NR-228 Nutrition, Health & Wellness - Set 5 - Part 2

Correct Answer: A less stringent goal near eight percent applies

Frailty, dementia, and prior severe hypoglycemia all call for a less stringent target, commonly around eight percent. The benefit of tight control takes about a decade to appear, while a hypoglycemic fall harms immediately. Option a is incorrect because tightening the target in this resident raises the hypoglycemia risk that has already caused harm twice. A near normal value offers no realistic microvascular benefit given her limited life expectancy. Option c is incorrect because adding or substituting insulin increases the chance of another severe low. The priority in a frail older adult is freedom from hypoglycemia and from symptomatic hyperglycemia, not a lower number. Option d is incorrect because raising a sulfonylurea drives insulin release regardless of the glucose level. This drug class already carries the highest hypoglycemia risk in older adults, and the current result does not warrant escalation.

Correct Answer: Kussmaul respirations with a fruity breath odor

Kussmaul respirations and fruity breath come from the ketoacidosis that defines diabetic ketoacidosis. Hyperosmolar hyperglycemic state has enough insulin to suppress lipolysis, so ketones stay minimal, the pH stays above seven point three, and neither sign appears. Option a is incorrect because a glucose that high points toward hyperosmolar hyperglycemic state rather than ketoacidosis. Ketoacidosis usually shows a glucose above two hundred fifty, and sodium glucose transport inhibitors can even produce a near normal value. Option b is incorrect because markedly raised osmolality is the hallmark of the hyperosmolar state described in the scenario. Osmolality above three hundred twenty milliosmoles per kilogram belongs to this client, not to the client in ketoacidosis. Option c is incorrect because severe fluid loss and neurological change dominate the hyperosmolar picture, developing slowly over days without an alarm sign. Dehydration occurs in both emergencies, so it cannot separate one from the other.

Correct Answer: Increasing protein and energy with low residue

Inflammation is catabolic and ulcerated mucosa leaks protein, so protein and energy needs rise during a flare. A low residue intake lowers mechanical irritation and stool bulk without cutting the protein that repairs mucosa. Option b is incorrect because bowel rest means reducing residue and mechanical load, never reducing protein. Cutting protein removes the substrate for mucosal repair in a client who is already losing it through the gut. Option c is incorrect because insoluble fiber increases stool bulk and abrades inflamed mucosa, and it can obstruct a narrowed segment if a stricture has formed. Fiber is added back only after remission. Option d is incorrect because prolonged fasting starves an already depleted client and causes intestinal mucosal atrophy. Parenteral feeding is reserved for obstruction, a nonfunctioning gut or a high output fistula.

Correct Answer: Assist the client into well fitting shoes

Helping a client put on properly fitted shoes is a routine task within the scope of assistive personnel. Assessment, teaching, and evaluation stay with the nurse because they require clinical judgment about a client at high ulcer risk. Option a is incorrect because examining insensate feet for early breakdown is an assessment. A missed blister or ulcer in a client who cannot feel pain can progress quickly, so the nurse performs this inspection. Option b is incorrect because client education cannot be handed to unlicensed staff. Explaining why walking barefoot is dangerous requires the nurse to link loss of sensation to injury the client will never feel. Option d is incorrect because judging how well a client grasps a self care routine is evaluation, one of the nursing steps that cannot be transferred. The nurse decides whether the teaching plan needs revision.

Correct Answer: Stop the feeding before lowering the bed

Laying a tube fed client flat removes the gravity gradient that keeps formula below the sphincter, so the volume is removed before the gravity is. The feeding is held first and resumed once the client is upright. Option a is incorrect because infusing formula into a supine client with a depressed cough combines the two conditions that produce aspiration. The procedure can wait the few seconds needed to pause the pump. Option c is incorrect because suctioning treats material that has already reached the airway rather than preventing it from getting there. Nothing in the scenario indicates secretions the client cannot manage right now. Option d is incorrect because a slower rate still adds volume to a stomach that will sit level with the pharynx. Reducing the rate belongs to a tolerance problem, not to a client about to lie flat.

Correct Answer: The manufacturer alone assures product safety

Under the Dietary Supplement Health and Education Act, supplements are regulated as food rather than drugs. No premarket approval is required, and the manufacturer carries responsibility for safety and truthful labeling. Option a is incorrect because no batch-by-batch federal testing exists for these products. That gap is precisely why a nurse cannot assume the bottle holds what the label states, at the stated dose. Option b is incorrect because medicines require approval before sale, while supplements do not. Structure and function claims such as supporting liver health are permitted without review, provided the mandatory disclaimer appears. Option c is incorrect because retail stocking involves no verification of contents or potency. Federal action comes only after a product is found unsafe, when it may be recalled or removed from sale.

Correct Answer: Report any redness or drainage promptly

Observing and reporting redness, tenderness, drainage or swelling at the insertion site is within assistive personnel scope and supports the every shift site assessment. The nurse still performs the assessment and interprets it. Option b is incorrect because accessing a central lumen is a sterile nursing procedure. Hub disinfection belongs to the person who will enter the line, and assistive personnel do not access central catheters. Option c is incorrect because the parenteral lumen is dedicated and is used for nothing else, including blood draws, unless policy specifically permits it. Every extra entry raises the risk of bloodstream infection. Option d is incorrect because hanging a solution means checking the label against the order, inspecting the bag for particulates or cracked emulsion, and programming the pump. Those steps require a licensed nurse.

Correct Answer: Choose lower fat foods and smaller meals

Dietary fat entering the duodenum releases cholecystokinin, which contracts the gallbladder against an obstructed outlet and causes the pain. Lower fat choices and smaller, more frequent meals reduce that stimulus. Option a is incorrect because carbohydrate does not trigger gallbladder contraction and cutting it is not part of standard management. The nutrient that provokes biliary colic is fat, not starch or sugar. Option b is incorrect because whole milk and cream are concentrated fat sources that will reproduce the very attack the client wants to prevent. Low fat dairy is the appropriate substitution here. Option d is incorrect because lean protein foods are needed for healing and are generally well tolerated. Removing them costs the client nutrition while fat, the principal trigger of biliary pain, remains unaddressed.

Correct Answer: Ask when iron and omeprazole are taken

Nonheme iron needs an acidic stomach to be reduced to the absorbable ferrous form. Omeprazole and calcium carbonate both raise gastric pH, so timing determines whether the supplement is working at all. Option a is incorrect because heme iron from meat is useful background information but does not explain a failed response to a prescribed supplement. The acid-suppressing drug is the more pressing lead. Option b is incorrect because dark stools simply confirm that tablets are being swallowed. That finding is expected with oral iron and says nothing about how much of the mineral was absorbed. Option c is incorrect because herbal use deserves a question at every visit, yet two known acid-reducing products already sit on this list. The obvious explanation should be pursued before a speculative one.

Correct Answer: Avoid milk because calcium binds the drug

Calcium and the antibiotic form an insoluble complex in the gut that cannot be absorbed, so the dose is effectively lost. Subtherapeutic levels mean treatment failure and encourage resistant organisms. Option a is incorrect because comfort is being bought at the cost of the antibiotic working at all. Milk, yogurt, cheese and ice cream are the dairy products named as problems with tetracycline. Option c is incorrect because yogurt carries the same calcium load that milk does. Changing the form of the dairy product does nothing to prevent the chelation happening in the gut lumen. Option d is incorrect because fortified juice supplies calcium just as dairy does. Antacids, calcium and magnesium must be taken six hours before or two hours after a tetracycline dose.

Correct Answer: Keep fiber high; those foods are safe.

Current guidance is that nuts, seeds and popcorn are not harmful in diverticulosis, and the old restriction has been withdrawn. High fiber lowers colonic pressure, which is what prevents further pouches and attacks. Option a is incorrect because the theory that a seed can lodge in a pouch was never supported by evidence. Cohort data found no added risk among men with the highest nut and popcorn intake. Option b is incorrect because clear liquids belong to an acute inflammatory attack and supply too little nutrition for long term use. This client has no pain and no fever to treat. Option c is incorrect because low fiber produces small hard stool that the colon must squeeze harder to move. That higher pressure is precisely the force that pushes mucosa out through the wall.

Correct Answer: Bloodstream infection from the central catheter

A sudden unexplained rise in glucose in a previously stable parenteral nutrition client is often the earliest sign of line sepsis, and fever supports it. The catheter is a direct conduit into the bloodstream. Option a is incorrect because refeeding syndrome appears as the infusion is first advanced and shows itself through falling phosphorus, potassium and magnesium. This client has been stable for a week. Option b is incorrect because rebound hypoglycemia follows an abrupt stop and produces low readings, not climbing ones. The infusion here is running as ordered, so the direction of change points elsewhere. Option d is incorrect because fatty liver develops quietly over longer periods and is detected on liver function tests rather than by fever. It does not produce an acute febrile picture within a single day.

Correct Answer: A failing kidney cannot clear the urea

Protein catabolism yields urea, which a failing kidney cannot excrete, so uremic symptoms build. Restricting intake before dialysis lowers that nitrogen load, while dialysis removes urea and removes the reason for the restriction. Option a is incorrect because absorption of dietary protein is normal in kidney disease. Dialysis clients need more protein because treatment strips amino acids and provokes a catabolic, inflammatory response. Option c is incorrect because potassium is controlled by adjusting potassium containing foods to keep the serum level normal. Limiting protein is aimed at urea, and it is not the lever used for potassium. Option d is incorrect because phosphorus is managed with food choices and binders taken with meals rather than by cutting total protein. The protein limit before dialysis exists to control nitrogenous waste.

Correct Answer: Confirm radiographic verification of placement is documented

Radiographic confirmation read by a radiologist is required before any blindly inserted tube is first used for feeding or medication. No bedside method reliably separates airway from stomach, so imaging comes first. Option b is incorrect because the auscultatory air bolus method is explicitly listed as unreliable and must not be used. Sound travels through the chest wall, so a tube in the bronchus produces the same whoosh. Option c is incorrect because pH testing is a confirmatory adjunct for ongoing checks rather than the initial verification. A gastric reading would still not rule out a tube coiled in the esophagus. Option d is incorrect because the water bubbling method appears on the same unreliable list as auscultation. Bubbles can come from stomach gas, and the manoeuvre risks pulling water into the lungs.

Correct Answer: Hold the feeding and request a radiograph

Fasting gastric aspirate is usually pH five or less even during acid suppression, so a reading of six or above means the tip is not in the stomach. Doubt is resolved by imaging. Option a is incorrect because resuming formula into a tube whose tip may sit in the airway or esophagus is the precise event that kills tube fed clients. Documentation does not make the reading safe. Option c is incorrect because flushing pushes water through a tube whose location is already in doubt and washes away the sample being evaluated. A repeated strip reading still cannot show where the tip lies. Option d is incorrect because blindly advancing a tube of unknown location can drive it further into the bronchial tree or perforate tissue. Repositioning belongs to the provider after imaging identifies the actual position.

Correct Answer: Polyuria, polydipsia, and polyphagia

The three P's of hyperglycemia are polyuria, polydipsia, and polyphagia. Glucose above the renal threshold pulls water into the urine, the resulting fluid loss triggers thirst, and starving cells generate hunger despite weight loss. Option b is incorrect because glycosuria is a laboratory finding rather than one of the three P's. Sugar in the urine does accompany hyperglycemia, but the classic triad the nurse is recognizing names hunger as its third member. Option c is incorrect because oliguria means scanty urine, the opposite of what this girl describes. Hyperglycemia produces copious dilute urine through osmotic diuresis, and low urine volume points instead toward dehydration from vomiting or blood loss. Option d is incorrect because hypoglycemia is not part of this presentation. The girl's symptoms arise from glucose that is too high to enter cells, and thirst with heavy urine output signals hyperglycemia rather than a low.

Correct Answer: Skip rinsing and use separate equipment

Washing raw poultry only sprays bacteria across the sink and counter. Separate boards for produce and raw meat, plus a clean plate for cooked food, block the two transfer routes seen here. Option a is incorrect because raw poultry is never washed at all. Rinsing does not remove bacteria and instead aerosolizes them onto the faucet, the counter and anything drying beside the sink. Option b is incorrect because a dry cloth spreads organisms rather than removing them. Boards and utensils need hot soapy water after contact with raw meat, and dish cloths are laundered in hot water. Option c is incorrect because extra cooking time does nothing for the salad greens or the platter. Those foods and surfaces were contaminated outside the pan, where no amount of heat will reach them.

Correct Answer: A grilled chicken sandwich with cooked vegetables

Immunity is compromised, so food safety becomes a clinical intervention. Thoroughly cooked poultry and cooked vegetables carry little risk, while cold ready to eat products and raw produce are the items to avoid. Option a is incorrect because cold deli meats and salami head the avoid list for an immunocompromised client. They are eaten without further cooking, so any contamination reaches the client intact. Option b is incorrect because soft cheeses and unwashed produce both appear among the foods this client must refuse. Washing fruit is a basic step that this selection skips entirely. Option d is incorrect because smoked fish and raw sprouts sit on the same prohibited list. Neither receives the cooking step that would destroy organisms a damaged immune system cannot contain.

Correct Answer: Contraceptive failure and unplanned pregnancy

St. John's wort induces CYP3A4 and P-glycoprotein, speeding the breakdown of many drugs. Oral contraceptive levels fall, and breakthrough pregnancy is the documented consequence the nurse must raise with this client. Option b is incorrect because this herb induces drug-metabolizing enzymes rather than inhibiting them. Levels of the contraceptive drop rather than rise, which is exactly why the method can fail. Option c is incorrect because no permanent effect on menstrual cycling has been attributed to this supplement. Reported side effects are things like upset stomach, dry mouth, headache, fatigue and photosensitivity. Option d is incorrect because calcium absorption is not affected by this product. The danger lies in accelerated clearance of prescription medicines such as contraceptives, cyclosporine, digoxin, warfarin and some HIV drugs.

Correct Answer: The client receiving continuous peritoneal dialysis

The peritoneum is a living membrane that leaks albumin and amino acids into the dialysate around the clock, so the peritoneal dialysis client sits at the top of the dialysis protein range. Option a is incorrect because protein is restricted rather than increased before dialysis begins, to hold down the urea a failing kidney cannot excrete. Stage three sits at the low end of the range. Option b is incorrect because a client approaching dialysis is still on a limited protein prescription under close supervision. Their allowance is roughly half what a client already on dialysis receives. Option c is incorrect because hemodialysis does raise protein needs, but the synthetic membrane retains plasma proteins and runs only a few hours three times a week. Losses are smaller than with continuous exchanges.