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A client with hypertension is being educated by a nurse about a heart-healthy diet. Which of the following statements indicates that the client understands the teaching?
- A. I will get 15% of my total daily calories from saturated fats.
- B. I will decrease the potassium in my diet.
- C. I will limit my daily sodium intake to 3 grams.
- D. I will eat five 8-ounce servings of fruit daily.
Correct Answer: C
Rationale: The correct answer is C. Limiting daily sodium intake to 3 grams is crucial in managing blood pressure and is a fundamental aspect of a heart-healthy diet. High sodium intake can contribute to hypertension and cardiovascular issues. Choices A, B, and D are incorrect because getting 15% of daily calories from saturated fats, decreasing potassium intake, and eating five servings of fruit do not directly address the management of hypertension through sodium restriction.
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A nurse is caring for a client who is receiving parenteral nutrition. Which of the following findings indicates the therapy is effective?
- A. Client has soft, formed bowel movements.
- B. Client's mucous membranes are pink.
- C. Client reports ability to complete ADLs.
- D. Client's blood glucose level is within the expected reference range.
Correct Answer: D
Rationale: The correct answer is D because having a blood glucose level within the expected reference range indicates that parenteral nutrition is effectively meeting the client's nutritional needs. Choices A, B, and C are incorrect because soft, formed bowel movements, pink mucous membranes, and the ability to complete activities of daily living do not directly reflect the effectiveness of parenteral nutrition therapy.
A healthcare professional is reviewing the laboratory findings of a client who has heart failure. Which of the following findings indicates that the client is experiencing fluid volume excess?
- A. BUN 8 mg/dL
- B. Hgb 15 g/dL
- C. Creatinine 0.8 mg/dL
- D. Sodium 140 mEq/L
Correct Answer: A
Rationale: A BUN level of 8 mg/dL indicates fluid volume excess in a client with heart failure. BUN (Blood Urea Nitrogen) levels can be low in fluid overload due to hemodilution, a common occurrence in heart failure. High levels of BUN usually indicate dehydration or impaired renal function, which are not the case in fluid volume excess. Choices B, C, and D are within normal ranges and do not specifically indicate fluid volume excess.
A client who is breastfeeding is being taught diet modification by a nurse. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should drink an 8-ounce glass of water each time my baby nurses.
- B. I should take a 1500-milligram iron supplement daily.
- C. I can eat a 2500-calorie daily diet to lose 1 lb per week.
- D. I can eat ounces of swordfish daily.
Correct Answer: A
Rationale: The correct answer is A because drinking an 8-ounce glass of water each time the baby nurses helps maintain hydration and support milk production. Choice B is incorrect as the need for iron supplementation should be discussed with a healthcare provider. Choice C is incorrect as a 2500-calorie diet is not typically recommended for weight loss during breastfeeding. Choice D is incorrect as consuming high levels of swordfish is not advisable due to its mercury content, which can be harmful to the baby.
During an initial visit with an older adult client living alone and having difficulty preparing meals, what should the home health nurse do first?
- A. Discuss nutritional requirements with the client.
- B. Refer the client to a senior citizen center.
- C. Arrange for a home-delivered meal program.
- D. Perform a nutrition screening.
Correct Answer: D
Rationale: Performing a nutrition screening is the most appropriate action for the nurse to take first. This allows the nurse to assess the client's current nutritional status and identify any specific needs. Discussing nutritional requirements with the client (Choice A) may be important but should come after the initial assessment. Referring the client to a senior citizen center (Choice B) or arranging for a home-delivered meal program (Choice C) are actions that may be considered later based on the findings of the nutrition screening.
A nurse is providing teaching about formula feeding to the parents of an infant. Which of the following instructions should the nurse include?
- A. Formula that remains in the bottle should not be used for one more feeding.
- B. Formula should be changed to whole milk when the infant is 12 months old.
- C. If the infant is gaining weight too rapidly, do not dilute the formula.
- D. If the infant turns away after taking most of the feeding, stop the feeding.
Correct Answer: D
Rationale: If the infant turns away after taking most of the feeding, it indicates they are full, and continuing to feed may lead to overfeeding. Choice A is incorrect because it is not safe to use formula that remains in the bottle for another feeding due to the risk of bacterial contamination. Choice B is incorrect as whole milk should be introduced after the infant is 12 months old, not 9 months old. Choice C is incorrect as diluting formula can compromise the infant's nutrition and should not be done without healthcare provider guidance.