HESI RN Nutrition Science (D440)
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Free HESI RN Nutrition Science (D440) Questions
Patient Data
History and Physical
The client is a 34-year-old male with a history of hypertension. He takes an angiotensin
converting enzyme (ACE) inhibitor to manage.
Nurses' Notes
The client is here for his annual visit. He reports that he has been eating a strict paleo diet for the
past 8 months. His body mass index (BMI) was 32 kg/m2 last year, and it is now 29 kg/m2
(normal 18.0 to 24.0 kg/m2). He says that he also is being active at least 30 minutes 5 times
per week. His blood pressure has decreased from 154/91 mm Hg at the last visit to 119/66 mm Hg.
Which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
-
Condition: Calcium deficiency
Actions to Take:- Suggest the client take a calcium supplement
- Teach the client about plant foods high in calcium
Parameters to Monitor: - Bone health
- Serum potassium
-
Condition: Protein deficiency
Actions to Take:- Collect blood for a serum chemistry
- Increase dairy in the diet
Parameters to Monitor: - Wound healing
- Blood glucose
-
Condition: Hyperkalemia
Actions to Take:- Change the client's blood pressure medication
- Increase dairy in the diet
Parameters to Monitor: - Serum potassium
- Dental health
-
Condition: Hypoglycemia
Actions to Take:- Increase the client's intake of complex carbohydrates
- Collect blood for a serum chemistry
Parameters to Monitor: - Blood glucose
- Serum potassium
Explanation
Explanation
The client is most likely experiencing calcium deficiency due to the strict paleo diet, which may lack sufficient calcium from dairy sources. To address this, the nurse should suggest a calcium supplement and educate the client on plant-based foods high in calcium. Monitoring bone health (due to calcium’s role in bone strength) and serum potassium is essential, as calcium and potassium are both involved in muscle function and metabolism.
Correct Answer Is:
A. Condition: Calcium deficiencyActions to Take:
- Suggest the client take a calcium supplement
- Teach the client about plant foods high in calcium
Parameters to Monitor: - Bone health
- Serum potassium
Why the other options are incorrect:
A client has a serum sodium level of 155 mEq/L (155 mmol/L). The nurse should encourage the client to make which selection from the lunch menu?
Reference Range:
Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]
- Bacon, lettuce, and tomato sandwich, grapes, and skim milk.
- Taco salad, refried beans, low-fat ice cream, and coffee.
- Chicken salad on toast, fruit-flavored yogurt, and iced tea.
- Canned cream of mushroom soup, tuna salad, and water.
Explanation
Explanation
This client has an elevated serum sodium level of 155 mEq/L, which indicates hypernatremia. A low-sodium diet is important to help manage this condition. The selected meal, C, is the best option for several reasons:
- Chicken salad on toast: The chicken provides a lean source of protein, and if it is prepared without added salt, it is naturally low in sodium. The toast, depending on the bread used, can be low in sodium as well, especially if it is not from highly processed bread that contains added salt.
- Fruit-flavored yogurt: While fruit-flavored yogurt can contain added sugars, it is typically low in sodium compared to other processed foods, making it a safer choice for a client with hypernatremia.
- Iced tea: Iced tea, when unsweetened or lightly sweetened, is typically low in sodium. It is a better option than beverages like soda, which can sometimes contain high levels of sodium or other additives.
By selecting this meal, the client is avoiding high-sodium foods like bacon, refried beans, and canned soup, all of which would exacerbate the elevated sodium levels and make it harder to manage hypernatremia.
Correct Answer Is:
C. Chicken salad on toast, fruit-flavored yogurt, and iced tea.Why the other options are incorrect:
A client who is transferred to the medical unit following a myocardial infarction has a prescription for a cardiac diet. The client points to the lunch tray and tells the nurse, "This hamburger has no flavor, it makes it hard to eat." Which selection is best for the nurse to suggest the client use to improve the taste of the hamburger?
- Pickles and yellow mustard.
- Tomatoes and fresh horseradish.
- Bacon and mayonnaise.
- Cheese and ketchup.
Explanation
Explanation
Tomatoes are heart-healthy, providing vitamins and antioxidants, and fresh horseradish can add a flavorful kick without excessive sodium or unhealthy fats. This option is the best for improving the taste of the hamburger while adhering to the restrictions of a cardiac diet.
Correct Answer Is:
B. Tomatoes and fresh horseradish.Why the other options are incorrect:
A client is discharged from the intensive care unit following a myocardial infarction, and the healthcare provider prescribes a low-sodium diet. Which lunch selection indicates to the nurse that this client understands the dietary restrictions?
- Bacon, lettuce, and tomato sandwich.
- Macaroni and cheese.
- Clam chowder.
- Turkey salad sandwich.
Explanation
Explanation
The turkey salad sandwich is the best choice for a low-sodium diet. Bacon and clam chowder are high in sodium, and macaroni and cheese can also contain high amounts of sodium, especially if processed. A turkey salad made with fresh ingredients, and without added salt or processed meats, is a better option for managing sodium intake after a myocardial infarction.
Correct Answer Is:
D. Turkey salad sandwich.Why the other options are incorrect:
The nurse is helping develop a meal plan based on nutritional guidelines for an older adult client being discharged to home with the client's spouse. Which statement by the client and spouse best indicates an understanding of the nutritional guidelines when planning meals?
- Nutritional meal planning for older adults should only be planned by a dietitian.
- Socioeconomics should not be an issue in planning nutritional meals for older adults.
- Age is not a factor in determining dietary needs for older adults.
- Dietary needs for older adults over and under age 70 are different.
Explanation
Explanation
Nutritional needs for older adults can change with age, and those over 70 may have different dietary requirements than those under 70. Factors such as metabolism, health conditions, and changes in body composition can affect nutritional needs. For example, older adults may require higher amounts of certain vitamins and minerals (like vitamin D or calcium) and may need to adjust their calorie intake.
Correct Answer Is:
D. Dietary needs for older adults over and under age 70 are different.Why the other options are incorrect:
A client who has a body mass index (BMI) of 29 kg/m² expresses a desire to lose weight. Which action should the nurse implement?
Reference Range:
Body mass index (BMI) [18.0 to 24.9 kg/m²]
- Instruct the client to eat 3 well-balanced meals daily.
- Review the client's dietary intake for the past week.
- Discuss ideas in developing an exercise schedule.
- Provide assistance in planning high-protein, low-carbohydrate meals.
Explanation
Explanation
Before providing specific recommendations, it is important to first understand the client's current eating habits. Reviewing the client's dietary intake for the past week will give the nurse insight into the client's food choices, portion sizes, and eating patterns. This information is essential for identifying areas that may need adjustment for weight loss. After understanding the client's habits, the nurse can offer tailored advice, including healthy eating and exercise strategies.
Correct Answer Is:
B. Review the client's dietary intake for the past week.Why the other options are incorrect:
The home health nurse is visiting an older adult client who was discharged from the hospital 3 days ago following hip pinning surgery. The client lives with her daughter, who prepares the family meals. In discussing nutrition for postoperative healing, which food choices should the nurse suggest for this client's diet? Select all that apply.
- Flavored gelatin.
- Baked chicken.
- Grilled salmon.
- Soda crackers.
- Scrambled eggs.
Explanation
Explanation
B. Baked chicken.
Baked chicken is a great source of lean protein, which is essential for postoperative healing. Protein plays a critical role in tissue repair, immune function, and muscle maintenance, all of which are crucial after surgery. Baked chicken is low in fat when prepared without skin and provides high-quality protein that supports healing and recovery.
C. Grilled salmon.
Grilled salmon is an excellent source of omega-3 fatty acids, which have anti-inflammatory properties that help reduce swelling and promote healing after surgery. Omega-3s also support heart health and can improve blood circulation, aiding in the healing process. Salmon is also high in protein, making it a beneficial food for recovery.
E. Scrambled eggs.
Scrambled eggs are a rich source of high-quality protein and provide essential amino acids that are necessary for tissue repair and muscle recovery following surgery. Eggs also contain important nutrients such as vitamins D and B12, and minerals like zinc, which are vital for the healing process and immune function. They are easy to digest and can be a good option for postoperative nutrition.
Correct Answer Is:
B. Baked chicken.C. Grilled salmon.
E. Scrambled eggs.
Why the other options are incorrect:
The nurse is planning a nutritional class for adequate daily intake of water. Which population of clients should drink the most amount of water to remain adequately hydrated?
- Older adult clients who are receiving dialysis twice a week.
- Lactating mothers who are breastfeeding.
- Adolescent females who are menstruating.
- Clients who are between the ages of 19 to 64-years-old.
Explanation
Explanation
Lactating mothers have increased water needs due to the fluid lost through breastfeeding. It is recommended that breastfeeding women consume extra fluids to support milk production and stay adequately hydrated. Typically, the recommendation is to drink an additional 16-32 ounces (about 500-1000 mL) of water per day to meet the increased fluid demands. While other populations also have hydration needs, lactating mothers require the most water to support both their own hydration and milk production.
Correct Answer Is:
B. Lactating mothers who are breastfeeding.Why the other options are incorrect:
The nurse is caring for an older adult who needs to limit sodium intake. Which food should the nurse encourage the client to avoid?
- Ground sirloin
- Cottage cheese
- Bananas
- Broccoli
Explanation
Explanation
Cottage cheese is often high in sodium, which can be a concern for clients who need to limit their sodium intake, especially older adults who may be at higher risk for conditions like hypertension or heart disease. Although it is a good source of protein and calcium, its sodium content can be quite high, so it is important for the nurse to encourage the client to limit or avoid cottage cheese if they need to manage their sodium intake.
Correct Answer Is:
B. Cottage cheeseWhy the other options are incorrect:
Patient Data
History and Physical
The client is a 64-year-old male who has come to the clinic several times in the past 3 months for a slow-healing wound on his left leg. He has been treated with antibiotics several times. The client sometimes lives in a shelter, but he reports he is currently homeless. Most of his meals come from a fast-food restaurant near to the encampment where he lives. The client has a history of schizophrenia but is not currently taking any medications. He reports he drinks occasionally and does not smoke.
Nurses' Notes
The client has a 2.4 in x 1.6 in (6 cm x 4 cm) wound on his left leg that occurred 3 months ago after a fall from a bicycle. The wound is granulated and red around the edges with serous drainage noted. Noted nail fungus on the client's toenails. The client has ecchymosis on his right arm and across his chest. The client reports that he is having trouble eating because his teeth feel loose.
Laboratory Results
Result | Laboratory Test | Reference Range |
|---|---|---|
77 mg/dL (4.3 mmol/L) | Blood glucose | 80 to 130 mg/dL (4.4 mmol/L to 7.2 mmol/L) |
15 g/dL (150 g/L) | Hemoglobin | 14 to 18 g/dL (140 to 180 g/L) |
45% (0.45) | Hematocrit | 42% to 52% (0.42 to 0.52) |
Flow Sheet
. Blood pressure: 118/77 mm Hg
· BMI: 21 kg/m2 (normal 18.0 to 24.9 kg/m2)
Which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
- Iron deficiency anemia, provide education on the effects of alcohol on nutrition, and assist the client in finding an appropriate supplement. Monitor for wound healing and weight.
- Vitamin B6 deficiency, advise the client to increase his intake of citrus fruits, and recommend the client eat more dairy. Monitor for dental health and mental status.
- Vitamin C deficiency (scurvy), advise the client to increase his intake of citrus fruits, and assist the client in finding an appropriate supplement. Monitor for wound healing and dental health.
- Thiamine deficiency, have the client count calories, and provide education on the effects of alcohol on nutrition. Monitor for wound healing and weight.
Explanation
Explanation
The client’s symptoms, including a slow-healing wound, loose teeth, and poor diet, are indicative of Vitamin C deficiency (scurvy). Vitamin C is essential for collagen production and wound healing, and its deficiency can result in slow wound healing and loose teeth (a common symptom of scurvy). The nurse should advise the client to increase citrus fruit intake, which is high in Vitamin C, and assist in finding an appropriate supplement. Monitoring for wound healing and dental health is essential as both are directly affected by Vitamin C levels.
Correct Answer Is:
C. Vitamin C deficiency (scurvy), advise the client to increase his intake of citrus fruits, and assist the client in finding an appropriate supplement. Monitor for wound healing and dental health.Why the other options are incorrect:
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Frequently Asked Question
It focuses on the role of nutrition in managing chronic conditions and promoting overall health.
It includes multiple-choice questions, case studies, and scenario-based questions assessing clinical decision-making.
Review key nutrition topics, practice case studies, and focus on diet management for chronic conditions.
Encourage reducing simple carbs, increasing fiber-rich foods, and managing portion sizes.
Calcium is crucial for bone health, and can be included through dairy, leafy greens, and fortified foods.
Reducing sodium and increasing potassium-rich foods help manage blood pressure effectively.
Consider health conditions, dietary habits, lab values, and accessibility to healthy food.