Chapter 11: Nutrition Counseling for Health Promotion
Edelman: Health Promotion Throughout the Life Span, 8th Edition
1. Which of the following statements about the current prevalence of obesity is accurate?
a. The current generation of children may be less healthy and have a shorter life expectancy than their parents.
b. The current incidence of obesity among American adults has stabilized.
c. The current statistics show that greater than 75% of American adults are either overweight or obese.
d. The current statistics report that about 50% of American children are either overweight or obese.
Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents. The current statistics show that two in three American adults and one in three children are either overweight or obese.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 231
2. A nurse is working with a family that is experiencing food insecurity. Which of the following statements best describes this family?
a. Members of this family are susceptible to food-borne illness.
b. This family’s access to adequate food is limited by lack of money.
c. This family is unable to purchase fresh fruits and vegetables.
d. Members of this family are obese.
When a family experiences food insecurity it means that their access to adequate food is limited by a lack of money and other resources. Individuals and families may be more likely to be overweight or obese, potentially because the relatively lower cost of junk foods can promote overconsumption of calories.
DIF: Cognitive Level: Apply (Application) REF: p. 234
3. Which of the following statements about the Dietary Reference Intakes (DRI) is correct?
a. The DRI is used to monitor deficiencies in nutritional intakes of obese populations.
b. The DRI is used to establish minimal amounts of nutrients needed to protect against nutrient deficiency.
c. The DRI is used to plan and assess diets of healthy people.
d. The DRI is used to set minimal guidelines to reduce risk of adverse outcomes from inadequate consumption of nutrients.
The DRI are a set of values for the dietary nutrient intakes of healthy people in the United States and Canada. They are used for planning and assessing diets. The four sets of values included in the DRI are Recommended Daily Allowance (RDA), Adequate Intake, Estimated Average Requirement, and Tolerable Upper Intake Levels. The previous RDA, which existed before 1997, established minimal amounts of nutrients needed to protect against nutrient deficiency.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 235
4. A community health nurse is using the Dietary Reference Intakes (DRIs) as a guide while developing an education presentation about nutrition for a community group. How will the use of the DRIs be helpful in developing this presentation?
a. It considers the unique differences among children, pregnant women, and elderly people.
b. It contains well-researched data that are reviewed on an annual basis.
c. It is prescriptive in the amount of nutrients that are needed on a daily basis.
d. It serves as an overall guideline for the population.
Dietary Reference Intakes may be used for individuals; however, ideally they are guidelines for population groups and apply over time. It is the trend that matters not the amount on a certain day. The DRIs are created even when limited data are available as this is deemed better than no guidance at all. The DRIs are only updated when deemed necessary. There are limited data relating to genetic diversity in the population or specific groups such as children, pregnant women, and elderly people.
DIF: Cognitive Level: Apply (Application) REF: p. 235
5. After the 2010 Dietary Guidelines were released, a community health nurse updated a nutrition presentation that was being used to educate various community groups about healthy eating habits. Which of the following information would have been added to the presentation?
a. Consumption of increased amounts of carbohydrates
b. Impact of the environment on the public’s food, drink, and activity choices
c. Revised guidelines for the use of MyPyramid
d. Inclusion of physical activity standards
For the first time, the 2010 Dietary Guidelines have an entire chapter devoted to addressing the impact of the broader food and physical environment on the public’s food, drink, and activity choices using the Social-Ecological model. Physical activity standards were included in the 2005 guidelines. MyPyramid was replaced with MyPlate. There was a shift in food intake patterns emphasizing more vegetables, cooked dried beans, fruits, whole grains, nuts and seeds.
DIF: Cognitive Level: Apply (Application) REF: p. 236
6. A community health nurse is educating a community group about the 2010 Dietary Guidelines for Americans. Which of the following information would be included in this presentation?
a. Limit consumption of dairy products.
b. Purchase organic fruits and vegetables.
c. Make at least half of your grains whole grains.
d. Consume fish on a daily basis.
One of the principal messages for consumers is “make at least half of your grains whole grains.” Other messages include “switch to fat-free or low-fat (1%) milk” and “make half your plate fruits and vegetables.” There is not an essential message to consume fish on a daily basis.
DIF: Cognitive Level: Apply (Application) REF: p. 236
7. A person states to the nurse, “The guidelines for what we should eat as Americans is constantly changing, just when I got used to using MyPyramid they changed it to MyPlate. I wonder what will be next and if they really know what they are doing with all of this change.” Which of the following would be the best response from the nurse?
a. “The USDA is constantly making changes in order to decrease the alarming rates of obesity in our country.”
b. “MyPyramid was developed in 2005, so it was time for this graphic to be revised.”
c. “The creation of MyPlate has decreased the need for additional teaching resources for nutrition.”
d. “MyPlate serves as a better visual aid, reminding Americans what a healthy ‘plate’ looks like.”
MyPate was released in June 2011 providing Americans easy to understand and useful advice. MyPlate visually “reminds” consumers what a healthy “plate” looks like using a familiar place setting. It is not meant to stand alone as a teaching tool.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 238-239
8. A person asks the nurse if it is safe to use dietary supplements. Which of the following would be the best reply from the nurse?
a. “It is important to be cautious when using any supplements.”
b. “All dietary supplements must be approved by the FDA before they can be sold and are safe.”
c. “No, dietary supplements have very limited regulations and should not be used.”
d. “Be sure to read the product label before using the supplement to see what health claims have been made by the product.”
The desirable way for the general public to obtain recommended levels of nutrients is by eating a variety of foods. Low-dose supplements that contain the recommended intakes for micronutrients appear to be generally safe. Caution is advised when using supplements, as natural is not always better. Dietary supplements are unregulated by the FDA in the sense that they do not require premarket review or approval by the FDA.
DIF: Cognitive Level: Apply (Application) REF: p. 240
9. A woman has asked the nurse about the benefits and risks of using ginseng to control her hot flashes associated with menopause. Which of the following governmental offices would most likely serve as a resource to answer the woman’s question?
a. American Dietetic Association (ADA)
b. National Center for Complementary and Alternative Medicine (NCCAM)
c. Food and Drug Administration (FDA)
d. United States Department of Agriculture (USDA)
The National Center for Complementary and Alternative Medicine (NCCAM) promotes and conducts the scientific study of the benefits and risks of dietary supplements, including medicinal herbs, in health maintenance and disease prevention.
DIF: Cognitive Level: Apply (Application) REF: p. 240
10. A 37-year-old woman asks the nurse if she should take a daily nutritional supplement. Which of the following would be the best reply by the nurse?
a. “Postmenopausal women should take a calcium supplement to prevent osteoporosis.”
b. “Many people use supplements as drugs instead of as supplements.”
c. “Supplements can enhance the medications that you take.”
d. “The best way to obtain nutrients is by eating a variety of foods.”
The desirable way for the general public to obtain nutrients is by eating a variety of foods. Dietary supplements needs to be used cautiously so that excess amounts are not consumed, which could lead to possible adverse effects.
DIF: Cognitive Level: Apply (Application) REF: pp. 240-241
11. A client who is taking Coumadin tells the nurse that she has started taking a vitamin E supplement as she has heard that this will help decrease the likelihood of her developing cancer. Which of the following would be the most appropriate response by the nurse?
a. “Vitamin E supplements are unnecessary, so I don’t recommend you use this supplement.”
b. “Vitamin E can interfere with the actions of vitamin K and enhance the effects of Coumadin .”
c. “Vitamin E supplements can interfere with the absorption of iron and create additional health problems.”
d. “Vitamin E must be used cautiously, as it is easy to experience a toxicity of this nutrient.”
High doses of vitamin E can interfere with vitamin K action and enhance the effect of Coumadin as one of the anticoagulant drugs. Because of this interaction, she should probably not be taking a supplement of vitamin E while taking the Coumadin. If she continues on the supplement, it may be necessary to adjust the dosage of Coumadin the woman is prescribed.
DIF: Cognitive Level: Apply (Application) REF: p. 241
12. A nurse is investigating an outbreak of a food-borne illness occurring at a local school. Which of the following would contribute to a chemical contamination resulting in food-borne illness?
a. Unintended allergen added to food
b. Bacteria on the countertops
c. Pesticide on the fresh fruit
d. Metal shavings in the food from a dull can opener
Food-borne illness is classified according to the source of its contamination. Food contaminants may be categorized as biological (bacteria), chemical (pesticides), or physical (metal shavings and unintended allergens).
DIF: Cognitive Level: Apply (Application) REF: p. 242
13. A school nurse is preparing to discuss food safety practices with high school students enrolled in a family and consumer science “foods” course. Which of the following information would be included in the presentation?
a. Wash hands thoroughly with running warm water with soap for 30 seconds.
b. Scrub firm services of all fruits and vegetables with a produce brush before eating.
c. Pay close attention to assure that meat is cooked all of the way through.
d. Refrigerate leftovers within 30 minutes of serving.
There are four principles at the cornerstones of Fight BAC!, a national food safety education campaign (Clean, Separate, Cook, and Chill). Clean—wash all parts of hands thoroughly with running warm water with soap and friction for about 20-30 seconds. Scrub firm surfaces like cantaloupe and cucumbers with a produce brush, other fresh fruits and vegetables can be rinsed under running water. A food thermometer should be used to make sure that food is cooked all the way through. Leftovers should be refrigerated within 2 hours or 1 hour in temperatures greater than 90° F.
DIF: Cognitive Level: Apply (Application) REF: p. 243
14. A community health nurse is working with a low-income family who is experiencing food insecurity. To assist the family in getting nutritious foods in their home, the family should be referred to which of the following programs?
a. Nutrition Service Incentive Program (NSIP)
b. Supplemental Nutrition for Women Infants and Children (WIC)
c. National School Lunch Program (NSLP)
d. Supplemental Nutrition Assistance Program (SNAP)
Supplemental Nutrition Assistance Program (SNAP) supplements the food-buying power of eligible low-income households and is the foundation of the Nations’ nutrition safety net. The program is designed to help low-income families and individuals purchase nutritionally adequate foods.
DIF: Cognitive Level: Apply (Application) REF: pp. 244-245
15. A school nurse is discussing the income eligibility requirements for free and reduced-price school meals with a family who is new to the school district. Which of the following statements would the nurse most likely make?
a. “If the employed member of your family earns less than $50,000 per year, your child will qualify for reduced-price meals.”
b. “If your family’s income is less than 185% above the federal poverty level, your child will qualify for free or reduced-price meals.”
c. “If you have more than five members living in your household, your child will qualify for reduced-price meals.”
d. “If your family has an income above the federal poverty level, your child will not qualify for free or reduced-price meals.”
Children from families with incomes greater than 130% to 185% of the federal poverty level are eligible for reduced-price school meals. Children from families with incomes at or less than 130% of the federal poverty level are eligible for free school meals. Consideration is given to both income level and number of members living in the household when interpreting the federal poverty guidelines.
DIF: Cognitive Level: Apply (Application) REF: p. 245
16. A nurse is counseling a person with heart disease. Which of the following statements made by the individual would require the nurse to provide additional education?
a. “I drink skim milk on a regular basis.”
b. “I try not to eat foods that have added salt on the label.”
c. “I eat American cheese about once every 2 weeks.”
d. “I add salt to many of the food that I eat to enhance the flavor.”
The 2006 AHA diet and lifestyle recommendations include the suggestion to reduce salt intake by comparing the sodium content of similar products and choosing products with less salt or sodium; choosing versions of processed foods, including cereals and baked goods, that are reduced in salt or sodium; and limited condiments. Sodium ingestion leads to retention of fluids and may be harmful to the cardiovascular system of someone who has heart disease.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 248
17. A 45-year-old man has been diagnosed with metabolic syndrome. Which of the following characteristics would this man exhibit?
a. Blood pressure: 146/88 mm Hg
b. Waist measurement: 36 inches
c. HDL: 48 mg/dL
d. Triglycerides: 140 mg/dL
Metabolic syndrome is diagnosed when a person has three or more of these factors: excessive abdominal fat, as indicated by too large a waist measurement (greater than 40 inches in men); elevated blood pressure (higher than 130/85 mm Hg), low HDL level (lower than 40 mg/dL), and elevated triglyceride level (higher than 150 mg/dL).
DIF: Cognitive Level: Analyze (Analysis) REF: p. 249
18. Which of the following individuals has a modifiable, nutrition-related risk factor for stroke?
a. African American man, age 65, who has a low salt intake
b. White woman, age 32, who follows the MyPlate recommendations
c. Russian man, age 40, who drinks 3 oz of vodka daily
d. Hispanic man, age 42, who exercises regularly
Modifiable risk factors are those that the person can control. Race, age, and gender are nonmodifiable risk factors. Habitual alcohol intake is a modifiable risk factor for stroke.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 250
19. A community health nurse is providing education about the “Dietary Approaches to Stop Hypertension” (DASH) eating plan to people attending cardiac rehabilitation. Which of the following recommendations would be included in this presentation?
a. The use of this dietary plan has the same health effects as a daily exercise program.
b. The use of this dietary plan will eliminate the need for medication to treat hypertension.
c. This dietary plan is excludes the consumption of processed foods.
d. This dietary plan includes eating greater amounts of fruits and vegetables.
Clinical studies show that blood pressure can be lowered by following the DASH eating plan. The DASH eating plan includes abundant fruits and vegetables, more fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Depending on the severity of hypertension, the plan may allow for a reduction or elimination of medication.
DIF: Cognitive Level: Apply (Application) REF: pp. 250-251
20. A man states that he would like to change his dietary habits to decrease his risk of developing cancer in the future. Which of the following statements would be the best response for the nurse?
a. “Consume at least cups of fruits and vegetables each day.”
b. “Dietary habits have minimal effect in reducing your risk of developing cancer.”
c. “A glass of red wine should be consumed daily.”
d. “Dietary supplements of specific nutrients will maximize the effects of dietary changes.”
Eating at least cups of a variety of fruits and vegetables can help protect against cancers at many sites, particularly for cancers of the gastrointestinal and respiratory tracks. Following the dietary recommendations included in the 2010 Dietary guidelines for Americans and MyPlate are consistent with those recommended by the ACS. Food appears to have a protective effect by itself that dietary supplements do not provide.
DIF: Cognitive Level: Apply (Application) REF: pp. 251-252
21. Which of the following people is at greatest risk for a hip fracture secondary to osteoporosis?
a. A 66-year-old White woman
b. A 66-year-old African American woman
c. A 66-year-old White man
d. A 66-year-old African American man
White postmenopausal women have the greatest prevalence of osteoporosis and incidence of hip fracture by gender and race.
DIF: Cognitive Level: Apply (Application) REF: p. 252
22. A school nurse is using height and weight measurements to calculate the body mass index (BMI) of the students. How will the nurse use these data?
a. BMI can be correlated to a specific percentage of body fat.
b. BMI can be used to determine if a child is obese or underweight.
c. BMI can be used to determine if a child will develop Type 2 diabetes.
d. BMI can be compared with others of the same ethnic background.
Body mass index (BMI) is a helpful indicator of obesity and being underweight. Height and weight measurements are needed in the calculation to determine BMI. BMI is a good indicator of body fat, but it cannot be interpreted as a specific percentage of body fat. BMI is used to screen and monitor a population to detect the risk of health or nutritional disorders. In an individual, other data must be used to determine if a high BMI is associated with increased risk of disease; BMI alone is not diagnostic. The growth charts released in 2000 by the CDC more accurately reflect the nation’s cultural and racial diversity, but there is not a different chart for each ethnic background.
DIF: Cognitive Level: Apply (Application) REF: p. 255
23. A community health nurse is educating health care providers in a local clinic about steps to take to help their clients improve their health-related behaviors. Which of the following would be included as the nurse teaches about the acronym LEARN?
a. Explain how small changes can affect health.
b. Acknowledge that action needs to be taken.
c. Negotiate an agreement.
d. Refer to community resources.
LEARN refers to the steps nurses can take to help the person who needs to improve health-related behavior. L = Listen with sympathy and understanding to the person’s perception of the problem, E = Explain personal perceptions of the problem, A = Acknowledge and discuss differences and similarities, R = Recommend treatment, N = Negotiate an agreement.
DIF: Cognitive Level: Apply (Application) REF: p. 256
24. Which of the following individuals would be at greatest risk to develop Type 2 diabetes?
a. White, 50-year-old woman, obese, second child weighed 10 pounds at birth
b. African American, 55-year-old man, hypertension, exercises regularly
c. Hispanic, 22-year-old woman, healthy weight, family history of diabetes
d. White, 75-year-old man, history of prostate cancer and high triglycerides
Risk factors for Type 2 diabetes include: having prediabetes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]), age greater than 45, being overweight or obese, not exercising regularly, having a family history of diabetes, a personal history of gestational diabetes or a baby of at least 9 pounds at birth, other risk factors such as high blood pressure, a low HDL cholesterol or high triglycerides, and one’s race and ethnicity. The White, 50-year-old woman who is obese and gave birth to a child weighing 10 pounds has the most risk factors of the clients described.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 256
25. A nurse is counseling a person who was recently diagnosed with diabetes about how to prevent the complications of this disease. Which of the following interventions would be stressed the most by the nurse?
a. Adjusting sliding scale insulin therapy as needed
b. Taking oral hypoglycemic medication as prescribed
c. Monitoring blood glucose daily
d. Adhering to medical nutrition therapy
Medicine may be used to control blood glucose level, and measuring the blood glucose daily helps in controlling its level. But the key to maintaining diabetic control is individualized medical nutrition therapy, the purpose of which is to delay or prevent diabetic complications.
DIF: Cognitive Level: Apply (Application) REF: pp. 257-258
26. A nurse is conducting an initial nutritional assessment on a person who is HIV positive. Which of the following questions would be most important for the nurse to ask?
a. What fresh fruits and vegetables do you like to eat?
b. Are you taking a daily multivitamin?
c. How often do you eat at restaurants?
d. Do you have any questions about your current medications?
Evidence suggests that micronutrient deficiencies are common among those with HIV and that those not taking vitamin supplementation have increased morbidity and mortality. Thus, asking about use of a daily multivitamin is the most important information for the nurse to collect. A nutrient-dense, protein-rich, well-balanced diet should be stressed as well as vitamin and mineral supplementation. Because of an altered immune function, they get sicker when exposed to food-borne organisms, so discussion about how to avoid food-borne illness is also important.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 259
1. Which of the following causes of death is/are directly associated with diet? (select all that apply)
a. Diabetes mellitus
b. Cirrhosis of the liver
d. Coronary heart disease (CHD)
ANS: A, C, D
Four leading causes of death directly associated with diet are coronary heart disease (CHD), some types of cancer, stroke, and diabetes mellitus. Four more major causes of death—accidents, cirrhosis of the liver, suicide, and homicide—are associated with excessive alcohol intake.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 231
2. A community health nurse is preparing an educational brochure about improving the nutritional behaviors of Americans. Which of the following topics would most likely be included in the brochure? (select all that apply)
a. Increasing daily intake of milk and dairy products
b. Decreasing daily sodium intake
c. Increasing daily intake of fruits and vegetables
d. Decreasing daily intake of sugar-sweetened drinks
ANS: B, C, D
Fewer than 15% of adults and 10% of adolescents eat the recommended amounts of fruits and vegetables every day. Sixty-three percent of adults and 84% of adolescents consume at least one sugar-sweetened drink each day. Most American adults consume more than twice the recommended average daily sodium intake level.
DIF: Cognitive Level: Apply (Application) REF: pp. 233-234
3. A community health nurse is developing educational materials related to nutrition. Which of the following resources would be most appropriate for the nurse to use? (select all that apply)
a. Recommended dietary allowances (RDAs)
c. Dietary reference intakes (DRIs)
ANS: C, D
The most current food and nutrition recommendations are found using the dietary reference intakes (DRIs) and MyPlate. These two resources replaced the previously issued recommended dietary allowances (RDAs) and MyPyramid.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 234
4. A person has been diagnosed with salmonellosis. Which of the following symptoms would the person most likely exhibit? (select all that apply)
a. Bloody diarrhea
c. Hypoactive bowel sounds
d. Abdominal cramping
ANS: B, D
Symptoms of salmonellosis include abdominal cramping, mild to severe diarrhea, nausea, vomiting, and fever within 8 to 72 hours after infection. Bloody diarrhea is more likely seen with E. coli infection.
DIF: Cognitive Level: Apply (Application) REF: p. 242