NR-228 Nutrition, Health & Wellness - Set 4 - Part 1

Correct Answer: Water intoxication with hyponatremia

Diluted formula delivers excess free water that an infant kidney cannot excrete, dropping serum sodium and producing cerebral edema. The typical presentation is a seizure in an afebrile, poorly growing infant. Option a is incorrect because a febrile seizure requires fever, and this infant is afebrile; the history of stretching formula points directly to a dilutional electrolyte problem instead. Option b is incorrect because infants of this age feed every few hours and the parents describe altered mixing rather than missed feedings, so a fasting mechanism does not fit the history. Option d is incorrect because over dilution lowers every nutrient the infant receives, including vitamin D; excess intake would require large supplemental doses, which the parents have not described giving.

Correct Answer: Hold the meal until the client wakes fully

A drowsy client cannot protect the airway, and no oral intake belongs in a mouth that is falling asleep. The meal waits until the client is awake and alert, then proceeds with upright positioning and small bites. Option b is incorrect because thickening slows a bolus but cannot replace consciousness. Thickened liquids reduce aspiration risk without eliminating it, and a client who is drifting off should receive nothing by mouth at all. Option c is incorrect because slowing the pace does not restore the alertness a safe swallow requires. Small bites help an awake client, but they offer nothing to one whose protective reflexes are dulled by sleep. Option d is incorrect because handing the tray to a visitor transfers a first post-stroke meal to someone untrained in aspiration precautions. The hazard is the drowsiness, and changing who holds the spoon does not remove it.

Correct Answer: About 340 calories above usual intake

Energy is the least elevated requirement in pregnancy. The second trimester adds only about 340 calories a day, roughly a glass of milk with peanut butter on whole grain toast. Option a is incorrect because no increase applies only to the first trimester, when fetal tissue is still small; by the second trimester maternal and fetal tissue growth raises the requirement. Option b is incorrect because 150 calories underestimates the second trimester allowance and would leave a normally active client short of the energy needed to support her recommended rate of gain. Option d is incorrect because 800 calories exceeds even the third trimester addition of about 450 calories; that surplus promotes excessive gestational gain, macrosomia and postpartum weight retention.

Correct Answer: Expenditure falls and hunger signals rise.

Weight loss triggers adaptive thermogenesis, so total expenditure drops by more than the lost tissue explains. Leptin falls and ghrelin rises, increasing hunger, which is physiology rather than a failure of effort. Option b is incorrect because assuming dishonesty damages trust and misreads a well documented biological response. A plateau appears even in clients who adhere closely, because the body defends its former fat stores. Option c is incorrect because a fall in triiodothyronine during energy restriction is an expected conservation response, not new thyroid disease. Jumping to a diagnosis would prompt unnecessary workup and miss the real mechanism. Option d is incorrect because adipocytes shrink during loss rather than multiplying to obstruct it. The barrier is reduced energy expenditure combined with stronger appetite drive, not the creation of new fat cells.

Correct Answer: The mother whose newborn has galactosemia

Classic galactosemia is the one infant condition that forbids human milk absolutely, because lactose yields galactose the infant cannot metabolize. These infants require a lactose free soy based or elemental formula. Option a is incorrect because mastitis is not a contraindication at all; continued emptying of the affected breast is part of the treatment, and stopping would worsen stasis and infection. Option b is incorrect because cracked nipples signal a poor latch that should be corrected; the nurse breaks suction, repositions the infant and relatches rather than ending breastfeeding. Option d is incorrect because hepatitis C does not appear on the list of true contraindications, and hepatitis B is also compatible with feeding when the infant receives immunoprophylaxis.

Correct Answer: Offer thickened drinks often and record intake.

Thickened liquids taste and feel unpleasant, so clients drink less and dehydration becomes a genuine complication of the order. Frequent offering plus careful intake and output monitoring is a nursing priority rather than a formality. Option b is incorrect because thin liquids move fastest and reach the pharynx before the larynx has closed, which is why they raise aspiration risk in dysphagia. Dehydration is treated without abandoning the prescribed consistency. Option c is incorrect because restricting fluid in an already dehydrated client compounds the very problem the visit revealed. Nothing about a swallowing disorder calls for less fluid, only for fluid of the prescribed thickness. Option d is incorrect because the consistency level is prescribed after evaluation, and thickening beyond it is not a nursing decision. Making drinks even less palatable would cut intake further and deepen the dehydration.

Correct Answer: Keep offering refused foods, since appetite falls as growth slows.

Growth velocity falls sharply after the first year and appetite falls with it, producing physiologic anorexia. The food jag is normal; the parent should keep offering rejected foods without pressure, since acceptance often takes ten or more exposures. Option a is incorrect because reduced intake with a food jag at this age is expected rather than pathologic, and sending a thriving toddler for blood work medicalizes normal development and alarms the family unnecessarily. Option b is incorrect because narrowing the diet to the one accepted food reinforces the jag and risks iron and zinc shortfalls. Rejected foods should stay on the plate even when they are refused. Option d is incorrect because using dessert as a reward raises the child's preference for the sweet and lowers it for the food being pushed. Bribery and coercion both backfire at the toddler table.

Correct Answer: Oral iron at 1 milligram per kilogram

Fetal iron stores last roughly four months. Exclusively or partially breastfed term infants receive 1 milligram per kilogram of oral iron daily from about four months until iron-rich complementary foods are established. Option a is incorrect because fluoride is withheld until six months of age, and even then it is given only when the local water supply contains too little to protect developing teeth. Option b is incorrect because routine zinc drops are not part of infant supplementation; zinc is supplied by human milk and later by iron-rich and zinc-rich complementary foods such as pureed meats. Option c is incorrect because cereal is never added to a bottle; it does not reduce reflux or improve sleep and it creates a choking and overfeeding hazard for a young infant.

Correct Answer: Marginal zinc intake, which can slow growth rates

The course notes marginal zinc intakes among finicky school-age eaters and links low zinc intake to slowed growth rates. Meat, seafood and legumes are the foods this child refuses, and they are the main zinc sources. Option b is incorrect because vitamin C deficiency shows itself as spongy bleeding gums and poor wound healing rather than a falling growth curve, and citrus and other produce are not the foods being refused here. Option c is incorrect because bread and pasta are enriched and supply thiamin readily, so a child living on those foods is unlikely to run short of it. Growth failure is not the classic presentation. Option d is incorrect because inadequate vitamin A first produces night blindness, Bitot's spots and xerophthalmia. Those eye findings, not a slowed growth rate, are what the nurse would expect to see.

Correct Answer: 25 to 35 pounds total

A pre-pregnancy body mass index of twenty-two falls in the normal weight category, for which the recommended total gain in a single pregnancy is 25 to 35 pounds under the ranges published by CDC. Option a is incorrect because 11 to 20 pounds is the range for a client whose pre-pregnancy body mass index is thirty or higher, which places her in the obesity category. Option b is incorrect because 15 to 25 pounds applies to the overweight band, a body mass index of 25.0 through 29.9, which is above this client's starting measurement. Option c is incorrect because 28 to 40 pounds is reserved for clients who begin pregnancy underweight, meaning a body mass index below 18.5, and would be excessive gain for her.

Correct Answer: The total covers roughly one pound.

One pound of body fat holds about three thousand five hundred kilocalories, so thirteen pounds requires roughly forty five thousand five hundred. The printed figure is barely more than a single pound and is wrong by a factor of ten. Option b is incorrect because multiplying thirteen pounds by the energy in a pound of fat gives a total in the tens of thousands. Accepting the handout would leave the client badly misinformed about the deficit needed. Option c is incorrect because seven pounds of fat would still represent well over twenty thousand kilocalories. No figure in the low thousands can account for more than a pound or so of stored fat. Option d is incorrect because the error runs in the opposite direction. The handout understates the requirement dramatically, and telling the client the number is too high would encourage an even smaller and slower deficit.

Correct Answer: The loss exceeds the one-month threshold and requires assessment

A loss of more than five percent of body weight in one month is a significant unintentional loss in long-term care. It triggers nutritional assessment and intervention rather than watchful waiting, and this resident has exceeded it. Option a is incorrect because day-to-day scale variation does not account for a drop of this size in four weeks. The institutional threshold has been crossed, and rechecking alone delays the needed workup. Option b is incorrect because unintentional weight loss is never a normal feature of growing old. It is the sentinel finding in institutional care and the earliest sign that intake or health is declining. Option d is incorrect because no edema is present and fluid alone rarely explains a change this large over a month. Charting without acting would leave a treatable nutrition problem unaddressed.

Correct Answer: Use WHO weight-for-length for the girl, CDC BMI-for-age for the boy

CDC recommends the WHO Child Growth Standards from birth to two years, where weight-for-length is plotted and BMI is not used. From age two through nineteen the CDC charts and BMI-for-age apply. Option b is incorrect because the two charts are reversed here. The WHO standard is the prescriptive one for infants and toddlers, while the CDC reference covers children from two years through nineteen. Option c is incorrect because body mass index is not calculated before the second birthday at all, so no BMI-for-age plot exists for the toddler. Weight-for-length is her measure instead. Option d is incorrect because weight-for-length stops being the indicator once a child turns two, and stature-for-age with BMI-for-age takes over. The school-age brother needs the percentile that tracks body mass.

Correct Answer: Screen her for iron deficiency anemia

Pica is strongly associated with iron deficiency anemia, and the craving often disappears once the deficiency is corrected. Screening for iron deficiency is therefore the appropriate next step after a nonjudgmental history. Option a is incorrect because eating nonfood substances displaces nutritious food, and starch and clay bind iron and zinc in the gut, deepening the very deficiency that provoked the craving. Option b is incorrect because pica in pregnancy is first evaluated as a nutritional finding; a mental health referral before any laboratory workup skips the treatable cause and may shame the client. Option d is incorrect because fiber addresses constipation rather than craving for nonfood items; it neither explains the ice chewing nor corrects the iron status that most likely underlies it.

Correct Answer: Basal metabolism, the body at rest

Basal or resting metabolism is the energy needed to keep cells, heart, lungs and kidneys working at rest, and it consumes roughly sixty to seventy five percent of total energy expenditure, far more than any other component. Option a is incorrect because physical activity ranks second and is the most variable component, not the largest. It feels dominant because a person notices moving, while resting metabolism runs silently every hour. Option b is incorrect because digesting, absorbing and storing food accounts for only about ten percent of daily energy use. Protein raises that fraction somewhat, but it never approaches the resting requirement. Option c is incorrect because adjusting to cold, trauma or a large intake change costs only a small and variable amount of energy. Adaptive thermogenesis modifies the total rather than dominating it.

Correct Answer: The speech-language pathologist

The speech-language pathologist performs the comprehensive clinical swallow evaluation and the instrumental studies, including videofluoroscopy and fiberoptic endoscopic evaluation, then prescribes the texture level, liquid consistency, postures and swallow maneuvers the team will follow. Option b is incorrect because the dietitian performs the in-depth nutrition assessment, calculates energy and protein needs and recommends the diet. Swallowing mechanics and instrumental imaging fall outside that scope entirely. Option c is incorrect because a nurse performs the brief screen that yields a pass or a referral, not the comprehensive evaluation. Screening identifies who needs the study; it does not substitute for it. Option d is incorrect because the provider writes the diet and NPO orders and decides about medications while fasting. Ordering the study is within that role, but carrying it out is not.

Correct Answer: I allow myself one glass of wine on weekends.

There is no known safe amount, type, or timing of alcohol in pregnancy. Ethanol crosses the placenta freely and is a direct teratogen, so any planned drinking requires correction. Option a is incorrect because caffeine is limited to less than 200 milligrams daily in pregnancy, which is roughly one twelve ounce cup of brewed coffee, so her intake is within the guideline. Option b is incorrect because stopping tobacco removes the uteroplacental vasoconstriction that causes growth restriction and low birth weight; this statement reflects exactly the behavior change the nurse wants to reinforce. Option c is incorrect because choosing a nonalcoholic drink in a social setting is a sound strategy for maintaining abstinence, so it shows understanding rather than a gap in her teaching.

Correct Answer: Assess for fluid retention and report findings

A gain of several pounds within two days reflects retained fluid rather than stored fat, since that much adipose tissue cannot form so fast. Assessing edema, intake, output and lung sounds and reporting the change is the priority. Option a is incorrect because restricting calories does nothing for retained water and delays recognition of worsening heart failure. The nurse would be treating a nutrition problem that this client does not actually have. Option b is incorrect because calling rapid gain normal is false reassurance and ignores a warning sign. Fat stores change slowly over weeks, so a sudden jump on the scale always warrants investigation. Option d is incorrect because impedance and similar measurements are distorted by fluid shifts and would give an unreliable result here. The finding calls for clinical assessment and prompt communication, not additional testing.

Correct Answer: Stop feeding and assess the airway

Airway comes before nutrition. A wet, gurgly voice means residue is sitting on or near the vocal folds, so the nurse halts intake immediately and evaluates breathing before any further bite reaches an unprotected airway. Option b is incorrect because charting is essential but follows the intervention. Writing the note while food remains in the client's mouth leaves the danger in place, and documentation never precedes protecting a threatened airway. Option c is incorrect because giving more fluid to a client who has just aspirated adds volume to an airway that is already compromised. Thickened liquids reduce risk but never make a swallow safe. Option d is incorrect because a speech-language pathology referral is appropriate later, once the client is stable. Calling from the bedside while the client is still coughing delays the hands-on action that the moment requires.

Correct Answer: Assess hydration status and begin scheduled fluid offers

Dehydration is the most common fluid disorder of older adults and presents as confusion before it presents as thirst. Blunted thirst and deliberate restriction fit the picture, so hydration is assessed and fluids are offered on a schedule. Option a is incorrect because new confusion is never a normal consequence of growing older. Treating it as expected would leave a reversible and common fluid problem undetected in a man who is already drowsy. Option b is incorrect because a workup for progressive cognitive decline does not fit an abrupt change in a man who deliberately limits what he drinks. Correct the fluid deficit before pursuing that pathway. Option c is incorrect because cutting intake further would deepen a deficit that is already producing symptoms. Fear of incontinence is a recognized barrier to drinking, and the nursing response is to counter it.