Chapter 01: Wellness Nutrition
Grodner et al.: Nutritional Foundations and Clinical Applications: A Nursing Approach, 7th Edition

MULTIPLE CHOICE

	1.	Examples of informal education include
a.	attending a workshop on coronary artery disease sponsored by the American Heart Association.	
b.	watching a television show about diabetes.	
c.	learning about food safety techniques in a high school economics course.	
d.	joining a support group to help overcome an eating disorder.	

ANS:	B
Watching a television show about diabetes is an example of informal education because it is an experience that occurs through a daily activity. Attending a workshop or joining a support group would be considered nonformal education; a high school course would be considered formal education.

DIF:	Cognitive Level: Applying	REF:	Page 13	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Health Promotion and Maintenance

	2.	A college student exercises regularly and generally eats a healthy variety of foods, is taking a course in general nutrition, buys locally produced food whenever possible, is an active member of an on-campus faith-based organization, and keeps a journal to help process her emotions. What else could be important for her to include in her life in order to develop her overall wellness?
a.	Growing some of her own food	
b.	Keeping a food record to help evaluate what she eats	
c.	Eating meals with friends throughout the week	
d.	Meeting with a registered dietitian to review her food choices	

ANS:	C
Wellness enhances a person’s level of health through development of each of the six dimensions of health: physical health, intellectual health, emotional health, social health, spiritual health, and environmental health. Exercise and eating a healthy variety of foods help develop physical health; taking a course in general nutrition helps develop intellectual health; buying locally produced food helps develop environmental health; being part of a faith-based organization helps develop spiritual health; and keeping a journal helps develop emotional health. The missing dimension in this example is development of social health; eating meals with friends throughout the week would add this dimension. Growing her own food would be another example of environmental health; keeping a food record would be another contributor to physical health; and meeting with a registered dietitian may contribute to physical, intellectual, and emotional health.

DIF:	Cognitive Level: Analyzing	REF:	Page 7 | Page 8	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Health Promotion and Maintenance

	3.	For a client who is missing meals because of poor planning or is too busy to eat, emotional health can be affected by _____, which can cause confusion or anxiety.
a.	low blood sugar levels	
b.	high blood sugar levels	
c.	high blood pressure	
d.	extremely low blood pressure	

ANS:	A
Poor eating habits affect emotional health. Missing meals may cause blood sugar levels to decrease, which can cause anxiety or confusion or make difficult to control emotions. Late night binges on snack food are likely to result in excessive energy intake but would have a less direct effect on emotional health. Eating small meals throughout the day is likely to maintain more constant blood sugar levels, which would actually have a positive effect on emotional health. Excessive caffeine consumption may contribute to anxiety, but 2 cups of caffeinated coffee is not considered excessive.

DIF:	Cognitive Level: Analyzing	REF:	Page 6	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	4.	The best example of the type of concern that is likely to be addressed by the U.S. Department of Health and Human Services when target goals for Healthy People 2030 are updated is
a.	preference for vegetarian eating patterns among white women.	
b.	low intake of fruits and vegetables by African American children.	
c.	widespread use of bottled water in higher socioeconomic groups.	
d.	common use of protein and vitamin supplements in athletes.	

ANS:	B
Healthy People is used to set targets for health promotion to improve the health of all individuals. It addresses environmental and social issues that affect health outcomes. Low intake of fruits and vegetables by African American children is likely to have an adverse effect on their health and so may be addressed when target goals are set. Vegetarian eating patterns, use of bottled water, and use of protein and vitamin supplements do not necessarily have an adverse effect on nutritional health and so are less likely to be addressed.

DIF:	Cognitive Level: Applying	REF:	Page 9 | Page 10	
TOP:	Nursing Process: Planning	MSC:	Client Needs: Health Promotion and Maintenance

	5.	An example of community support for health promotion is
a.	teaching a young mother skills in safe food preparation.	
b.	watching a television documentary about industry errors in food processing.	
c.	labeling fresh poultry packages with information about proper food storage.	
d.	being aware that Salmonella can be transmitted because of inadequate food preparation.	

ANS:	C
Food labeling information is an example of community support because it is a regulatory measure that supports new health-promoting behaviors within a social context. Teaching, watching television, and awareness may increase knowledge, but they do not alter the social context by regulation or environmental change.

DIF:	Cognitive Level: Applying	REF:	Page 8	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Health Promotion and Maintenance

	6.	An example of a technique for health promotion is
a.	exercising five times a week.	
b.	local supermarkets’ expanding the availability of fresh fruits and vegetables.	
c.	teaching a teenager how to choose healthier foods at fast-food restaurants.	
d.	information about the relationship of dietary intake and diet-related disorders.	

ANS:	C
Health promotion consists of strategies that are designed to improve the health of individuals, families, groups, and communities, such as teaching a teenager how to choose healthier fast foods. Exercising regularly contributes to wellness, but it is not bringing about a change in health unless this is a change in behavior. Stocking a wider availability of fresh produce does not promote health, unless the supermarket uses specific strategies to encourage consumption. Information about the relationship between nutrients and disease is simply information unless it is used to promote behavior change.

DIF:	Cognitive Level: Applying	REF:	Page 7 | Page 8	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Health Promotion and Maintenance

	7.	For the efficient functioning and maintenance of the body, a person needs to consume sufficient amounts of
a.	fiber.	
b.	nutrients.	
c.	minerals.	
d.	supplements.	

ANS:	B
The body needs sufficient amounts of all nutrients for efficient functioning and maintenance. Both fiber and minerals are needed, but each represents only one type of nutrient. Supplements are not always necessary because sufficient nutrients can often be obtained from food.

DIF:	Cognitive Level: Understanding	REF:	Page 5	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	8.	A nurse has just been assigned to a community health program for older adults. She should check the document Healthy People 2020 to become familiar with
a.	nutrition priorities and goals for older American adults.	
b.	dietary standards for Americans older than 50 years.	
c.	dietary guidelines recommended for older adults.	
d.	MyPlate recommendations for older adults.	

ANS:	A
Healthy People 2020 focuses on targets and goals for improving the health of the nation. The nurse would check the Dietary Reference Intakes for information about dietary standards. The Dietary Guidelines for Americans and MyPlate are separate documents from Healthy People 2020 and focus on specific advice and guidelines for healthy eating.

DIF:	Cognitive Level: Applying	REF:	Pages 8-10	TOP:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	9.	A healthy female middle-aged client asks what she can do to prevent the development of type 2 diabetes. Weight control and nutrition strategies discussed are considered
a.	primary treatment.	
b.	primary prevention.	
c.	secondary prevention.	
d.	tertiary prevention.	

ANS:	B
Action to prevent the development of type 2 diabetes is considered primary prevention. Secondary prevention involves early detection to halt and minimize the effects of the disease, and tertiary prevention minimizes complications and helps restore health after the disorder has developed. “Primary treatment” is not a recognized term.

DIF:	Cognitive Level: Applying	REF:	Page 11	TOP:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	10.	As a home health care nurse, you are visiting a 70-year-old client who has just returned home from the hospital after being treated for coronary artery disease. The medical nutrition therapy developed for him by the hospital dietitian is considered
a.	palliative care.	
b.	primary prevention.	
c.	secondary prevention.	
d.	tertiary prevention.	

ANS:	D
This is an example of tertiary prevention, which entails minimizing complications and helping restore health after heart disease has developed. Primary prevention would occur before the disease developed, and secondary prevention would involve early detection to minimize the effects of the disease. Palliative care is intended only to minimize symptoms.

DIF:	Cognitive Level: Applying	REF:	Page 12	TOP:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	11.	A nutrient that can be made by the body is called
a.	essential.	
b.	complete.	
c.	incomplete.	
d.	nonessential.	

ANS:	D
Nonessential nutrients can be made by the body. Essential nutrients cannot be made by the body and must be consumed. The terms complete and incomplete refer to proteins. Complete proteins contain all the essential amino acids; incomplete proteins are lacking one or more essential amino acids.

DIF:	Cognitive Level: Remembering	REF:	Page 16	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	12.	A client exercises regularly and wants to make sure that he has sufficient energy for his workouts. The type of nutrient that will be most helpful in providing the energy he needs is
a.	carbohydrates.	
b.	water.	
c.	minerals.	
d.	protein.	

ANS:	A
Carbohydrates are the best source of fuel to provide energy for the body. Protein can also provide fuel for energy, but its primary purpose is to play important structural and functional roles. Water and minerals are important for health but do not provide fuel for energy.

DIF:	Cognitive Level: Applying	REF:	Pages 8-10	TOP:	Nursing Process: Planning
MSC:	Client Needs: Physiological Integrity		

	13.	A 45-year-old man tells you that he drinks 3 ounce of Scotch whiskey most evenings. His alcohol intake is considered
a.	insignificant.	
b.	moderate.	
c.	higher than is recommended.	
d.	dangerously high.	

ANS:	B
Moderate alcohol intake is two servings or fewer per day for men. One serving of spirits, such as whiskey, is 1.5 ounces. Therefore, 3 ounce of whiskey per day is considered moderate alcohol intake.

DIF:	Cognitive Level: Analyzing	REF:	Page 9	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Health Promotion and Maintenance

	14.	A dessert contains 4 g of protein, 30 g of carbohydrate, 15 g of fat, and 5 g of alcohol. The nutrient that provides the most kilocalories in the dessert is
a.	protein.	
b.	carbohydrate.	
c.	fat.	
d.	alcohol.	

ANS:	C
Fat provides the highest number of kilocalories: At 9 kcal/g, 15 g of fat provides 135 kcal. At 4 kcal/g, 4 g of protein provides 16 kcals. At 4 kcal/g, 30 g of carbohydrate provides 120 kcal. At 7 kcal/g, 5 g of alcohol provides 35 kcal.

DIF:	Cognitive Level: Applying	REF:	Page 9	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Health Promotion and Maintenance

	15.	A cup of frozen yogurt contains 24 g of carbohydrate, 2 g of fat, and 4 g of protein. The total number of kilocalories in the frozen yogurt is
a.	110.	
b.	130.	
c.	140.	
d.	162.	

ANS:	B
At 4 kcal/g, 24 g of carbohydrate provides 96 kcal. At 9 kcal/g, 2 g of fat provides 18 kcal. At 4 kcal/g, 4 g of protein provides 16 kcal. Therefore, the total kilocalories in the frozen yogurt is 130 kcal (96 + 18 + 16).

DIF:	Cognitive Level: Applying	REF:	Page 8 | Page 9	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Health Promotion and Maintenance

	16.	Combinations of amino acids link together to form
a.	protein.	
b.	carbohydrates.	
c.	dietary fiber.	
d.	lipids.	

ANS:	A
Proteins are made up of various combinations of amino acids, linked together. Carbohydrates are made up of one or more units of simple sugars. Dietary fiber consists mostly of carbohydrate that cannot be digested. Lipids are made up of glycerol and triglycerides or sterols.

DIF:	Cognitive Level: Remembering	REF:	Page 8 | Page 9	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	17.	A bodybuilder tells you that all of his meals and snacks include high-protein foods such as eggs, canned tuna, chicken, milk, and cheese. Most of the extra protein is probably used by his body to form
a.	strong bones and joints.	
b.	body fat stores.	
c.	healthy brain tissue.	
d.	increased muscle mass.	

ANS:	B
Excess protein is broken down to amino acids and then used for energy or stored as body fat. This man’s body will use some of this protein to increase muscle mass, but increasing protein intake beyond the amount needed does not increase muscle formation. Excess protein intake does not improve bone, joint, or brain health.

DIF:	Cognitive Level: Applying	REF:	Page 20	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	18.	When clients have a strong family history of both heart disease and cancer, the nurse should encourage them to reduce their intake of
a.	dietary fiber.	
b.	protein.	
c.	monounsaturated fat.	
d.	saturated fat.	

ANS:	D
Saturated fat intake is related to risk of heart disease and certain types of cancer. Monounsaturated fat intake has less effect on risk of these diseases. Dietary fiber intake should be increased to help reduce risk of cardiovascular disease and cancer. The effects of protein intake on risk of these diseases are much less significant.

DIF:	Cognitive Level: Applying	REF:	Pages 19-21	TOP:	Nursing Process: Planning
MSC:	Client Needs: Physiological Integrity		

	19.	The National Health and Nutrition Examination Survey (NHANES) is able to assess the overall nutritional and health status of Americans because
a.	the populations surveyed are representative of the total population.	
b.	it focuses on ethnic and socioeconomic groups at greatest risk.	
c.	it collects large volumes of survey data from all over the nation.	
d.	survey methods and standards are consistent from year to year.	

ANS:	A
Data from NHANES represent America overall because the survey populations are carefully selected to represent the total population. Their data therefore provide a better indication of the nation’s overall health than do large amounts of data from all over the country. It does not focus specifically on populations at high risk for disease. Standardization over time provides useful data on trends and changes but does not reveal the overall health of the nation.

DIF:	Cognitive Level: Applying	REF:	Page 11	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Health Promotion and Maintenance

	20.	In working with an ethnic minority population, a helpful way to increase health literacy could be to
a.	invite members of the community to help identify needs and teaching strategies.	
b.	encourage acculturation and adoption of healthful American eating patterns.	
c.	set up a feeding program to provide healthy food for members of the community.	
d.	use visual aids rather than written materials during health education encounters.	

ANS:	A
Members of an ethnic minority population can be very helpful in identifying needs and effective teaching strategies for people in their community and in encouraging people in the community to accept advice from nurses or other health professionals. They do not necessarily need to adopt American eating patterns; often these are less healthful than their traditional eating patterns. Setting up feeding programs does not promote positive self-efficacy. Visual aids may be helpful, but their use is not necessarily the best educational strategy.

DIF:	Cognitive Level: Applying	REF:	Page 13 | Page 14	
TOP:	Nursing Process: Planning	MSC:	Client Needs: Physiological Integrity

	21.	A client has heard that nutrients can be converted to other nutrients in the body. He takes high-dose vitamin C supplements because he believes this will supply his body’s need for other vitamins. What would you tell him?
a.	He should switch to a multivitamin supplement instead of just vitamin C.	
b.	Each vitamin has a specific function and needs to be supplied through a variety of foods.	
c.	Vitamin C can provide only water-soluble vitamins, and he still needs to consume fat-soluble vitamins.	
d.	Vitamin C supplements should be taken only when he has symptoms of a cold or influenza.	

ANS:	B
Vitamins are compounds that indirectly assist other nutrients through the complete processes of digestion, absorption, metabolism, and excretion. Vitamins cannot be converted into other vitamins; each has a specific function, and the best way to consume adequate amounts of each vitamin is to eat a variety of foods. Vitamin C is water soluble, but it cannot be converted to other water-soluble vitamins. Vitamin C is needed by the body at all times, not just when someone is ill. A multivitamin supplement would provide a better range of vitamins than just vitamin C, but it is still better to consume vitamins from food, rather than from supplements.

DIF:	Cognitive Level: Applying	REF:	Page 21	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	22.	For a mother with two children who works in health care management 60 to 70 hours a week, the biggest barrier to healthy eating is likely to be
a.	lack of concern for her own or her children’s health.	
b.	inadequate income to purchase healthy foods.	
c.	insufficient time to plan and prepare healthful meals.	
d.	lack of knowledge about healthy eating.	

ANS:	C
For busy professionals and families, the biggest barrier to healthy eating is usually hectic schedules and lack of time to plan and prepare healthy meals. Most mothers, especially those who work in a health care field, are concerned about their family’s health. Many professional women have at least some understanding of healthy eating. With a professional job, lack of income is not very likely to be a barrier to healthy eating.

DIF:	Cognitive Level: Applying	REF:	Page 15	TOP:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	23.	A class of nutrients that is important in body structure and influences the function of muscles and the central nervous system is
a.	proteins.	
b.	minerals.	
c.	vitamins.	
d.	carbohydrates.	

ANS:	B
Minerals are important in body structures and influence the function of muscles and the central nervous system. Proteins are structural components and form part of muscles but are less influential in the central nervous system. Vitamins and carbohydrates do not have structural functions.

DIF:	Cognitive Level: Understanding	REF:	Page 19 | Page 20	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	24.	If mine workers were trapped in a mine and it took several days for a rescue team to reach them, the nutrient that they would need most in order to survive is
a.	protein.	
b.	carbohydrates.	
c.	water.	
d.	vitamins.	

ANS:	C
The body can survive only a few days without water. The body may not function optimally without other nutrients, but it can survive many days and even weeks without them.

DIF:	Cognitive Level: Applying	REF:	Page 22	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	25.	The client who would benefit most from an increase in dietary fiber intake is one with
a.	fatigue.	
b.	constipation.	
c.	dehydration.	
d.	coronary heart disease.	

ANS:	B
Adequate dietary fiber and fluid intake can help alleviate constipation. It has a small but less significant effect in helping reduce risk of coronary heart disease. Dietary fiber intake does not affect fatigue or hydration status.

DIF:	Cognitive Level: Applying	REF:	Page 19	TOP:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	26.	To provide adequate amounts of vitamins and minerals, the best course of action is to
a.	lose weight to achieve ideal body weight.	
b.	eat a variety of foods from each food group.	
c.	follow the same general food pattern each day.	
d.	consume foods high in fiber and low in saturated fat.	

ANS:	B
Including a variety of foods from each food group increases the likelihood of obtaining adequate amounts of vitamins and minerals. Achieving ideal body weight does not guarantee adequate nutrient intake. Following the same general food pattern each day could actually limit vitamin and mineral intake because the assortment of foods is likely to be limited. Choosing foods high in fiber and low in saturated fat diet does not necessarily result in intake of adequate levels of vitamins and minerals.

DIF:	Cognitive Level: Applying	REF:	Page 12	TOP:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	27.	If a nurse wants to evaluate whether a client’s vitamin or mineral supplement contains too much of a specific nutrient, the nurse should
a.	check the manufacturer’s recommendations about intake for that nutrient.	
b.	request blood and urine tests to determine the client’s body stores of that nutrient.	
c.	compare the amount in the supplement to the tolerable upper intake level (UL) for that nutrient.	
d.	compare the amount in the supplement to the Recommended Dietary Allowance (RDA) for that nutrient.	

ANS:	C
The UL is the maximum intake that should not be exceeded to prevent adverse health risks; this should be compared to the amount in the supplement. The Recommended Dietary Allowance is the amount that meets the needs of most health individuals in a life-stage and gender group, but it is not the upper level for safety. Manufacturers do not necessarily provide reliable information about safety of supplements they are marketing. Blood and urine tests may or may not show whether the body is accumulating unsafe levels of a nutrient, depending on the nutrient and how long the supplement has been taken.

DIF:	Cognitive Level: Applying	REF:	Page 24	
TOP:	Nursing Process: Assessment | Nursing Process: Evaluation	
MSC:	Client Needs: Physiological Integrity		

	28.	Why is it difficult to specify the number of grams of protein that he or she should eat each day?
a.	More research studies are needed to help determine ideal levels of protein intake for various age and gender groups.	
b.	Health care professionals should not give specific advice to clients, to avoid lawsuits.	
c.	It is unrealistic to expect clients to meet precise levels of protein intake.	
d.	Recommended protein intakes are expressed as a range and are based on a percentage of energy intake, which varies between individuals.	

ANS:	D
Protein intake does not need to be precise and can be within an acceptable range, expressed as a percentage of energy intake. Health care professionals should not give unnecessarily precise advice, but they can give scientifically based advice without concern for lawsuits. A reasonable amount of research has been conducted to be able to give at least general advice about protein intake. The likelihood that clients will achieve a specific protein intake is not related to the difficulty in identifying what their intake level should be.

DIF:	Cognitive Level: Analyzing	REF:	Page 24 | Page 25	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	29.	If a college student is eating only one small meal per day in an attempt to lose weight and is taking high doses of vitamin and mineral supplements to try to make up for the lack of food, the student would be described as having
a.	malnutrition.	
b.	disordered nutrition.	
c.	overnutrition.	
d.	undernutrition.	

ANS:	A
An imbalance of intake of nutrients, energy, or both (in this case, high intake of some nutrients and low intake of energy) is called malnutrition. Overnutrition refers only to excessive intake, excessive nutrients, or excessive energy. Undernutrition refers only to inadequate intakes of nutrients, energy, or both. “Disordered nutrition” is not a recognized term.

DIF:	Cognitive Level: Applying	REF:	Page 29	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Physiological Integrity

	30.	An overweight client has been trying to lose weight for years. She tells you that she believes she is genetically designed to be overweight and that the foods available in supermarkets today make weight loss impossible. The client’s attitude shows
a.	positive self-efficacy.	
b.	negative self-efficacy.	
c.	poor environmental health.	
d.	poor emotional health.	

ANS:	B
The client’s attitude demonstrates negative self-efficacy. She does not perceive that she has power over her life and behaviors. A belief that she could change her personal behaviors would reflect positive self-efficacy. She is able to express her feelings, and so she does not necessarily have poor emotional health. Her belief about healthy food choices in her environment is not necessarily accurate.

DIF:	Cognitive Level: Applying	REF:	Page 30	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity