ATI Nutrition Practice Exam

Correct Answer A: Constantly moist skin

Explanation of the correct answer:

A. Constantly moist skin:

Moisture is one of the major risk factors for pressure injuries, as it can weaken the skin and make it more vulnerable to breakdown. Constant moisture, whether from perspiration, incontinence, or other sources, increases the risk of maceration (softening and breaking down of the skin), which facilitates the development of pressure injuries. Therefore, constant moisture is a critical factor identified on the Braden scale that would place a client at the greatest risk for pressure injury development.

Why the other options are incorrect:

B. Intermittent paresthesia of the lower extremities:

While paresthesia (numbness or tingling) may indicate nerve compression or impaired circulation, it is not as directly associated with the development of pressure injuries as constant moisture. Pressure injuries are primarily caused by sustained pressure and moisture on the skin, whereas paresthesia, while important to monitor, is not an immediate risk factor for pressure injury formation.

C. Limited mobility with independent position changes:

Limited mobility does increase the risk of pressure injuries, but if the client is still able to change position independently, they are at a reduced risk compared to someone who is immobile or unable to reposition. The ability to independently change position reduces the risk by helping relieve sustained pressure on vulnerable areas.

D. Continuous enteral nutrition:

While continuous enteral nutrition may increase the risk for aspiration or other complications, it is not a direct risk factor for pressure injury development. Enteral nutrition itself does not increase moisture or pressure on the skin, which are the main contributing factors for pressure injuries.

Summary:

The greatest risk for developing a pressure injury is constant moisture, as this can significantly weaken the skin and lead to breakdown. Other factors like intermittent paresthesia, limited mobility, and enteral nutrition may contribute to overall health concerns but are not the most significant risk factors for pressure injury in this scenario.

Correct Answer B: I should choose whole grain pastas when selecting my foods.

Explanation of the correct answer:

B) I should choose whole grain pastas when selecting my foods.

Whole grain foods, including whole grain pastas, are high in fiber and can help lower blood pressure by improving overall cardiovascular health. A diet rich in whole grains is an important part of managing hypertension (HTN) as it provides essential nutrients and helps maintain a healthy weight, which is also beneficial for controlling blood pressure.

Why the other options are incorrect:

A) I can drink up to 3 glasses of wine/day.

Consuming alcohol in excess can raise blood pressure, and the general recommendation for alcohol consumption is no more than one drink per day for women and two drinks per day for men. Drinking three glasses of wine daily exceeds the recommended limit and can negatively affect blood pressure.

C) I should decrease my consumption of foods high in potassium.

Potassium is actually beneficial for managing blood pressure. It helps balance the effects of sodium and can lower blood pressure. Therefore, decreasing potassium intake is not recommended. Instead, increasing potassium-rich foods, such as bananas, potatoes, and spinach, is helpful.

D) I can eat dairy products because they do not have much sodium.

While some dairy products are lower in sodium, they can still contribute to increased sodium intake, especially if processed or high-fat dairy products are consumed. A focus on low-fat, low-sodium dairy options is recommended to help manage hypertension.

Summary:

The best dietary recommendation for managing hypertension includes choosing whole grain foods, which are high in fiber and beneficial for overall heart health. Alcohol intake should be limited, potassium-rich foods should be encouraged, and careful selection of low-sodium dairy products is important for blood pressure control.

Correct Answer C. 1 cup dried apricots

Explanation of Correct Answer

C. 1 cup dried apricots

Dried fruits, especially dried apricots, are extremely rich in potassium. One cup of dried apricots can contain over 1,500 mg of potassium, making it one of the highest dietary sources. Potassium is essential for maintaining fluid balance, nerve conduction, and muscle function, and dried apricots far exceed the potassium levels found in grains or dairy in this comparison.

Why the Other Options Are Wrong

A. 1 cup cheddar cheese

Cheddar cheese provides some potassium (about 200 mg per cup), but it is not considered a high-potassium food compared with dried fruits, vegetables, or legumes.

B. 1 cup cooked quinoa

Cooked quinoa contains around 320 mg of potassium per cup. While it is a nutritious whole grain, its potassium content is much lower than dried apricots.

D. 1 cup brown rice

Brown rice contains roughly 150 mg of potassium per cup when cooked. It is among the lowest potassium sources listed here, making it less effective for boosting potassium intake compared with dried apricots.

Correct Answer A: BUN 8 mg/dL

Explanation of the correct answer:

BUN (Blood Urea Nitrogen) is a lab test that can help indicate fluid volume status. When a client has fluid volume excess, the kidneys may be less efficient at clearing waste products, leading to a dilution of the blood. In the case of heart failure, fluid retention can lead to low levels of BUN. A BUN of 8 mg/dL is at the low end of the normal range, which can indicate fluid overload or dilution, meaning that the body is retaining excess fluid. Elevated fluid levels can dilute the concentration of waste products like BUN, suggesting fluid volume excess.

Why the other options are incorrect:

B) Hgb 15 g/dL:

Hemoglobin (Hgb) is a measurement of the amount of oxygen-carrying protein in the blood. A normal level of 15 g/dL is within the expected range and does not indicate fluid volume excess. In cases of fluid overload, hemoglobin may actually appear falsely low due to dilution, but it would not increase in fluid volume excess.

C) Creatinine 0.8 mg/dL:

Creatinine is a waste product from muscle metabolism that is normally excreted by the kidneys. A level of 0.8 mg/dL is within the normal range and does not suggest fluid volume excess. In cases of renal dysfunction or fluid volume overload, creatinine may be elevated, but in this case, the level is normal.

D) Sodium 140 mEq/L:

Sodium is an electrolyte that helps regulate fluid balance. A level of 140 mEq/L is within the normal range and does not indicate fluid volume excess. In fluid volume overload, sodium levels might drop due to dilution, but a sodium level of 140 is normal.

Summary:

A low BUN (8 mg/dL) in a client with heart failure suggests that fluid volume excess is present, likely due to dilution. The other lab values are within normal ranges and do not indicate fluid volume excess

Correct Answer  A: Dextrose in 10% water

Explanation of the correct answer:

A) Dextrose in 10% water:

When a client is receiving total parenteral nutrition (TPN), it is important to maintain glucose levels and prevent hypoglycemia when a new bag of TPN is not available. Dextrose in 10% water (D10W) is an appropriate solution to infuse temporarily, as it provides glucose to prevent hypoglycemia, maintaining energy needs until the new bag of TPN arrives.

Why the other options are incorrect:

B) 0.45% sodium chloride:

This solution does not provide any calories or glucose, which are essential for a patient who is on TPN. It is an isotonic solution, primarily used for hydration, and would not help maintain blood sugar levels.

C) Dextrose 5% in LR:

While this solution contains dextrose, the concentration is only 5%, which may not be enough to maintain glucose levels for a patient on TPN. Additionally, lactated Ringer's (LR) contains electrolytes that may not be ideal for a patient who requires only glucose replacement without additional electrolytes.

D) 0.9% sodium chloride:

This solution is a saline solution and does not provide glucose or calories, so it is not appropriate for maintaining blood glucose levels in a client receiving TPN.

Summary:

When a new bag of TPN is unavailable, dextrose in 10% water (D10W) should be infused to prevent hypoglycemia and maintain glucose levels, as it provides the necessary caloric support. Other solutions like 0.45% sodium chloride, D5LR, and 0.9% sodium chloride do not provide the glucose needed for this purpose.

Correct Answer B) :I will avoid toasting my bread.

Explanation of the correct answer:

B) I will avoid toasting my bread.

Toasted bread can be rough and abrasive, which can cause further irritation to the mouth, especially in a client with stomatitis. The goal is to avoid foods that can aggravate mouth sores and discomfort. Soft, non-abrasive foods are preferable to minimize irritation and make eating more comfortable.

Why the other options are incorrect:

A) I will try chewing larger pieces of food.

Chewing larger pieces of food can cause more friction and discomfort in the mouth, which can worsen the symptoms of stomatitis. Small, soft pieces are recommended to prevent additional irritation.

C) I will consume more food in the morning.

While this can be helpful for some individuals, it is not the most specific or directly relevant intervention for managing stomatitis. The primary focus should be on avoiding irritating foods and maintaining a soft diet throughout the day.

D) I will add more citrus foods to my diet.

Citrus foods are acidic and can irritate the mouth, making stomatitis symptoms worse. They should be avoided, as they can increase discomfort and delay healing.

Summary:

To manage stomatitis effectively during cancer treatment, clients should avoid foods that are rough or abrasive, such as toasted bread, which can irritate the mouth further. Soft, non-irritating foods and small bites are preferred to prevent exacerbating mouth sores.

Correct Answer D: Flush the client's tube with 30 mL of water every 4 hr.

Explanation of the correct answer: D. Flush the client's tube with 30 mL of water every 4 hr:

Flushing the gastrostomy tube with water is an essential step in preventing tube occlusion and ensuring that the tube remains patent. Flushing with 30 mL of water every 4 hours helps to keep the tube clear, prevents clogging, and maintains proper flow for the continuous enteral feeding. Flushing is also important to ensure that any residual formula or medications are cleared from the tube.

Why the other options are incorrect:

A. Measure the client's gastric residual every 12 hr:

Measuring gastric residual is generally done more frequently for clients receiving enteral feedings, particularly in the initial stages. Typically, it is measured every 4 to 6 hours in patients receiving continuous feedings. Measuring only every 12 hours may not adequately monitor for delayed gastric emptying or possible aspiration risk.

B. Obtain the client's electrolyte levels every 4 hr:

Monitoring electrolytes is important for clients receiving enteral feedings, especially if they are on long-term feedings or have other risk factors. However, obtaining electrolyte levels every 4 hours is excessive unless the client is critically ill or there are specific concerns. Typically, electrolyte levels are checked less frequently, based on the client's condition and clinical needs.

C. Keep the client's head elevated at 15° during feedings:

The head of the bed should generally be elevated at a higher angle during enteral feedings to reduce the risk of aspiration and promote gastric emptying. The head of the bed should be elevated to at least 30° to 45° during feedings to reduce the risk of aspiration and improve the effectiveness of the feeding. A 15° elevation is too low to effectively prevent aspiration.

Summary:

Flushing the gastrostomy tube with water every 4 hours is essential for maintaining tube patency and preventing clogging, which is a crucial part of safe enteral feeding management. Monitoring gastric residual more frequently, ensuring proper head elevation, and adjusting electrolyte monitoring are also important but need to be done at appropriate intervals based on the client's clinical status.

Correct Answer C: Limit protein intake

Explanation of the correct answer:

In clients with chronic kidney disease (CKD), the kidneys are less able to filter waste products, and protein metabolism produces nitrogenous waste, which can further stress the kidneys. Limiting protein intake helps reduce the buildup of waste products like urea, thus preventing further kidney damage. A renal diet typically focuses on moderating protein consumption to prevent excess strain on the kidneys while still providing enough nutrients for the body.

Why the other options are incorrect:

A) Increase phosphorus intake:

Phosphorus is typically elevated in CKD due to the kidneys' inability to excrete it efficiently. High phosphorus levels can lead to complications like bone disease and cardiovascular issues. Therefore, the nurse should recommend limiting phosphorus intake, not increasing it.

B) Limit calcium intake:

Calcium intake should not be generally limited in CKD. In fact, the nurse may recommend appropriate levels of calcium, as it is important for bone health. However, excessive calcium, especially from supplements, should be avoided as it can contribute to vascular calcification and other complications in CKD.

D) Increase potassium intake:

In CKD, the kidneys' ability to excrete potassium may be impaired, leading to hyperkalemia, which can cause life-threatening cardiac arrhythmias. Therefore, clients with CKD should limit their potassium intake, not increase it.

Summary:

In chronic kidney disease, it is important to limit protein intake to reduce the buildup of nitrogenous waste products. Additionally, phosphorus and potassium intake should be restricted, while calcium intake should be managed carefully to avoid complications.

Correct Answer D: Potatoes

Explanation of the correct answer:

D. Potatoes:

Potatoes are a good food choice for individuals with gastroesophageal reflux disease (GERD) as they are low in fat and non-acidic. They help minimize heartburn and are easily digested. Boiled, baked, or mashed potatoes without butter or cream are considered safe for people with GERD. They don't trigger the release of stomach acid and won't contribute to symptoms like heartburn.

Why the other options are incorrect:

A. Orange juice:

Orange juice is highly acidic and can irritate the esophagus, making it counterproductive for GERD patients. The acidity can exacerbate symptoms of heartburn and acid reflux. It is better to recommend non-citrus juices like apple juice or pear juice instead, as they are less likely to trigger symptoms.

B. Decaffeinated coffee:

Although decaffeinated coffee may have less caffeine, it still contains acids that can contribute to heartburn and acid reflux in some individuals. Additionally, coffee (both caffeinated and decaffeinated) can relax the lower esophageal sphincter (LES), which may allow stomach acid to flow back into the esophagus, worsening symptoms of GERD.

C. Peppermint:

Peppermint is a known relaxant for the muscles of the digestive tract, including the lower esophageal sphincter (LES). It can actually worsen GERD symptoms by relaxing the LES, allowing stomach acid to enter the esophagus and causing heartburn. Therefore, peppermint should be avoided by individuals with GERD.

Summary:

Potatoes are the best choice to minimize heartburn in individuals with GERD because they are non-acidic, low in fat, and easily digested. The other options—orange juice, decaffeinated coffee, and peppermint—can all trigger GERD symptoms and should be avoided.