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Diets and
Nutrition
www.ArcheReview.com
These slides are vey brief summary of the
high-yield Archer NCLEX Diets/ Nutrition
webinar
Archer Review NCLEX Crash Course
Welcome!
● Please stay muted so that there is no background noise.
● If you have a question please enter it in the chat, or use the ‘raise hand’
feature, so that I can un-mute you and you can ask your question.
● We will be taking a 5-10 minute breaks throughout the course, and a
break for lunch.
Electrolytes
Who needs what and when?!
Potassium
When is a high potassium diet needed?
● Low potassium levels
○ K < 3.5
○ EKG changes
● When a patient is on a potassium wasting diuretic
○ Furosemide
○ Loop diuretics
● Cushing’s syndrome
● NGT to suction
● Vomiting
● Diarrhea
● Hyperinsulinism
When is a low potassium diet needed?
● High potassium levels
○ K >5
○ EKG changes
● Adrenal insufficiency
● Renal failure
● DKA
● Drugs that increase potassium levels
○ ACE inhibitors
○ NSAIDs
○ Potassium-sparing diuretics
NCLEX Question
A patient who is taking Lasix knows that he should increase the intake of
what food?
A. Avocado
B. Iceberg lettuce
C. Plums
D. Apples
Answer: A
The correct answer is A. Lasix is the most frequently prescribed loop diuretic. It can increase urine
output, even when blood flow to the kidneys is diminished. The rapid excretion of large amounts of
water caused by loop diuretics may produce adverse effects, such as dehydration and electrolyte
imbalances. Potassium loss may result in dysrhythmias. Therefore, potassium supplements and
foods high in potassium are encouraged. Avacado has high levels of potassium in it, which tends to
be lower in a patient taking Lasix.
B, C, and D are incorrect. Each of these options offers little no value of potassium to the diet.
NCSBN Client Need
Topic: Physiological Integrity
Subtopic: Pharmacological Therapies
Chapter 28: Drugs for Fluid, Acid-Base and Electrolyte Disorders
Core Concepts in Pharmacology (Holland/Adams)
Calcium
When is a high calcium diet needed?
● Low calcium levels
○ Ca < 8.4
● Renal failure
● Acute pancreatitis
● Malnutrition
○ Bulimia
● Malabsorption
○ Celiac disease
○ Crohn's disease
● Alcoholism
● Vitamin D deficiency
● Hypoparathyroidism
● Hyperphosphatemia
When is a low calcium diet needed?
● Low calcium levels
○ Ca >10.2
● Cancer of the bones
● Thiazide diuretics
● Glucocorticoids
● Immobility
● Kidney stones
● Vitamin D toxicity
● Hyperparathyroidism
● Hypophosphatemia
Foods low in calcium
NCLEX Question
The nurse educates the client with urinary tract calculi that he may have which
of the following foods: Select All That Apply.
A. Broccoli
B. Lettuce
C. Cheese
D. Apples
Answer: A, B, and D
Kidney stones in the urinary tract are formed in several ways. Calcium can combine with chemicals,
such as oxalate or phosphorous, in the urine. This can happen if these substances become so
concentrated that they solidify. Kidney stones can also be caused by a buildup of uric acid related to
the metabolism of protein. Most urinary tract calculi can usually be avoided through diet.
The correct answers are A, B, and D.
C is incorrect. Cheese has a high calcium contact, which can increase the risk of developing urinary
tract calculi and should, therefore, be avoided.
NCSBN Client Need
Topic: Physiological Integrity
Subtopic: Physiological Adaptation
Chapter 48: Urinary Elimination
Lesson: Altered Urinary Elimination
Reference: Fundamentals of Nursing(Kozier and Erb)
Phosphorus
When is a high phosphorus diet needed?
● Low phosphorus levels
○ Phos <3
● Malnutrition
● Starvation
● Refeeding syndrome
● Alcoholism
● TPN
● Hyperparathyroidism
When is a low phosphorus diet needed?
● High phosphorus levels
○ Phos >4.5
● Renal failure
● Tumor lysis syndrome
● Hypoparathyroidism
Foods low in phosphorus
NCLEX Question
The nurse is reviewing the diet of the patient with hypoparathyroidism. The
nurse understands that the client should be on what type of diet?
A. High calorie, low calcium diet
B. Low calcium, low phosphorus diet
C. High phosphorus, low calcium diet
D. High calcium, low phosphorus diet
Answer: D
A is incorrect. It does not matter whether the client is eating a high-calorie diet, as long as the client
adheres to high calcium and low phosphorus diet.
B is incorrect. A client with hypoparathyroidism should receive a diet that is high in calcium and low
in phosphorus.
C is incorrect. A client with hypoparathyroidism should receive a diet that is high in calcium and low
in phosphorus.
D is correct. A client with hypoparathyroidism should receive a diet that is high in calcium and low
in phosphorus. A high calcium diet may increase the client’s serum calcium levels through the food
he eats. A low phosphorus diet ensures that his phosphorus levels are small so that it will not
interfere with his calcium levels. Calcium and Phosphorus have an inversely proportional
relationship.
Reference
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
Low sodium
When is a low sodium diet needed?
● Heart failure
○ CHF
○ Right
○ Left
● High blood pressure
● Cirrhosis
● Edema
● Kidney disease
○ Glomerulonephritis
○ Nephrotic syndrome
High sodium
When is a high sodium diet needed?
● Addison’s disease
NCLEX Question
A client has been placed on a sodium-restricted diet following a myocardial
infarction. Which of the following would be the most appropriate meals to
suggest?
A. Turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1
orange
B. Broiled fish, 1 baked potato, ½ cup canned beets, 1 orange, and milk
C. Canned salmon, fresh broccoli, 1 biscuit, tea, and 1 apple
D. A bologna sandwich, fresh eggplant, 2 oz. fresh fruit, tea, and apple juice
Answer: A
The correct answer is A. People with heart failure may improve their symptoms by reducing the
amount of sodium in their diet. Sodium is a mineral found in many foods, especially salt.
Overeating salt causes the body to keep or retain too much water, worsening the fluid buildup.
Patients should be encouraged to follow a low-sodium diet to help manage symptoms of
hypertension and to reduce edema. One of the most natural things a patient can do at home to
reduce sodium intake is to eat fresh vegetables rather than canned. If canned vegetables are the
only option, the patient should rinse the plants with clean water and cook them with new, unsalted
water.
B is incorrect. Canned vegetables should be avoided.
C and D are incorrect. Canned or processed meats are higher in sodium and should be avoided.
NCSBN Client Need
Topic: Physiological Integrity
Subtopic: Basic Care and Comfort
Fundamentals of Nursing
Chapter 51: Circulation
Lesson: Alterations in Cardiac Functioning/Dietary Consideration
Vitamins & Minerals
They might be small but they’re oh so important!
Iron
When is a high iron diet needed?
● Iron deficiency anemia
● Pregnant women
Foods high in iron
NCLEX Question
The home health nurse is talking to a client with iron-deficiency anemia.
Which meal plan would indicate to the nurse that the client understood her
discharge instructions?
A. Roast beef, gelatin salad, green beans, and peach pie
B. Chicken salad, coleslaw, French fries, ice cream
C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisins
D. Pork chop, creamed potatoes, corn, and coconut cake
Answer: C
A is incorrect. Roast beef is high in iron; however, the other dishes accompanying the meal are low
in iron.
B is incorrect. Chicken and green leafy vegetables are rich in iron; however, French fries and ice
cream have low nutritional value.
C is correct. Foods that are high in iron are egg yolks, wheat bread, carrots, green leafy vegetables,
and raisins. This is an optimal meal for the client to increase his dietary iron intake.
D is incorrect. Pork chops contain high iron. Potatoes, corn, and coconuts, however, contain low
iron.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
High fiber
When is a high fiber diet needed?
● Constipation
● Irritable bowel syndrome
● CAD
Foods high in fiber
Low fiber
When is a low fiber diet needed?
● Crohn’s
● Ulcerative Colitis
NCLEX Question
The client is talking to the nurse about dietary modifications for his Irritable
Bowel Syndrome. The nurse listens carefully to what the client says he has
been eating and interrupts to provide further instructions when she hears the
client say:
A. He has been drinking 8 glasses of water daily
B. He has been eating more broccoli and fresh vegetables lately
C. He ate pasta two days ago
D. He has been eating brown rice instead of white rice ever since he was
discharged from the hospital
Answer: C
A is incorrect. The patient should drink 6-8 eight-ounce glasses of water daily to help regulate stool
consistency and frequency.
B is incorrect. The patient with Irritable Bowel Syndrome should eat a high fiber diet to produce
bulkier stools and reduce the tension in the Sigmoid colon. Broccoli and other fresh vegetables are
foods that are high in fiber.
C is correct. The nurse should provide further teaching to the client when he states that he ate
pasta because pasta is a low fiber food, and patients with IBS should have a fiber diet.
D is incorrect. The patient with Irritable Bowel Syndrome should eat a high fiber diet to produce
bulkier stools and reduce the tension in the Sigmoid colon. Brown rice is high in fiber.
Reference:
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
Break!Back at….
Macronutrients
Carbs, proteins, and all the good stuff
Carbohydrates
High carb foods
Low carb foods
Diabetes and Diets
What to eat
● Low carb
● Complex carbs
● High proteins
● Fruits
● Veggies
● Eat before exercising
Specifics
● Count carbs
○ Average - 60 carbs/meal
● Take insulin with meals
○ Cover carbs
○ Sliding scale for BG correction
High Protein
When is a high protein diet needed?
● Nephrotic syndrome*
● Cystic fibrosis
With kidney issues: low protein EXCEPT for nephrotic syndrome!
Low protein
When is a low protein diet needed?
● Liver disease
○ Hepatitis
○ Hepatic coma
○ Cirrhosis
● Kidney disease
○ Glomerulonephritis
Foods low in protein
Cholesterol
When is a low cholesterol diet needed?
● Hyperlipidemia
Foods high in cholesterol
● Red meats
● Polyunsaturated fats
○ Vegetable oils
NCLEX Question
The patient has just been diagnosed with hyperlipidemia. Aside from the
prescribed Atorvastatin, she is advised to lose weight and implement some
dietary changes. The nurse talks to her about possible nutritional
modifications. All of the following are accurate except:
A. Replace vegetable oil with canola oil when cooking.
B. Eat fish like tuna and salmon more often.
C. Eat more fruits and vegetables.
D. Eat more red meats more often.
Answer: D
A is incorrect. Replacing vegetable oils high in polyunsaturated fats with canola oil
(monounsaturated fats) is beneficial to reduce cholesterol levels.
B is incorrect. Fish like tuna and salmon are rich in Omega 3 fatty acids, which help in
reducing harmful cholesterol levels.
C is incorrect. Fruits and vegetables contain fiber, which promotes a healthy cholesterol
level.
D is correct. Red meats are rich in saturated fat. They should be eaten less frequently
because it contributes to high cholesterol levels.
Reference
Nugent, P., et al., Mosby&rsquo;s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
Specific
Diets
DASH Diet
What is the DASH diet?
● Dietary Approaches to Stop Hypertension
● Low sodium
● High calcium
● High potassium
● Low fat
● High fiber
NCLEX Question
The patient is being discharged from the hospital after being admitted
because of Hypertension. The nurse is talking to the patient about dietary
modifications to address hypertension. The nurse should reinforce her
teaching when the client states which of the following:
A. “I’m glad I can still eat beef and pork every day.”
B. “I will need to get used to eating fruits and vegetables.”
C. “I should stop eating canned foods”
D. “I have already told my son to buy me some yogurt when I get home.”
Answer: A
A is correct. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium,
and potassium diet. The nurse should reeducate the client that eating beef and pork is rich in
saturated fats and should only be eaten sparingly.
B is incorrect. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium,
and potassium diet. Fruits and vegetables have a high fiber and vitamin and mineral content and
must be consumed regularly to help lower blood pressure.
C is incorrect. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium,
and potassium diet. Canned foods have high sodium content due to its preservatives. The patient
should avoid these.
D is incorrect. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium,
and potassium diet. Yogurt is rich in calcium and low in fat.
Reference
Nugent, P., et al., Mosby&rsquo;s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
Heart Healthy Diet
What is a heart healthy diet?
● Low fat
● Low salt
● Low cholesterol
● Low saturated fats
● Complex carbohydrates and vegetable proteins
● Reducing caloric intake to achieve/maintain ideal body weight
When is a heart healthy diet needed?
● Heart disease
● MI
● High cholesterol
● High BMI
● Metabolic syndrome
● CAD
NCLEX Question
The nurse is giving an in-service on decreasing CAD risk. Which information
regarding nutritional recommendations should be included? (Select all that
apply)
A. Increase complex carbohydrates in diet.
B. Decrease caloric intake to achieve BMI of 25-29.9.
C. Reduce sodium intake.
D. Reduce saturated fat intake.
Answer: A, C, and D
A, C, and D are correct. Dietary recommendations for reducing CAD risk
include increasing dietary complex carbohydrates and vegetable proteins,
reducing sodium intake, reducing caloric intake to achieve/maintain ideal
body weight, and limiting dietary cholesterol and total and saturated (animal)
fats.
B is incorrect. The BMI range of 25-29.9 is considered overweight. The target
BMI range is 18.5-24.9.
Subject: Adult health
Lesson: Nutrition
Topic: Nutrition and oral hydration, illness management
Reference: (Lewis, Dirksen, Heitkemper, Bucher, &amp; Camera, 2011, p. 767)
Gluten Free Diet
When is a gluten free diet needed?
● Celiac disease
● Gluten intolerance
Gluten-free foods
Foods with gluten
NCLEX Question
The mother of a toddler with Celiac disease is being instructed by the nurse
regarding dietary modifications for her child. Which food choice by the
mother would indicate a need for further discussion?
A. Rice cakes
B. Resturant made french fries
C. Milk shake
D. Grilled chicken
Answer: B
Choice B is correct. Clients with Celiac disease are advised on a gluten-free diet. While potatoes are naturally free of
gluten, French fries made at restaurants aren't necessarily gluten-free. According to the Celiac Disease Foundation,
French fries are among the most easily cross-contaminated food in the restaurants. The majority of fast food joints
and restaurants fry these fries with other gluten-filled eats (shared fryers), causing cross-contamination. Among the
options above, restaurant based French Fried are the ones to avoid unless they are labeled strictly gluten free. Such
food choice by the mother requires further discussion and clarification.
Choice A is incorrect. Anything made from brown, white, or wild rice, including rice-based products, such as rice
cakes and puffed rice usually, do not contain gluten. Therefore, it is safe for the child to eat Rice cakes.
Choice C is incorrect. Milk does not contain gluten; therefore, it is safe for the child.
Choice D is incorrect. Meat is naturally gluten-free. Chicken does not contain gluten; therefore, it is safe for the child
to eat.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams &amp; Wilkins, 2003
Ketogenic Diet
What is a ketogenic diet?
● A ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet
used to treat hard-to-control epilepsy in children. In this diet, because the
body has so few carbs to use for energy, it burns fat, which produces
ketones.
Religious & Cultural
Dietary needs
Orthodox Jewish
● Kosher
○ No shellfish
○ No pork
○ Meats that are allowed include animals that are vegetable eaters, cloven-hoofed, and
those that are ritually slaughtered.
● Patient will need wrapped plastic utensils and they will unwrap the
utensils and prepare their own meal
● Do not combine meats and dairy products in the same meal.
Seventh-Day Adventist church
● No alcohol
● No caffeine
● Lacto-ovo vegetarians
○ Eggs and dairy products okay
○ No meat
● No pork
Islam
● Halal
○ No alcohol
○ No meat
○ No fish
○ No eggs
○ Dairy -okay!
● Ramadan
○ Fast during daylight hours
Hinduism
● Hindus practice ayurvedic medicine, which encompasses all aspects of
life, including diet, sleep, elimination, and hygiene.
● Most Hindus are lacto-vegetarians.
○ No eggs
○ No fish or other meat
○ Dairy - okay!
● Fasting usually means eating only pure foods, such as fruit or yogurt, but
is not expected of the sick.
NCLEX Question
You are caring for a client in the step-down unit who tells you that they are
an active member of the Seventh-Day Adventist church. When their breakfast
tray comes up, you see the following items. Knowing the religious dietary
preferences of these clients, which item does the nurse remove from the
breakfast tray? Select all that apply
A. Coffee
B. Bacon
C. Scrambled eggs
D. Pancakes
Answers: A and B
The correct answers are A and B. Members of the Seventh-Day Adventist church are not permitted
to consume alcohol or caffeinated beverages. Due to this dietary preference the nurse should
remove the coffee from the client’s breakfast tray. These individuals are usually Lacto-ovo
vegetarians, and for those who do consume meat pork is avoided. Because of this, the nurse
should remove the bacon from the breakfast tray.
C is incorrect. Scrambled eggs would be allowed for Lacto-ovo vegetarians.
D is incorrect. Pancakes would not violate any of these dietary restrictions.
NCSBN client need:
Topic: Psychosocial Integrity Subtopic: Religious and Spiritual Influences on Health
Reference:
Silvestri, L.; Saunders Comprehensive Review for the NCLEX-RN Examination, ed 6, St. Louis, 2014, Elsevier, p. 97
Diet ordersNPO, clears, and more, oh my!
NPO
● Nothing by mouth
● Pre-op
● Post-op before bowel sounds return
Clear liquids
● Clear liquid diets
consist of foods and
liquids that are
transparent to light
and are liquid when
at body temperature.
● This diet is best for
patients who have not
had oral intake for
some time, and for
the first time, a
patient eats after
complete bowel rest.
Full liquids
● This diet is appropriate as a transition after a clear liquid diet for patients
following surgery, but should not be the first diet ordered.
● Ice cream
● Strained soups
● Sherbet
● Milk
● Pudding
● Custards
● Refined cooked cereals
● Strained vegetable juices
Mechanical soft
● Facilitate mastication
○ Patients without teeth
○ Jaw surgery or injuries
● Swallowing problems
● Dentition problems
NCLEX Question
While working in a post-operative unit, the nurse is assigned to take care of a
32-year-old who is post-op day one from an appendectomy. The patient has
not eaten for the past three days and is asking when she will be allowed to
have a meal again. Upon consulting with the interdisciplinary team, the
provider decides it is time to place a diet order for your patient. Which diet
does the nurse expect the provider will order?
A. Full liquid diet
B. Clear liquid diet
C. Soft diet
D. Mechanical diet
Answer: B
Correct Answer: B. A clear liquid diet is the most appropriate choice for this patient. Clear liquid
diets consist of foods and liquids that are transparent to light and are liquid when at body
temperature. This diet is best for patients who have not had oral intake for some time, and for the
first time, a patient eats after complete bowel rest.
A is incorrect. A full liquid diet is wrong. This diet is appropriate as a transition after a clear liquid
diet for patients following surgery, but should not be the first diet ordered.
C is incorrect. A soft diet is also wrong, as this is only indicated when patients have difficulty
chewing or swallowing and need foods that are much easier to eat.
D is incorrect. A mechanical diet is not appropriate for this patient. This diet consisted of foods that
have been processed so that they do not require some or any chewing. It is used for patients with
dental problems, surgeries to the head and neck, or other disorders that make chewing difficult or
unsafe.
NCSBN Client Need:
NCLEX Question
A post gastric bypass client has been advanced from a clear liquid diet to a
full liquid diet. The client verbalized that he was happy about the diet change
because he has been bored with the clear liquid diet. Which item should the
nurse offer to the client that belongs to a full liquid diet?
A. Gelatin
B. Tea
C. Custard
D. Popsicle
Answer: C
Rationale: A full liquid diet includes food items such as plain ice cream, soups
that are strained, sherbet, milk, pudding and custard, breakfast drinks,
refined cooked cereals, and strained vegetable juices. A clear liquid diet, on
the other hand, consists of relatively transparent foods. The food items in
options A, B, and D are clear liquids and are, therefore, the incorrect answer.
Custard is under the full liquid diet specification and is the correct answer.
Source: Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
Wrap up
questions
NCLEX Question
Select the diet that would most likely be ordered for a client who is
edentulous.
A. A low sodium diet to prevent edema and excessive fluid
B. A mechanical soft diet to facilitate mastication
C. A renal diet to prevent fluid retention and edema
D. A high fiber diet to prevent constipation secondary to edema
Answer: B
B is correct. A mechanical soft diet to facilitate mastication would most likely be ordered for a client
who is edentulous. This diet would help the client who is without teeth, or edentulous, to chew, or
gnaw, their food with their gums. Other diets do not meet this nutritional and safe eating need.
Choice A is incorrect. A low sodium diet to prevent edema and excessive fluid is indicated for
clients affected with edema, renal disease, and heart disease, but not edentulous clients.
Choice C is incorrect. A renal diet to prevent fluid retention and edema is indicated for clients
affected with renal disease and kidney failure, but not edentulous clients.
Choice D is incorrect. A high fiber diet is indicated for clients at risk for and constipated, but it is not
indicated for clients who are edentulous.
Reference: Knippa, Audrey, Sheryl Sommer, Brenda Ball et al. (2010) Nutrition for Nursing 4.0; ATI Nursing Education.
NCLEX Question
Select the therapeutic diet that is accurately paired with an indicator of it.
A. The DASH diet: Heart failure
B. A high fiber diet: Coronary artery disease
C. Mechanical soft diet: Myocardial infarction
D. A weight reduction diet: Heart disease
Answer: B
Choice B is correct. A high fiber diet and a low cholesterol diet are indicated for clients affected with
coronary artery disease. The goal of the low cholesterol diet is to decrease the patient’s LDL level by
limiting dietary cholesterol intake to less than 200 mg per day and the goal of a high fiber diet to lower
LDL.
Choice A is incorrect. The DASH diet is used for clients who are affected with hypertension rather than
heart failure. The DASH diet consists of foods low in sodium, high in calcium and high in potassium.
Choice C is incorrect. A mechanical soft diet is used for clients with swallowing and dentition problems
rather than for clients who have had a myocardial infarction. Instead, clients who have had a myocardial
infarction have a clear liquid diet for 24 hours post the event and then a diet without caffeine.
Choice D is incorrect. A weight reduction diet is not necessarily indicated with clients affected with heart
disease because many clients with heart disease may be of normal weight or underweight.
NCLEX Question
A client admitted due to emergent hypertension is about to be discharged.
The nurse is giving instructions about dietary modifications. Which food
choice by the client would indicate an accurate understanding of low fat, low
cholesterol diet?
A. Macaroni and cheese
B. Fish and chips
C. Turkey breast salad
D. Pepperoni pizza
Answer: C
A is incorrect. Macaroni and cheese contain 8 grams of cholesterol and 5 grams of fat per 100-gram
servings.
B is incorrect. Fish and chips contain an average of 11.1 grams of fat per 100-gram serving.
C is correct. Turkey breast contains 2.2 grams of saturated fats, 2.1 grams of polyunsaturated fats,
and 2.6 grams of monounsaturated fats per 100 grams. It is also a high protein source `with 29
grams per 100 grams.
D is incorrect. Pepperoni pizza contains 10 grams of fat per 100-gram serving. It is also high in
saturated fat.
Reference
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Archer NCLEX Webinars - Diets and Nutrition crash course

  • 1. Diets and Nutrition www.ArcheReview.com These slides are vey brief summary of the high-yield Archer NCLEX Diets/ Nutrition webinar Archer Review NCLEX Crash Course
  • 2. Welcome! ● Please stay muted so that there is no background noise. ● If you have a question please enter it in the chat, or use the ‘raise hand’ feature, so that I can un-mute you and you can ask your question. ● We will be taking a 5-10 minute breaks throughout the course, and a break for lunch.
  • 5. When is a high potassium diet needed? ● Low potassium levels ○ K < 3.5 ○ EKG changes ● When a patient is on a potassium wasting diuretic ○ Furosemide ○ Loop diuretics ● Cushing’s syndrome ● NGT to suction ● Vomiting ● Diarrhea ● Hyperinsulinism
  • 6.
  • 7. When is a low potassium diet needed? ● High potassium levels ○ K >5 ○ EKG changes ● Adrenal insufficiency ● Renal failure ● DKA ● Drugs that increase potassium levels ○ ACE inhibitors ○ NSAIDs ○ Potassium-sparing diuretics
  • 8.
  • 9. NCLEX Question A patient who is taking Lasix knows that he should increase the intake of what food? A. Avocado B. Iceberg lettuce C. Plums D. Apples
  • 10. Answer: A The correct answer is A. Lasix is the most frequently prescribed loop diuretic. It can increase urine output, even when blood flow to the kidneys is diminished. The rapid excretion of large amounts of water caused by loop diuretics may produce adverse effects, such as dehydration and electrolyte imbalances. Potassium loss may result in dysrhythmias. Therefore, potassium supplements and foods high in potassium are encouraged. Avacado has high levels of potassium in it, which tends to be lower in a patient taking Lasix. B, C, and D are incorrect. Each of these options offers little no value of potassium to the diet. NCSBN Client Need Topic: Physiological Integrity Subtopic: Pharmacological Therapies Chapter 28: Drugs for Fluid, Acid-Base and Electrolyte Disorders Core Concepts in Pharmacology (Holland/Adams)
  • 12. When is a high calcium diet needed? ● Low calcium levels ○ Ca < 8.4 ● Renal failure ● Acute pancreatitis ● Malnutrition ○ Bulimia ● Malabsorption ○ Celiac disease ○ Crohn's disease ● Alcoholism ● Vitamin D deficiency ● Hypoparathyroidism ● Hyperphosphatemia
  • 13.
  • 14. When is a low calcium diet needed? ● Low calcium levels ○ Ca >10.2 ● Cancer of the bones ● Thiazide diuretics ● Glucocorticoids ● Immobility ● Kidney stones ● Vitamin D toxicity ● Hyperparathyroidism ● Hypophosphatemia
  • 15. Foods low in calcium
  • 16. NCLEX Question The nurse educates the client with urinary tract calculi that he may have which of the following foods: Select All That Apply. A. Broccoli B. Lettuce C. Cheese D. Apples
  • 17. Answer: A, B, and D Kidney stones in the urinary tract are formed in several ways. Calcium can combine with chemicals, such as oxalate or phosphorous, in the urine. This can happen if these substances become so concentrated that they solidify. Kidney stones can also be caused by a buildup of uric acid related to the metabolism of protein. Most urinary tract calculi can usually be avoided through diet. The correct answers are A, B, and D. C is incorrect. Cheese has a high calcium contact, which can increase the risk of developing urinary tract calculi and should, therefore, be avoided. NCSBN Client Need Topic: Physiological Integrity Subtopic: Physiological Adaptation Chapter 48: Urinary Elimination Lesson: Altered Urinary Elimination Reference: Fundamentals of Nursing(Kozier and Erb)
  • 19. When is a high phosphorus diet needed? ● Low phosphorus levels ○ Phos <3 ● Malnutrition ● Starvation ● Refeeding syndrome ● Alcoholism ● TPN ● Hyperparathyroidism
  • 20.
  • 21. When is a low phosphorus diet needed? ● High phosphorus levels ○ Phos >4.5 ● Renal failure ● Tumor lysis syndrome ● Hypoparathyroidism
  • 22. Foods low in phosphorus
  • 23. NCLEX Question The nurse is reviewing the diet of the patient with hypoparathyroidism. The nurse understands that the client should be on what type of diet? A. High calorie, low calcium diet B. Low calcium, low phosphorus diet C. High phosphorus, low calcium diet D. High calcium, low phosphorus diet
  • 24. Answer: D A is incorrect. It does not matter whether the client is eating a high-calorie diet, as long as the client adheres to high calcium and low phosphorus diet. B is incorrect. A client with hypoparathyroidism should receive a diet that is high in calcium and low in phosphorus. C is incorrect. A client with hypoparathyroidism should receive a diet that is high in calcium and low in phosphorus. D is correct. A client with hypoparathyroidism should receive a diet that is high in calcium and low in phosphorus. A high calcium diet may increase the client’s serum calcium levels through the food he eats. A low phosphorus diet ensures that his phosphorus levels are small so that it will not interfere with his calcium levels. Calcium and Phosphorus have an inversely proportional relationship. Reference Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
  • 26. When is a low sodium diet needed? ● Heart failure ○ CHF ○ Right ○ Left ● High blood pressure ● Cirrhosis ● Edema ● Kidney disease ○ Glomerulonephritis ○ Nephrotic syndrome
  • 27.
  • 29. When is a high sodium diet needed? ● Addison’s disease
  • 30.
  • 31. NCLEX Question A client has been placed on a sodium-restricted diet following a myocardial infarction. Which of the following would be the most appropriate meals to suggest? A. Turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1 orange B. Broiled fish, 1 baked potato, ½ cup canned beets, 1 orange, and milk C. Canned salmon, fresh broccoli, 1 biscuit, tea, and 1 apple D. A bologna sandwich, fresh eggplant, 2 oz. fresh fruit, tea, and apple juice
  • 32. Answer: A The correct answer is A. People with heart failure may improve their symptoms by reducing the amount of sodium in their diet. Sodium is a mineral found in many foods, especially salt. Overeating salt causes the body to keep or retain too much water, worsening the fluid buildup. Patients should be encouraged to follow a low-sodium diet to help manage symptoms of hypertension and to reduce edema. One of the most natural things a patient can do at home to reduce sodium intake is to eat fresh vegetables rather than canned. If canned vegetables are the only option, the patient should rinse the plants with clean water and cook them with new, unsalted water. B is incorrect. Canned vegetables should be avoided. C and D are incorrect. Canned or processed meats are higher in sodium and should be avoided. NCSBN Client Need Topic: Physiological Integrity Subtopic: Basic Care and Comfort Fundamentals of Nursing Chapter 51: Circulation Lesson: Alterations in Cardiac Functioning/Dietary Consideration
  • 33. Vitamins & Minerals They might be small but they’re oh so important!
  • 34. Iron
  • 35. When is a high iron diet needed? ● Iron deficiency anemia ● Pregnant women
  • 37. NCLEX Question The home health nurse is talking to a client with iron-deficiency anemia. Which meal plan would indicate to the nurse that the client understood her discharge instructions? A. Roast beef, gelatin salad, green beans, and peach pie B. Chicken salad, coleslaw, French fries, ice cream C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisins D. Pork chop, creamed potatoes, corn, and coconut cake
  • 38. Answer: C A is incorrect. Roast beef is high in iron; however, the other dishes accompanying the meal are low in iron. B is incorrect. Chicken and green leafy vegetables are rich in iron; however, French fries and ice cream have low nutritional value. C is correct. Foods that are high in iron are egg yolks, wheat bread, carrots, green leafy vegetables, and raisins. This is an optimal meal for the client to increase his dietary iron intake. D is incorrect. Pork chops contain high iron. Potatoes, corn, and coconuts, however, contain low iron. Reference Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014 Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013 Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
  • 40. When is a high fiber diet needed? ● Constipation ● Irritable bowel syndrome ● CAD
  • 41. Foods high in fiber
  • 43. When is a low fiber diet needed? ● Crohn’s ● Ulcerative Colitis
  • 44.
  • 45. NCLEX Question The client is talking to the nurse about dietary modifications for his Irritable Bowel Syndrome. The nurse listens carefully to what the client says he has been eating and interrupts to provide further instructions when she hears the client say: A. He has been drinking 8 glasses of water daily B. He has been eating more broccoli and fresh vegetables lately C. He ate pasta two days ago D. He has been eating brown rice instead of white rice ever since he was discharged from the hospital
  • 46. Answer: C A is incorrect. The patient should drink 6-8 eight-ounce glasses of water daily to help regulate stool consistency and frequency. B is incorrect. The patient with Irritable Bowel Syndrome should eat a high fiber diet to produce bulkier stools and reduce the tension in the Sigmoid colon. Broccoli and other fresh vegetables are foods that are high in fiber. C is correct. The nurse should provide further teaching to the client when he states that he ate pasta because pasta is a low fiber food, and patients with IBS should have a fiber diet. D is incorrect. The patient with Irritable Bowel Syndrome should eat a high fiber diet to produce bulkier stools and reduce the tension in the Sigmoid colon. Brown rice is high in fiber. Reference: Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
  • 53. What to eat ● Low carb ● Complex carbs ● High proteins ● Fruits ● Veggies ● Eat before exercising Specifics ● Count carbs ○ Average - 60 carbs/meal ● Take insulin with meals ○ Cover carbs ○ Sliding scale for BG correction
  • 55. When is a high protein diet needed? ● Nephrotic syndrome* ● Cystic fibrosis With kidney issues: low protein EXCEPT for nephrotic syndrome!
  • 56.
  • 58. When is a low protein diet needed? ● Liver disease ○ Hepatitis ○ Hepatic coma ○ Cirrhosis ● Kidney disease ○ Glomerulonephritis
  • 59. Foods low in protein
  • 61. When is a low cholesterol diet needed? ● Hyperlipidemia
  • 62. Foods high in cholesterol ● Red meats ● Polyunsaturated fats ○ Vegetable oils
  • 63. NCLEX Question The patient has just been diagnosed with hyperlipidemia. Aside from the prescribed Atorvastatin, she is advised to lose weight and implement some dietary changes. The nurse talks to her about possible nutritional modifications. All of the following are accurate except: A. Replace vegetable oil with canola oil when cooking. B. Eat fish like tuna and salmon more often. C. Eat more fruits and vegetables. D. Eat more red meats more often.
  • 64. Answer: D A is incorrect. Replacing vegetable oils high in polyunsaturated fats with canola oil (monounsaturated fats) is beneficial to reduce cholesterol levels. B is incorrect. Fish like tuna and salmon are rich in Omega 3 fatty acids, which help in reducing harmful cholesterol levels. C is incorrect. Fruits and vegetables contain fiber, which promotes a healthy cholesterol level. D is correct. Red meats are rich in saturated fat. They should be eaten less frequently because it contributes to high cholesterol levels. Reference Nugent, P., et al., Mosby&rsquo;s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
  • 67. What is the DASH diet? ● Dietary Approaches to Stop Hypertension ● Low sodium ● High calcium ● High potassium ● Low fat ● High fiber
  • 68.
  • 69. NCLEX Question The patient is being discharged from the hospital after being admitted because of Hypertension. The nurse is talking to the patient about dietary modifications to address hypertension. The nurse should reinforce her teaching when the client states which of the following: A. “I’m glad I can still eat beef and pork every day.” B. “I will need to get used to eating fruits and vegetables.” C. “I should stop eating canned foods” D. “I have already told my son to buy me some yogurt when I get home.”
  • 70. Answer: A A is correct. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium, and potassium diet. The nurse should reeducate the client that eating beef and pork is rich in saturated fats and should only be eaten sparingly. B is incorrect. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium, and potassium diet. Fruits and vegetables have a high fiber and vitamin and mineral content and must be consumed regularly to help lower blood pressure. C is incorrect. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium, and potassium diet. Canned foods have high sodium content due to its preservatives. The patient should avoid these. D is incorrect. The client’s dietary modifications include low fat, low sodium, high fiber, high calcium, and potassium diet. Yogurt is rich in calcium and low in fat. Reference Nugent, P., et al., Mosby&rsquo;s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
  • 72. What is a heart healthy diet? ● Low fat ● Low salt ● Low cholesterol ● Low saturated fats ● Complex carbohydrates and vegetable proteins ● Reducing caloric intake to achieve/maintain ideal body weight
  • 73.
  • 74. When is a heart healthy diet needed? ● Heart disease ● MI ● High cholesterol ● High BMI ● Metabolic syndrome ● CAD
  • 75. NCLEX Question The nurse is giving an in-service on decreasing CAD risk. Which information regarding nutritional recommendations should be included? (Select all that apply) A. Increase complex carbohydrates in diet. B. Decrease caloric intake to achieve BMI of 25-29.9. C. Reduce sodium intake. D. Reduce saturated fat intake.
  • 76. Answer: A, C, and D A, C, and D are correct. Dietary recommendations for reducing CAD risk include increasing dietary complex carbohydrates and vegetable proteins, reducing sodium intake, reducing caloric intake to achieve/maintain ideal body weight, and limiting dietary cholesterol and total and saturated (animal) fats. B is incorrect. The BMI range of 25-29.9 is considered overweight. The target BMI range is 18.5-24.9. Subject: Adult health Lesson: Nutrition Topic: Nutrition and oral hydration, illness management Reference: (Lewis, Dirksen, Heitkemper, Bucher, &amp; Camera, 2011, p. 767)
  • 78. When is a gluten free diet needed? ● Celiac disease ● Gluten intolerance
  • 81. NCLEX Question The mother of a toddler with Celiac disease is being instructed by the nurse regarding dietary modifications for her child. Which food choice by the mother would indicate a need for further discussion? A. Rice cakes B. Resturant made french fries C. Milk shake D. Grilled chicken
  • 82. Answer: B Choice B is correct. Clients with Celiac disease are advised on a gluten-free diet. While potatoes are naturally free of gluten, French fries made at restaurants aren't necessarily gluten-free. According to the Celiac Disease Foundation, French fries are among the most easily cross-contaminated food in the restaurants. The majority of fast food joints and restaurants fry these fries with other gluten-filled eats (shared fryers), causing cross-contamination. Among the options above, restaurant based French Fried are the ones to avoid unless they are labeled strictly gluten free. Such food choice by the mother requires further discussion and clarification. Choice A is incorrect. Anything made from brown, white, or wild rice, including rice-based products, such as rice cakes and puffed rice usually, do not contain gluten. Therefore, it is safe for the child to eat Rice cakes. Choice C is incorrect. Milk does not contain gluten; therefore, it is safe for the child. Choice D is incorrect. Meat is naturally gluten-free. Chicken does not contain gluten; therefore, it is safe for the child to eat. Reference Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams &amp; Wilkins, 2003
  • 84. What is a ketogenic diet? ● A ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet used to treat hard-to-control epilepsy in children. In this diet, because the body has so few carbs to use for energy, it burns fat, which produces ketones.
  • 85.
  • 87. Orthodox Jewish ● Kosher ○ No shellfish ○ No pork ○ Meats that are allowed include animals that are vegetable eaters, cloven-hoofed, and those that are ritually slaughtered. ● Patient will need wrapped plastic utensils and they will unwrap the utensils and prepare their own meal ● Do not combine meats and dairy products in the same meal.
  • 88. Seventh-Day Adventist church ● No alcohol ● No caffeine ● Lacto-ovo vegetarians ○ Eggs and dairy products okay ○ No meat ● No pork
  • 89. Islam ● Halal ○ No alcohol ○ No meat ○ No fish ○ No eggs ○ Dairy -okay! ● Ramadan ○ Fast during daylight hours
  • 90. Hinduism ● Hindus practice ayurvedic medicine, which encompasses all aspects of life, including diet, sleep, elimination, and hygiene. ● Most Hindus are lacto-vegetarians. ○ No eggs ○ No fish or other meat ○ Dairy - okay! ● Fasting usually means eating only pure foods, such as fruit or yogurt, but is not expected of the sick.
  • 91. NCLEX Question You are caring for a client in the step-down unit who tells you that they are an active member of the Seventh-Day Adventist church. When their breakfast tray comes up, you see the following items. Knowing the religious dietary preferences of these clients, which item does the nurse remove from the breakfast tray? Select all that apply A. Coffee B. Bacon C. Scrambled eggs D. Pancakes
  • 92. Answers: A and B The correct answers are A and B. Members of the Seventh-Day Adventist church are not permitted to consume alcohol or caffeinated beverages. Due to this dietary preference the nurse should remove the coffee from the client’s breakfast tray. These individuals are usually Lacto-ovo vegetarians, and for those who do consume meat pork is avoided. Because of this, the nurse should remove the bacon from the breakfast tray. C is incorrect. Scrambled eggs would be allowed for Lacto-ovo vegetarians. D is incorrect. Pancakes would not violate any of these dietary restrictions. NCSBN client need: Topic: Psychosocial Integrity Subtopic: Religious and Spiritual Influences on Health Reference: Silvestri, L.; Saunders Comprehensive Review for the NCLEX-RN Examination, ed 6, St. Louis, 2014, Elsevier, p. 97
  • 93. Diet ordersNPO, clears, and more, oh my!
  • 94. NPO ● Nothing by mouth ● Pre-op ● Post-op before bowel sounds return
  • 95. Clear liquids ● Clear liquid diets consist of foods and liquids that are transparent to light and are liquid when at body temperature. ● This diet is best for patients who have not had oral intake for some time, and for the first time, a patient eats after complete bowel rest.
  • 96. Full liquids ● This diet is appropriate as a transition after a clear liquid diet for patients following surgery, but should not be the first diet ordered. ● Ice cream ● Strained soups ● Sherbet ● Milk ● Pudding ● Custards ● Refined cooked cereals ● Strained vegetable juices
  • 97. Mechanical soft ● Facilitate mastication ○ Patients without teeth ○ Jaw surgery or injuries ● Swallowing problems ● Dentition problems
  • 98. NCLEX Question While working in a post-operative unit, the nurse is assigned to take care of a 32-year-old who is post-op day one from an appendectomy. The patient has not eaten for the past three days and is asking when she will be allowed to have a meal again. Upon consulting with the interdisciplinary team, the provider decides it is time to place a diet order for your patient. Which diet does the nurse expect the provider will order? A. Full liquid diet B. Clear liquid diet C. Soft diet D. Mechanical diet
  • 99. Answer: B Correct Answer: B. A clear liquid diet is the most appropriate choice for this patient. Clear liquid diets consist of foods and liquids that are transparent to light and are liquid when at body temperature. This diet is best for patients who have not had oral intake for some time, and for the first time, a patient eats after complete bowel rest. A is incorrect. A full liquid diet is wrong. This diet is appropriate as a transition after a clear liquid diet for patients following surgery, but should not be the first diet ordered. C is incorrect. A soft diet is also wrong, as this is only indicated when patients have difficulty chewing or swallowing and need foods that are much easier to eat. D is incorrect. A mechanical diet is not appropriate for this patient. This diet consisted of foods that have been processed so that they do not require some or any chewing. It is used for patients with dental problems, surgeries to the head and neck, or other disorders that make chewing difficult or unsafe. NCSBN Client Need:
  • 100. NCLEX Question A post gastric bypass client has been advanced from a clear liquid diet to a full liquid diet. The client verbalized that he was happy about the diet change because he has been bored with the clear liquid diet. Which item should the nurse offer to the client that belongs to a full liquid diet? A. Gelatin B. Tea C. Custard D. Popsicle
  • 101. Answer: C Rationale: A full liquid diet includes food items such as plain ice cream, soups that are strained, sherbet, milk, pudding and custard, breakfast drinks, refined cooked cereals, and strained vegetable juices. A clear liquid diet, on the other hand, consists of relatively transparent foods. The food items in options A, B, and D are clear liquids and are, therefore, the incorrect answer. Custard is under the full liquid diet specification and is the correct answer. Source: Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
  • 103. NCLEX Question Select the diet that would most likely be ordered for a client who is edentulous. A. A low sodium diet to prevent edema and excessive fluid B. A mechanical soft diet to facilitate mastication C. A renal diet to prevent fluid retention and edema D. A high fiber diet to prevent constipation secondary to edema
  • 104. Answer: B B is correct. A mechanical soft diet to facilitate mastication would most likely be ordered for a client who is edentulous. This diet would help the client who is without teeth, or edentulous, to chew, or gnaw, their food with their gums. Other diets do not meet this nutritional and safe eating need. Choice A is incorrect. A low sodium diet to prevent edema and excessive fluid is indicated for clients affected with edema, renal disease, and heart disease, but not edentulous clients. Choice C is incorrect. A renal diet to prevent fluid retention and edema is indicated for clients affected with renal disease and kidney failure, but not edentulous clients. Choice D is incorrect. A high fiber diet is indicated for clients at risk for and constipated, but it is not indicated for clients who are edentulous. Reference: Knippa, Audrey, Sheryl Sommer, Brenda Ball et al. (2010) Nutrition for Nursing 4.0; ATI Nursing Education.
  • 105. NCLEX Question Select the therapeutic diet that is accurately paired with an indicator of it. A. The DASH diet: Heart failure B. A high fiber diet: Coronary artery disease C. Mechanical soft diet: Myocardial infarction D. A weight reduction diet: Heart disease
  • 106. Answer: B Choice B is correct. A high fiber diet and a low cholesterol diet are indicated for clients affected with coronary artery disease. The goal of the low cholesterol diet is to decrease the patient’s LDL level by limiting dietary cholesterol intake to less than 200 mg per day and the goal of a high fiber diet to lower LDL. Choice A is incorrect. The DASH diet is used for clients who are affected with hypertension rather than heart failure. The DASH diet consists of foods low in sodium, high in calcium and high in potassium. Choice C is incorrect. A mechanical soft diet is used for clients with swallowing and dentition problems rather than for clients who have had a myocardial infarction. Instead, clients who have had a myocardial infarction have a clear liquid diet for 24 hours post the event and then a diet without caffeine. Choice D is incorrect. A weight reduction diet is not necessarily indicated with clients affected with heart disease because many clients with heart disease may be of normal weight or underweight.
  • 107. NCLEX Question A client admitted due to emergent hypertension is about to be discharged. The nurse is giving instructions about dietary modifications. Which food choice by the client would indicate an accurate understanding of low fat, low cholesterol diet? A. Macaroni and cheese B. Fish and chips C. Turkey breast salad D. Pepperoni pizza
  • 108. Answer: C A is incorrect. Macaroni and cheese contain 8 grams of cholesterol and 5 grams of fat per 100-gram servings. B is incorrect. Fish and chips contain an average of 11.1 grams of fat per 100-gram serving. C is correct. Turkey breast contains 2.2 grams of saturated fats, 2.1 grams of polyunsaturated fats, and 2.6 grams of monounsaturated fats per 100 grams. It is also a high protein source `with 29 grams per 100 grams. D is incorrect. Pepperoni pizza contains 10 grams of fat per 100-gram serving. It is also high in saturated fat. Reference
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