NR-228 Nutrition, Health & Wellness - Set 4 - Part 2

Correct Answer: Alcohol supplies calories and no protective benefit.

Alcohol yields seven kilocalories per gram, so wine is not calorie free. Current dietary guidance does not recommend that anyone begin drinking or drink more for cardiovascular benefit, and drinking less is better than drinking more. Option a is incorrect because national dietary guidance explicitly advises that adults who do not drink should not start, and no health authority prescribes daily wine as a cardiovascular intervention for any patient. Option b is incorrect because every gram of alcohol releases seven kilocalories during oxidation regardless of the amount consumed. Those calories displace normal fuel use and are readily deposited as body fat. Option d is incorrect because the body has no requirement for alcohol, cannot store it, and clears it as a toxin. Yielding energy does not make a substance a nutrient.

Correct Answer: Level two, mildly thick

Nectar-thick is the legacy term for IDDSI Level two, Mildly Thick. A mildly thick drink flows off a spoon quickly and can still be sipped through a standard straw with effort, which is exactly what nectar described. Option a is incorrect because Slightly Thick, the first level, has no older equivalent at all. It was created inside the framework and is used mainly in pediatrics, so no legacy word maps onto it. Option c is incorrect because honey-thick, not nectar-thick, is the term that Moderately Thick replaced. A drink at that level drips slowly in dollops through fork prongs and may be taken from a cup or spoon. Option d is incorrect because pudding-thick and spoon-thick are the legacy words for Extremely Thick. That consistency holds its shape on a spoon and cannot be drunk from a cup, unlike a nectar-thick drink.

Correct Answer: Low bone density and stress fractures

Low energy availability suppresses hypothalamic GnRH, lowering estrogen and releasing bone resorption. In an adolescent athlete this happens while peak bone mass should be accumulating, so osteopenia and stress fractures are the lasting consequence. Option b is incorrect because functional hypothalamic amenorrhoea usually reverses once energy availability is restored. Fertility generally returns with adequate intake and reduced training load, so permanent infertility is not the lasting risk here. Option c is incorrect because marrow suppression belongs to advanced starvation rather than to the triad itself. Anemia in female endurance athletes more often reflects iron depletion, which responds well to repletion. Option d is incorrect because thyroid output falls as an energy conserving adaptation and recovers with restored intake. Lifelong replacement is not the expected outcome, and the skeleton carries the durable damage instead.

Correct Answer: Obtain orthostatic vitals and serum electrolytes

Bradycardia, hypothermia and orthostatic symptoms signal cardiovascular instability, the leading medical cause of death in anorexia nervosa. Orthostatic vital signs, cardiac monitoring and electrolytes including potassium, phosphorus and magnesium guide urgent care. Option a is incorrect because nutrition planning matters but does not come before stabilising a heart that is beating dangerously slowly. Feeding an unmonitored client with unknown electrolytes also risks refeeding complications. Option b is incorrect because walking a bradycardic, volume depleted adolescent invites syncope, falls and arrhythmia. Activity is restricted until cardiac status and electrolytes are known to be stable. Option d is incorrect because passive warming alone treats a symptom while ignoring the unstable heart underneath. Waiting until morning delays detection of hypokalaemia and arrhythmia, both of which can prove fatal overnight.

Correct Answer: A glass of whole milk

Dairy is the boundary between the two levels. Milk is opaque and is excluded from clear liquids, but full liquids add anything liquid at room temperature, which brings milk, ice cream, pudding and cream soup onto the tray. Option a is incorrect because clear fat-free broth was already on the clear liquid tray, so advancing the order adds nothing new here. It remains allowed at the full liquid level as well. Option c is incorrect because gelatin is a standard clear liquid food that the client has been eating all along. It carries over unchanged to full liquids and therefore does not answer the question. Option d is incorrect because cranberry juice is pulp-free and transparent, one of the three juices already permitted on clear liquids. Orange, prune and tomato juice are the ones that first appear when full liquids begin.

Correct Answer: Menstrual losses add to the needs of growth itself

Adolescent iron needs rise for both sexes to support expanding blood volume and lean mass, but the female requirement is higher because menstrual losses are added on top. This is the first life stage where that happens. Option a is incorrect because adolescent males have a substantial iron requirement of their own, driven by rapidly expanding blood volume and by the lean body mass gained during the growth spurt. Option b is incorrect because the allowances diverge once menstruation starts, and adolescence is the point where they separate. Before puberty the two sexes are given the same daily figure. Option c is incorrect because girls need more iron, not less, during these years. Although the female growth spurt does finish sooner, monthly blood loss more than offsets that shorter period of rapid growth.

Correct Answer: Identify changes he can make with available food

A therapeutic diet that cannot be executed will not be followed. The nursing move is to prescribe within what is actually obtainable, prioritize the modifications that matter most, and connect him with food assistance programs. Option b is incorrect because instructions for home cooking assume a kitchen this man does not have. Shelter and pantry meals are what he actually eats, and teaching has to work within that reality. Option c is incorrect because buying and storing fresh food requires money and refrigeration, neither of which he has. Advice that ignores those barriers raises foodborne illness risk and will simply be abandoned. Option d is incorrect because waiting for housing abandons a man with a new diagnosis for an indefinite period. Partial, realistic modification is achievable now and is what the nursing intervention aims for.

Correct Answer: Clear liquids, full liquids, pureed, soft, then regular

The staged progression moves from clear liquids to full liquids, then pureed, then soft, and finally regular food over several weeks as the surgical team directs. Each step adds texture only when the previous one is tolerated. Option a is incorrect because full liquids come after clear liquids, never before them. Dairy and cream soups are added once the simplest see-through fluids are tolerated, and soft food cannot precede a pureed stage. Option b is incorrect because a pureed stage cannot open the sequence. Texture is reintroduced only after the pouch has handled fluids, so beginning with spoon-thick food would overwhelm a stomach that has just been reduced. Option d is incorrect because this order jumps to regular food before soft food, which reverses the final two stages. It also places pureed food ahead of full liquids, skipping the gentler step that should come first.

Correct Answer: They reflect inflammation and predict risk of poor outcomes

The ASPEN position is that albumin and prealbumin characterize inflammation rather than nutrition status, and they should not be used as nutrition markers. What they do predict well is the patient's risk of an adverse outcome. Option a is incorrect because neither protein serves as a proxy for total body protein. The malnutrition here is established by the temporal wasting and the intake history, not by a serum concentration. Option b is incorrect because prealbumin has a half-life of two to three days, not hours, and in ongoing sepsis it will stay low however much nutrition is delivered until the inflammation settles. Option c is incorrect because muscle mass is judged at the bedside, by looking at the temples, the clavicles and the back of the hand and by testing grip strength. No blood level substitutes for that.

Correct Answer: Hold oral intake and notify the provider

These findings are the classic late evidence of silent aspiration, where material passes the vocal folds without any cough. The nurse stops oral intake, protects the airway and reports the picture so evaluation can be repeated. Option a is incorrect because pressing on with meals feeds a client who is already showing signs of aspiration pneumonia. Fever, desaturation and new crackles are reasons to stop intake, not reasons to encourage more. Option c is incorrect because extra calories address nutrition while the immediate problem is an airway that material is entering. A supplement given by mouth would travel the same unsafe route the meals have taken. Option d is incorrect because the absence of coughing is never proof of a safe swallow. Laryngeal sensation is often lost after a stroke, so aspiration can occur silently and declare itself days later as infection.

Correct Answer: Increase her fluid intake along with fiber

Fiber increases stool bulk only when enough water is present to hydrate it. Raising fiber without fluid hardens stool further, so fluid must be increased alongside the added bran. Option a is incorrect because stimulant laxatives are avoided in pregnancy and the cause here is an isolated fiber increase; a medication order is not the first step for a correctable dietary problem. Option b is incorrect because mineral oil impairs absorption of the fat soluble vitamins, including the vitamin K that a fetus already has in short supply, so it is avoided during pregnancy. Option c is incorrect because iron is contributing but stopping it risks anemia at a time of high demand; taking the dose with food is preferred over discontinuing supplementation.

Correct Answer: The participant with the most muscle

Lean body mass is the strongest determinant of basal metabolic rate because muscle, liver, kidney and brain are metabolically active, while adipose tissue is comparatively quiet. Two people of equal weight differ if fat free mass differs. Option a is incorrect because ageing lowers basal metabolic rate through progressive loss of lean tissue and reduced activity. Body size alone raises the rate only modestly, and it cannot overcome sarcopenia. Option c is incorrect because stored fat consumes very little energy at rest. A large fat mass adds weight without adding metabolically active tissue, so it does not raise basal requirements. Option d is incorrect because deficient thyroid hormone slows mitochondrial respiration and sodium potassium pump activity in nearly every tissue. Hypothyroidism therefore lowers the basal rate rather than raising it.

Correct Answer: Clear the cheek and use the stronger side

Pocketed food on the weak side is aspirated hours later, so the nurse clears it immediately. Placing food on the stronger side of the mouth and directing chewing there prevents the residue from collecting again. Option b is incorrect because washing solid food down with fluid mixes consistencies in one mouthful. The liquid outruns the solid and reaches an airway that has not yet closed, which is a recognized aspiration hazard. Option c is incorrect because lying the client down after a meal invites reflux and regurgitation into an unprotected pharynx. Charting matters, but it follows removal of the food and thirty to forty-five minutes upright. Option d is incorrect because the weak side is exactly where control of the bolus is lost. Directing chewing there increases pocketing and leaves more residue for the next breath to carry into the airway.

Correct Answer: Stunting, which reflects chronic undernutrition over years

Stunting is low height-for-age and marks chronic undernutrition sustained over years, with physical and cognitive delay as its consequence. His weight is appropriate for his height, which rules out the acute picture. Option a is incorrect because wasting is low weight-for-height and signals an acute problem such as food shortage or a diarrheal illness. This child's weight matches his height, so that pattern is absent. Option b is incorrect because underweight is defined by low weight-for-age and is a composite category. It does not distinguish chronic from acute deficits, and an underweight child may be stunted, wasted, or both. Option d is incorrect because overnutrition means consuming too much energy or too many nutrients relative to the standards. The child described has the opposite problem, a long-standing shortfall of food.

Correct Answer: Take the iron with orange juice instead

Vitamin C in orange juice enhances non-heme iron absorption, while milk and calcium supplements inhibit it. Taking the dose with a vitamin C source is standard teaching for prenatal iron. Option b is incorrect because calcium in milk competes with iron for absorption, and pairing the two is one of the most common reasons a prenatal iron dose is poorly absorbed. Option c is incorrect because tannins in tea bind iron in the gut lumen; tea, coffee and antacids all belong in the group of substances separated from an iron dose. Option d is incorrect because antacids raise gastric pH and reduce the solubility needed for iron uptake; a client with stomach upset should take the dose with food rather than neutralize acid.

Correct Answer: One hundred fifty moderate minutes weekly

Adults should accumulate one hundred fifty to three hundred minutes of moderate aerobic activity each week, or seventy five to one hundred fifty vigorous minutes, plus muscle strengthening on two or more days. Option a is incorrect because the guidelines set a weekly total rather than a fixed daily session. Prescribing alternating daily blocks of activity does not match the national recommendation for adults. Option b is incorrect because sixty minutes weekly falls far short of the moderate activity target and delivers only a fraction of the cardiovascular, metabolic and mood benefits described in the guidelines. Option d is incorrect because that volume of vigorous work daily exceeds any published recommendation and invites injury. Vigorous activity counts roughly double, so far less of it is needed to meet the target.

Correct Answer: Seat the client fully upright before any food

Delegated tasks come with specific directions, and upright positioning is the single measure that keeps the bolus travelling down the esophagus. The aide seats the client at ninety degrees in a chair or high Fowler's before anything is offered. Option a is incorrect because a straw sends a fast bolus straight to the pharynx and is prohibited in many dysphagia plans. No aide should introduce one, and no nurse should direct it without the speech-language pathologist's plan. Option b is incorrect because the client must stay upright for thirty to forty-five minutes after eating. Lowering the bed at the end of the meal allows reflux into a pharynx that cannot protect itself. Option c is incorrect because a flat position during eating removes the gravity that carries food past the airway. Lying down to eat is unsafe for anyone, and for a client with impaired swallowing it invites aspiration.

Correct Answer: Thirst lags behind the fluid already lost

Thirst appears only after a deficit has developed, so an athlete is already dehydrated before feeling thirsty. Weighing before and after exercise guides replacement, with about two cups of fluid for each pound lost. Option a is incorrect because waiting for thirst delays replacement until losses are already significant. Dizziness, headache, dark urine and a rising heart rate can appear before the sensation ever prompts drinking. Option c is incorrect because body weight is checked immediately before and after each session, not weekly. Only same session weighing captures the sweat loss that determines how much fluid to replace. Option d is incorrect because sodium without water worsens the deficit rather than correcting it. Electrolyte containing drinks help when exercise runs beyond about ninety minutes or occurs in heat, but they supplement fluid rather than replace it.

Correct Answer: The neural tube closes about four weeks after conception

Neural tube closure is complete by about the twenty-eighth day after conception, which is often before a missed period is noticed, so folate must already be adequate at that point. Option a is incorrect because closure happens in the first month, not the second trimester; by the time the second trimester begins the structure has been formed for many weeks. Option b is incorrect because folate acts within rapidly dividing embryonic cells that require it for DNA synthesis; placental development has no bearing on when the vitamin becomes useful. Option d is incorrect because the folate recommendation rises in pregnancy from 400 to 600 micrograms of dietary folate equivalents daily and continues throughout gestation for maternal erythropoiesis and fetal growth.

Correct Answer: Overweight, requiring lifestyle counselling and monitoring

The CDC places an index of twenty five to just under thirty in the overweight category, so this client is overweight rather than having obesity. Lifestyle counselling and continued monitoring match that classification. Option a is incorrect because obesity class one begins at an index of thirty. A value below that threshold does not meet the definition, and surgical referral is not indicated on this finding alone. Option b is incorrect because the healthy range stops below twenty five. Documenting a healthy weight would remove this client from follow up at exactly the point where cardiometabolic risk starts to climb. Option c is incorrect because underweight means an index below eighteen point five, far below this value. An index near thirty signals excess weight, and the underweight threshold is a lower limit, never an upper one.