PTS: 1 REF: Medical Nutrition Therapy for Hyperlipidemia: Table 18-1

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 and cream soups b. coconut and cereals; sausage and d. whole-grain breads and buttermilk; processed cheese bakery products and butter ANS: C

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 client’s 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. cereal, two slices of whole- c. egg-white omelet with wheat toast with one broccoli, a plain bagel with a tablespoon of butter on each, tablespoon of honey, two slices two slices of bacon, and orange of cantaloupe, and a cup of juice coffee with fat-free milk b. egg and cheese sandwich on a d. sausage gravy on two biscuits, croissant with a glass of 2% milk and an orange, and a glass of 100% hash browns cranberry juice

ANS: C 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 fat- controlled 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 client’s 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 potassium b. a loss of potassium; fruits and d. swelling of the abdomen; a fat- vegetables restricted diet ANS: B 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 leaven quick breads and cakes 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 Baking powder—used to leaven quick breads and cakes, baking soda—used to leaven breads and cakes; sometimes added to vegetables in cooking or used as an “alkalizer” for indigestion, brine—used 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 chloride—used 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. glass of cranberry juice d. pork and sauerkraut, applesauce, and 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 REF: Adjustment to Sodium Restriction

MULTIPLE RESPONSE

1. The nurse is evaluating an adult client for metabolic syndrome in order to assess the risk for 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 d. High HDL b. Blood pressure of 142/85 mm Hg e. High LDL c. High blood lipids such as high 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 client’s comfort after a myocardial infarction? Select all that apply.

a. avoid foods that are hard to digest d. consume foods that are difficult to chew b. avoid foods that are too hot e. consume high-fiber foods c. avoid roughage f. consume very cold foods ANS: A, B, C 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 client’s 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 client’s 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 have a diet totally free of sodium b. Notify the client that in order to reduce d. Notify the client what foods would be the amount of sodium in the diet, the appropriate for a sodium-free diet amount of potassium in the diet must be increased ANS: C

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.

NUMERIC RESPONSE

1. The client tells the nurse that the doctor has put him on a sodium-restricted diet that would 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.

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