TEST BANK FOR NUTRITIONAL FOUNDATIONS AND CLINICAL APPLICATIONS A NURSING APPROACH 6TH EDITION BY GRODNER

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1 Link download full: TEST BANK FOR NUTRITIONAL FOUNDATIONS AND CLINICAL APPLICATIONS A NURSING APPROACH 6TH EDITION BY GRODNER Chapter 07: Vitamins Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition MULTIPLE CHOICE 1. A patient is admitted to the hospital with confusion, memory loss, and ataxia. What other information would lead you to suspect that his symptoms may be caused by secondary thiamin deficiency? a. The patient has very limited funds and has been eating mainly rice and beans. b. The patient admits that he struggles with alcoholism. c. The patient is recovering from a minor stroke. d. The patient has a family histor disease.

2 ANS: B Alcoholism may be associated with a secondary thiamin deficiency because the liver needs increased amounts of thiamin to detoxify alcohol. Limited food intake may cause primary deficiency (although legumes are a good source of thiamin, and so primary deficiency is unlikely). Stro disease may cause confusion, memory loss, and ataxia, but not in relation to a secondary vitamin deficiency. DIF: Cognitive Level: Analyzing REF: Page 107 Pages Page 119 TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological 2. An example of someone who has a relatively high risk for vitamin deficiencies is a(n) a. 45-year-old half marathon runner. b. 85-year-old man living independently. c. college-age woman living with roommates. d. breastfed newborn. ANS: B

3 Subgroups of the population at risk for vitamin deficiencies include older adults because of decreased vitamin absorption and limited physical and economic resources to purchase and prepare food. Active middle-aged adults and college students usually consume enough food to ensure adequate vitamin intake. Vitamin deficiencies are rare among breastfed newborns. DIF: Cognitive Level: Applying REF: Page 106 Page 124 TOP: Nursing Process: Assessment promotion and maintenance MSC: Client Needs: Health 3. Deficiencies are likely to develop most rapidly with low intake of vitamin a. A. b. C. c. D. d. E. ANS: B Vitamin C is water soluble; vitamins A, D, and E are fat soluble. Deficiencies of water-soluble vitamins develop more rapidly because they are not stored in the body. DIF: Cognitive Level: Applying REF: Pages

4 TOP: Nursing Process: Assessment promotion and maintenance MSC: Client Needs: Health 4. The best way to ensure intake of a variety of phytochemicals is to a. take a daily multivitamin supplement that includes phytochemicals. b. increase intake of soy-based foods, such as soy milk, tofu, and soy flour. c. choose whole grains and include at least five servings of fruits and vegetables daily. d. include at least three servings of dairy products daily and use a variety of herbs and spices. ANS: C The best way to ensure intake of a variety of phytochemicals is to eat a variety of plant-based foods, including whole grains, fruits, and vegetables. Multivitamin supplements do not necessarily contain phytochemicals. Soy-based foods contain only a limited selection of phytochemicals. Dairy products do not contain phytochemicals; herbs and spices may provide some but are used in small quantities and so would not provide significant amounts. DIF: Cognitive Level: Applying REF: Page 109 Page 111

5 TOP: Nursing Process: Planning promotion and maintenance MSC: Client Needs: Health 5. The person who would have the highest need for thiamin is a. someone who lifts weights to maintain health. b. a pregnant woman. c. a professional cyclist. d. an older adult who walks 2 miles daily. ANS: C Thiamine needs are related to metabolic rate (i.e., energy expenditure) because thiamine is a coenzyme in energy metabolism. Therefore, the professional cyclist needs the most thiamin because he or she has the greatest energy needs. Pregnancy, walking, and weightlifting all increase energy needs, but less so than professional athletic training. DIF: Cognitive Level: Analyzing REF: Page 111 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

6 6. A homeless man is brought into the emergency room with muscle weakness, loss of coordination, and tachycardia. He has alcohol on his breath. He may be suffering from a deficiency of a. thiamin. b. riboflavin. c. niacin. d. folate. ANS: A Symptoms of thiamine deficiency include muscle weakness, loss of coordination, and tachycardia. Alcoholism increases t thiamin and may contribute to a secondary thiamin deficiency. Symptoms of riboflavin deficiency include cheilosis, glossitis, and dermatitis. Niacin deficiency causes pellagra, characterized by dermatitis, dementia, and diarrhea. Symptoms of folate deficiency include megaloblastic anemia, glossitis, diarrhea, irritability, absent-mindedness, depression, and anxiety. DIF: Cognitive Level: Applying REF: Pages TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological 7. If whole milk is stored in a clear bottle in a refrigerator with a glass front,

7 a. the milk fat may separate and rise to the top of the bottle. b. some of the protein in the milk may become denatured. c. the ultraviolet light exposure may destroy the vitamin D. d. the ultraviolet light exposure may destroy the riboflavin. ANS: D Riboflavin is destroyed by ultraviolet light, and so storage of milk in a clear bottle and a glass-front refrigerator may cause loss of riboflavin. Vitamin D is not affected by ultraviolet light. Ultraviolet light does not cause milk fat to separate out and does not denature protein. DIF: Cognitive Level: Remembering REF: Page 92 Page 112 Page 121 TOP: Nursing Process: Assessment promotion and maintenance MSC: Client Needs: Health 8. A good way to increase intake of riboflavin would be to

8 a. eat cereal with skim milk for breakfast instead of toast and juice. b. replace romaine lettuce salad with spinach salad. c. drink orange juice instead of apple juice. d. make sandwiches with whole grain bread instead of white bread. ANS: A The most significant source of riboflavin in the United States is milk, and so switching to cereal with milk for breakfast would increase riboflavin intake. Replacing romaine lettuce with spinach would increase intake of folate. Replacing apple juice with orange juice would increase vitamin C intake. Eggs, meats, and whole grains are all good but lesser sources of riboflavin. Using whole grains would increase intake of several vitamins and would increase riboflavin intake slightly, but less than by drinking extra milk. DIF: Cognitive Level: Applying REF: Pages Page 115 Pages TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

9 9. In a very poor country where the subsistence crop is corn and intake of animal protein is very limited, the population has a high risk for developing a. scurvy. b. pellagra. c. spina bifida. d. pernicious anemia. ANS: B Corn has low levels of niacin, and low intake of animal protein would mean that relatively little tryptophan would be available to be converted to niacin; therefore, the population would be at risk for developing pellagra, the niacin deficiency disorder. Scurvy is caused by deficiency of vitamin C. Lack of folate during early pregnancy can lead to spina bifida. Pernicious anemia is caused by lack of intrinsic factor in the stomach to facilitate absorption of vitamin B12. DIF: Cognitive Level: Applying REF: Pages TOP: Nursing Process: Assessment integrity MSC: Client Needs: Psychosocial 10. Niacin can be manufactured by the body from the amino acid

10 a. alanine. b. arginine. c. tryptophan. d. phenylalanine. ANS: C Niacin can be manufactured by the body from tryptophan, but not from alanine, arginine, or phenylalanine. DIF: Cognitive Level: Remembering REF: Page 129 TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Physiological integrity 11. A young woman recently married tells you that she is excited to have children. She should be especially careful to consume adequate amounts of a. folic acid. b. vitamin B12.

11 c. pyridoxine. d. vitamin E. ANS: A Women who may become pregnant need to ensure adequate intake of folic acid to prevent neural tube defects. The neural tube forms before many women know they are pregnant, and so it is important to ensure adequate intake of folic acid before pregnancy. Vitamin B12, pyridoxine, and vitamin E are all important vitamins, but the need for them is not especially associated with pregnancy. DIF: Cognitive Level: Understanding REF: Pages Page 119 Page 123 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity Client Needs: Health promotion and maintenance 12. An example of a high-folate meal is a. fish, French fries, and coleslaw. b. spinach salad with orange segments.

12 c. oatmeal with brown sugar and raisins. d. pork chops with applesauce. ANS: B Good sources of folate include leafy green vegetables (including spinach), legumes, ready-to-eat cereals, and some fruits and juices (including orange). Fish, oatmeal, raisins, pork, and applesauce are not good sources of folate. DIF: Cognitive Level: Applying REF: Page 115 Page 119 TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 13. The type of anemia associated with folate deficiency is anemia. a. microcytic b. pernicious c. megaloblastic d. iron deficiency

13 ANS: C The type of anemia associated with folate deficiency is megaloblastic anemia. Microcytic anemia is associated with iron deficiency. Pernicious anemia is associated with vitamin B12 deficiency. Iron deficiency anemia is (as its name suggests) associated with deficiency of iron, not of folate. DIF : Cognitive Level: Remembering REF: Pages TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological 14. If an older adult develops delusions and hallucinations, it is important to check his or her blood levels of a. vitamin B12. b. intrinsic factor. c. folic acid. d. thiamin. ANS: A

14 Delusions and hallucinations may be signs of vitamin B12 deficiency, even before development of anemia. Intrinsic factor is produced by the stomach and is vital for absorption of vitamin B12; it is not found in the blood. Loss of intrinsic factor in older adults contributes to vitamin B12 deficiency. Folic acid deficiency may cause irritability, absent-mindedness, depression, and anxiety, and thiamin deficiency causes memory loss and confusion, but neither of these is associated with delusions and hallucinations. DIF : Cognitive Level: Applying REF: Page 112 Page 116 TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological 15. If a patient needs regular injections of vitamin B12, the most likely explanation is that a. he or she follows a vegan eating pattern. b. he or she struggles with alcoholism. c. he or she has a malabsorption syndrome. d. his or her stomach does not produce intrinsic factor. ANS: D Vitamin B12 injections are necessary for patients who do not produce intrinsic factor, which is essential for absorption of vitamin B12 from the gut. Patients

15 who follow a vegan eating pattern need vitamin B12 supplements because this vitamin is found only in animal foods. However, they can use oral supplements because they are still able to absorb the vitamin; they do not need injections. Alcoholism does not affect absorption of vitamin B12. Malabsorption syndromes may decrease absorption of vitamin B12, but with adequate dietary intake and supplements, affected patients may still be able to absorb sufficient amounts from the gut. DIF : Cognitive Level: Applying REF: Page 116 TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological 16. An example of a meal with high levels of biotin is a a. cheese-and-tomato sandwich. b. roast beef and mustard sandwich. c. peanut butter and jelly sandwich. d. vegetarian sandwich with avocado and alfalfa sprouts. ANS: C The richest sources of biotin include liver, kidney, peanut butter, egg yolks, and yeast.

16 DIF : Cognitive Level: Applying REF: Page 117 Page 119 TOP: Nursing Process: Planning promotion and maintenance MSC: Client Needs: Health 17. Some choline can be synthesized by the body from a. glycerol. b. cholesterol. c. tryptophan. d. methionine. ANS: D The body can synthesize some choline from methionine, but not enough to meet the needs of the body. The body cannot synthesize choline from glycerol, cholesterol, or tryptophan. DIF : Cognitive Level: Remembering REF: Page 117 TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological

17 18. Scurvy would be most likely to occur in someone who lives in a a. remote village in northern Minnesota. b. farming community in Florida. c. city in central California. d. fishing community on the coast of Maine. ANS: A Scurvy is caused by vitamin C deficiency. Both Florida and California produce abundant citrus fruit, other fruits, and vegetables, which are excellent sources of vitamin C. A community on the coast of Maine does not necessarily produce good sources of vitamin C locally, but it is connected to commercial transportation, and so a variety of foods are probably available. A remote village in northern Minnesota may not have good access to fresh fruits and vegetables during the winter months, and so scurvy could potentially develop. DIF : Cognitive Level: Applying REF: Pages TOP: Nursing Process: Assessment integrity MSC: Client Needs: Physiological 19. If a registered dietitian is concerned about the adequacy of a client s vitamin C intake, he or she would want to client

18 a. drinks milk. b. follows a vegan diet. c. has regular exposure to sunlight. d. smokes cigarettes. ANS: D The dietitian would need to know whether the client smokes cigarettes because smokers require more vitamin C than nonsmokers. A vegan diet raises concerns about intake of vitamin B12 (found only in animal foods) but does not necessarily affect vitamin C intake. Regular exposure to sunlight and milk intake affect vitamin D status but not vitamin C status. DIF: Cognitive Level: Applying REF: Pages Pages TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Physiological integrity Client Needs: Health promotion and maintenance 20. Vegetables are likely to be highest in vitamin C if they are a. boiled.

19 b. canned. c. stir-fried. d. oven roasted. ANS: C Vegetables are likely to be highest in vitamin C if they are stir-fried. Heat destroys vitamin C, and so cooking for the minimum amount of time preserves vitamin C. Oven roasting is a slow cooking method, and so more vitamin C is lost. Vitamin C is also water soluble, and so cooking methods that use water, such as boiling and canning, cause loss of vitamin C into the cooking liquid. In stir-frying, vegetables are cooked quickly without water. DIF: Cognitive Level: Understanding REF: Page 118 TOP: Nursing Process: Planning Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 21. Foods that are good sources of preformed vitamin A include a. sweet potatoes. b. egg yolk.

20 c. tomatoes. d. carrots. ANS: B Preformed vitamin A is found only in the fat of animal foods; egg yolk is a good source. Sweet potatoes, tomatoes, and carrots are all good sources of carotenoids, which can be converted to retinoids (vitamin A) in the body. DIF: Cognitive Level: Applying REF: Page 120 TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Physiological integrity 22. The best description of blindness caused by vitamin A deficiency in developing countries is that it is a. temporary and treatable. b. infectious and often fatal. c. limited to night blindness. d. permanent but preventable.

21 ANS: D The blindness caused by vitamin A deficiency is permanent once it occurs, but it can be prevented by administration of periodic supplements. Vitamin deficiencies may be exacerbated by infections that increase nutrient needs, but the deficiencies themselves are not infectious. Blindness may cause early death but is itself not fatal. Vitamin A deficiency may cause both night blindness and complete blindness. DIF: Cognitive Level: Understanding REF: Page 120 TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Physiological integrity 23. Foods rich in antioxidant vitamins include a. oranges and vegetable oils. b. apples and butter. c. carrots and olive oil. d. mushrooms and milk. ANS: A

22 The two vitamins that function as antioxidants in the body are vitamins C and E. Citrus fruits such as oranges are excellent sources of vitamin C; vegetable oils are excellent sources of vitamin E. DIF: Cognitive Level: Understanding REF: Pages Page 123 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity Client Needs: Health promotion and maintenance 24. The main reason that the adequate intake (AI) for vitamin D increases in older adults is that a. their ability to absorb dietary vitamin D is diminished. b. conversion of vitamin D to its active forms is less efficient. c. their skin is less efficient in synthesizing vitamin D during sun exposure. d. they require more vitamin D than do younger adults to maintain bone health. ANS: C

23 Older adults need more dietary vitamin D because their skin is less efficient in synthesizing vitamin D during sun exposure. Their ability to absorb vitamin D and convert vitamin D to its active form has less effect on vitamin D needs. They do not necessarily require more total vitamin D than do younger adults for bone health; they need more from foods because their skin manufactures less. DIF: Cognitive Level: Understanding REF: Pages TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity Client Needs: Health promotion and maintenance 25. Rickets would be most likely to develop in a(n) a. elderly frail adult who lives alone. b. Asian college student who does not drink milk. c. white toddler who has been weaned from breast milk. d. 9-month-old breastfed African American baby. ANS: D Rickets is caused by vitamin D deficiency in infants and toddlers; those who are breast-fed and have dark skin are at higher risk because breast milk is low

24 in vitamin D and dark skin is less efficient at forming vitamin D when exposed to sun. In response to low intake of vitamin D and calcium, elderly adults may develop osteoporosis and younger adults may develop osteomalacia. DIF: Cognitive Level: Applying REF: Page 122 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity Client Needs: Safe and effective care environment 26. The most likely cause of vitamin toxicity is a. high intake of fortified foods. b. increased absorption as a result of medications. c. long-term use of megadose supplements. d. high intake of nutrient-dense foods. ANS: C Vitamin toxicity is usually caused by use of high-dose supplements over a long period of time. Levels of vitamins in fortified foods are unlikely to be toxic, and very few foods contain high enough levels to cause toxicity. Medications do not cause significant increases in vitamin absorption.

25 DIF: Cognitive Level: Understanding REF: Page 106 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity 27. An example of a meal with high levels of vitamin K is a. grilled shrimp with rice and green beans. b. eggs, bacon, and hash browns. c. stir-fried beef with broccoli. d. bacon, lettuce, and tomato sandwich. ANS: C The best source of vitamin K is green leafy vegetables, such as broccoli. Dairy products, meats, cereals, and fruits provide smaller amounts. DIF: Cognitive Level: Applying REF: Page 124 TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 28. Vitamin K deficiency could be a problem in someone who

26 a. does not produce intrinsic factor. b. uses antibiotics for several months. c. struggles with alcoholism. d. has limited skin exposure to sunlight. ANS: B Antibiotics kill gut bacteria that synthesize vitamin K, and so long-term use of antibiotics may cause vitamin K deficiency. Intrinsic factor is required for absorption of vitamin B12, not vitamin K. Alcoholism is associated with secondary deficiencies of several B vitamins. Skin exposure to sunlight stimulates production of vitamin D. DIF: Cognitive Level: Applying REF: Page 124 TOP: Nursing Process: Assessment Nursing Process: Planning MSC: Client Needs: Physiological integrity 29. The first step to ensure adequate intake of vitamins is to a. use a daily multivitamin supplement.

27 b. increase fortification of key foods in the food supply. c. target specific supplements for specific subgroups of the population. d. ensure that the diet includes a variety of foods from all of the food groups. ANS: D The best way to ensure adequate intake of vitamins is to start with a diet that includes a variety of foods from all the food groups. Reliance on supplements and food fortification do not result in an overall optimal diet. Use of supplements by specific subgroups of the population may be a second step in ensuring dietary adequacy, but it would not be the first step. DIF: Cognitive Level: Applying REF: Page 106 Pages TOP: Nursing Process: Planning Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance 30. The primary reason that many Americans use vitamin supplements on a regular basis is that a. supplements taste better than food.

28 b. this practice is necessary for good health. c. it is cheaper than consuming an adequate diet. d. it is easier than making dietary and behavioral modifications.