NUR 204 EXAM 1 QUESTIONS WITH COMPLETE SOLUTIONS
You are taking care of an elderly patient with osteoporosis. Which dietary supplements
would be most appropriate as a treatment regimen?
a. Iron and calcium
b. Calcium and vitamin D
c. Vitamin K and B-complex vitamins
d. Fluoride and iron -- Correct Answer ✔✔ B
Rationale: Vitamin D actively assists in calcium absorption; osteoporosis is defined as a
reduction in bone mass and is commonly related to chronic insufficient calcium intake;
thus, increasing calcium intake is necessary. Iron is not indicated for osteoporosis but is
more appropriate treatment for a low red blood cell (RBC) count and low hemoglobin.
Vitamin K is indicated for formation of prothrombin and other clotting factors; B-
complex vitamins assist in various carbohydrate, protein, and glycogen metabolism (B1,
B2, B3, folic acid) and formation of RBCs (B12). Fluoride maintains bone/tooth structure
but is not directly related to osteoporosis.
Impaired liver function related to chronic alcohol use may result in inadequate digestive
function. Which of the following processes would be impacted? SATA
a. Digestion
b. Absorption
c. Metabolism
d. Excretion -- Correct Answer ✔✔ B, C
Rationale: Alcohol's toxic effect on the intestinal mucosa can impair the normal
absorption of nutrients. Chronic alcohol use can cause irreversible changes to the liver
cells, affecting the liver's role in metabolic pathways.
,The following groups must increase their calcium, protein, and iron intakes to prevent
nutritional deficits:
a. Pregnant women
b. Lactating women
c. Older adults
d. Newborns -- Correct Answer ✔✔ A
Rationale: The diet for pregnant women should include substantial increases in calories,
protein, calcium, folic acid, and iron. Lactating women do not need to increase iron,
older adults do not need a high-protein diet, and newborns do not need dietary
supplements.
You are providing patient education for a patient with anemia. Which of the following
foods should you recommend that the patient includes in her regular diet? SATA
a. Beef
b. Spinach
c. Milk
d. Enriched whole wheat bread -- Correct Answer ✔✔ A, B, D
Rationale: Meat is an excellent source of protein, B-complex vitamins, iron, and zinc.
Vegetables provide vitamins A and C, folate, magnesium, and iron. Enriched breads and
cereals are good sources of thiamine, iron, niacin, and riboflavin. Milk contains little iron.
In caring for a patient with a history of alcohol abuse, you administer thiamine, niacin,
folate, and IV TPN with lipids. Your patient education should consist of which of the
following? SATA
a. "B-complex vitamin supplements are quickly used up in alcohol metabolism, leaving
your body at a deficit."
b. "Liver damage impairs your ability to metabolize fats and nutrients."
c. "Nutrient absorption in the intestines is impaired by alcohol's effects on the mucosa."
d. "Your appetite and oral intake are excellent; I'll talk to the provider about canceling
these supplements." -- Correct Answer ✔✔ A, B, C
,Rationale: These are true statements. It is not appropriate to discontinue the vitamins
and parenteral nutrition based on oral intake because absorption and metabolism are
impaired.
You hear in report that your elderly patient was admitted for malnutrition. In planning
for discharge to home, you discuss which of the following issues with the social worker?
SATA
a. Local food availability
b. History of depression
c. Poor-fitting dentures
d. Impaired mobility -- Correct Answer ✔✔ A, B, C, D
Rationale: All are important considerations related to nutrition and food availability,
particularly for elderly patients.
Your physical assessment findings include poor blood clotting, muscle weakness, and
delayed fracture healing. Which of the following nutritional deficits is most likely based
on these findings?
a. Protein deficiency
b. Calcium deficiency
c. Iron deficiency
d. B-complex deficiency -- Correct Answer ✔✔ B
Rationale: Calcium is important in the conversion of prothrombin to thrombin and
other steps of the coagulation process as well as nerve impulse transmission via the
formation of acetylcholine and contraction/relaxation of muscles, most notably the heart
muscle. Increase in bone fractures and delayed fracture healing are also common in
osteoporosis.
Your patient reports that he just started a new diet including spinach salads daily for
lunch and kale, chard, or broccoli for dinner. He has been taking Coumadin for a history
of deep vein thrombosis. Which of the following symptoms would be most concerning?
a. Leg pain and swelling
b. Bleeding gums
, c. Serum iron within normal limits
d. International normalized ratio (INR) 2.6 -- Correct Answer ✔✔ A
Rationale: Spinach, kale, chard, and broccoli are all high in vitamin K, which decreases
the effectiveness of the anticoagulant Coumadin. Leg pain and swelling would be
symptoms of a DVT or clot. Dietary intake of vitamin K should be consistent while on
Coumadin; adoption of a new diet indicates the time of highest risk. Bleeding gums
indicate anticoagulation, normal levels of iron indicate no blood loss, and an
international normalized ratio (INR) of 2.6 is therapeutic while on Coumadin.
You suspect that your patient is experiencing acute malnutrition. Which lab would give
you the best indication of the patient's current nutritional status?
a. Low albumin
b. Low prealbumin
c. Elevated white blood cell count
d. Elevated cholesterol -- Correct Answer ✔✔ B
Rationale: Prealbumin has a half-life of 2 days and accurately assesses protein synthesis
and nitrogen balance. It is considered a very sensitive and specific marker for nutritional
status. Low albumin indicates a more chronic nutritional problem since the half-life is
about 18 days. Low albumin may also be related to overhydration. Elevated white blood
cell count may indicate infection not directly related to nutritional status. Low white
blood cell count may be exhibited in severe nutritional depletion. Elevated cholesterol
does not indicate malnutrition.
You are monitoring a tube feeding for a patient with altered mental status following a
CVA. Which of the following would you do to prevent aspiration?
a. Maintain the head of the bed greater than 30 degrees.
b. Check residual volumes hourly.
c. Hold tube feeding if residual volumes are greater than 100 mL.
d. Monitor blood glucose two to four times per day while on tube feeding. -- Correct
Answer ✔✔ A
Rationale: Maintaining the head of the bed at 30 to 45 degrees in Fowler position at all
times when feedings are infusing and 30 minutes after completion of intermittent or
You are taking care of an elderly patient with osteoporosis. Which dietary supplements
would be most appropriate as a treatment regimen?
a. Iron and calcium
b. Calcium and vitamin D
c. Vitamin K and B-complex vitamins
d. Fluoride and iron -- Correct Answer ✔✔ B
Rationale: Vitamin D actively assists in calcium absorption; osteoporosis is defined as a
reduction in bone mass and is commonly related to chronic insufficient calcium intake;
thus, increasing calcium intake is necessary. Iron is not indicated for osteoporosis but is
more appropriate treatment for a low red blood cell (RBC) count and low hemoglobin.
Vitamin K is indicated for formation of prothrombin and other clotting factors; B-
complex vitamins assist in various carbohydrate, protein, and glycogen metabolism (B1,
B2, B3, folic acid) and formation of RBCs (B12). Fluoride maintains bone/tooth structure
but is not directly related to osteoporosis.
Impaired liver function related to chronic alcohol use may result in inadequate digestive
function. Which of the following processes would be impacted? SATA
a. Digestion
b. Absorption
c. Metabolism
d. Excretion -- Correct Answer ✔✔ B, C
Rationale: Alcohol's toxic effect on the intestinal mucosa can impair the normal
absorption of nutrients. Chronic alcohol use can cause irreversible changes to the liver
cells, affecting the liver's role in metabolic pathways.
,The following groups must increase their calcium, protein, and iron intakes to prevent
nutritional deficits:
a. Pregnant women
b. Lactating women
c. Older adults
d. Newborns -- Correct Answer ✔✔ A
Rationale: The diet for pregnant women should include substantial increases in calories,
protein, calcium, folic acid, and iron. Lactating women do not need to increase iron,
older adults do not need a high-protein diet, and newborns do not need dietary
supplements.
You are providing patient education for a patient with anemia. Which of the following
foods should you recommend that the patient includes in her regular diet? SATA
a. Beef
b. Spinach
c. Milk
d. Enriched whole wheat bread -- Correct Answer ✔✔ A, B, D
Rationale: Meat is an excellent source of protein, B-complex vitamins, iron, and zinc.
Vegetables provide vitamins A and C, folate, magnesium, and iron. Enriched breads and
cereals are good sources of thiamine, iron, niacin, and riboflavin. Milk contains little iron.
In caring for a patient with a history of alcohol abuse, you administer thiamine, niacin,
folate, and IV TPN with lipids. Your patient education should consist of which of the
following? SATA
a. "B-complex vitamin supplements are quickly used up in alcohol metabolism, leaving
your body at a deficit."
b. "Liver damage impairs your ability to metabolize fats and nutrients."
c. "Nutrient absorption in the intestines is impaired by alcohol's effects on the mucosa."
d. "Your appetite and oral intake are excellent; I'll talk to the provider about canceling
these supplements." -- Correct Answer ✔✔ A, B, C
,Rationale: These are true statements. It is not appropriate to discontinue the vitamins
and parenteral nutrition based on oral intake because absorption and metabolism are
impaired.
You hear in report that your elderly patient was admitted for malnutrition. In planning
for discharge to home, you discuss which of the following issues with the social worker?
SATA
a. Local food availability
b. History of depression
c. Poor-fitting dentures
d. Impaired mobility -- Correct Answer ✔✔ A, B, C, D
Rationale: All are important considerations related to nutrition and food availability,
particularly for elderly patients.
Your physical assessment findings include poor blood clotting, muscle weakness, and
delayed fracture healing. Which of the following nutritional deficits is most likely based
on these findings?
a. Protein deficiency
b. Calcium deficiency
c. Iron deficiency
d. B-complex deficiency -- Correct Answer ✔✔ B
Rationale: Calcium is important in the conversion of prothrombin to thrombin and
other steps of the coagulation process as well as nerve impulse transmission via the
formation of acetylcholine and contraction/relaxation of muscles, most notably the heart
muscle. Increase in bone fractures and delayed fracture healing are also common in
osteoporosis.
Your patient reports that he just started a new diet including spinach salads daily for
lunch and kale, chard, or broccoli for dinner. He has been taking Coumadin for a history
of deep vein thrombosis. Which of the following symptoms would be most concerning?
a. Leg pain and swelling
b. Bleeding gums
, c. Serum iron within normal limits
d. International normalized ratio (INR) 2.6 -- Correct Answer ✔✔ A
Rationale: Spinach, kale, chard, and broccoli are all high in vitamin K, which decreases
the effectiveness of the anticoagulant Coumadin. Leg pain and swelling would be
symptoms of a DVT or clot. Dietary intake of vitamin K should be consistent while on
Coumadin; adoption of a new diet indicates the time of highest risk. Bleeding gums
indicate anticoagulation, normal levels of iron indicate no blood loss, and an
international normalized ratio (INR) of 2.6 is therapeutic while on Coumadin.
You suspect that your patient is experiencing acute malnutrition. Which lab would give
you the best indication of the patient's current nutritional status?
a. Low albumin
b. Low prealbumin
c. Elevated white blood cell count
d. Elevated cholesterol -- Correct Answer ✔✔ B
Rationale: Prealbumin has a half-life of 2 days and accurately assesses protein synthesis
and nitrogen balance. It is considered a very sensitive and specific marker for nutritional
status. Low albumin indicates a more chronic nutritional problem since the half-life is
about 18 days. Low albumin may also be related to overhydration. Elevated white blood
cell count may indicate infection not directly related to nutritional status. Low white
blood cell count may be exhibited in severe nutritional depletion. Elevated cholesterol
does not indicate malnutrition.
You are monitoring a tube feeding for a patient with altered mental status following a
CVA. Which of the following would you do to prevent aspiration?
a. Maintain the head of the bed greater than 30 degrees.
b. Check residual volumes hourly.
c. Hold tube feeding if residual volumes are greater than 100 mL.
d. Monitor blood glucose two to four times per day while on tube feeding. -- Correct
Answer ✔✔ A
Rationale: Maintaining the head of the bed at 30 to 45 degrees in Fowler position at all
times when feedings are infusing and 30 minutes after completion of intermittent or
