Test bank for nutritional foundations and clinical applications a nursing approach 6th edition by grodner download

Test Bank for Nutritional Foundations and Clinical
Applications A Nursing Approach 6th Edition by Grodner
Chapter 07: Vitamins
Grodner and Escott-Stump: Nutritional Foundations and Clinical
Application: A Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. A patient is admitted to the hospital with confusion, memory loss,
and ataxia. What other information would lead you to suspect that his
symptoms may be caused by secondary thiamin deficiency?
a.

The patient has very limited funds and has been
eating mainly rice and beans.

b.

The patient admits that he struggles with
alcoholism.

c.

The patient is recovering from a minor stroke.

d.

The patient has a family histor disease.


ANS: B

Alcoholism may be associated with a secondary thiamin deficiency because the liver
needs increased amounts of thiamin to detoxify alcohol. Limited food intake may cause
primary deficiency (although legumes are a good source of thiamin, and so primary
deficiency is unlikely). Stro disease may cause confusion, memory loss, and ataxia, but
not in relation to a secondary vitamin deficiency.

DIF: Cognitive Level: Analyzing
Page 119
TOP: Nursing Process: Assessment
integrity

REF: Page 107 | Pages 111-112 |
MSC: Client Needs: Physiological

2. An example of someone who has a relatively high risk for vitamin
deficiencies is a(n)
a.

45-year-old half marathon runner.

b.

85-year-old man living independently.

c.

college-age woman living with roommates.

d.

breastfed newborn.

ANS: B


Subgroups of the population at risk for vitamin deficiencies include older
adults because of decreased vitamin absorption and limited physical and
economic resources to purchase and prepare food. Active middle-aged adults
and college students usually consume enough food to ensure adequate
vitamin intake. Vitamin deficiencies are rare among breastfed newborns.

DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
promotion and maintenance

REF: Page 106 | Page 124
MSC: Client Needs: Health

3. Deficiencies are likely to develop most rapidly with low intake of vitamin
a.

A.

b.

C.

c.

D.

d.

E.

ANS: B
Vitamin C is water soluble; vitamins A, D, and E are fat soluble. Deficiencies
of water-soluble vitamins develop more rapidly because they are not stored in
the body.

DIF: Cognitive Level: Applying

REF: Pages 108-109


TOP: Nursing Process: Assessment
promotion and maintenance

MSC: Client Needs: Health

4. The best way to ensure intake of a variety of phytochemicals is to
a.

take a daily multivitamin supplement that includes
phytochemicals.

b.

increase intake of soy-based foods, such as soy
milk, tofu, and soy flour.

c.

choose whole grains and include at least five
servings of fruits and vegetables daily.

d.

include at least three servings of dairy products
daily and use a variety of herbs and spices.

ANS: C
The best way to ensure intake of a variety of phytochemicals is to eat a
variety of plant-based foods, including whole grains, fruits, and vegetables.
Multivitamin supplements do not necessarily contain phytochemicals. Soybased foods contain only a limited selection of phytochemicals. Dairy products
do not contain phytochemicals; herbs and spices may provide some but are
used in small quantities and so would not provide significant amounts.

DIF: Cognitive Level: Applying

REF: Page 109 | Page 111


MSC: Client Needs: Health

TOP: Nursing Process: Planning
promotion and maintenance

5. The person who would have the highest need for thiamin is
a.

someone who lifts weights to maintain health.

b.

a pregnant woman.

c.

a professional cyclist.

d.

an older adult who walks 2 miles daily.

ANS: C
Thiamine needs are related to metabolic rate (i.e., energy expenditure)
because thiamine is a coenzyme in energy metabolism. Therefore, the
professional cyclist needs the most thiamin because he or she has the
greatest energy needs. Pregnancy, walking, and weightlifting all
increase energy needs, but less so than professional athletic training.

DIF: Cognitive Level: Analyzing
Process: Planning

REF: Page 111

MSC: Client Needs: Physiological integrity

TOP: Nursing

6. A homeless man is brought into the emergency room with muscle
weakness, loss of coordination, and tachycardia. He has alcohol on
his breath. He may be suffering from a deficiency of
a.

thiamin.

b.

riboflavin.

c.

niacin.

d.

folate.

ANS: A
Symptoms of thiamine deficiency include muscle weakness, loss of coordination, and
tachycardia. Alcoholism increases t thiamin and may contribute to a secondary thiamin
deficiency. Symptoms of
riboflavin deficiency include cheilosis, glossitis, and dermatitis. Niacin
deficiency causes pellagra, characterized by dermatitis, dementia, and
diarrhea. Symptoms of folate deficiency include megaloblastic anemia,
glossitis, diarrhea, irritability, absent-mindedness, depression, and anxiety.

DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
integrity

REF: Pages 111-116
MSC: Client Needs: Physiological

7. If whole milk is stored in a clear bottle in a refrigerator with a glass front,


a.

the milk fat may separate and rise to the top of
the bottle.

b.

some of the protein in the milk may
become denatured.

c.

the ultraviolet light exposure may destroy the
vitamin D.

d.

the ultraviolet light exposure may destroy the
riboflavin.

ANS: D
Riboflavin is destroyed by ultraviolet light, and so storage of milk in a clear
bottle and a glass-front refrigerator may cause loss of riboflavin. Vitamin D
is not affected by ultraviolet light. Ultraviolet light does not cause milk fat to
separate out and does not denature protein.

DIF: Cognitive Level: Remembering REF: Page 92 | Page 112 | Page 121
TOP: Nursing Process: Assessment
promotion and maintenance

MSC: Client Needs: Health

8. A good way to increase intake of riboflavin would be to


a.

eat cereal with skim milk for breakfast instead of
toast and juice.

b.

replace romaine lettuce salad with spinach salad.

c.

drink orange juice instead of apple juice.

d.

make sandwiches with whole grain bread instead
of white bread.

ANS: A
The most significant source of riboflavin in the United States is milk, and so
switching to cereal with milk for breakfast would increase riboflavin intake.
Replacing romaine lettuce with spinach would increase intake of folate.
Replacing apple juice with orange juice would increase vitamin C intake.
Eggs, meats, and whole grains are all good but lesser sources of riboflavin.
Using whole grains would increase intake of several vitamins and would
increase riboflavin intake slightly, but less than by drinking extra milk.

DIF: Cognitive Level: Applying
Pages 118-119

REF: Pages 112-113 | Page 115 |

TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance


9. In a very poor country where the subsistence crop is corn and intake
of animal protein is very limited, the population has a high risk for
developing
a.

scurvy.

b.

pellagra.

c.

spina bifida.

d.

pernicious anemia.

ANS: B
Corn has low levels of niacin, and low intake of animal protein would mean
that relatively little tryptophan would be available to be converted to niacin;
therefore, the population would be at risk for developing pellagra, the niacin
deficiency disorder. Scurvy is caused by deficiency of vitamin C. Lack of folate
during early pregnancy can lead to spina bifida. Pernicious anemia is caused
by lack of intrinsic factor in the stomach to facilitate absorption of vitamin B12.

DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
integrity

10.

REF: Pages 113 -117
MSC: Client Needs: Psychosocial

Niacin can be manufactured by the body from the amino acid

a.

alanine.

b.

arginine.

c.

tryptophan.

d.

phenylalanine.

ANS: C
Niacin can be manufactured by the body from tryptophan, but not
from alanine, arginine, or phenylalanine.

DIF: Cognitive Level: Remembering

REF: Page 129

TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Physiological integrity

11.
A young woman recently married tells you that she is excited to
have children. She should be especially careful to consume

adequate amounts of
a.

folic acid.

b.

vitamin B12.


c.

pyridoxine.

d.

vitamin E.

ANS: A
Women who may become pregnant need to ensure adequate intake of folic
acid to prevent neural tube defects. The neural tube forms before many
women know they are pregnant, and so it is important to ensure adequate
intake of folic acid before pregnancy. Vitamin B12, pyridoxine, and vitamin E
are all important vitamins, but the need for them is not especially
associated with pregnancy.

DIF: Cognitive Level: Understanding REF: Pages 114-116 | Page 119 |
Page 123
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion

and maintenance

12.

An example of a high-folate meal is

a.

fish, French fries, and coleslaw.

b.

spinach salad with orange segments.


c.

oatmeal with brown sugar and raisins.

d.

pork chops with applesauce.

ANS: B
Good sources of folate include leafy green vegetables (including spinach),
legumes, ready-to-eat cereals, and some fruits and juices (including orange).
Fish, oatmeal, raisins, pork, and applesauce are not good sources of folate.

DIF: Cognitive Level: Applying

REF: Page 115 | Page 119

TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

13.
The type of anemia associated with folate deficiency is _____
anemia.
a.

microcytic

b.

pernicious

c.

megaloblastic

d.

iron deficiency


ANS: C
The type of anemia associated with folate deficiency is megaloblastic anemia.
Microcytic anemia is associated with iron deficiency. Pernicious anemia is
associated with vitamin B12 deficiency. Iron deficiency anemia is (as its name
suggests) associated with deficiency of iron, not of folate.

DIF:

Cognitive Level: Remembering

TOP: Nursing Process: Assessment
integrity

REF: Pages 114-116
MSC: Client Needs: Physiological

14.
If an older adult develops delusions and hallucinations, it
is important to check his or her blood levels of
a.

vitamin B12.

b.

intrinsic factor.

c.

folic acid.

d.

thiamin.

ANS: A


Delusions and hallucinations may be signs of vitamin B12 deficiency, even
before development of anemia. Intrinsic factor is produced by the stomach
and is vital for absorption of vitamin B12; it is not found in the blood. Loss of
intrinsic factor in older adults contributes to vitamin B12 deficiency. Folic acid
deficiency may cause irritability, absent-mindedness, depression, and
anxiety, and thiamin deficiency causes memory loss and confusion, but
neither of these is associated with delusions and hallucinations.

DIF:

Cognitive Level: Applying

TOP: Nursing Process: Assessment
integrity

REF: Page 112 | Page 116
MSC: Client Needs: Physiological

15.
If a patient needs regular injections of vitamin B12, the most likely
explanation is that
a.

he or she follows a vegan eating pattern.

b.

he or she struggles with alcoholism.

c.

he or she has a malabsorption syndrome.

d.

his or her stomach does not produce intrinsic
factor.

ANS: D
Vitamin B12 injections are necessary for patients who do not produce intrinsic
factor, which is essential for absorption of vitamin B12 from the gut. Patients


who follow a vegan eating pattern need vitamin B12 supplements because this
vitamin is found only in animal foods. However, they can use oral
supplements because they are still able to absorb the vitamin; they do not
need injections. Alcoholism does not affect absorption of vitamin B12.
Malabsorption syndromes may decrease absorption of vitamin B12, but with
adequate dietary intake and supplements, affected patients may still be able
to absorb sufficient amounts from the gut.

DIF:

Cognitive Level: Applying

REF: Page 116

TOP: Nursing Process: Assessment
integrity

16.

MSC: Client Needs: Physiological

An example of a meal with high levels of biotin is a

a.

cheese-and-tomato sandwich.

b.

roast beef and mustard sandwich.

c.

peanut butter and jelly sandwich.

d.

vegetarian sandwich with avocado and alfalfa
sprouts.

ANS: C
The richest sources of biotin include liver, kidney, peanut butter, egg yolks,
and yeast.

DIF:

Cognitive Level: Applying

TOP: Nursing Process: Planning
promotion and maintenance

17.

REF: Page 117 | Page 119
MSC: Client Needs: Health

Some choline can be synthesized by the body from

a.

glycerol.

b.

cholesterol.

c.

tryptophan.

d.

methionine.

ANS: D
The body can synthesize some choline from methionine, but not enough to
meet the needs of the body. The body cannot synthesize choline from
glycerol, cholesterol, or tryptophan.

DIF:

Cognitive Level: Remembering

TOP: Nursing Process: Assessment
integrity

REF: Page 117
MSC: Client Needs: Physiological


18.

Scurvy would be most likely to occur in someone who lives in a

a.

remote village in northern Minnesota.

b.

farming community in Florida.

c.

city in central California.

d.

fishing community on the coast of Maine.

ANS: A
Scurvy is caused by vitamin C deficiency. Both Florida and California produce
abundant citrus fruit, other fruits, and vegetables, which are excellent sources
of vitamin C. A community on the coast of Maine does not necessarily
produce good sources of vitamin C locally, but it is connected to commercial
transportation, and so a variety of foods are probably available. A remote
village in northern Minnesota may not have good access to fresh fruits and
vegetables during the winter months, and so scurvy could potentially develop.

DIF:

Cognitive Level: Applying

TOP: Nursing Process: Assessment
integrity

REF: Pages 117-119
MSC: Client Needs: Physiological

19.
If a registered dietitian is concerned about the adequacy of a
client’s vitamin C intake, he or she would want to client

a.

drinks milk.

b.

follows a vegan diet.

c.

has regular exposure to sunlight.

d.

smokes cigarettes.

ANS: D
The dietitian would need to know whether the client smokes cigarettes
because smokers require more vitamin C than nonsmokers. A vegan diet
raises concerns about intake of vitamin B12 (found only in animal foods) but
does not necessarily affect vitamin C intake. Regular exposure to sunlight
and milk intake affect vitamin D status but not vitamin C status.

DIF: Cognitive Level: Applying
123

REF: Pages 116-119 | Pages 121-

TOP: Nursing Process: Assessment| Nursing Process: Planning

MSC: Client Needs: Physiological integrity | Client Needs: Health promotion
and maintenance

20.
a.

Vegetables are likely to be highest in vitamin C if they are
boiled.


b.

canned.

c.

stir-fried.

d.

oven roasted.

ANS: C
Vegetables are likely to be highest in vitamin C if they are stir-fried. Heat
destroys vitamin C, and so cooking for the minimum amount of time preserves
vitamin C. Oven roasting is a slow cooking method, and so more vitamin C is
lost. Vitamin C is also water soluble, and so cooking methods that use water,
such as boiling and canning, cause loss of vitamin C into the cooking liquid. In
stir-frying, vegetables are cooked quickly without water.

DIF: Cognitive Level: Understanding

REF: Page 118

TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance

21.

Foods that are good sources of preformed vitamin A include

a.

sweet potatoes.

b.

egg yolk.


c.

tomatoes.

d.

carrots.

ANS: B
Preformed vitamin A is found only in the fat of animal foods; egg yolk is a

good source. Sweet potatoes, tomatoes, and carrots are all good sources
of carotenoids, which can be converted to retinoids (vitamin A) in the body.

DIF: Cognitive Level: Applying

REF: Page 120

TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Physiological integrity

22.
The best description of blindness caused by vitamin A deficiency
in developing countries is that it is
a.

temporary and treatable.

b.

infectious and often fatal.

c.

limited to night blindness.

d.

permanent but preventable.

ANS: D
The blindness caused by vitamin A deficiency is permanent once it occurs, but
it can be prevented by administration of periodic supplements. Vitamin
deficiencies may be exacerbated by infections that increase nutrient needs,
but the deficiencies themselves are not infectious. Blindness may cause early
death but is itself not fatal. Vitamin A deficiency may cause both night
blindness and complete blindness.

DIF: Cognitive Level: Understanding

REF: Page 120

TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Physiological integrity

23.

Foods rich in antioxidant vitamins include

a.

oranges and vegetable oils.

b.

apples and butter.

c.

carrots and olive oil.

d.

mushrooms and milk.

ANS: A


The two vitamins that function as antioxidants in the body are vitamins C and
E. Citrus fruits such as oranges are excellent sources of vitamin C; vegetable
oils are excellent sources of vitamin E.

DIF: Cognitive Level: Understanding

REF: Pages 117-118 | Page 123

TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion
and maintenance

24.
The main reason that the adequate intake (AI) for vitamin D
increases in older adults is that
a.

their ability to absorb dietary vitamin D is
diminished.

b.

conversion of vitamin D to its active forms is less
efficient.

c.

their skin is less efficient in synthesizing vitamin D
during sun exposure.

d.

they require more vitamin D than do
younger adults to maintain bone health.

ANS: C


Older adults need more dietary vitamin D because their skin is less efficient in
synthesizing vitamin D during sun exposure. Their ability to absorb vitamin D
and convert vitamin D to its active form has less effect on vitamin D needs.
They do not necessarily require more total vitamin D than do younger adults
for bone health; they need more from foods because their skin manufactures
less.

DIF: Cognitive Level: Understanding

REF: Pages 121-122

TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion
and maintenance

25.

Rickets would be most likely to develop in a(n)

a.

elderly frail adult who lives alone.

b.

Asian college student who does not drink milk.

c.

white toddler who has been weaned from breast
milk.

d.

9-month-old breastfed African American baby.

ANS: D
Rickets is caused by vitamin D deficiency in infants and toddlers; those who
are breast-fed and have dark skin are at higher risk because breast milk is low


in vitamin D and dark skin is less efficient at forming vitamin D when exposed
to sun. In response to low intake of vitamin D and calcium, elderly adults may
develop osteoporosis and younger adults may develop osteomalacia.

DIF: Cognitive Level: Applying

REF: Page 122

TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective
care environment

26.

The most likely cause of vitamin toxicity is

a.

high intake of fortified foods.

b.

increased absorption as a result of medications.

c.

long-term use of megadose supplements.

d.

high intake of nutrient-dense foods.

ANS: C

Vitamin toxicity is usually caused by use of high-dose supplements over a
long period of time. Levels of vitamins in fortified foods are unlikely to be toxic,
and very few foods contain high enough levels to cause toxicity. Medications
do not cause significant increases in vitamin absorption.


DIF: Cognitive Level: Understanding
Process: Planning

REF: Page 106

TOP: Nursing

MSC: Client Needs: Physiological integrity

27.

An example of a meal with high levels of vitamin K is

a.

grilled shrimp with rice and green beans.

b.

eggs, bacon, and hash browns.

c.

stir-fried beef with broccoli.

d.

bacon, lettuce, and tomato sandwich.

ANS: C
The best source of vitamin K is green leafy vegetables, such as broccoli.
Dairy products, meats, cereals, and fruits provide smaller amounts.

DIF: Cognitive Level: Applying

REF: Page 124

TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

28.

Vitamin K deficiency could be a problem in someone who