagnosis. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application The nurse reads that a client has a nursing diagnosis of altered nutrition: more than body requirements related to excessive nutrient intake, evidenced by BMI = 29. What assessment data would the nurse expect to find about this client? The client’s weight is in excess of 200 pounds The client has a sedentary job The client looks obese The client’s weight is out of proportion to height Answer: 4 Rationale: The BMI is a measure of weight to height. It does not account for all parameters of lean body mass (muscle); however, it reasonable to assume that height and weight are out of proportion. A client may be of short stature and not weigh 200 pounds but still have a BMI of 29. The client may or may not have a sedentary job; a BMI of 29 indicates that caloric intake exceeds caloric expenditure. A client may not look obese because of a large frame size. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analysis What data must the nurse have to establish a nursing diagnosis of a knowledge deficit? The client is obese The client does not speak or read English The client is elderly and hard of hearing There are gaps in the client’s understanding Answer: 4 Rationale: A knowledge deficit exists when there is a gap between what the client needs to know and what the client is able to explain about a topic. A client does not need to be proficient in English to have the knowledge the nurse expects. A client’s weight, age, and hearing ability are also not related to the client’s acquisition and understanding of new knowledge. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 5 To differentiate between a nutritional screening and a nutritional assessment. The nurse who is completing a nutritional screening will ask the client: “How do you feel?” “What problems do you experience with chewing or swallowing?” “Have you eaten today?” “Where do you do your grocery shopping?” Answer: 2 Rationale: The purpose of a nutritional screening is to gather relevant data quickly to determine if a complete assessment should be done. Questions that ask about potential problem areas, like chewing or swallowing, elicit more relevant information than questions about the general state of health or well-being, grocery shopping, or the last meal eaten. That data would be gathered as part of a thorough assessment. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application The nurse recommends that a dietician be consulted for a nutritional assessment when the client: Has difficulty understanding the nurse’s questions. Asks too many questions that the nurse cannot answer. Has medical conditions with obvious nutritional implications. Wants foods that are not on the menu. Answer: 3 Rationale: When a client has conditions like diabetes mellitus or coronary artery disease, the dietician should be part of the team that plans for optimum client outcomes; that includes a nutritional assessment. The nurse needs to rephrase questions if a client does not understand what the nurse needs to know. Likewise, the nurse should seek appropriate sources to answer client questions and that may include a dietician. It would not necessitate a nutritional assessment. Client food preferences do not merit a nutritional assessment. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application What anthropometric data should the nurse expect to gather as part of a nutritional screening in a clinic setting? Skinfold measurements Height and weight Religious practices Hemoglobin and hematocrit Answer: 2 Rationale: The nutritional screening includes data that are gathered quickly. Height and weight are easily obtained data. Skinfold measurements require more sophisticated devices and special training to use correctly. Religious practices are not routine data gathered by the nurse. Lab results are not anthropometric data. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension Learning Outcome 6 To relate the importance of a nutritional screening during each client encounter. On the basis of a nutritional screening, the nurse has developed a care plan that includes a diagnosis of imbalanced nutrition: less than body requirements. What would be a realistic goal for this client? Increase weight by one pound per week Decrease physical activity to 2 hours per week Increase fat in the diet Replace sweets with high-protein foods Answer: 1 Rationale: A nutrition screening may serve as the basis for nursing diagnoses. When a client has a diagnosis that indicates a client is not meeting body requirements for nutrients, a small weekly weight gain is appropriate. Weight gain is promoted by increasing caloric consumption rather than restricting activity. Increasing intake of fats is rarely recommended. Replacing sweets with protein does not necessarily increase the number of calories consumed. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application After gathering and analyzing anthropometric data, the nurse concludes that a client has a “pear” body type. What analysis led the nurse to that conclusion? A waist-to-hip ratio of 1.05 A waist-to-hip ratio of 0.90 A waist-to-hip ratio of 0.85 A waist-to-hip ratio of 0.78 Answer: 4 Rationale: The waist-to-hip ratio is calculated by dividing the waist measurement by the hip measurement. “Pear” body types have a ratio at or below 0.8; “apple” body types have a ratio near or exceeding 1.0. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Analysis A nurse needs to collect nutrition screening data from an elementary school classroom. What data will be collected? Head circumference of each child to assess for growth Height and weight to calculate BMI Food frequency information How many children receive free or reduced-price lunches Answer: 2 Rationale: Anthropometric data, which include physical characteristics, are part of the screening process. Height and weight are measured quickly and are used to calculate BMI. Head circumference is measured in infants to assess growth. Food frequency is part of a more comprehensive assessment. The nurse does not need to know about school lunch participation for screening purposes. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 7 To categorize appropriate tools to use as guidelines for nutrient intake and nutritional standards. The nurse knows the client is reading the Nutrition Facts food label correctly when the client states: (Select all that apply.) “It lists all ingredients in descending order.” “I can tell if it is a reduced fat food.” “It lists a portion size.” “I can tell if the food has trans fats.” “Total calories for the package are listed.” Answer: 1, “It lists all ingredients in descending order”; 2, “I can tell if the food has trans fats.” Rationale: The Nutrition Facts panel is required to list all ingredients by weight in descending order. A reduced fat designation may be on the container or package label, but it is not part of the Nutrition Facts panel. A serving size is on the label; a portion size is what the client chooses to eat. It may or may not match the serving size as designated by the manufacturer or producer. The Nutrition Facts panel must have the trans fat content listed as a subheading under fats. Calories are listed by serving size, not package contents. Consumers can calculate the calories for the package by multiplying the calories per serving by the number of servings per package. Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analysis The nurse is gathering information for a presentation to a group of elementary school children. Which of the following sources will the nurse want to consult while preparing for the session? Dietary Guidelines for Americans MyPyramid for Children Nutrition Facts food labels Healthy People 2010 Answer: 2 Rationale: MyPyramid for Children has many resources that the nurse can easily use with children of varying ages. The Dietary Guidelines and Healthy People 2010 are broad resources for health professionals who are planning for population groups. Nutrition Facts may be useful with older children, but are not considered a resource useful for planning a presentation. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application What should the nurse tell the client who states that the Nutrition Facts label is useless because it doesn’t have realistic serving sizes? “The serving size is realistic for most people.” “The serving size should be followed for optimum nutrition.” “The serving size is determined by the manufacturer of the product.” “The FDA is looking out for the health of all Americans.” Answer: 3 Rationale: The manufacturer determines serving size, even though it may differ from what the usual consumer considers realistic. For example, many consumers do not believe ½ cup of ice cream constitutes a serving. However, the consumer can use the label to calculate the nutrient value of the portion size that is actually consumed. Optimum nutrition is determined by the total nutrients that are consumed, not one food. The FDA does not regulate Nutrition Facts labels. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application 4 ©2011 by Education, Inc. Tucker/Dauffenbach, Test Item File for Nutrition and Diet Therapy for Nurses

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