NR-228 Nutrition, Health & Wellness - Set 3 - Part 1

Correct Answer: Stop the supplement and limit liver intake

Preformed vitamin A is a proven human teratogen causing malformations of the eye, skull, lungs and heart. Liver is the richest source and one serving exceeds the adult upper limit, so the supplement stops and liver is limited. Option a is incorrect because continuing both stacks two concentrated sources of retinol well above the ceiling set for pregnancy. Excess preformed vitamin A causes congenital malformations rather than supporting fetal development. Option b is incorrect because swapping in iron ignores the retinol already being consumed in the liver servings. Iron supplementation is a separate prenatal issue and does not reduce the teratogenic exposure. Option d is incorrect because taking the capsule with fat improves absorption and therefore raises the retinol dose reaching the fetus. Changing the timing of a teratogenic supplement makes the hazard worse, not safer.

Correct Answer: Thiamin, or vitamin B1

Wet beriberi is thiamin deficiency. Impaired myocardial energy production and peripheral vasodilation produce high output heart failure with edema, tachycardia and dyspnea, and chronic alcohol use is the dominant cause of thiamin depletion. Option b is incorrect because riboflavin deficiency, called ariboflavinosis, shows itself in the mouth and skin as cheilosis, angular stomatitis, a magenta tongue and seborrheic dermatitis. It does not cause edema or heart failure. Option c is incorrect because pellagra, the niacin deficiency disease, brings a symmetric rash on sun exposed skin, diarrhea and dementia. Fluid overload and a bounding pulse are not part of that picture. Option d is incorrect because cobalamin deficiency presents with pallor, fatigue, a smooth beefy red tongue, paresthesias and gait ataxia from demyelination. Peripheral edema and high output cardiac failure are not features of it.

Correct Answer: Three ounces of canned salmon with bones

Canned salmon is eaten with its softened bones, and those bones supply roughly one hundred eighty milligrams of calcium per three ounce serving. Chicken breast, spinach and broccoli deliver far less usable calcium than the fish. Option a is incorrect because chicken breast holds only about thirteen milligrams of calcium in three ounces, roughly one percent of the adult requirement, and it appears on no authoritative calcium food list. Option b is incorrect because oxalic acid in spinach binds the calcium into an insoluble complex, so only about five percent is absorbed despite the respectable amount listed on a nutrient table. Option d is incorrect because raw broccoli supplies only about twenty one milligrams of calcium per half cup. Its calcium is well absorbed, yet the portion needed to rival the fish would be enormous.

Correct Answer: Both of those foods can stay in your diet

Butter holds almost no potassium, and poultry is a moderate protein that renal diets keep as a protein source. Neither belongs on an avoid list, and cutting them adds needless restriction. Option b is incorrect because it repeats the pamphlet's error and worsens the hunger the client reports. Removing a protein source from a renal diet without cause risks inadequate intake. Option c is incorrect because chicken is a lean protein renal diets retain rather than eliminate, and the potassium it carries is moderate. Restricting it leaves the client with fewer acceptable main dishes. Option d is incorrect because butter contains only a trace of potassium, roughly three milligrams in a tablespoon. A potassium modified diet places no limit on it at all.

Correct Answer: Deficiency of riboflavin

Cheilosis, angular stomatitis, a magenta tongue and seborrheic dermatitis are the cluster of ariboflavinosis. Dairy is the signature riboflavin source, so someone who avoids milk, yogurt and cheese falls into a named risk group. Option a is incorrect because ascorbic acid deficiency attacks collagen, giving swollen bleeding gums, petechiae, corkscrew hairs and wounds that will not close. The tongue is relatively spared in scurvy. Option b is incorrect because cobalamin deficiency also inflames the tongue, but that tongue is smooth and beefy red, and the picture includes macrocytic anemia, paresthesias and ataxia rather than seborrheic dermatitis. Option d is incorrect because pantothenic acid is so widespread in food that dietary deficiency is essentially unknown. Experimental depletion produces burning feet and fatigue, not cracked lips or a magenta tongue.

Correct Answer: Coach the client to slow her breathing

Rapid breathing produces respiratory alkalosis, which increases calcium binding to albumin and lowers ionized calcium without changing the total. Slowing the breathing corrects the pH and the tetany resolves. Option a is incorrect because the client's total body calcium is not depleted. Feeding calcium addresses a deficiency that does not exist and leaves the underlying breathing pattern untreated. Option b is incorrect because intravenous calcium is reserved for true hypocalcemia with severe tetany, laryngospasm or seizures. Reaching for it here escalates care before the simplest correction has been attempted. Option c is incorrect because a magnesium level is useful when hypocalcemia will not correct, not during an acute hyperventilation episode. Drawing blood delays the intervention that would end the spasm.

Correct Answer: Almonds, black beans and leafy greens

Magnesium sits at the center of chlorophyll, so green leafy vegetables carry it, and nuts, seeds, legumes and whole grains are the other main sources. Refining grain strips the magnesium away. Option a is incorrect because refining removes the germ and bran where the magnesium sits. White rice, white bread and crackers are precisely the foods that processing has stripped. Option b is incorrect because none of these items appears on the magnesium source list. The mineral is concentrated in plant foods such as greens, nuts, seeds, legumes and whole grains. Option d is incorrect because these fruits are low potassium choices offered on renal diets, not magnesium sources. Apples, grapes and canned pears supply fluid and fiber rather than this mineral.

Correct Answer: "Dark stools are expected while you take iron."

Unabsorbed iron is oxidized in the gut and darkens the stool, so black or very dark green stools are expected and harmless. True melena is sticky, tarry and foul smelling with bleeding signs. Option b is incorrect because stopping an effective medication for a normal, anticipated effect interrupts repletion. This client reports none of the dizziness, tachycardia or falling energy that accompany genuine blood loss. Option c is incorrect because the darkening comes from iron that was never absorbed, not from blood in the bowel. Frightening the client this way invites abandonment of the prescribed therapy. Option d is incorrect because no laxative is indicated for stool color, and a bulk former adds fiber that binds iron. A stool softener suits constipation better than a bulk product.

Correct Answer: Have the well water tested first

Private well water is unregulated and unmonitored, so it may carry almost no fluoride or far too much naturally occurring fluoride. Testing the water first is the nursing action in either direction. Option a is incorrect because supplements are intended only for children without access to fluoridated water. If this well already runs high, the drops would push the toddler toward dental fluorosis. Option b is incorrect because replacing the water removes any fluoride the child might have received and still leaves the well untested. Caries risk would rise without anyone knowing the actual concentration. Option c is incorrect because a toddler has only a narrow margin between the adequate intake and the upper limit. Swallowed toothpaste alone can exceed that margin, so a smear is what is taught.

Correct Answer: Hold the diuretic and notify the provider

A potassium below three point five with a client on digoxin is a dysrhythmia risk, because hypokalemia potentiates digoxin toxicity. The diuretic is held, the provider is notified and cardiac monitoring continues. Option a is incorrect because a single piece of fruit cannot raise a potassium level quickly enough to protect a client taking digoxin. Food is part of the follow up plan, not the immediate response. Option b is incorrect because education belongs after the acute danger is addressed. Teaching a client about apricots and beans while an unrecognized dysrhythmia risk continues reverses the order of nursing priorities. Option d is incorrect because extra fluid does not replace potassium and may simply increase urinary losses while the diuretic is still acting. The low value would remain untreated and unreported.

Correct Answer: Weighing the client each morning before breakfast

Daily weight on the same scale at the same time is a measurement within assistive personnel's scope, and it is the most sensitive indicator of fluid change, since one liter equals one kilogram. Option b is incorrect because auscultation is an assessment skill reserved for the nurse. Detecting whether crackles have worsened guides the plan of care and requires clinical judgment. Option c is incorrect because judging a medication response means weighing output, lung sounds and laboratory values together. That analysis sits squarely with the licensed nurse and cannot be assigned away. Option d is incorrect because client teaching is a nursing responsibility, not a delegated one. Explaining which foods carry hidden sodium calls for knowledge that unlicensed staff are not prepared to supply.

Correct Answer: Teach mixing the formula exactly as directed

Over diluted formula is hypotonic and can cause water intoxication in an infant whose immature kidney cannot clear a water load. Irritability and drowsiness precede seizures, so correcting the mixing comes immediately. Option a is incorrect because plain water is exactly what an infant must not receive. Extra water dilutes nutrients, slows growth, disturbs electrolyte balance and can bring on seizures. Option b is incorrect because thickening a bottle does not restore the nutrients that dilution removed and does not address the sodium the infant has lost. The mixing error itself must be corrected. Option c is incorrect because an irritable, drowsy infant on diluted formula is already showing early neurologic change. Delay allows the dilution to continue toward seizure and loss of consciousness.

Correct Answer: Eight milligrams of iron daily

A woman aged fifty-one and older is normally postmenopausal, so menstrual losses have stopped and her requirement falls to eight milligrams daily, matching a man's. The eighteen milligram figure belongs to women aged nineteen through fifty. Option a is incorrect because eighteen milligrams covers the monthly blood loss of a menstruating woman. This client's age places her past that loss, so the higher intake is no longer needed. Option c is incorrect because twenty-seven milligrams is the recommended dietary allowance during pregnancy, when plasma volume expands and the fetus builds its own stores. This client is not pregnant. Option d is incorrect because forty-five milligrams names the tolerable upper intake level for adults, not a daily target. Treating that ceiling as a goal would push intake toward toxicity.

Correct Answer: "Light rapidly destroys the riboflavin in milk."

Riboflavin is extraordinarily sensitive to ultraviolet and visible light, and milk is a major dietary source of it. Opaque cardboard or nontransparent plastic containers block that light and prevent significant photodegradation of the vitamin. Option a is incorrect because fat separation is managed by homogenization, a mechanical process that breaks fat globules apart, and it has nothing to do with the material of the container. Option b is incorrect because calcium does not settle out of milk in a way a container can prevent. The packaging question concerns a light sensitive vitamin, not a mineral suspended in the fluid. Option d is incorrect because vitamin D is fat soluble and far more stable than riboflavin during storage. The nutrient that drives the opaque packaging decision is riboflavin, the signature vitamin of dairy foods.

Correct Answer: Report the findings and check cobalamin

A normal hemoglobin with new sensory loss and unsteadiness is the classic picture of masked cobalamin deficiency. Measuring cobalamin, and methylmalonic acid if needed, identifies the cause before subacute combined degeneration becomes permanent. Option b is incorrect because a corrected hemoglobin is exactly what makes this situation dangerous. The blood count improved while demyelination of the dorsal and lateral columns advanced, so reassurance would delay urgent evaluation. Option c is incorrect because more folic acid deepens the masking without touching the nerve injury. Folate cannot substitute for cobalamin in methylmalonyl coenzyme A mutase, which is the reaction that protects myelin. Option d is incorrect because a walker manages the risk of falling but ignores why she is falling. Safety equipment can be arranged later, after the treatable vitamin problem behind the ataxia has been identified.

Correct Answer: Report the finding and arrange bleeding evaluation

In an adult man, new iron deficiency anemia is gastrointestinal blood loss until proven otherwise, and occult malignancy is the diagnosis that must not be missed. Daily aspirin adds to that suspicion. Option a is incorrect because dietary teaching alone leaves the source of loss unexamined. Food changes cannot outpace ongoing bleeding, and the delay allows a treatable lesion to progress unnoticed. Option b is incorrect because age does not explain depleted iron stores in a man, who has no menstrual losses at all. Offering false reassurance closes off the investigation that is needed. Option d is incorrect because replacing iron without finding the cause treats the number and abandons the patient. The hemoglobin may improve while a bleeding lesion continues to grow.

Correct Answer: Offering scheduled fluids and recording intake

Offering fluids on a schedule and documenting intake is a standard task within assistive personnel's scope. Older adults have blunted thirst, so waiting for a request is exactly what allows dehydration to develop. Option a is incorrect because interpreting laboratory results requires nursing judgment and cannot be handed to unlicensed staff. Assistive personnel may report values but may not decide what they mean. Option b is incorrect because choosing a route of fluid replacement is a provider and nursing decision built on assessment data. Delegation never covers the judgment that selects an intervention. Option c is incorrect because assessment belongs to the nurse, and skin turgor in an older adult needs skilled interpretation. Elasticity declines with age alone, which makes the finding easy to misread.

Correct Answer: Two thousand milligrams each day

The tolerable upper intake level for calcium steps down at age fifty one, from two thousand five hundred milligrams to two thousand milligrams daily, for both sexes from then onward. Option a is incorrect because that figure is her recommended dietary allowance, the amount she should aim to reach each day. A target intake and a safety ceiling are two different values. Option c is incorrect because the upper level of two thousand five hundred milligrams applies to adults aged nineteen through fifty. This client passed that age band more than a decade ago. Option d is incorrect because three thousand milligrams is the ceiling set for adolescents aged nine through eighteen, whose skeletons are still being built. Applying it to an older adult risks stones and blocked mineral absorption.

Correct Answer: Beef liver with a green salad

Beef liver is a heme iron source from animal flesh, and about twenty-five percent of heme iron is absorbed. Heme iron is taken up as an intact unit and is largely shielded from meal inhibitors. Option b is incorrect because enriched rice carries non-heme iron, of which seventeen percent or less is absorbed. Fortified and enriched grains contribute useful amounts across a day but not the best absorbed form. Option c is incorrect because lentils supply non-heme iron alongside phytates in the whole wheat roll, and phytates chelate iron into insoluble complexes that pass through the gut unabsorbed. Option d is incorrect because spinach looks iron rich on paper, yet its oxalate content locks much of that iron away. Almonds add phytates, lowering the yield from this plate even further.

Correct Answer: Take the binder with meals and avoid dark cola

A binder works only while it is in the gut with food, so it is taken with every meal and snack. Dark colas carry phosphate additives that are almost completely absorbed. Option a is incorrect because the phosphorus in cola comes from an additive rather than from sugar, so a diet version is no safer. The timing error also remains completely uncorrected. Option c is incorrect because a binder given ahead of eating has passed beyond the food by the time phosphorus arrives. Only simultaneous contact in the gut keeps the mineral from being absorbed. Option d is incorrect because how the tablet is swallowed is not the issue, and juice does not solve it. Crushing a binder taken at bedtime still leaves it in an empty stomach.