NR-228 Nutrition, Health & Wellness - Set 5 - Part 1

Correct Answer: Type two diabetes often needs insulin as beta cells fail.

The discriminator is whether the pancreas can still make insulin, not whether insulin is prescribed. Beta cell secretion declines progressively in type two diabetes, so many adults eventually need insulin while remaining type two. Option b is incorrect because prescribing insulin says nothing about endogenous production. People with type two diabetes often have circulating insulin that their tissues resist, and they are given insulin when diet, activity, and oral agents stop working. Option c is incorrect because type one diabetes can begin at any age. A slowly progressive autoimmune form appears in adults and is often mislabeled as type two at first, so age alone settles nothing. Option d is incorrect because unexplained weight loss, not gain, marks the classic type one presentation. Calories are lost in the urine as glucose while fat and muscle are catabolized for fuel, so the student has it backward.

Correct Answer: Try warm water with gentle push pull

Warm water instilled with gentle push and pull on the plunger is the correct first attempt at a clog. If that fails, a pancreatic enzyme and bicarbonate declogging kit is used per protocol. Option a is incorrect because carbonated and acidic drinks precipitate the formula protein already sitting in the lumen. Letting cola dwell hardens the obstruction rather than dissolving it, and the clog then becomes harder to clear. Option b is incorrect because a small syringe multiplies the pressure applied to a fragile lumen and can rupture the tube. Force is the wrong response to resistance in any feeding device. Option d is incorrect because a gastrostomy tube is removed and replaced by the provider, and only after simpler measures fail. Most clogs clear at the bedside without losing established access.

Correct Answer: The client who had a partial gastrectomy

The pylorus meters chyme into the duodenum a few milliliters at a time. Gastric surgery removes or bypasses that valve, so a hyperosmolar bolus reaches the jejunum and produces dumping syndrome. Option b is incorrect because removing part of the colon leaves the pylorus intact, so gastric emptying is still metered normally. Colon resection changes water and electrolyte absorption rather than the speed of emptying. Option c is incorrect because appendectomy does not alter the stomach, the pylorus or the upper small bowel. Nothing about that procedure allows a concentrated meal to arrive rapidly in the jejunum. Option d is incorrect because hernia repair works on the abdominal wall and leaves the gastrointestinal lumen untouched. Postoperative teaching for this client centers on lifting limits and wound care, not on meal size.

Correct Answer: Return the aspirate and continue feeding

Feeding is not automatically stopped for a residual under five hundred milliliters when no other sign of intolerance exists. The aspirate holds the client's own fluid, electrolytes and formula, so it is returned and monitoring continues. Option a is incorrect because discarding the aspirate throws away gastric acid, electrolytes and partly digested formula that belong to the client. Holding a feeding for this volume also drives the caloric deficits seen with threshold based practice. Option b is incorrect because nothing in this assessment suggests the stomach is failing to empty. Residual volume correlates poorly with emptying, reflux and aspiration, so this number alone gives the provider nothing to act on. Option d is incorrect because repositioning is not the issue when the client is already comfortable with a benign abdomen. The aspirate still needs to go back, and flushing alone would leave that fluid discarded.

Correct Answer: Hang a dextrose ten percent solution

Sustained concentrated dextrose drives high insulin levels, so stopping abruptly produces rebound hypoglycemia. Dextrose ten percent is hung at the same rate as a bridge, the provider is notified, and glucose is monitored. Option a is incorrect because monitoring alone does not stop the fall in glucose that follows an abrupt halt. Insulin stays elevated for a period after the dextrose supply disappears, and hypoglycemia follows. Option b is incorrect because altering the prescribed rate changes the dose of dextrose, amino acids and lipid the client receives. Parenteral nutrition runs on a pump at the ordered rate, not a stretched one. Option c is incorrect because saline supplies volume but no carbohydrate at all. Replacing a concentrated dextrose infusion with a solution containing none leaves the client exposed to the same rebound drop in glucose.

Correct Answer: Take it with meals and with snacks

A binder works by trapping the phosphate in food so it leaves in stool instead of entering the blood. The drug must be in the stomach with the meal, which is why snacks count too. Option b is incorrect because that schedule borrows from proton pump inhibitors. A binder swallowed an hour ahead has already left the stomach when the phosphate containing food arrives, so it binds nothing. Option c is incorrect because bedtime dosing suits statins, not binders. Taken with water alone there is no dietary phosphate present, so serum phosphate keeps climbing and drives parathyroid hormone higher. Option d is incorrect because phosphate enters with every meal on every day, not only on treatment days. Sevelamer, for example, is dosed three times daily with meals throughout the week.

Correct Answer: I will cut carbohydrates sharply so I lose some weight.

Carbohydrate must not drop below one hundred seventy five grams daily in pregnancy, and weight loss is not a goal. Severe restriction starves the fetal brain of glucose and drives maternal ketosis. Option a is incorrect because a bedtime snack is part of standard gestational diabetes teaching. Spreading carbohydrate over three meals and two or three snacks limits peaks after eating and prevents ketosis overnight. Option b is incorrect because limiting carbohydrate at breakfast is correct advice. Placental hormones and cortisol make insulin resistance highest in the early morning, so the first meal is usually the smallest in carbohydrate. Option d is incorrect because walking after meals lowers the glucose rise that follows eating. Moderate activity is encouraged in pregnancy unless an obstetric problem rules it out, so this plan needs no correction.

Correct Answer: An orogastric tube passed through the mouth

Midface trauma with clear nasal drainage suggests a basilar skull fracture, and a nasal tube can pass through the fracture into the cranial vault. The mouth is used instead, giving the same gastric access. Option b is incorrect because passing anything through the nose is specifically forbidden when a basilar skull fracture is suspected. The consequence is intracranial placement of the tube, which is catastrophic. Option c is incorrect because it still enters through the nose and carries the identical fracture hazard. Advancing past the pylorus addresses gastric emptying problems, and nothing in this presentation points to one. Option d is incorrect because the digestive tract is working normally in this client. Intravenous feeding is reserved for a gut that cannot be used, and a peripheral line could not carry full nutrition anyway.

Correct Answer: Add oats, barley and psyllium each day

Soluble fiber binds bile acids in the gut, forcing the liver to pull cholesterol from circulation to make more. Five to ten grams daily from oats, barley and psyllium lowers low density lipoprotein. Option a is incorrect because stick margarine is a classic source of partially hydrogenated oil. Trans fat is uniquely damaging since it raises low density lipoprotein and lowers high density lipoprotein at once. Option c is incorrect because that change abandons a recommended monounsaturated oil in favor of a saturated animal fat. Guidance runs the other way, toward olive and canola oils, nuts and avocado. Option d is incorrect because frequent red meat raises saturated fat intake, and the advice is to substitute plant protein and fish. Fish at least twice a week supplies the omega three fats instead.

Correct Answer: A gastrostomy tube through the abdominal wall

Feeding expected to last beyond about four to six weeks calls for a tube placed through the abdominal wall. A gastrostomy avoids the nasal, pharyngeal and esophageal erosion that a long dwelling nasal tube causes. Option a is incorrect because nasal tubes are intended for short term use of roughly four to six weeks. Months of pressure against the nasal ala produce sinusitis, ulceration and esophageal stricture. Option b is incorrect because moving past the pylorus is chosen for gastroparesis, recurrent aspiration or pancreatitis, none of which appears here. It also remains a short term nasal device. Option c is incorrect because the oral route substitutes for the nose only when a basilar skull fracture, midface trauma or nasal obstruction blocks it. Duration of need is unchanged by switching entry points.

Correct Answer: I take my calcium chewable right after the thyroid pill.

Calcium binds levothyroxine in the gut and blocks its absorption, which explains the persistent fatigue. Calcium supplements and calcium containing antacids must be separated from the thyroid tablet by at least four hours. Option a is incorrect because a full glass of water is exactly how the tablet should be swallowed. Water carries the drug into an empty stomach and adds nothing that could bind it. Option c is incorrect because consistent daily timing is part of correct levothyroxine use. Taking the dose at the same hour keeps absorption steady and makes the thyroid blood levels used for dose adjustment meaningful. Option d is incorrect because waiting before breakfast follows the instruction to take the drug thirty to sixty minutes before the first meal. An hour of fasting after the dose supports rather than hinders absorption.

Correct Answer: The deli turkey served cold

Listeria grows at refrigerator temperature, and deli meats are its classic vehicle. People receiving chemotherapy sit in the high-risk group, so cold deli meat is the item that needs attention first. Option a is incorrect because rinsing produce under running water is exactly the recommended step. No soap or commercial wash is used, and firm produce is scrubbed with a clean brush instead. Option b is incorrect because pasteurization is the step that removes the hazard from milk. Raw milk appears on every high-risk list precisely because that heating step has been left out. Option d is incorrect because eggs cooked until both yolk and white are firm meet the safety standard. A fully cooked egg poses no particular threat to a person receiving chemotherapy.

Correct Answer: Separate the antibiotic from all mineral products

Calcium, magnesium, aluminum, zinc and iron chelate fluoroquinolones into an unabsorbable complex. These products must be taken at least six hours before or two hours after ciprofloxacin so the dose is absorbed. Option b is incorrect because convenience here costs the client the antibiotic. Every one of those three products contains a cation that binds ciprofloxacin in the gut and prevents it from being absorbed. Option c is incorrect because stopping needed supplements and acid relief is unnecessary when timing alone solves the problem. Nurses teach spacing rather than discontinuation, and a nurse cannot stop prescribed products independently. Option d is incorrect because pairing the dose with calcium carbonate is the worst option on the list. Calcium is the classic cation that renders a fluoroquinolone dose useless when swallowed at the same time.

Correct Answer: The chilled non-alcoholic beer

Tyramine is produced during fermentation, not by the alcohol itself, so removing the alcohol does not remove the tyramine. Alcohol-free and reduced-alcohol beer and wine are explicitly on the avoid list. Option a is incorrect because fresh fruit carries essentially no tyramine. Fruits and vegetables eaten fresh are on the permitted list, and watermelon is a common safe choice at outdoor gatherings. Option b is incorrect because meat becomes hazardous only when it is cured, aged or stored too long. Poultry cooked and eaten promptly is expressly allowed, and grilled chicken fits that description. Option c is incorrect because grains and cereals hold no meaningful tyramine, and rice requires no restriction whatsoever. Bread, cereal and rice all appear among the foods this client may eat freely.

Correct Answer: Providing oral care twice each shift

Oral care twice daily is a standard, non judgement task within the assistive personnel scope, and it matters because aspiration pneumonia is usually seeded by mouth flora rather than by formula. Option b is incorrect because confirming where a feeding tube sits requires interpreting external length against the documented mark and, when doubt exists, arranging imaging. Those decisions stay with the registered nurse. Option c is incorrect because aspirating and returning residual involves entering the tube, evaluating the volume against the client's abdominal findings, and choosing whether feeding continues. Assistive personnel do not perform that assessment. Option d is incorrect because judging tolerance means weighing distension, girth, bowel sounds, pain and nausea together before acting. Clinical judgement of that kind cannot be handed to unlicensed staff.

Correct Answer: Fifteen grams of carbohydrate

One carbohydrate choice, also called a serving or exchange, equals fifteen grams of carbohydrate. A slice of bread, one third cup of rice, one cup of milk, and a small piece of fruit each supply that amount. Option a is incorrect because five grams is far below the standard exchange and would make every meal plan appear to contain far more choices than it really does. The accepted conversion is three times that figure. Option c is incorrect because thirty grams represents two carbohydrate choices rather than one. Students often reach this number by thinking of a typical sandwich, which contains two slices of bread and therefore two servings. Option d is incorrect because forty five grams is a common total for an entire meal, not for a single serving. Many adults are allotted roughly that much carbohydrate at each main meal, which equals three choices.

Correct Answer: I can eat oats labeled certified gluten free.

Oats contain no gluten; ordinary oats are contaminated during growing, transport and milling alongside wheat. Certified gluten free oats are tested to under twenty parts per million, so moderate amounts are safe. Option a is incorrect because rye is one of the four gluten grains named alongside wheat, barley and triticale. Freshness has no bearing on the immune attack that gluten triggers in celiac disease. Option b is incorrect because barley carries gluten, and so do malt and malt vinegar made from it. Substituting barley for wheat exchanges one prohibited grain for another and keeps villous atrophy going. Option d is incorrect because malt is a barley product and appears in cereals, drinks and flavorings that the client must avoid. Label reading for malt is part of the teaching, not an exception.

Correct Answer: Contact the pharmacy about the modified release forms

Extended release and enteric coated preparations must never be crushed, so the nurse needs an alternative formulation or a substitute drug before giving them. Crushing an extended release tablet delivers a whole day of drug at once. Option a is incorrect because two of these tablets lose their protective design the moment they are crushed. Giving several drugs together in one syringe also risks precipitation that blocks a narrow tube. Option b is incorrect because medication is never added to the formula bag. Dose delivery becomes unmeasurable if the feed is interrupted, and drug and formula can react physically before either reaches the client. Option c is incorrect because each drug is given separately, diluted in water, with a flush between every one. Combining them in a single syringe defeats that rule and still does not solve the coated preparations.

Correct Answer: Enteral tube feeding into the stomach

The gut digests and absorbs normally, shown by active bowel sounds and normal stool, so the least invasive workable route is enteral tube feeding. Only ingestion and swallowing have failed, which a tube bypasses directly. Option a is incorrect because central parenteral nutrition is reserved for a gut that cannot be used at all. Starting it here exposes the client to line infection and hyperglycemia with no added benefit. Option b is incorrect because peripheral solutions still bypass a working intestine and deliver only limited calories. This client absorbs nutrients normally, so an intravenous route adds thrombophlebitis risk without meeting full nutritional needs. Option d is incorrect because thin liquids are the highest aspiration risk texture for an unsafe swallow, and supervision does not make them safe. The airway remains unprotected during every sip the client takes.

Correct Answer: Check 165 for poultry, 160 for burgers

Poultry and any stuffing must reach 165 degrees Fahrenheit, and ground meat must reach 160, because grinding spreads surface bacteria throughout. Color is unreliable, so a food thermometer is the only proof. Option b is incorrect because 145 degrees is the target for whole cuts and fish, not for poultry. A turkey and its stuffing both need 165 to be considered safe to serve. Option c is incorrect because juice color and meat color are not safety indicators. Ground beef can turn brown before it is safe and can stay pink after it has reached a safe temperature. Option d is incorrect because the two numbers are reversed. Burgers are ground meat and need 160, while poultry needs the higher target of 165, and stuffing soaked in poultry juices needs 165 as well.