Download Chapter 08: Water and Minerals Grodner and Escott

Chapter 08: Water and Minerals
Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A
Nursing Approach, 6th Edition
MULTIPLE CHOICE
1. If a woman who drinks a cup of decaffeinated coffee in the morning, a cup of fruit juice with
lunch, 6 cups of water throughout the day and a cup of tea at bedtime, her fluid intake would
be considered
a. dangerously low.
b. below optimal.
c. optimal.
d. too high.
ANS: C
This woman’s total fluid intake for the day is 9 cups, the recommended amount for women.
Minimum fluid intake for health is around 4 cups; intake below this would be considered
dangerously low. Fluid intake can be too high, but the specific amount that causes water
intoxication is unknown.
DIF: Cognitive Level: Applying
REF: Page 130
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance
2. Having only softened tap water at home would be of most concern to a(n)
a. pregnant woman.
b. full-time student who also works part-time.
c. elderly woman with osteoporosis.
d. retired man with hypertension.
ANS: D
Softened water has relatively high levels of sodium, which exacerbates hypertension in
salt-sensitive individuals. It is not ideal for anyone to drink softened water on a regular basis,
but it is of special concern for someone with hypertension. Someone who is retired is more
likely to drink beverages made with tap water at home. An elderly woman with osteoporosis
would benefit from the calcium in hard water, but this is less of a concern. A student who is
gone at work or school most of the day would not consume much of the softened tap water.
Sodium intake is not a specific concern in pregnancy.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
3. Interstitial fluid is the body fluid
a. within the cells.
b. outside the cells.
c. between the cells.
d. in the bloodstream.
ANS: C
REF: Page 130
MSC: Client Needs: Health promotion and maintenance
Interstitial fluid is the body fluid between the cells. The fluid within the cells is intracellular
fluid; the fluid outside the cells is extracellular fluid; the fluid in the bloodstream is blood
plasma.
DIF: Cognitive Level: Remembering
TOP: Nursing Process: Assessment
REF: Page 131
MSC: Client Needs: Physiological integrity
4. Dehydration is most likely to have a negative effect on
a. digestion of food.
b. storage of excess energy.
c. nerve impulse conduction.
d. body temperature regulation.
ANS: D
Within the body, water helps to regulate body temperature by absorbing and distributing heat
throughout the body and through perspiration. Digestion of food requires secretion of
digestive fluids, but this is less immediately affected by dehydration. Water is not needed to
store excess energy in adipose tissue. Water is not important for this conduction of nerve
impulses.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Pages 131-132
MSC: Client Needs: Physiological integrity
5. It would be most difficult for the body to maintain homeostasis if over several days someone
had an inadequate intake of
a. calcium.
b. sodium.
c. iron.
d. fluoride.
ANS: B
Homeostasis is maintenance of physiologic equilibrium within the body. All of these minerals
help maintain homeostasis, but inadequate intake of sodium over just a few days would have
the most effect. Sodium is an electrolyte and is important for maintaining fluid balance in the
body. If calcium intake is inadequate, the body can draw on reserves in bone; if iron intake is
inadequate, the body has some reserves in the spleen, and so body homeostasis would not be
affected unless the deficiency continued long term. Fluoride deficiency may cause dental
caries and may affect bone density, but this is also a long-term effect and would not affect the
body over a few days.
DIF: Cognitive Level: Applying
REF: Page 133 | Page 138 | Page 142 | Page 147 | Page 151
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological integrity
6. If an athlete ran a marathon, sweated profusely, and drank only water with some sugar to
replace fluids and carbohydrate, his or her body would increase secretion of
a. adrenaline.
b. aldosterone.
c. alanine.
d. antidiuretic hormone (ADH).
ANS: B
The body would respond to loss of sodium in sweat by releasing the hormone aldosterone; this
would prompt the kidney to decrease sodium excretion. During a marathon, the body may
produce adrenaline in response to stress, but this would not address the problem of fluid and
energy replacement without sodium replacement. Alanine is an amino acid and has no effect
on sodium balance. ADH causes the kidneys to decrease water excretion but does not affect
sodium excretion.
DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Assessment
REF: Page 133
MSC: Client Needs: Physiological integrity
7. If a patient complained of muscle weakness, confusion, decreased appetite, and irregular
heartbeat, it would be important to check blood levels of
a. sodium.
b. calcium.
c. potassium.
d. magnesium.
ANS: C
These symptoms are typical of a possible blood potassium level that is either too low or too
high; both conditions can be very dangerous. Low sodium levels cause headache, muscle
cramps, weakness, reduced ability to concentrate, and loss of memory and appetite; high
sodium levels may cause edema and hypertension. High calcium levels cause weakness, lack
of energy, poor appetite, nausea and vomiting, constipation, or bone pain; low blood calcium
levels cause muscle cramps, spasms, and twitching and tingling in the fingers and around the
mouth. Symptoms of magnesium deficiency include twitching of muscles, muscle weakness,
and convulsions; symptoms of magnesium overload are long-term diarrhea and dehydration.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Page 143 | Pages 145-146
MSC: Client Needs: Physiological integrity
8. In an older adult who is usually very alert, disorientation may be a sign of
a. iron deficiency.
b. malnutrition.
c. edema.
d. dehydration.
ANS: D
Disorientation may be a sign of dehydration, which is common in older adults, partly because
their thirst mechanism is diminished. Iron deficiency anemia causes fatigue but not
disorientation. Severe malnutrition may affect mental acuity but is less likely than dehydration
to cause acute disorientation. Edema causes swelling but does not usually affect orientation.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Pages 133-134 | Pages 148-149
MSC: Client Needs: Physiological integrity
9. If an elderly client who lives alone and has a limited income has edema, it would be important
to evaluate his or her dietary intake of sodium and
a. protein.
b. calcium.
c. chloride.
d. potassium.
ANS: A
Edema may be caused by high intake of sodium or inadequate intake of protein if protein
levels in the body become so low that cellular fluid levels become imbalanced. Edema is not
related to dietary intake of calcium, chloride, or potassium.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Page 144
MSC: Client Needs: Physiological integrity
10. The term bioavailability means the
a. total amount of a mineral in a food.
b. ratio of free mineral to bound mineral in a food.
c. amount of a mineral that is excreted by the body.
d. amount of a mineral that can be absorbed by the body from a food.
ANS: D
Bioavailability is the amount of a mineral that can be absorbed by the body from a food. It is
generally lower than the total amount of the mineral in a food. It may be related to the ratio of
free mineral to bound mineral in a food, but that is only one of many factors affecting
bioavailability. It is not related to the amount excreted by the body.
DIF: Cognitive Level: Understanding
REF: Page 136
MSC: Client Needs: Physiological integrity
TOP: Nursing Process: Planning
11. Long-term dietary calcium intake has the greatest effect on
a. body temperature.
b. muscular strength.
c. bone calcium levels.
d. blood calcium levels.
ANS: C
Long-term dietary calcium intake affects bone calcium levels. Calcium does not affect body
temperature. The body maintains steady levels of calcium in the blood and muscles, using
calcium from bone if dietary intake is insufficient.
DIF: Cognitive Level: Understanding
TOP: Nursing Process: Assessment
REF: Pages 138-142
MSC: Client Needs: Physiological integrity
12. If people want to maximize their absorption of calcium, they should avoid drinking
a. tea.
b. milk.
c. orange juice.
d. bottled water.
ANS: A
Tea contains oxalic acid and tannins, both of which decrease absorption of calcium. Milk
contains lactose and vitamin D, which increase calcium absorption. Orange juice and bottled
water do not have a significant positive or negative effect on calcium absorption.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Planning
REF: Pages 140-142
MSC: Client Needs: Health promotion and maintenance
13. Lifestyle changes that may help prevent development of osteoporosis include
a. reducing intake of animal protein.
b. eating a piece of fruit with lunch every day.
c. taking a daily multivitamin supplement with adequate amounts of calcium and
vitamin D.
d. taking a 30-minute walk most days.
ANS: D
Taking a 30-minute walk most days may help prevent development of osteoporosis because
regular exercise stimulates an increase in bone density. Eating vegetable versus animal
protein, increasing intake of fruit, and use of multivitamin supplements with adequate
amounts of calcium and vitamin D are unlikely to prevent osteoporosis (although they may
have other health benefits).
DIF: Cognitive Level: Applying
TOP: Nursing Process: Planning
REF: Pages 140-142
MSC: Client Needs: Health promotion and maintenance
14. An example of a food with high levels of phosphorus is
a. rice.
b. carrots.
c. cheese.
d. bananas.
ANS: C
Foods high in phosphorus include dairy foods (such as cheese). Many processed convenience
foods and soft drinks also contain phosphorus as additives. Fruits, vegetables, and rice are not
good sources of phosphorus.
DIF: Cognitive Level: Applying
REF: Pages 142-143 | Page 147
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
15. A good source of calcium for someone who follows a strict vegetarian (i.e., vegan) diet would
be
a.
b.
c.
d.
coconut milk.
a bean burrito.
skim milk.
pasta salad.
ANS: B
A good vegan source of calcium is a bean burrito because legumes contain calcium. Coconut
milk and pasta salad are not good sources of calcium. Skim milk is not included in a vegan
diet.
DIF: Cognitive Level: Applying
REF: Pages 138-142 | Page 147
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance
16. Secondary magnesium deficiency is most likely to occur in
a. areas where access to fresh fruits and vegetables is limited.
b. clients with type 1 diabetes mellitus.
c. association with excessive vomiting and diarrhea.
d. association with dehydration attributable to heat exposure.
ANS: C
Secondary magnesium deficiency may occur with excessive vomiting and diarrhea. Primary
magnesium deficiency is rare; deficiency is not usually related to poor intake, and fruits and
vegetables are not the only good sources of magnesium. Type 1 diabetes and dehydration due
to heat exposure do not cause magnesium deficiency.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Pages 133-134 | Page 143 | Page 147
MSC: Client Needs: Physiological integrity
17. Of the following, the food choice that contains the least sodium is
a. cornbread.
b. corn tortilla.
c. corn on the cob.
d. buttered popcorn.
ANS: C
The food choice that contains the least sodium is corn on the cob. Of all these forms of corn,
this is the least processed. Food processing usually involves addition of sodium.
DIF: Cognitive Level: Applying
REF: Pages 144-145
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance
18. A sodium intake of 2100 mg daily by a healthy adult would be considered
a. below the adequate intake (AI).
b. within the recommended range.
c. below the maximum recommended level.
d. above the maximum recommended level.
ANS: C
A sodium intake of 2100 mg daily is below the maximum level recommended by the National
Research Council (2400 mg/day) and the American Heart Association (2300 mg/day). The AI
is 1500 mg. There is no recommended range for sodium intake, just the AI and upper limits.
DIF: Cognitive Level: Applying
REF: Pages 144-145
TOP: Nursing Process: Assessment| Nursing Process: Evaluation
MSC: Client Needs: Health promotion and maintenance
19. A family with three young children has limited income, relies on public transportation, and
has just moved into a very old apartment complex with old plumbing and lead pipes. The best
recommendation to minimize lead exposure would be to
a. use only bottled water.
b. run the tap water for 2 minutes before using it.
c. boil the tap water for 2 minutes before using it.
d. use only hot water for drinking, cooking, and preparing food.
ANS: B
The best recommendation would be to run the tap water for 2 minutes before using it, so that
any water sitting in the pipes that may have absorbed lead would not be used. Using bottled
water is not practical for a family with limited income who uses public transportation. Boiling
the water would not remove the lead and would actually concentrate it. Hot water would
dissolve more lead; in fact, only cold water should be used.
DIF: Cognitive Level: Analyzing
REF: Page 130
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance
20. If someone took a 6-hour car ride in an air-conditioned vehicle without making any bathroom
stops, they weigh less at the end of the trip than at the beginning because
a. of insensible fluid losses from the skin and lungs.
b. body fat stores would be metabolized for energy.
c. muscle mass would be lost.
d. fluid would be lost through sweating.
ANS: A
Even in an air-conditioned vehicle, the body still loses fluid through the skin and lungs. The
person would not lose significant amounts of sweat in an air-conditioned vehicle. A small but
fairly insignificant amount of body fat would be metabolized. Muscle mass would be lost only
if the driver were inactive or had low protein or carbohydrate intake over several days.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Page 132
MSC: Client Needs: Physiological integrity
21. The main reason that young women require more dietary iron than young men is
a. that they absorb iron less efficiently.
b. to compensate for their lower muscle mass.
c. to replace blood losses during menstruation.
d. that they recycle hemoglobin more rapidly.
ANS: C
Young women require more dietary iron than young men to replace blood losses during
menstruation. There is no difference between iron absorption or hemoglobin recycling in
young men versus young women. Higher iron intake does not compensate for lower muscle
mass in women.
DIF: Cognitive Level: Understanding
REF: Pages 148-149
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Physiological integrity
22. The most easily absorbed form of iron is found in
a. a grilled pork chop.
b. tomatoes cooked in an iron skillet.
c. collard greens cooked with bacon.
d. spinach salad with strawberries.
ANS: A
Heme iron is absorbed most easily; it is found in animal foods, such as pork. Cooking an
acidic food such as tomatoes in an iron skillet would increase the iron content, but the iron
would be nonheme, which is less well absorbed than heme iron. Similarly, the vitamin C in
the strawberries would increase the absorption of the iron in the spinach, but it is still the
nonheme form that is less well absorbed. Bacon may contribute a very small amount of heme
iron to the collard greens, but it would be much less than the pork chop.
DIF: Cognitive Level: Applying
REF: Page 148
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance
23. The first signal that the body needs fluid is
a. dark, concentrated urine.
b. the sensation of hunger.
c. the sensation of thirst.
d. headache.
ANS: C
The body signals its need for fluid via the sensation of thirst, a dryness in the mouth. Dark,
concentrated urine also indicates a need for fluid, and headache may also be caused by
dehydration, but these symptoms occur later than thirst, at a time when the body’s need for
fluid is much greater. Hunger is a signal that the body needs food, not fluid.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Page 133
MSC: Client Needs: Health promotion and maintenance
24. Hemosiderosis, storage of too much iron in the body, is most likely to occur in a(n)
a. man who drinks five or more alcoholic beverages every night.
b. adolescent who drinks four or more soft drinks daily.
c. toddler who prefers drinking milk to eating meals.
d. pregnant woman who takes iron supplements.
ANS: A
Hemosiderosis is most likely to occur in a man with high alcohol intake. Adolescents who
have high intake of soft drinks are likely to have high intake of phosphorus. Toddlers who
prefer to drink milk rather than eating meals may develop iron deficiency. Pregnant women
who take iron supplements are unlikely to store too much iron because iron needs are very
high during pregnancy.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Page 143 | Pages 148-150
MSC: Client Needs: Physiological integrity
25. In countries where the staple food source is unleavened bread made from whole grains, zinc
deficiency may be prevented by eating
a. refined grains.
b. breads with yeast.
c. fortified grains.
d. bread in which the grains were soaked before being baked.
ANS: B
Zinc deficiency may be prevented by making breads with yeast; the yeast breaks the bond
between the zinc and phytic acid, which prevents zinc from being absorbed. Eating refined
grains would result in even lower zinc intake; fortification of grains does not include adding
zinc; and soaking grains before making bread does not release the zinc from the phytic acid.
DIF: Cognitive Level: Applying
REF: Page 150
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance
26. The most reliable source of iodine in the United States is
a. seafood.
b. dairy products.
c. fortified table salt.
d. residues of cleaning products.
ANS: C
The main source of iodine in the United States is fortified table salt. Seafood is a good source,
but most Americans do not eat it often enough for it to be their main source of iodine. Dairy
products may contain some iodine, depending on the animal that produced them, but they are
not reliable sources. Residues of cleaning products may provide some dietary iodine, but the
amount is not usually enough to be significant.
DIF: Cognitive Level: Applying
REF: Pages 150-151
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
27. A client feels constantly tired even though she is getting 8 hours of sleep each night, and she
is gaining about 2 lbs a month even though she has not changed her eating habits. You
discover that she eats only organic and natural foods and avoids anything that is fortified. She
may have a deficiency of
a. iron.
b. zinc.
c. potassium.
d. iodine.
ANS: D
Deficiency of iodine causes lethargy and weight gain; the most reliable source of iodine is
iodized salt, but if the client avoids fortified foods, she may be avoiding this valuable source.
Iron deficiency would cause anemia and tiredness, but not weight gain. Deficiency of zinc
impairs growth, reduces appetite, and causes immunologic disorders. Deficiency of potassium
causes muscle weakness, confusion, decreased appetite, and, in severe cases, cardiac
dysrhythmias. Foods are not usually fortified with iron, zinc, and potassium, and so avoiding
fortified foods would not necessarily affect intake of these nutrients.
DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Assessment
28. Dietary fluoride is important for
a. decreasing staining of teeth.
b. decreasing sensitivity of teeth.
c. stimulating production of saliva.
REF: Page 146 | Pages 148-150
MSC: Client Needs: Physiological integrity
d. increasing the strength of tooth enamel.
ANS: D
Dietary fluoride is important for the strength of tooth enamel. It does not decrease staining or
sensitivity of teeth or stimulate production of saliva.
DIF: Cognitive Level: Remembering
REF: Page 173
TOP: Nursing Process: Assessment| Nursing Process: Planning
MSC: Client Needs: Physiological integrity
29. Measuring the amount of a mineral in a plant food may not necessarily indicate whether it is a
valuable dietary source of that mineral because
a. plant foods contain phytates, oxalates, and binders that reduce bioavailability.
b. plant foods require cooking or processing to make minerals bioavailable.
c. plants often contain inactive forms of minerals.
d. the amount of minerals in plants varies widely, depending on growing conditions.
ANS: A
Plant foods contain phytates, oxalates, and binders that may limit the amount of a mineral that
is available to the body, even if it is present in the food. Minerals may become more
bioavailable with cooking or processing, but this is not necessarily true. Most minerals do not
exist in different forms; they are generally either present or absent. The amount of minerals in
plants may vary somewhat depending on the growing conditions, but this is less of a factor
than bioavailability.
DIF: Cognitive Level: Applying
REF: Page 136
MSC: Client Needs: Physiological integrity
TOP: Nursing Process: Planning
30. Wilson’s disease is an inherited disorder that causes excessive accumulation of
a. iron.
b. zinc.
c. copper.
d. chromium.
ANS: C
Wilson’s disease causes excessive accumulation of copper. Excessive accumulation of iron is
called hemosiderosis. Excessive accumulations of zinc and chromium do not have specific
names.
DIF: Cognitive Level: Remembering
TOP: Nursing Process: Assessment
REF: Page 149 | Pages 152-153
MSC: Client Needs: Physiological integrity
31. A good dietary source of chromium is
a. pasta.
b. grapes.
c. oatmeal.
d. cauliflower.
ANS: C
Oatmeal is a good dietary source of chromium because it is a whole grain. Good sources do
not include refined grains (such as pasta), fruits, and vegetables.
DIF: Cognitive Level: Applying
REF: Page 152
TOP: Nursing Process: Planning| Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance
32. Apart from lowering dietary sodium intake, a dietary change that is most likely to help
decrease high blood pressure levels is
a. decreasing intake of dairy products.
b. increasing intake of vegetable protein.
c. increasing intake of calcium and potassium.
d. replacing saturated fats with polyunsaturated fats.
ANS: C
Dietary changes that may help decrease high blood pressure include increasing intake of
calcium and potassium. This could be accomplished by increasing, rather than decreasing,
intake of dairy products. Intake of vegetable versus animal protein and replacing saturated fats
with polyunsaturated fats do not decrease blood pressure, although these changes may have
other health benefits.
DIF: Cognitive Level: Analyzing
REF: Page 138 | Pages 146-147
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance
33. A wife who blames her high blood pressure on her husband’s preference for salty foods is an
example of
a. denial.
b. chaining.
c. reframing.
d. projection.
ANS: D
A wife who blames her high blood pressure on her husband’s preference for salty foods is an
example of projection. She is projecting her unhealthy behaviors on her husband instead of
taking responsibility for her own health. Denial would be ignoring the problem. Chaining
would be associating one behavior with another. Reframing would be replacing negative
expectations and associations with positive ones.
DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
REF: Pages 153-154
MSC: Client Needs: Physiological integrity