Roth 10e NCLEX Chapter 18

MULTIPLE CHOICE 1. After becoming aware that the client has hyperlipidemia, the nurse educates the client on

medical nutrition therapy designed to improve the condition. The nurse explains to the client that this treatment involves a restriction of fats in the diet, and that foods such as ______ should be included, while foods such as ______ should be avoided.
a. bacon and salad dressings; sherbet and c. pita bread and peanut oils; blue cheese

plain bagels b. coconut and cereals; sausage and processed cheese

ANS: C

and cream soups d. whole-grain breads and buttermilk; bakery products and butter

See Table 18_1. Pita bread and peanut oils are in foods to include list and blue cheese and cream soups are in foods to avoid list.
PTS: 1 REF: Medical Nutrition Therapy for Hyperlipidemia: Table 18-1

2. After explaining to the client that a fat-controlled diet is necessary to help alleviate the clients

high cholesterol levels, the client asks the nurse to provide an example of a breakfast that would satisfy all with the fat restriction. Which of the following would be an appropriate example of a breakfast for the nurse to give the client?
a. c. cereal, two slices of wholewheat toast with one tablespoon of butter on each, two slices of bacon, and orange juice b. egg and cheese sandwich on a d. croissant with a glass of 2% milk and hash browns ANS: C

egg-white omelet with broccoli, a plain bagel with a tablespoon of honey, two slices of cantaloupe, and a cup of coffee with fat-free milk sausage gravy on two biscuits, an orange, and a glass of 100% cranberry juice

Egg whites, fruits and vegetables, plain bagels, honey, and fat-free milk are all foods to include in fat-restricted diets. Each of the other responses has at least one food to avoid in fat-restricted diets, so they would not be considered good examples of fatcontrolled breakfasts.
PTS: 1 REF: Medical Nutrition Therapy for Hyperlipidemia: Table 18-1

3. The physician notified the nurse that the client is suffering from congestive heart failure, and

is presenting with edema. The nurse is then notified that diuretics will be prescribed to aid in the excretion of water and sodium, in order to alleviate the clients edema. The nurse must advise the client that a potential side effect of diuretics is _______, and this can be addressed by the client by consuming ______.

a. again in sodium; supplementary

c. a loss of potassium; saltines d. swelling of the abdomen; a fat-

potassium
b. a loss of potassium; fruits and

vegetables
ANS: B

restricted diet

Diuretics can cause an excessive loss of potassium. Fruits, especially oranges, bananas, and prunes, can be useful in such a situation because they are excellent sources of potassium and contain only negligible amounts of sodium.
PTS: 1 REF: Congestive heart failure

4. The client asks the nurse to identify some examples of products that often have sodium added

to them and to describe the purpose of adding sodium, so the client can increase awareness of foods to avoid in a sodium-restricted diet. One accurate example that can be provided by the nurse is:
a. Baking powder, which is used to c. Brine, which is used in many chocolate

milks and ice creams for smooth texture b. Baking soda, which is present in some d. Sodium Chloride, which is used in quick-cooking cereals and processed pasteurized cheeses and in some cheeses breads and cakes to inhibit growth of mold
ANS: A

leaven quick breads and cakes

Baking powderused to leaven quick breads and cakes, baking sodaused to leaven breads and cakes; sometimes added to vegetables in cooking or used as an alkalizer for indigestion, brineused in processing foods to inhibit growth of bacteria; in cleaning or blanching vegetables and fruits; in freezing and canning certain foods and for flavor, as in corned beef, pickles, and sauerkraut, sodium chlorideused in cooking or at the table and in canning and processing
PTS: 1 REF: Sodium-restricted diets

5. The nurse is aware that the client has been prescribed a 2 gram sodium-restricted diet, and it is

necessary to provide the client with an example of a dinner that would satisfy the diet requirements. Which of the following examples of a dinner would be appropriate for the nurse to give to a client on a sodium-restricted diet? Please select the best answer. a. a large salad with almonds, canned c. glass of fat-free milk, fresh salad with chicken, cheddar cheese, dried oil, vinegar and unsalted nuts, fresh cranberries, and low-fat ranch dressing fish with lemon juice, and rice. with a cup of tea b. d. pork and sauerkraut, applesauce, and glass of cranberry juice cocktail, ham, frozen tomato soup with a glass of red wine vegetables, and a baked potato
ANS: C

Based on Table 18-5, each of the food items in answer C is present in the permitted foods column, while one or more of the food items in each of the other answers are listed in the table as a food to limit or avoid.
PTS: 1 MULTIPLE RESPONSE 1. The nurse is evaluating an adult client for metabolic syndrome in order to assess the risk for REF: Adjustment to Sodium Restriction

cardiovascular disease. The client is concerned about his obese child as well. Which of these risk factors that the adult client may demonstrate would also be a risk factor for a child? Select all that apply.
a. Blood pressure of 138/88 mm Hg b. Blood pressure of 142/85 mm Hg c. High blood lipids such as high d. High HDL e. High LDL f. Low C-reactive protein

triglycerides
ANS: A, B, E

A blood pressure of 142/85 mm Hg would classify the client as having Stage 1 hypertension, with high blood pressure being a risk factor associated with metabolic syndrome. High blood lipids such as high triglycerides, low HDL, and high LDL are risk factors associated with metabolic syndrome. Elevated highly sensitive C-reactive protein in the blood is also a risk factor associated with metabolic syndrome. Each of the risk factors listed in the section apply to children as well as adults.
PTS: 1 REF: Objectives

2. A client suffered a myocardial infarction 24 hours ago, but is now able to consume a low-

cholesterol-low-sodium diet. Which of the following dietary modifications could the nurse suggest that would increase the clients comfort after a myocardial infarction? Select all that apply.
a. avoid foods that are hard to digest b. avoid foods that are too hot c. avoid roughage ANS: A, B, C d. consume foods that are difficult to

chew
e. consume high-fiber foods f. consume very cold foods

Foods should not be extremely hot or extremely cold. They should be easy to chew and digest and contain little roughage so that the work of the heart will be minimal. Both chewing and the increased activity of the gastrointestinal tract that follow ingestion of high-fiber foods cause extra work for the heart.
PTS: 1 REF: Myocardial infarction

3. The client tells the nurse that the physician advised the client to restrict the amount of sodium

consumed to help control the clients hypertension. The client thinks it would be best to simply consume no sodium or sodium containing foods. What would be the most appropriate way for the nurse to respond to the clients statement? Please choose the best answer.
a. Notify the client that no sodium is c. Notify the client that it is impossible to

needed for survival the amount of sodium in the diet, the amount of potassium in the diet must be increased
ANS: C

have a diet totally free of sodium appropriate for a sodium-free diet

b. Notify the client that in order to reduce d. Notify the client what foods would be

It is impossible to have a diet totally free of sodium. Meats, fish, poultry, dairy products, eggs, cereals, vegetables, fruits, and fats all contain certain amounts of sodium naturally. Water contains varying amounts of sodium.
PTS: 1 NUMERIC RESPONSE 1. The client tells the nurse that the doctor has put him on a sodium-restricted diet that would REF: Sodium-restricted diets

allow him to consume 2 grams of sodium per day. Assuming the client consumes the average amount of sodium consumed by U.S. adults, how many grams of sodium must the client restrict per day in order to satisfy the prescribed sodium-restricted diet?
ANS: 5 Rationale: It is estimated that the average adult consumes 7 grams of sodium a day. In order to

consume 2g of sodium per day, the client would need to restrict 5 grams per day.
PTS: 1 REF: Sodium-restricted diets

2. The client notifies the nurse that the physician prescribed a diet for hyperlipidemia that would

restrict the clients percentage of calories from fats to the maximum recommended by the American Heart Association. Assuming the client consumes an average U.S. diet, what percentage of decrease in calories from fats must the nurse say the client needs to incorporate into his/her daily diet?
ANS: 5 Rationale: The American Heart Association has developed guidelines that recommend that

adult diets contain less than 200mg of cholesterol per day and that fats provide no more than 20% to 35% of calories. Currently, it is believed that nearly 40% of the calories in the average U.S. diet come from fats. 40% (average) 35% (maximum recommended) = 5% decrease.

PTS: 1

REF: Medical Nutrition Therapy For Hyperlipidemia