SIX ESSENTIAL NUTRIENTS (UNIT 3 ASSESSMENT)

Date Taken: 11/13/2020

BSN 2C Group 8 Members

Arlane Sitaca
Jannine Tan
Michi Marit Viedor
Krisha Lei Yap

1. A middle-aged patient has begun a very-low-carbohydrate diet to lose weight. What

possible consequences should the nurse be aware might occur with prolonged carbohydrate
deficiency?
● Iron-deficiency anemia and weight loss
● Bleeding gums and muscle weakness
● Headaches and muscle weakness
● Ketosis and low blood sugar

Rationale: Ketosis and low blood sugar can be some of the adverse effects of a low-carb diet.
Physiologic ketosis is a normal response to low glucose availability, such as low-
carbohydrate diets or fasting, that provides an additional energy source for the brain in the
form of ketones.

2. The nurse has been teaching a patient about low-carbohydrate diets. What response
by the patient indicates to the nurse that teaching has been effective?
● Iron-deficiency anemia and weight loss
● “Each gram of carbohydrate I eliminate from my diet should be replaced by
grams of protein.”
● “I can only lose weight by cutting carbohydrate intake in half.”
● “Any carbohydrates I do eat should be high in fiber.”

Rationale: This indicates that the patient has limited her carbohydrate intake and has
increased her consumption of macronutrients such as protein and fats and other
micronutrients. The statement from the patient also suggests that he has been effectively
implementing his low-carbohydrate diet since encouraging higher protein loads can help
with supporting physical activity and can be a big help with improving body composition and
metabolic adaptation considering the lowered intake of carbohydrate which is the body’s
main source of energy.

3. Which of the following foods would the nurse suggest for a patient who wants to
increase consumption of complex carbohydrates? *
● “Whole wheat spaghetti”
● Peaches
● Celery
● English muffins
Rationale:Complex carbohydrates, found in whole grains, legumes, and starchy vegetables,
contain longer chains of sugar molecules, they are found in whole foods like whole wheat
pasta, as they're high in fiber.

4. A patient tells the nurse, “All artificial sweeteners are bad for you.” How should the
nurse respond?
● “Most are bad, but some have no harmful effects.”
● “A small amount on a daily basis is not likely to cause any harm to anyone.”
● “Artificial sweeteners are approved by the FDA for use in foods and
beverages.”
● “Artificial sweeteners are good for you because they prevent tooth decay.”

Rationale:Artificial sweeteners don't contribute to tooth decay and cavities, may help with
weight control and have no virtual calories. The FDA established Acceptable Daily Intake
(ADI) levels for the approved high-intensity sweeteners, which is the amount of the high-
intensity sweetener that is considered safe to consume each day over the course of a
person's lifetime.

5. What foods can the nurse suggest to a patient concerned about preventing
diverticulosis?
● Apples and pears
● Buttered popcorn
● Peanut butter and bread
● Puffed wheat cereal and milk

Rationale: A high-fiber diet decreases the risk of diverticulitis. Food such as whole-grain
breads, oatmeal, bran cereals, fresh fruits and vegetables, which are high in fiber soften
waste material and help it pass more quickly through your colon. Fibrous food also prevents
constipation and assists in decreasing the pressure in the colon which aids in preventing
flare-ups of diverticulitis.

6. “What should the nurse say to a patient who expresses interest in beginning a high-
protein diet?

● “Make sure you eat only high biologic value protein for best results.”
● “A high-protein diet is expensive so you need to make sure you have the resources to
continue once you start.”
● "Use a formula to determine the minimum amount of protein you need and then double
that amount.”
● “Why do you want to start a high-protein diet?”

Rationale:Since there are many types of high-protein diets, it is essential to assess and
evaluate why your patient is interested first in order to give the correct and suitable type of
high-protein diet.
7. The school nurse is teaching a high school class about complete and incomplete
proteins. What is the best explanation of complete protein?
● It contains all of the essential amino acids.
● A minimum amount needs to be consumed for good health.
● It is the best source of protein.
● It is the protein necessary to promote positive nitrogen balance.

Rationale:Complete protein contains all essential amino acids needed for chon synthesis.

8. The nurse has been teaching a patient about complementary proteins. Which of the
following statements by the patient indicates that teaching has been effective?
● “If I consume a variety of incomplete proteins, I will have the amino acids I need.”
● “High biologic value proteins are the preferred source of proteins.”
● “Complementary proteins are required for a vegetarian diet.”
● “I need to combine incomplete proteins each day so that I have adequate
protein intake.”

Rationale: Eating 2 or more of these incomplete proteins together forms a complementary

protein – a protein that then contains all the essential amino acids required by our bodies in
sufficient amounts.

9. Which of the following individuals is most likely to have a negative nitrogen balance?
● A preschooler with asthma
● A young adult vegetarian who is a teacher
● A teenager who is on the school basketball team
● An elderly patient with an open leg ulcer that is not healing

Rationale: The element nitrogen is a distinguishing trait of protein from fats and
carbohydrates. Simply, under the context of macronutrients, nitrogen is exclusively found in
proteins; thus, the relative homeostasis of its output and intake is an indicator of protein
metabolism, which in turn, denotes the individual’s protein nutrition. Considering that
proteins are essential for tissue growth and repair, poor protein nutrition manifesting as
negative nitrogen balance, which occurs when nitrogen losses are greater than intake,
results in the slow wound healing process or non-healing wounds, wasting of the body, and
burns, among others.

10. The nurse has taught a patient with renal disease about high biologic value protein.
Which of the following statements by the patient indicates the need for more teaching?
● “Eggs are a good source of high biologic value protein.”
● “I can eat only a limited amount of protein so I should select those sources with a high
biologic value.”
● “Eating protein at each meal increases its biologic value.”
● “A good vegetarian source of high biologic value is soy protein.”

Rationale: The biologic value assigned to a protein source depends on the adequacy of the
essential amino acids it contains; the greater amounts of amino acids correspond to higher
values. Studies have shown that eggs and soy are high biological value protein foods.
Furthermore, clients with kidney diseases should decrease their protein intakes to prevent
the condition from worsening; however, in order to meet the daily protein requirements, the
said nutrient is still ought to be consumed so selection should involve high biologic value
proteins to meet the body’s needs even with the limitations placed upon. In addition to that,
the biologic value does not increase with the number of proteins consumed, rather it is
assigned to single protein food.

11. How should the nurse respond to the patient who already limits trans and saturated
fats and now wants to reduce cholesterol in the diet?
● “Eliminate all deep-fried foods from the diet.”
● “Eat no more than two to four eggs per week.”
● “Limit the portion of foods from animal sources, including meat and dairy products.”
● "Select only foods that have less than 7 grams of total fat per serving.”

Rationale: Cholesterol is different from fats in which there are distinct food considerations
made respective of the person’s preference. Eggs are high in cholesterol; hence,
consumption of such must be reduced to lower cholesterol levels. If the client has already
limited his or her consumption of trans and saturated fats, he or she has most likely avoided
consuming fried foods, red meat, whole-fat dairy products, as well as others high in fat
content.

12. The school nurse is preparing to teach a class of 16-year-olds about cholesterol.
Which of the following statements would the nurse use to describe cholesterol?
● Foods high in omega-3 fatty acids do not contain cholesterol.
● Red meat is the primary source of cholesterol.
● The body manufactures some of its own cholesterol in the liver.
● Cholesterol should be eliminated from the diet of middle-age adults.

Rationale: The liver naturally manufactures all of the cholesterol the body needs, so one
does not need to include cholesterol in his or her diet as high levels of such predisposes the
person to coronary heart disease. Additionally, since the audience is composed of 16-year-
old adolescents, discussing concerns on the diets of middle-aged adults is not appropriate.
Red meat, furthermore, is more associated with unhealthy saturated fats than cholesterol.
Other than that, a number of researches have suggested that fish oil, rich in omega-3 fatty
acids, increased levels of low-density lipoprotein (LDL), regarded as bad cholesterol, for
some.

13. The nurse encourages patients to increase consumption of omega-3 fatty acids.
Which foods would the nurse suggest?
● Fresh salmon
● Whole wheat pasta
● Whole grain bread
● Skinless chicken breast
Rationale: Salmon is the most well-known source of fatty acids, alongside other fatty fishes
such as mackerel, sardine, trout, anchovies, and tuna.

14. The nurse has taught a patient about limiting trans-fatty acids in the diet. Which
statement by the patient indicates that teaching has been effective?
● “I need to limit my intake of fried foods, mayo, and butter.”
● “I need to eat more fresh and canned fish to reduce trans-fatty acids.”
● “Trans-fatty acids come from the same source as monounsaturated fats.”
● “Eating vegetables with meat will limit the absorption of trans-fatty acids.”

Rationale: Trans-fatty acids are mostly found in fried foods and are also present in
mayonnaise as well as butter, but only in minute amounts.

15. The nurse has been working with a patient about the necessity of limiting intake of
total fat. Which diet selection by the patient indicates that the patient has understood the
teaching?
● Stir-fried beef with broccoli
● Macaroni and cheese
● White chicken chili
● Shredded beef taco with refried beans

Rationale: Chicken is lower in saturated fat compared to beef and whole-fat dairy products,
which are the main ingredients of the first, second, and fourth dishes.

16. The mother of a newborn tells the nurse that she is concerned that her baby is not
healthy because the baby got a “vitamin shot.” How should the nurse respond?
● “Vitamin K is given to newborns to help blood clot properly because they
don’t have vitamin K stored.”
● “Your baby is fine. You must have misunderstood what was said, but I will check and
get back to you.”
● “A vitamin shot is given to all newborns to get them off to a good nutritional start in
life.”
● “A vitamin C shot is given to help protect newborns from infections and keep them
healthier.”

Rationale: A vitamin K shot is given to newborns at birth to increase the amount of vitamin
K in the baby’s blood that is vital to its clotting ability, thus preventing vitamin K deficiency
bleeding or hemorrhagic disease of the newborn that is potentially fatal as internal or
external bleeding cannot be stopped normally with low blood-clotting factors.

17. The patient asks the nurse why vitamin-enriched foods are a good choice. The nurse
responds that:
● Extra vitamins are added to the processed foods to make them more nutritious.
● Vitamins are lost from foods during processing so enrichment adds them
back after processing.
● Enriched foods are safer because vitamins that normally are not in foods are added
during processing.
● Vitamins are added so a smaller amount of any given food has a higher proportion of
vitamins.

Rationale: An enriched food means that nutrients that were lost during processing are added
back in. Many refined grains are enriched. Wheat flour, for example, may have folic acid,
riboflavin, and iron added back in after processing. This is intended to restore its original
vitamin levels. Thus, the nurse should respond that “Vitamins are lost from foods during
processing so enrichment adds them back after processing”.

18. A toddler has been diagnosed with early-stage rickets. The nurse is counseling the
mother and suggests increasing which of the following foods in the child’s diet?
● Whole grain bread
● Green peas
● Apple juice
● Milk

Rationale: Rickets is the softening and weakening of bones in children, usually because of
an extreme and prolonged vitamin D deficiency. Therefore, what we need to add in the
child’s diet is Vitamin D that will promote calcium absorption and maintain adequate serum
calcium and phosphate concentrations in the child’s body. Milk is a great source of Vitamin D.

19. A known alcoholic is admitted to the medical unit. What vitamin does the nurse
expect will be part of the treatment plan?

● Vitamin D
● Vitamin C
● Folic acid
● Thiamin

Rationale: Thiamine deficiency is fairly common with people who suffer from alcohol
addiction, due to: the overall poor nutrition, alcohol inhibiting a person’s ability to fully
absorb the necessary nutrients from their food, Cells struggling to uptake this vitamin and a
reduced ability to properly use thiamine in cellular functions. This can become very
dangerous, leading to a serious and even life-threatening brain disorder called Wernicke–
Korsakoff syndrome, or “wet brain.” So, Thiamine is the vitamin that the nurse should
include in the treatment plan.

20. The nurse determines that dietary teaching has been effective when a patient who is
planning pregnancy states which of the following food items has the highest folic acid
content?
● Spaghetti with meatballs
● Vanilla pudding
● Tuna salad
● Spinach salad
Rationale: Folate is naturally present in a wide variety of foods, including vegetables, fruits
and fruit juices, nuts, beans, peas, seafood, eggs, dairy products, meat, poultry, and grains
Spinach, liver, asparagus, and brussels sprouts are among the foods with the highest folate
levels. Hence, the food that contains the highest folic acid among others is Spinach salad.

21. The nurse determines that teaching has been effective when a patient who needs to
be on a sodium-restricted diet states that which of the following foods should be avoided?
● Sirloin steak
● Whole milk
● Poached egg
● Salami

Rationale: Effective Health teaching is observed if the patient categorized Salami as to be

avoided for the reason that it contains a lot of salt, and made with sodium-containing
preservatives and other additives. A 2-ounce serving packs 1,016 mg, or 44% of the RDI.

22. The nurse is discussing the importance of fluoride in dental health of children with a
patient. The nurse would want to be sure to state which of the following?
● Fluoride supplements will prevent dental problems.
● Minute amounts of fluoride are added to most public water supplies to
prevent dental caries.
● Children who have adequate fluoride will not need to worry about dental caries as an
adult.
● Fluoride should be taken with calcium to ensure strong teeth.

Rationale: The ADA recognizes the use of fluoride and community water fluoridation as safe
and effective in preventing tooth decay for both children and adults. When used as directed
or within the context of community water fluoridation programs, fluoride is a safe and
effective agent that can be used to prevent and control dental caries.

23. The nurse determines that a patient has an adequate understanding of potassium
restrictions when the patient makes the following selection from a lunch menu.
● Vanilla milk shake
● Baked potato with broccoli and melted cheese
● Fruit salad with blueberries, strawberries, and cantaloupe
● Cottage cheese on a pear half

Rationale: Compared to vanilla milk shake, baked potato with broccoli and melted cheese;
and fruit salad with blueberries, strawberries, and cantaloupe, cottage cheese on a pear half
has the lowest potassium content. A serving of cottage cheese is a ½ cup and one serving
provides 110 mg potassium.

24. A patient has started taking a daily iron supplement. The nurse suggests that the
patient take the supplement with which of the following foods to increase the absorption of
the iron?
● Leafy green vegetables
● Whole wheat bread
● Milk
● Orange juice

Rationale: Leafy green vegetables are a best source of iron, however, orange juice contains
vitamin C and that micronutrient helps improve absorption of iron. Milk and whole wheat
bread may hinder iron absorption.

25. A middle-age female patient tells the nurse that she feels an increasing desire to
consume ice chips, now amounting to at least 6 cups a day. The nurse will want to assess
the patient for which of the following conditions?

● Dehydration
● Potassium excess
● Sodium deficiency
● Iron deficiency

Rationale: Research shows that people who always crave for ice chips usually have iron-
deficiency anemia. It was found out that participants with iron-deficiency anemia usually had
symptoms of pagophagia which is manifested by eating a lot of ice chips.

26. A 24-year-old office worker tells the nurse about hearing that drinking alcohol will
help prevent heart disease. How should the nurse respond to this statement?

● “Alcohol consumption is a risk factor in many disease processes so it should be

avoided.”
● “What specific kind of alcohol are you talking about?”
● “Alcohol may be beneficial if used in moderate amounts.”
● “The risk of alcoholism is too great to recommend consumption of alcohol to prevent
heart disease.”

Rationale: Alcohol has benefits such as raising the HDLs, or prevent damage caused by LDLs.
However, in healthy people without any complications which observe a healthy lifestyle as
well, one must consider to consume it in moderate amounts. Healthy amount would mean
up to 1 drink a day for women and up to 2 drinks a day for men. Examples of one drink will
include beer 12 oz. or wine 5 fluid oz.

27. What assessment data is the nurse certain will be present in a patient who is known
to be dehydrated?

● Dry mouth
● Dry skin
● Pale skin
● Diminished muscle tone
Rationale: In a study of 38 signs and symptoms commonly attributed to dehydration among
emergency ward patients, best indicators for severity of dehydration included: tongue
dryness, longitudinal tongue furrows and dryness of the mucous membranes of the mouth
(Gross et al, 1992).

28. The nurse is caring for each of the following patients. Which one will require
increased fluid intake?

● An elderly patient with intermittent diarrhea

● A middle-age patient on antibiotics for a respiratory condition
● A middle-age patient with severe heart failure
● An elderly patient receiving diuretics

Rationale: Having diarrhea may make a patient lose a lot of water. Thus, it is recommended
to take 8-10 glasses a day. Diuretic medications get rid of fluid from the body, people with
heart failure also need their fluid to be limited to avoid complications. It was not also
specified on what kind of respiratory illness the patient has so it is assumed that it may not
really require attention to fluid intake.

29. How should the nurse respond to the middle-age patient who reported hearing that
coffee is bad because it causes dehydration?

● “That is not true. Coffee contains beneficial substances like antioxidants.”

● “Coffee is bad because it contains caffeine, which raises the heart rate, which may be a
problem as people age.”
● “Coffee acts as a mild diuretic but does not cause dehydration because it is
almost all water.”
● “That is only true about caffeinated coffee, not decaffeinated coffee.”

Rationale: Drinking caffeine-containing beverages such as coffee as part of a normal lifestyle

do not cause fluid loss in excess of the volume ingested. Although they have a mild diuretic
effect, studies showed that they don't appear to increase the risk of dehydration.

30. A patient reports to the nurse that the urine seems to be very yellow and has a mild
odor. Which of the following is the most appropriate response by the nurse?

● “ The urine is concentrated and you need to drink more water.”

● “This is a normal variation and is of no concern.”
● “Call your health care provider immediately and share your concern.”
● “Tell me all of the medications you are currently taking; they may be affecting the
urine.”

Rationale: Urine color ranging from yellowish to amber is considered normal and is supposed
to have a mild smell or even unnoticed at all so drinking water may help since having that
color is a sign that the patient is dehydrated or needs to drink water.