Chapter 47: Nutrition

Question

1. What factors affect one’s nutritional requirements?

 The factors are based on level of activity, age of the individual (infant, preschool,
child, adolescent, adult and older adult), and gender

2. Summarize information related to nutrition on the My Pyramid guidelines.



3. What do the Dietary Reference Intakes (DRIs) recommend concerning of consumption

of various types of fats.

4. What do the guidelines recommend for dairy product consumption?

5. What are the Dietary Reference Intakes (DRIs)

6. What are the Estimated Average Requirements (EARs) and Recommended Dietary
Allowances (RDAs)?

7. What is the unit of measurement of energy requirements?

8. What are other names for simple carbohydrates?

9. What percent of calories of the total daily dietary intake of an adult is recommended to
come from carbohydrates?

10. Carbohydrates supply kilocalories of energy per gram, fats supply

kilocalories of energy per gram, and proteins supply kilocalories of energy
per gram.

11. What are the end products of protein metabolism?

12. How many water-soluble and fat-soluble vitamins are there to date?

13. Why are minerals essential to life?

14. Name three forms of malnutrition.

15. What laboratory studies can be used to assess lean body mass?
 16. Differentiate between enteral and parenteral nutrition.

17. Explain components of a nutritional assessment.

18. What physical changes are related to a malnourished state?

19. What are the general routines used for checking tube placement and residuals of enteral
feedings?

20. When in the use of enteral nutrition contraindicated?

21. What assessments should be performed prior to administering enteral nutrition?

22. Differentiate among bolus, intermittent, and continuous feedings.

23. How should prescribed medications be administered via a feeding tube?

24. List adverse effects of enteral feedings that should be reported to the health care
provider.

25. What is the difference between peripheral parenteral nutrition solutions (PPN), and total
parenteral nutrition (TPN) solutions?

26. List premedication assessments that should be performed before administering TPN or
PPN.

27. List adverse effects of parenteral feedings that should be reported to the health care
provider.

28. List key signs and symptoms of fat-soluble and water-soluble vitamin deficiencies.

FILL IN THE BLANKS

1. are the only sugars capable of being used directly to

produce energy for the body.
 2. Complex carbohydrates such as starch, dextrin, and fiber are also known as
.

3. is a protein deficiency that develops when the

patient receives adequate fats and carbohydrates in the diet, but little or no protein.

4. The equipment used to administer tube feedings are changed in accordance with the
clinical facility’s policy which is usually ever hours.

5. Deficiencies of vitamin are often associated with neurologic alterations.

6. Carbohydrates and proteins supply approximately kilocalories of energy per

gram.

7. Edema of the abdomen and subcutaneous tissue is a possible sign of

deficiency.

8. A deficiency can increase the heart rate and heart size.

9. A pyridoxine deficiency can result in .

10. Vitamin deficiency can result in anemia, depression, and delayed wound
healing.

MATCHING

11. Oral supplements a. Isocal

12. standard isotonic formulas b. Boost

13. pediatric formulas c. Glucerna

14. specialized formulas d. Similac

TRUE OR FALSE

15. Fiber is recognized as a macronutrient, a separate factor necessary for complete

nutrition and wellness.

16. Essential fatty acids (EFAs) are produced by the body.

17. Parenteral feedings are administered orally, either by drinking or instillation into the
stomach by way of a feeding tube or feeding gastrostomy port.

18. Total parenteral nutrition (TPN) orders are formulated daily based on the patient’s
status, weight, and fluid and electrolyte balance.
 19. Vitamins, whose name originally derived from the term “vital amines”, are a specific
set of chemical molecules that regulate human metabolism necessary to maintain health.

20. Patients receiving warfarin (Coumadin) should avoid herbal medicines that inhibit
platelet aggregation.

PRACTICE QUESTION

1. What are advantages of enteral nutrition over parenteral nutrition? ( Select all that
apply).

1. Enteral nutrition provides gastrointestinal stimulation

2. Enteral nutrition has less chance of infection associated with its use.
3. Enteral feedings are more expensive.
4. Enteral nutrition is more physiologic.
5. Enteral nutrition therapy does not require blood glucose assessment.

2. When administering drugs to a patient receiving an enteral feeding, what does the
nurse do?

1. Crushes enteric-coated tablets before administration via the feeding tube.

2. Crushes slow-release tablets before administration via the feeding tube
3. Combines all drugs together and administers at the same time.
4. Administers the medicines on an empty stomach.

3. The nurse teaches a patientto take calcium channel blockers with which liquids?
(Select all that apply)

1. Milk
2. Orange juice
3. Grapefruit juice
4. Carbonated soft drink
5. Water

4. A patient is receiving total parenteral nutrition at a rate of 80 mL per hour. The TPM
bag is due to be changed at 0900. The nurse enters the patient’s room at 0845 and
finds 300 mL of the TPN fluid remaining in the bag. What does the nurse do next?

1. Continues the infusion of the current rate until it is complete

2. Increase the rate of the TPN to150 mL per hour to use up the remainder of
fluid in the least amount of time.
3. Hangs an IV bag of normal saline if the next bag of TPN is not readily
available.
4. Discards any TPN remaining in the current bag andhangs a new bag of TPN

5. A patient admitted with a diagnosis of malnutrition has been ordered total parenteral
 nutrition (TPN). In the initial stages of therapy, the nurse assesses for the
development of which common adverse effect of TPN?

1. Hyperglycemia
2. Rash
3. Diarrhea
4. Abdominal cramping

6. When providing patient teaching about kwashiorkor, which statements doesthe

nurse include? (Select all that apply)

1. “It occurs because of a fat deficiency in the diet.”

2. “Patients with this condition are often difficult to recognize because they
appear to be well-nourished.”
3. “Patients with this condition receive adequate carbohydrates in the diet.”
4. “Patients with this condition receive adequate fat in the diet.”
5. “Patients are usually dehydrated when they have this condition.”

7. Which routes can be used for administering enteral nutrition? ( Select all that apply).

1. Central nervous
2. Nasogastric
3. Intrathecal
4. Nasojejunal
5. Needle-catheter jejunostomy

8. A patient is ordered Ensure ¼ strength 120 mL every 2 hours for 3 feedings. Ensure
is available in 4- and 8-ounce cans. How many can of Ensure are needed?
1. One 4-ounce can
2. One 8-ounce
3. One 4-ounce can AND one 8-ounce can
4. Two 4-ounce AND two 8-ounce cans

9. A patient is ordered Boost 800 mL at ¾ strength to infuse over 8 hours. Boost is available in
10 fluid ounce cans. How many mL of solvent does the nurse add? mL

10. A patient is ordered 2/3 strength Ensure 6 fluid ounces over 13 hours. Ensure is available in
4 fluid ounce cans. How many ounces of water does the nurse add to the 4 fluid ounce can?
fl oz.
Chapter 48: Herbal and Dietary Supplement Therapy

QUESTION

1. Define the key terms associated with this chapter.

2. Describe the role of the Food and Drug Administration (FDA) in the regulation of herbal
products.

3. What factors should be considered when recommending herbal products?

4. Prepare a list of herbal products listed in the chapter and insert the corresponding
popular used by lay people of these herbal products.

5. What questions as part of a medication history should elicit information regarding the
use of herbal products and other alternative medicines?

6. What potential drug interactions may occur with each herbal product listed?

7. What is the common use for aloe?

8. What is the most common drug interaction with aloe?

9. What is the common use for black cohosh?

10. When should black cohosh not be used?

11. What is the common use for chamomile?

12. What is Echinacea commonly used for?

13. What is ephedra commonly used for?

14. When is the use of ephedra contraindicated?

15. What are the adverse effects of ephedra?

16. What is feverfew commonly used for?

17. What is garlic commonly used for?

18. What is ginger commonly used for?

19. What is ginkgo commonly used for?

 20. What is ginseng commonly used for?

21. What is goldenseal commonly used for?

22. When should goldenseal not be taken?

23. What is green tea commonly used for?

24. What is palmetto commonly used for?

25. What drug should not be used with saw palmetto?

26. What is St. John’s wort commonly used for?

27. What are the adverse effects of St. John’s wort?

28. What syndrome is use of St. John’s wort associated with?

29. What is valerian commonly used for?

30. What is coenzyme Q10 commonly used for?

31. What is creatine commonly used for?

32. What is gamma-hydroxybutyrate (GHB) commonly used for?

33. What are the adverse effects of GHB?

34. What is lycopene commonly used for?

35. What is melatonin commonly used for?

36. What is policosanol commonly used for?

37. What are the omega-3 fatty acids primarily used for?

38. What is SAM-e commonly used for?

FILL IN THE BLANK

1. Medicines are defined as natural substances derived from

botanical or plant origin.

2. Concurrent consumption of large quantities of green tea with warfarin may

the anticoagulant effects of warfarin.

3. The most common use of ginger is to alleviate and

.
 4. Most individuals using St. John’s wort do so for its supposed ability to treat mild
and to heal .

5. There is some evidence to suggest that diets high in may reduce

the risk of prostate cancer.

MATCHING

6. Valerian a. Squawroot

7. St. John’s wort b. Klamath weed

8. Ginkgo c. Burn plant

9. Black cohosh d. Maidenhair tree

10. Echinacea e. Amantilla

11. Aloe f. Purple coneflower

12. Goldenseal g. Yellow root

TRUE OR FALSE

13. Under the Dietary Supplement Health and Education Act (DSHEA) of 1994, almost all
herbal medicines, vitamins, minerals, amino acids, and other supplemental chemicals used for
health were reclassified legally as dietary supplements, a food category.

14. Diet supplements should not be recommended for use by pregnant women, lactating
mothers, infants, or young children without approval from the patient’s primary care health
provider.

15. Homeopathy employs the use of therapeutic doses of botanical drugs.

16. It is reported that SAM-e may reduce some of the adverse effects of levodopa used
to treat parkinsonism, but it is also thought that SAM-e may reduce the benefiial effects of
levodopa in the treatment of parkinsonism over time.

17. Ginseng has been shown to lower insulin levels in laboratory animals.

18. Chamomile has been shown to be an effective antidepressant.

19. Echinacea is a bacteriostatic and bactericidal agent.

20. There are essentially no drug interactions with ephedra.

 21. Feverfew is used as an antiplatelet and antihypertensive agent.

22. Garlic affects platelet aggregation and therefore should be used with caution for
patients taking antiplatelet medications.

23. Saw palmetto is used to treat symptoms of benign prostatic hyperplasia.

24. Ginseng may cause hyperglycemia.

25. Valerian is used as a sleep aid and as a mild tranquilizer.

PRACTICE QUESTIONS

1. A 62-year-old woman is on hormone replacement therapy to treat symptoms

associatedwith menopause and to prevent osteoporosis. She also takes medication to control
high blood pressure. She is interested in taking black cohosh and asks the nurse about it. What
is the best response by the nurse?

1. “Studies have found that black cohosh is an excellent herb for woman to treat
symptoms of menopause that are not controlled by hormone replacement
therapy.”

2. “High blood pressure will be lowered with the use of black cohosh, so you
won’t need to take your high blood pressure pills any longer.”

3. “Black cohosh works by stimulating the body to produce its own natural
testosterone.

4. “Black cohosh may cause added antihypertensive effectswhen taken with

medication to lower high blood pressure. Consult your health care provider
before adding black cohosh to your treatment regimen.”

2. Which herb is most commonly used in the treatment of asthma?

1. Ephedra

2. Echinacea

3. Chamomile

4. Goldenseal

3. Which statements does the nurse include when teaching a patient about St. John’s
wort? (Select all that apply)
 1. “The active ingredient of St.John’swort areunkown.”

2. “St. John’s wort may cause photosensitivity, so individuals using it should

avoid overexposure to the sun.”

3. “Patient who take other serotonin stimulants should not take St. John’s wort
without consulting heir health care provider.”

4. “St. John’s wort is a safe drug for anyone with depression.”

5. “There are no adverse effects associated with the use of St. John’s wort.”

4. Which conditions are possible indications for the use of S-adenosylmethinonine (SAM-
e)? (Select all that apply.)

1. Depression

2. Osteoarthritis

3. Diabetes mellitus

4. Fibromyalgia

5. Infection

5. Which herb is most commonly used for treating symptoms associated with benign
prostatic hypertrophy?

1. Valerian

2. Feverfew

3. Saw palmetto

4. Ginseng

6. Which statements about herbal medicines and dietary supplements are correct?
(Select all that apply.)

1. Black cohosh is often taken in conjunction with antihypertensive medications.

2. Patients taking platelet inhibitors should use garlic with caution.

3. Ginseng has the potential to induce hyperglycemia.

4. Patients taking melatonin should avoid alcohol.

5. Goldenseal may turn urine a distinctive dark amber or brown color.

 7. When a patient is taking aloe, it is most important for the nurse to assess the patient
for the development of which condition?

1. Infection

2. Hypertension

3. Hypokalemia

4. Hypoglycemia

8. A patient with which condition is most likely to benefit from the administration of
Echinacea?

1. Acquired immunodeficiency syndrome (AIDS)?

2. Multiple sclerosis

3. Viral respiratory tract infection

4. Systemic lupus erythematosus