Nokea
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.
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A nurse is assessing the nutritional status of an infant who is 6 months old. The infant weighed 2.7 kg at birth. Which of the following indicates to the nurse that the infant is within the expected range?
- A. 5.5 kg
- B. 6.4 kg
- C. 4.5 kg
- D. 3.6 kg
Correct Answer: B
Rationale: The correct answer is B, 6.4 kg. An infant's weight should approximately double by 6 months. In this case, starting from a birth weight of 2.7 kg, a weight of 6.4 kg at 6 months indicates normal growth. Choice A (5.5 kg) is below the expected range for a 6-month-old infant. Choices C (4.5 kg) and D (3.6 kg) are also below the expected weight gain, indicating inadequate growth.
A client who practices Islam and is currently observing dietary restrictions for the month of Ramadan. Which of the following interventions should the nurse include in the plan of care?
- A. Remove pork products from the dietary plan
- B. Facilitate fasting during daylight hours
- C. Serve meat and dairy items together
- D. Provide a low-carb diet on Fridays
Correct Answer: B
Rationale: During Ramadan, individuals fast from dawn to sunset. Facilitating fasting during daylight hours respects the dietary practices of clients observing Ramadan. Choice A is incorrect as the dietary restriction during Ramadan involves abstaining from all food and drink during daylight hours, not just beef products. Choice C is incorrect as Muslims generally do not consume meat and dairy together due to religious dietary laws. Choice D is incorrect as providing a low-carb diet on Fridays does not specifically align with the dietary restrictions observed during Ramadan.
A nurse is teaching a group of clients about stress. Which of the following should the nurse include in the teaching?
- A. Protein requirements decrease in times of stress.
- B. Acute stress causes an increase in metabolism.
- C. Stress causes a positive nitrogen balance in the body.
- D. Glucose is broken down more slowly during times of stress.
Correct Answer: B
Rationale: The correct answer is B: Acute stress causes an increase in metabolism. During acute stress, the body's fight-or-flight response is activated, leading to an increase in metabolism to provide energy for the body to respond to the stressor. Choices A, C, and D are incorrect. Protein requirements actually increase during times of stress to support the body's needs. Stress typically leads to a negative nitrogen balance in the body, not a positive one. Glucose is broken down more rapidly, not slowly, during times of stress to provide immediate energy.
A client has a small-bore jejunostomy and is receiving a continuous tube feeding with a high-viscosity formula. Which of the following actions should the nurse take to prevent the tubing from clogging?
- A. Replace the bag and tubing every 24 hours
- B. Flush the tubing with 10 mL water every 6 hours
- C. Administer the feeding by gravity drip
- D. Heat the formula prior to infusion
Correct Answer: B
Rationale: To prevent clogging when using high-viscosity formulas in a small-bore jejunostomy, the nurse should flush the tubing with 10 mL of water every 6 hours. This action helps maintain tube patency and prevent blockages. Replacing the bag and tubing every 24 hours (Choice A) is unnecessary and does not specifically address preventing clogging. Administering the feeding by gravity drip (Choice C) or heating the formula prior to infusion (Choice D) are not effective interventions for preventing tubing clogging.
A nurse is teaching a group of clients who are at risk for heart disease about decreasing saturated fats in their diet. Which of the following fats should the nurse recommend the clients use when cooking?
- A. Palm oil
- B. Peanut oil
- C. Canola oil
- D. Stick margarine
Correct Answer: C
Rationale: Canola oil is lower in saturated fats compared to palm oil, peanut oil, and stick margarine, making it a healthier option for clients at risk for heart disease. Palm oil is high in saturated fats, peanut oil has a moderate amount of saturated fats, and stick margarine is also high in saturated fats and trans fats, which are not heart-healthy choices.