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Nutritional Foundations And Clinical Applications- A Nursing Approach- 6th Edition Michele Grodner Test Bank
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Nutritional Foundations And Clinical Applications- A Nursing Approach- 6th Edition Michele Grodner Test Bank
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Nutritional Foundations And Clinical Applications- A Nursing Approach- 6th Edition Michele Grodner Test Bank
Chapter 02: Personal and Community Nutrition
Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition
MULTIPLE CHOICE
- A client tells you that he cannot eat most green vegetables because they taste too bitter. What is the most likely explanation?
| a. | He has certain genetic taste markers that make him a super taster. |
| b. | He associates eating green vegetables with unpleasant childhood memories. |
| c. | He needs to train himself to enjoy the acquired taste of bitter vegetables. |
| d. | He is making an excuse to avoid making healthful changes in his eating habits. |
ANS: A
Some people have variations in genetic taste markers that make them super tasters. These people often experience the taste of certain vegetables as being bitter. Environmental factors such as childhood memories may also influence food choices but are not usually associated with tasting vegetables as bitter. Tastes can be acquired and sometimes people make excuses to avoid making changes, but these are less likely explanations for this particular problem
DIF: Cognitive Level: Applying REF: Page 18
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
- A teenaged client is hungry and goes to the refrigerator for a snack. A holiday has just been celebrated at her home, and many of her favorite foods are available. She selects some slices of roast turkey and a cup of her aunts special fruit salad. This is an example of
| a. | bingeing. |
| b. | abundance. |
| c. | food choice. |
| d. | food preference. |
ANS: D
This teenager is able to select foods according to her preferences. Food choices are restricted by convenience, but many of her favorite foods are available, and so her choices are not limited. The food is abundant, and she may choose to binge and overeat, but her selections are made according to her food preference.
DIF: Cognitive Level: Analyzing REF: Page 18
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity
- A mother tells you that she does not allow her young children to eat while they watch television, even though her husband often eats high-fat, sugary foods while they watch television as a family. The most important thing to discuss with her is the
| a. | genetic factor of preference for sweet and salty tastes. |
| b. | influence of ethnicity on preference for sour tastes. |
| c. | childrens weights when they were born and their weights now. |
| d. | environmental effects of parental food choices and television watching. |
ANS: D
Because young children spend so much time with their families, their parents food choices have a major effect on their own future food choices. Preventing young children from eating while watching television will have only a short-term effect, and they are likely to imitate their father in eating high-fat, high-sugar snacks. The fathers food preferences are probably influenced by genetics and ethnicity, and it may be interesting to find out whether the childrens current weights are healthy for their heights (although their birth weight is probably not relevant), but this information has less immediate effect on the nutritional health of this family.
DIF: Cognitive Level: Applying REF: Page 18 | Page 35
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial integrity
- If a middle-aged couple with two teenage children has insufficient income to purchase food, the most helpful program for them would be the
| a. | MyPlate food guidance system. |
| b. | National School Lunch and School Breakfast Programs. |
| c. | federal governments Supplemental Nutrition Assistance Program (SNAP). |
| d. | Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). |
ANS: C
SNAP provides financial assistance to buy nutritious foods for individuals and families with incomes below certain levels. WIC provides assistance only to women who are pregnant or breastfeeding and to infants and children up to the age of 5 who are at nutritional risk. School meal programs would benefit the children but not the adults. MyPlate would help the family make healthy food choices but would not help with their financial problems.
DIF: Cognitive Level: Applying REF: Pages 18-19 | Page 21
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- For most Americans, the most significant nutrition concerns are
| a. | lack of interest in making healthy food choices. |
| b. | poor availability of fruits and vegetables in many areas. |
| c. | excessive intake of saturated fats, cholesterol, sodium, and sugars. |
| d. | inadequate intake of key vitamins, minerals, and phytochemicals. |
ANS: C
Most Americans have high intake of saturated fats, cholesterol, sodium, and sugars, which is associated with increased prevalence of chronic disease. Many people have inadequate intake of micronutrients, but this has a lesser overall effect than excessive intakes of fats, sodium, and sugars. Some areas of the country have poor availability of fruits and vegetables, but this is not a widespread problem in the country as a whole. Many Americans express at least some concern about making healthy food choices.
DIF: Cognitive Level: Understanding REF: Pages 18-20 | Page 30
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
- Excessive intake of high-sodium, high-fat foods can lead to diet-related illnesses such as
| a. | genetic disorders, hypertension, and diabetes. |
| b. | hypertension and sickle cell anemia. |
| c. | viral infections that necessitate antibiotics. |
| d. | coronary artery disease and hypertension. |
ANS: D
Coronary artery disease and hypertension are more common in individuals who consume high-sodium, high-fat diets. The risk for genetic disorders, sickle cell anemia, and viral infections is not affected by dietary fat and sodium intake.
DIF: Cognitive Level: Applying REF: Page 19
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
- Of the following, the most important overall dietary modification to help reduce the risk of chronic disease is
| a. | eating fewer foods that contain preservatives. |
| b. | buying mostly locally grown foods. |
| c. | eating more plant-based foods. |
| d. | eating more animal-based foods. |
ANS: C
Scientific evidence from the nutrition literature shows that shifting to a more plant-based diet is one of four significant modifications to dietary intake patterns that will improve the overall health of Americans. Preservatives per se have not been associated with health status (although foods that contain preservatives may be more highly processed and may have higher levels of fat, sugar, and sodium and lower levels of nutrients than do foods without preservatives). Buying locally grown foods may be a good agricultural and economic practice, but it does not affect health status. Eating more animal-based foods would be the opposite of what is recommended.
DIF: Cognitive Level: Applying REF: Page 20 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
- One way to help clients follow the Dietary Guidelines for Americans is to encourage them to use
| a. | Healthy People 2020. |
| b. | the MyPlate food guidance system. |
| c. | the Supplemental Nutrition Assistance Program (SNAP). |
| d. | the Exchange Lists for Meal Planning. |
ANS: B
MyPlate is designed to help clients implement the recommendations of the Dietary Guidelines for Americans. Healthy People 2020 sets national targets for health promotion. SNAP provides funds for individuals and families with low incomes to buy nutritious foods. The Exchange Lists for Meal Planning is intended primarily for patients with diabetes and those who need to lose weight; the system helps patients choose appropriate portion sizes to control their intake of fat, protein, carbohydrate, and energy.
DIF: Cognitive Level: Understanding REF: Pages 18-23 | Pages 27-28
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- For a client who follows a vegan diet, the most helpful meal planning tool would be
| a. | the Healthy Eating Plate, produced by the Harvard School of Public Health. |
| b. | the Mediterranean Diet Pyramid, from Oldways Preservation and Exchange Trust. |
| c. | the Power Plate, created by the Physicians Committee for Responsible Medicine. |
| d. | Exchange Lists for Meal Planning, from the American Diabetes Association and the American Dietetic Association |
ANS: C
The Power Plate is a vegan food planning guide that eliminates all sources of animal foods. The Healthy Eating Plate and Mediterranean Diet Pyramid could be adapted for a vegan diet, but they include meat and dairy options. The Exchange Lists for Meal Planning is intended to help design eating patterns for clients who need to monitor their intake of energy and specific macronutrients, such as clients with diabetes.
DIF: Cognitive Level: Applying REF: Pages 22-25 | Pages 27-28
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- An indirect benefit of the Fruits & VeggiesMore Matters program is
| a. | better understanding of fruit and vegetable preparation techniques. |
| b. | increased availability of fruits and vegetables in food deserts. |
| c. | eating more fresh produce in season. |
| d. | decreasing dietary fat intake. |
ANS: D
Fruits & VeggiesMore Matters is designed to increase intake of fruits and vegetables. Fruits and vegetables are naturally low in fat; they would replace higher fat foods in the diet and thus would indirectly decrease dietary fat intake. The program does not address fruit and vegetable preparation techniques, does not target availability of produce in food desert areas, and does not address eating fruits and vegetables in season versus out of season.
DIF: Cognitive Level: Applying REF: Page 23 | Page 26 | Page 30
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- A meal planning guide that would be helpful for a patient who needs to closely monitor their intake of calories, carbohydrates, protein, and fat is the
| a. | National Fruit and Vegetable Program. |
| b. | MyPlate food guidance system. |
| c. | Dietary Guidelines for Americans. |
| d. | Exchange Lists for Meal Planning. |
ANS: D
In the Exchange Lists for Meal Planning, foods are grouped according to their kilocalorie, carbohydrate, protein, and fat content, and serving sizes that contain specific amounts of each of these are listed. Therefore, this guide can help clients monitor their intake. The National Fruit and Vegetable Program simply encourages increased intake of fruits and vegetables. The Dietary Guidelines for Americans gives general advice but does not translate this into specific amounts of foods. MyPlate would help patients achieve healthy intake of kilocalories, carbohydrate, protein, and fat, but it would not be specific enough for them to monitor their intake closely.
DIF: Cognitive Level: Applying REF: Pages 19-23 | Pages 26-28
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- One reason that increasing fruit and vegetable consumption helps decrease dietary fat intake is that fruits and vegetables
| a. | are natural appetite suppressants. |
| b. | replace high-fat foods in the diet. |
| c. | are rich in antioxidants and phytochemicals. |
| d. | decrease absorption of fat from foods. |
ANS: B
Fruits and vegetables replace high-fat foods in the diet because they are high in fiber and water; they cause satiety so that clients have less desire for high-fat foods. Fruits and vegetables are not, and do not contain, natural appetite suppressants and do not hinder absorption of fat from foods. They are rich in antioxidants and phytochemicals, but increased intake of these substances does not affect fat intake.
DIF: Cognitive Level: Understanding REF: Page 23 | Pages 26-27
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
- Why are health professionals concerned about the trend toward eating more food away from home?
| a. | Larger portion sizes often contribute to excessive caloric intake. |
| b. | Eating away from home means less social interaction. |
| c. | Eating out tends to decrease the variety of foods eaten. |
| d. | Restaurant meals are associated with more sedentary lifestyles. |
ANS: A
Restaurants and fast food outlets often serve large portions that increase caloric intake. Eating away from home does not necessarily decrease social interaction, inasmuch as families or friends may eat away from home in groups. Eating out does not necessarily decrease the variety of foods eaten, depending on individual food choices. Eating out has not been related to physical activity levels.
DIF: Cognitive Level: Understanding REF: Page 21 | Page 29
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- If clients want to use the food label to check the number of kilocalories in a product, they should also check the
| a. | calories from fat. |
| b. | servings per container. |
| c. | Percent Daily Value. |
| d. | ingredient list. |
ANS: B
The number of calories in a product is stated for a standard serving size of that food. Clients need to multiply the calories per serving by the number of servings in the container to know how many calories are in the container. The calories from fat are not related to the total number of calories in the food. The Percent Daily Value refers to the nutrient content of the food rather than its caloric value. The ingredient list does not give any information about calories.
DIF: Cognitive Level: Analyzing REF: Page 32
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- The most useful part of the food label for clients who want to make sure they choose foods high in nutrients is the
| a. | Percent Daily Value. |
| b. | health claims. |
| c. | organic seal. |
| d. | amount of nutrients per serving. |
ANS: A
The Percent Daily Value shows how a food fits into the overall daily diet and would therefore show whether it makes a high or low contribution to nutrient intake. Health claims may indicate that a food has high or low amounts of specific nutrient related to that particular health claim, but they would not indicate overall nutrient content of the food. The organic seal, if present, indicates the farming methods used to grow the food but does not give any information about nutrient content. The amount of nutrients per serving is listed for only some nutrients; the listing would not give any information about vitamins and minerals in the food because these are listed only as Percent Daily Values.
DIF: Cognitive Level: Applying REF: Pages 31-35
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- If a client is trying to increase intake of dietary fiber, a useful symbol to look for on the food label would be the
| a. | MyPlate food guidance graphic. |
| b. | U.S. Department of Agriculture (USDA) 100% Organic seal. |
| c. | Fruits & VeggiesMore Matters logo. |
| d. | 100% Whole Grain stamp. |
ANS: D
Whole grains are an important source of dietary fiber, and so the 100% Whole Grain stamp would help a client select high-fiber foods. Fruits and vegetables also contain high amounts of dietary fiber, but the Fruits & VeggiesMore Matters logo is not used in labeling individual foods. MyPlate is also not used on food labels. The organic status of a food does not reveal any information about its dietary fiber content.
DIF: Cognitive Level: Understanding REF: Pages 21-23 | Page 27 | Pages 33-34
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- The Nutrition Facts panel on a food label is useful for
| a. | determining the ingredients in a product. |
| b. | determining the ease of preparing a product. |
| c. | comparing the price value of two or more products. |
| d. | comparing the nutritional value of two or more products. |
ANS: D
The Nutrition Facts panel on a food label lists the quantities of specific key nutrients in the food and can therefore be used to compare the nutritional value of two or more products. The ingredients are listed elsewhere on the package, rather than in the Nutrition Facts panel. The Nutrition Facts panel does not indicate how easy the food is to prepare and does not include any information about cost or price.
DIF: Cognitive Level: Understanding REF: Pages 32-33
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- A pregnant woman may look for a health claim on food labels that links
| a. | sodium intake and risk of stroke. |
| b. | calcium intake and risk of osteoporosis. |
| c. | folic acid intake and risk of neural tube defects. |
| d. | fruit and vegetable intake and risk of heart disease. |
ANS: C
The U.S. Food and Drug Administration has approved use of a health claim stating the relationship between folic acid intake during pregnancy and decreased risk of neural tube defects in infants. It has also approved use of a health claim stating the relationships between (1) calcium intake and (2) decreased risk of osteoporosis, between (1) a diet rich in fiber-containing grain products, fruits, and vegetables and (2) reduced risk of coronary heart disease, and between (1) a diet low in sodium and (2) reduced risk of high blood pressure (not specifically stroke); however, this information is not directly relevant to a pregnant women.
DIF: Cognitive Level: Applying REF: Page 35
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- An eating behavior that is most likely to have a negative long-term effect on health is
| a. | a monthly meal out at an expensive restaurant. |
| b. | eating French fries with lunch once a week. |
| c. | avoiding a specific fruit or vegetable. |
| d. | drinking one can of sugar-sweetened beverage every day. |
ANS: D
Small daily practices have a cumulative effect on nutritional health. Eating a rich meal once a month or even ordering French fries once a week will have less overall effect on health than daily habits. It is possible to avoid a specific fruit or vegetable and still make healthy food choices by including other fruits and vegetables.
DIF: Cognitive Level: Applying REF: Page 18 | Page 21
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
- The most helpful general recommendation for making healthy food choices would be to
| a. | focus on organic and natural foods. |
| b. | learn to use the Nutrition Facts Panel on food labels. |
| c. | eat more food from plant sources and less food from animal sources. |
| d. | replace refined grain products with whole grain foods. |
ANS: C
The most helpful overall recommendation would be a shift to a more plant-based diet, which automatically decreases intake of saturated fat and cholesterol. Replacing refined grains with whole grains is a good choice, but it is only one aspect of healthy eating. Organic and natural foods do not necessarily improve nutrient intake. Learning to use the Nutrition Facts Panel is helpful, but not all foods have these labels (fruits, vegetables, and meats do not have to carry these labels).
DIF: Cognitive Level: Analyzing REF: Page 20 | Pages 32-34
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- A client works at a fast food restaurant and usually orders a cheeseburger and regular soda at lunchtime. What would be the most simple recommendation to make this a healthier choice?
| a. | Eat the meat patty and cheese without the bun, and drink juice. |
| b. | Do not add ketchup or mustard, and drink cappuccino. |
| c. | Skip this meal and fast until dinner. |
| d. | Omit the cheese from the burger, and drink skim milk. |
ANS: D
Omitting the cheese from the hamburger would decrease intake of saturated fat and calories; replacing the soda with skim milk would replace the calcium without added fat and sodium. Removing the bun would decrease calories but would not decrease the fat content; drinking juice would provide some nutrients but also an amount of sugar similar to that of regular soda. Ketchup and mustard add sodium and a relatively small number of calories, but their impact is less significant than the cheese; fast-food cappuccino is high in sugar and fat. Missing meals does not usually help improve overall dietary intake; regular intake of nutrients throughout the day helps body metabolism function well.
DIF: Cognitive Level: Analyzing REF: Pages 19-21 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
- A male client is 38 years old. He is married with two children, aged 7 and 9 years. Both he and his wife work full time. What other information would be important to know when showing him how to use MyPlate to develop a personalized food plan?
| a. | His wife enjoys cooking home-made meals. |
| b. | He is currently training to run a marathon. |
| c. | Both his father and mother both have type 2 diabetes. |
| d. | He has an allergy to nuts. |
ANS: B
MyPlate recommendations are based on age, sex, and activity level. Therefore, the most important information would be that he is training for a marathon. MyPlate gives recommendations for numbers of servings from each food group each day; it does not recommend specific foods, and so allergy information not important because other foods within the food group could be selected. His parents health problems may help motivate him to make healthy food choices, but this information is not needed to use MyPlate. The number of foods from each food group is not affected by whether foods are home cooked or preprepared.
DIF: Cognitive Level: Applying REF: Page 21
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
- For a busy client who works 50 hours a week, a helpful strategy for making healthy food choices is
| a. | eating several small meals throughout the day. |
| b. | planning meals and snacks in advance. |
| c. | buying fruits and vegetables in season. |
| d. | using the Dietary Guidelines for Americans as a guide. |
ANS: B
Planning ahead for meals and snacks can be very helpful for busy clients so that they do not rely on impulsive food choices. It allows them to make decisions ahead of time instead of waiting until they are tired and hungry. Eating several small meals throughout the day may help maintain energy in a long workday but does not help make healthier food choices. Buying fruits and vegetables in season helps to save money on groceries but is not necessarily related to making healthy food choices. The Dietary Guidelines for Americans provides general advice but does not help with specific food choices.
DIF: Cognitive Level: Applying REF: Page 31 | Page 35
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- A single mother has epilepsy and does not drive. She works full time from home, and her three children take the bus to school. She generally rides her bike or walks wherever she needs to go. What would be your greatest concern related to the familys nutritional well-being?
| a. | It is not safe for someone with epilepsy to prepare food with sharp knives and a hot stove. |
| b. | She is unlikely to be able to afford healthy food for three children as a single mother. |
| c. | Because she does not drive, she may not have access to affordable and high-quality food. |
| d. | Working full time would not leave her enough time to prepare nutritious food for her family. |
ANS: C
The greatest concern is that because she does not drive, she may not have access to affordable and quality food. Depending on her job, she may have sufficient income to purchase nutritious food, and many women are able to work full time and make time to prepare food for their families. She may need to be careful in the kitchen and perhaps cook only when other family members are home in case she has a seizure, but if her epilepsy is well controlled, there is no reason why she should not cook.
DIF: Cognitive Level: Analyzing REF: Pages 29-31
TOP: Nursing Process: Assessment MSC: Client Needs: Safe and effective care environment
- For someone who is able to shop for food only once a month, the most nutritious fruits and vegetables would be _____ fruits and vegetables.
| a. | fresh seasonal |
| b. | frozen |
| c. | canned |
| d. | dried |
ANS: B
When they have to be stored for longer than a few days, the most nutritious type of fruits and vegetables would be frozen. Many fresh fruits and vegetables lose some vitamins and may start to rot after a few days. Canned and dried fruits and vegetables are better than none at all, but they contain lower levels of vitamins and may contain added salt or sugar.
DIF: Cognitive Level: Applying REF: Pages 30-31
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- In choosing between two types of canned soup with regard to the best source of calcium, what information would you look for?
| a. | Dairy products in the ingredient list |
| b. | The Percent Daily Value for calcium |
| c. | Health claims related to calcium content |
| d. | A Good source of calcium description |
ANS: B
The most helpful comparison would be the Percent Daily Value for calcium in the two products. The presence of dairy products in the ingredient list does not indicate the amount of calcium in the product. Similarly, health claims and Good source of calcium descriptions would not help you compare the two products.
DIF: Cognitive Level: Applying REF: Pages 32-33
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- In a comparison of food products, the description that means the lowest fat content per serving is
| a. | lean. |
| b. | very lean. |
| c. | light. |
| d. | low fat. |
ANS: D
Low fat means no more than 3 g of fat per serving. Lean means no more than 10 g of fat per serving. Extra lean means no more than 5 g of fat per serving. Light means that the food contains one third fewer calories, or half the fat, of the original, which does not give any specific information about the fat content.
DIF: Cognitive Level: Analyzing REF: Page 33
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance
- The main reason for choosing organic foods is
| a. | to support the local economy. |
| b. | concern for the environment. |
| c. | to improve nutrient intake. |
| d. | better taste and quality. |
ANS: B
The main reason for choosing organic foods is concern for the environment. Many organic foods are grown and sold locally, but this is not a primary concern. Organic foods are not necessarily better in terms of nutritional value, taste, and quality.
DIF: Cognitive Level: Applying REF: Pages 33-34 TOP: Nursing Process: Planning
MSC: Client Needs: Safe and effective care environment
- An individual would be described as having an external locus of control if he or she
| a. | writes out a shopping list each week and generally buys only foods on the list. |
| b. | tries to eat mostly foods produced through organic and sustainable farming practices. |
| c. | has decided to eat a turkey sandwich but ends up ordering pizza with friends. |
| d. | tries to influence friends and family to help them make healthier food choices. |
ANS: C
Individuals with an external locus of control do not feel they are able to control outside forces that have power over their experiences, so they may be easily influenced to eat pizza instead of a sandwich. Individuals who write and buy foods from a shopping list would be described as having an internal locus of control because they have an inner sense of their ability to guide life events. Use of organic foods and a desire to influence other peoples food choices are not related to locus of control.
DIF: Cognitive Level: Applying REF: Page 43
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity
- In a research study, subjects in one group decrease their intake of saturated fat and cholesterol, and those in a control group maintain their current level of intake for 2 years, with regular monitoring of risk factors for cardiovascular disease. This type of research study is called a(n)
| a. | case study. |
| b. | epidemiologic study. |
| c. | monitoring study. |
| d. | experimental study. |
ANS: D
In experimental studies, researchers compare health outcomes of subjects who receive treatment or intervention with those of subjects in a control group, who receive no treatment or intervention. In epidemiologic studies, researchers track the occurrence of health or disease processes among populations to determine possible causative factors. In case studies, researchers examine individual cases of disease or health problems. Monitoring studies is not a recognized research term.
DIF: Cognitive Level: Remembering REF: Page 29
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance
Chapter 20: Nutrition in Cancer and HIV/AIDS
Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition
MULTIPLE CHOICE
- When someone smokes cigarettes and drinks three alcoholic beverages a day, he or she is contributing to his or her cancer risk via
| a. | initiation. |
| b. | metastasis. |
| c. | promotion. |
| d. | progression. |
ANS: C
Cigarettes and alcohol contribute to cancer risk by promoting abnormal cell growth in cells that are already mutated. Initiation is the stage in which the DNA in a normal cell is mutated. Progression is the stage in which the abnormal cells spread outside their original location. Metastasis is the spread of cancer to secondary sites. The DNA of the cell undergoes mutation in the initiation stage of carcinogenesis. Promotion is the second stage, in which abnormal cell growth occurs. Progression is the third stage, in which cancer cells spread beyond their original location. Metastasis is formation of cancer in secondary sites.
DIF: Cognitive Level: Applying REF: Pages 415-416
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance
- Someone who uses sunscreen and wears UV protective clothing and hats to prevent development of skin cancer may need to
| a. | use light therapy to prevent seasonal affective disorder. |
| b. | consume extra vitamins C and E and other dietary antioxidants. |
| c. | ensure adequate intake of vitamin D from fortified foods and supplements. |
| d. | consume additional fluids to replace sweat losses caused by additional clothing. |
ANS: C
Dietary antioxidants, found in fruits and vegetables, as well as in some other foods, may help protect against carcinogenesis. Electrolytes, amino acids, and monounsaturated fatty acids are all important in maintaining good nutritional status but do not help protect against carcinogenesis.
DIF: Cognitive Level: Applying REF: Page 415 | Page 423
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
- Fruits and vegetables help prevent cancer because they have high amounts of
| a. | phytosterols. |
| b. | vitamins. |
| c. | antineoplastics. |
| d. | antioxidants. |
ANS: D
Fruits and vegetables have high amounts of antioxidants that help prevent DNA mutation that leads to cancer. Antioxidants have antineoplastic qualities, but this is not what they are called. Fruits and vegetables contain vitamins, but not all vitamins help prevent cancer. Phytosterols are found in plant oils and help lower blood cholesterol level.
DIF: Cognitive Level: Remembering REF: Pages 415-416
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
- A dietary change that would help prevent cancer, according to the National Cancer Institute recommendations, is
| a. | eating vegetarian meals two or more times a week. |
| b. | choosing organic, pesticide-free fruits and vegetables. |
| c. | eating five or more daily servings of fruits and vegetables. |
| d. | consuming three or more daily servings of low-fat dairy products. |
ANS: C
Eating five of more daily servings of fruits and vegetables would help prevent cancer. Eating vegetarian meals two or more times a week may help prevent cardiovascular disease. Choosing organic, pesticide-free fruits and vegetables would help protect the environment. Consuming three or more daily servings of low-fat dairy products would help prevent osteoporosis and hypertension.
DIF: Cognitive Level: Understanding REF: Page 415 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
- Factors that contribute to loss of lean body mass in many patients with cancer that are outside the patients control include
| a. | hypermetabolism. |
| b. | inadequate protein intake. |
| c. | inadequate energy intake. |
| d. | drug noncompliance. |
ANS: A
Hypermetabolism may be caused by release of cytokines as part of the cancer process; this is outside the patients control. It may be difficult to maintain adequate intakes of protein and energy and to comply with drug regimens, but these factors are within the patients control.
DIF: Cognitive Level: Applying REF: Page 416 | Page 423
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
- A patient in whom cancer has been newly diagnosed is about to begin intense chemotherapy. She tells you that the only good thing about this diagnosis is that she will now be able to lose weight without even trying. The most appropriate nursing response would be to
| a. | encourage the patient to celebrate the positive aspects of the disease. |
| b. | encourage adequate nutrient intake to maximize tolerance of chemotherapy. |
| c. | reinforce the need to achieve and maintain ideal body weight. |
| d. | emphasize eating the right types of foods rather than an amount of food. |
ANS: B
Patients tolerate chemotherapy better when they are able to maintain good nutritional status. Even though weight loss may seem like a positive side effect, it could have a negative effect if nutrient stores are depleted. Minimizing loss of lean body mass and maximizing nutrient stores are more important than attaining ideal body weight in patients with cancer. Making good food choices is important, but eating enough food to maintain lean body mass stores is more important.
DIF: Cognitive Level: Analyzing REF: Pages 416-418 | Page 423
TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance
- If a patient is going to have surgery to remove cancer of the esophagus, it is important to
| a. | prevent poor food intake as a result of depression by warning the patient that the surgery may be disfiguring. |
| b. | emphasize complete abstinence from cigarette smoking and use of alcoholic beverages. |
| c. | provide nutrition support to reverse malnutrition caused by difficulty eating during the disease progression. |
| d. | encourage the patient to enjoy favorite foods to maximize intake. |
ANS: C
Many patients with head and neck cancer enter surgery with protein-energy malnutrition because the disease may have prevented adequate intake; nutrition support to reverse malnutrition can greatly improve outcomes. Warning a patient about being disfigured may not prevent depression. Abstinence from cigarette smoking and alcoholic beverages is wise, but is not necessarily the first priority. Enjoying favorite foods may be helpful to attain adequate intakes of energy, but good sources of protein and micronutrients should also be emphasized.
DIF: Cognitive Level: Analyzing REF: Pages 416-417
TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity
- If a patient has dumping syndrome after surgery to remove a tumor, he or she has probably had a
| a. | vagotomy. |
| b. | gastrectomy. |
| c. | pancreatectomy. |
| d. | small bowel resection. |
ANS: B
Dumping syndrome often occurs after a full or partial gastrectomy. Vagotomy may cause gastric stasis, diarrhea, and fat malabsorption. Pancreatectomy may cause type 1 diabetes and malabsorption of many nutrients. Small bowel resection may cause malabsorption of multiple nutrients, depending on the site and extent of resection.
DIF: Cognitive Level: Applying REF: Page 417
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
- Bone marrow cells and cells lining the gastrointestinal tract are more susceptible than other cells to damage caused by chemotherapy because they
| a. | are target cells for drugs. |
| b. | have a rapid turnover rate. |
| c. | are exposed to higher doses of the drugs. |
| d. | absorb more of the drugs than they excrete. |
ANS: B
Bone marrow cells and cells lining the gastrointestinal tract have a rapid turnover rate, which makes them highly susceptible to damage caused by chemotherapy. The drugs do not target these cells specifically, nor are the cells exposed to higher doses of the drugs. The effect of chemotherapy drugs on these cells is not related to absorption and excretion.
DIF: Cognitive Level: Understanding REF: Page 417
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
- If a patient with cancer is receiving a combination of chemotherapeutic agents that is known to interfere with bone marrow, they should give special attention to prevention of
| a. | dehydration. |
| b. | foodborne illness. |
| c. | nausea and vomiting. |
| d. | loss of bone mass. |
ANS: B
The effects of chemotherapy on bone marrow cause immunosuppression because bone marrow produces many immune factors; therefore, it would be especially important to avoid risk of foodborne illness. Certain types of chemotherapy may cause nausea, vomiting, or diarrhea (which may cause dehydration) or may interfere with calcium metabolism, causing loss of bone mass, but these side effects are not caused by the drugs effects on bone marrow.
DIF: Cognitive Level: Applying REF: Pages 417-418
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
- If a patient has cancer and is being treated with chemotherapy, the greatest food safety concern is
| a. | avoiding pesticide residues. |
| b. | potential food-drug interactions. |
| c. | choosing natural food products. |
| d. | preventing foodborne illness. |
ANS: D
Individuals undergoing chemotherapy have weakened immune systems and therefore need to be especially careful to prevent foodborne illness. Concerns about pesticide residues are no greater for patients with cancer than for the rest of the population. Food-drug interactions may be a concern for specific individuals but are not related to food safety. Choosing natural food products is not necessarily beneficial and is not a particular concern for patients receiving chemotherapy.
DIF: Cognitive Level: Applying REF: Pages 418-420
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Safe and effective care environment
- If a patient is receiving radiation therapy to the head and neck, he or she may need
| a. | moist and semiliquid foods because of loss of saliva. |
| b. | dry foods because of taste changes. |
| c. | extra fluids and electrolytes because of diarrhea. |
| d. | extra dietary fiber and fluids to prevent constipation. |
ANS: A
Radiation of the head and neck may damage salivary glands; therefore, moist and semiliquid foods may be needed. The patient may experience taste changes, but dry foods do not help with this problem. Diarrhea and constipation are more common with radiation to the abdomen and pelvis.
DIF: Cognitive Level: Applying REF: Page 417 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity
- Patients who have just received bone marrow transplants should not eat
| a. | canned tuna. |
| b. | soft cheeses. |
| c. | mayonnaise. |
| d. | steamed vegetables. |
ANS: B
Patients who have just received a bone marrow transplant have immunosuppression as a result of the transplantation and drug therapies; thus they should avoid potential sources of foodborne illness, such as soft cheeses made from unpasteurized milk. Canned tuna, commercial mayonnaise, and steamed vegetables carry a lower risk for causing foodborne illness.
DIF: Cognitive Level: Applying REF: Pages 417-419
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity
- Patients who receive bone marrow transplants often require parenteral nutrition. Some oral intake is important to help
| a. | achieve adequate nutrient intake. |
| b. | provide nutrients that cannot be infused. |
| c. | maintain the integrity of the small intestine. |
| d. | maintain a sense of normality for the patient. |
ANS: C
Some oral or enteral intake is important for patients receiving bone marrow transplants and parenteral nutrition to help maintain the integrity of the small intestine. It is possible to achieve adequate intake through parenteral nutrition; all nutrients can be infused if parenteral nutrition is carefully planned. Oral intake does help maintain some normality for the patient, but this is not the main reason for using it.
DIF: Cognitive Level: Understanding REF: Page 417 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity
- If a patient with immunosuppression needs to follow a low-bacterial diet, a meal that he or she should avoid is
| a. | Caesar salad dressing with alfalfa sprouts. |
| b. | breakfast cereal with milk. |
| c. | homemade bread with butter. |
| d. | chicken breast sandwich with mayonnaise. |
ANS: A
Patients with immunosuppression who need to follow a low-bacterial diet should avoid Caesar salad dressing made with raw eggs and alfalfa sprouts. Commercial dressings are safe, and the other salad ingredients would be safe as long as they are washed. Breakfast cereal, pasteurized milk, homemade or store-bought bread, butter, cooked chicken, and mayonnaise may all be included as part of a low-bacterial diet.
DIF: Cognitive Level: Applying REF: Pages 418-420
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment
- The Patient-Generated Subjective Global Assessment tool
| a. | should not be used as a basis for interventions because the data are subjective. |
| b. | provides a method for assessing the psychosocial effects of cancer on the patient. |
| c. | allows for early identification of patients who have po
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