Chapter 10: Nutrition Across The Life Span My Nursing Test Banks

Chapter 10: Nutrition Across The Life Span

Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. A pregnant client complains of constipation during pregnancy. This is probably caused by

a.

inadequate intakes of dietary fiber and fluids.

b.

reduced activity levels as body size increases.

c.

increased levels of the hormone estrogen.

d.

increased levels of the hormone progesterone.

ANS: D

During pregnancy, increased progesterone levels cause relaxation of smooth muscle, which slows intestinal transit and may cause constipation. Estrogen levels also increase but do not cause constipation. Increases in fiber and fluid intake may help relieve constipation, but low intake is not the primary cause during pregnancy. Similarly, reduced levels of physical activity may exacerbate constipation but are not the primary cause.

DIF: Cognitive Level: Applying REF: Pages 188-189 | Page 198

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2. If a woman has had preeclampsia and hypertension in a previous pregnancy, then during this pregnancy she should

a.

restrict her sodium intake.

b.

continue her regular sodium intake.

c.

restrict her protein intake.

d.

take iron and calcium supplements.

ANS: B

It is dangerous to restrict sodium intake during pregnancy; sodium restriction can reduce plasma volume and cardiac output. Therefore, a woman with preeclampsia and hypertension should continue her regular sodium intake. She should follow a well-balanced diet, including plenty of protein to replace urinary losses, and receive adequate vitamins and minerals. She should not restrict protein intake, and iron and calcium supplements are not generally recommended.

DIF: Cognitive Level: Applying REF: Page 189 | Pages 195-196

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3. For a woman with a healthy prepregnancy weight, gaining a total of 31 pounds throughout pregnancy would be considered

a.

too low for a healthy pregnancy.

b.

too high for a healthy pregnancy.

c.

within the current recommended range for weight gain.

d.

within the current recommended range for weight gain for a woman experiencing gestational diabetes.

ANS: C

The recommended range of weight gain by a woman with a healthy weight before pregnancy is 25 to 35 pounds. Weight gain recommendations for women with gestational diabetes are the same as those for women without this condition and are based on prepregnancy weight.

DIF:Cognitive Level: ApplyingREFages 189-190

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4. If an obese woman is 6 months pregnant and has gained about 8 lbs so far, her health care provider should recommend that she

a.

try to maintain her current weight throughout the rest of her pregnancy.

b.

continue to gain weight at about the same rate throughout the pregnancy.

c.

increase her weight gain to achieve weight gain in the recommended range.

d.

plan food choices carefully and gradually lose weight during pregnancy.

ANS: B

For an obese woman, the recommended amount of weight gain in the second and third trimesters of pregnancy is 11 to 20 lb. When 6 months pregnant, the woman is at the end of the second trimester and so should have gained about half of this amount, 5.5 to 10 lbs. Her 8-lb weight gain is within this range, and so she should continue to gain weight at about the same rate throughout her pregnancy. It is unsafe to attempt to lose weight during pregnancy, and even maintaining her current weight may indicate that she is ingesting insufficient nutrients to support a healthy pregnancy.

DIF:Cognitive Level: ApplyingREFages 189-192

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5. The nutrient that pregnant women are most likely to need to take in the form of a supplement is

a.

iron.

b.

calcium.

c.

protein.

d.

vitamin C.

ANS: A

Pregnant women need almost twice as much iron as nonpregnant women because of the expansion in maternal red blood cell volume and to supply the needs of the developing fetus. This amount is hard to achieve without use of a supplement; it cannot easily be achieved simply with a well-balanced diet. Pregnant women absorb more of their dietary calcium, and so the amount they need to ingest does not increase. Increased protein needs are easily met by typical diets. Vitamin C needs increase slightly, but the higher amount can be obtained easily from a well-balanced diet.

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6. The health care provider would be most concerned if a pregnant woman told him or her that she

a.

has to taste wines to pair with foods for catering events.

b.

has cravings for salty snacks throughout the day.

c.

follows a vegan pattern of eating.

d.

lost 40 lb during the year before she became pregnant.

ANS: A

There is no safe level of alcohol consumption during pregnancy; therefore, a job that requires tasting alcoholic beverages would be a major concern. The client could be encouraged to taste wines but spit them out instead of swallowing them. Excessive salt intake is not wise, but moderate sodium intake is not a problem during pregnancy, and salt restriction can be dangerous. Well-planned vegan diets can support a healthy pregnancy; vegan mothers need supplemental vitamin B12, iron, and possibly other nutrients. Weight loss before the pregnancy is likely to have a positive effect on health outcomes, as long as nutrient intake is adequate.

DIF: Cognitive Level: Analyzing REF: Pages 188-190 | Page 194

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7. If a woman in her last trimester of pregnancy has marked edema, what else should be evaluated?

a.

Body temperature and hematocrit

b.

Blood and urinary glucose levels

c.

Blood pressure and urine protein levels

d.

Sodium intake and urinary sodium excretion

ANS: C

Edema in late of pregnancy may be a sign of preeclampsia; hypertension and proteinuria would confirm this diagnosis. Sodium intake and excretion, blood and urinary glucose levels, body temperature, and hematocrit are not usually related to edema in pregnancy.

DIF:Cognitive Level: ApplyingREFages 195-196

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8. Recommendations for treatment of gestational diabetes include

a.

weight loss.

b.

dietary control.

c.

avoidance of sugar.

d.

oral diabetes medication.

ANS: B

Gestational diabetes is generally treated through dietary control and moderate exercise. These measures help regulate weight gain; weight loss is not recommended during pregnancy. Dietary control may include limiting sugar intake, but sugar need not be avoided completely. If gestational diabetes cannot be controlled through diet and exercise, insulin may be used, but oral diabetes mediations are not used during pregnancy.

DIF:Cognitive Level: UnderstandingREFage 196

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9. The best way for a nursing mother to increase her milk supply is to

a.

nurse her infant more often and for longer periods of time.

b.

provide supplemental formula to allow milk reserves to build.

c.

drink lactogenic herbal teas that stimulate milk production.

d.

drink extra milk and add extra servings of dairy products.

ANS: A

Nursing the infant more often and for longer periods of time stimulates milk production. Providing supplemental formula will actually decrease milk production. Lactogenic herbal teas may increase milk production slightly, but it is important to check their safety with a physician. Extra milk and dairy products do not increase milk supply.

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10. The most potentially harmful situation for an infant is

a.

breastfeeding during the day and bottle-feeding at night.

b.

running out of infant formula and using whole milk for a few days instead.

c.

breastfeeding by a mother who is being treated with antibiotics.

d.

breastfeeding by a mother who gained less weight than is recommended during pregnancy.

ANS: B

Whole milk used instead of infant formula is harmful to infants. The protein and sodium levels are too high, and the increased renal solute load may cause dehydration. Levels of several other nutrients are also inadequate. A routine of breastfeeding during the day and bottle-feeding at night is less ideal than exclusive breastfeeding, but it is acceptable. Antibiotic use is not necessarily a contraindication to breastfeeding; mothers should check with the pharmacist to make sure the particular antibiotic they are using is safe. Gaining too little weight during pregnancy may affect a mothers ability to produce milk, but adequate lactation may still be possible if dietary intake is adequate.

DIF:Cognitive Level: AnalyzingREFages 200-202

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11. A meal that a family should not share with their 10-month-old infant is

a.

meatloaf and mashed potatoes.

b.

refried beans and cheese.

c.

peanut butter and honey sandwich.

d.

baked fish and butternut squash.

ANS: C

Ten-month-old infants can eat most soft foods but should not be given pieces of a peanut butter and honey sandwich because honey may cause infantile botulism and peanut butter can be a choking hazard.

DIF:Cognitive Level: ApplyingREFages 202-203

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12. To prevent baby bottle tooth decay in infants who need a bottle at bedtime, the bottle should not contain

a.

fruit juice.

b.

beverages sweetened with sugar.

c.

any liquid other than water.

d.

iron-fortified infant formula.

ANS: C

Baby bottle tooth decay is caused when infants go to sleep with bottles containing any liquids that contain sugar or other nutrients, including formula, breast milk, fruit juice, or other sweetened beverages. If they are put to bed with a bottle, it should contain only water.

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13. The best way to encourage children to consume adequate nutrients with less than 30% of kilocalories from fat is to

a.

avoid fast food and fried foods.

b.

follow a vegan eating pattern.

c.

provide low-fat foods and a vitamin or mineral supplement.

d.

include plenty of fruits, vegetables, and whole grains.

ANS: D

Children should be provided with a diet that includes plenty of fruits, vegetables, and whole grains to help them consume adequate nutrients with less than 30% of kilocalories from fat. It is not necessary to avoid fat food and fried foods completely, although they should be eaten in moderation. A vegan eating pattern may not provide adequate amounts of iron, zinc, vitamin B12, and other important nutrients found in lean meats and low-fat dairy products. Low-fat processed food products can help limit fat intake, but a vitamin or mineral supplement does not compensate for omitting fruits, vegetables, and whole grains.

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14. If a 2-year-old is drinking four 8-oz cups of milk daily, he or she is probably drinking

a.

too little milk to provide sufficient calcium for the growing skeleton.

b.

approximately the right amount of milk to meet nutrient needs.

c.

approximately the right amount of milk, if the child is at a healthy weight.

d.

too much milk, which may displace other important foods from the diet.

ANS: D

Children aged 1 to 3 years should drink two to three 8-oz cups of milk per day. Therefore, four cups of milk is probably too much and may displace other important foods from their diet.

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15. A mother of a toddler tells you that her child drinks several cups of fruit juice each day. How would you respond?

a.

It is important to decrease juice intake because high potassium intake can be dangerous for young children.

b.

Even though fruit juice contains some micronutrients, intake should be limited because it also has high levels of natural sugar.

c.

As long as the juice is 100% real fruit juice, this is a good way to increase intake of fruits and micronutrients.

d.

Drinking juice is healthful as long as the child has adequate intake of foods from all the food groups.

ANS: B

Excessive juice intake may displace more nutrient-dense foods from the diet because it provides kilocalories with few nutrients. Even 100% real fruit juice has high levels of natural sugar. If intake of foods from other food groups is adequate, the childs energy intake may be too high. The amount of potassium in juice is not harmful.

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16. If a child does not like a food when he or she tries it for the first time, the

a.

childs preference should be respected, and the child should not be encouraged to try it again.

b.

child should be offered a reward if he or she eats a reasonable amount of the food.

c.

child should be encouraged to eat at least five bites to see whether his or her taste buds adjust.

d.

child should be offered the food at least 8 to 10 times at other meals before he or she decides whether he or she likes it.

ANS: D

Children often need to be exposed to new food 8 to 10 times before they will accept them. Rewarding children for eating foods and forcing them to eat specific amounts do not usually encourage acceptance. They should be offered the food again because one time is not sufficient to determine food preferences.

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17. The child most likely to develop type 2 diabetes is the one who

a.

is obese.

b.

is malnourished.

c.

has multiple food allergies.

d.

lives in a low-income household.

ANS: A

Type 2 diabetes is strongly associated with obesity. Malnutrition, food allergies, and poverty do not generally contribute to type 2 diabetes.

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18. An example of a breakfast that would meet the School Breakfast Program requirements would be

a.

scrambled egg, bacon, toast, and orange juice.

b.

cold breakfast cereal with milk, toast with honey.

c.

toast with peanut butter, banana, and milk.

d.

turkey sausage, hash browns, ketchup, and milk.

ANS: C

School Breakfast Program requirements indicate that a breakfast must include a serving of milk, a serving of fruit, and two servings consisting of meat or bread and cereal. Toast (bread serving), peanut butter (meat serving), banana (fruit serving), and milk (milk serving) meets this requirement. A meal of scrambled egg (meat serving), bacon (meat serving), toast (bread serving), and orange juice (fruit serving) is missing milk. A meal of cold breakfast cereal (bread serving), milk (milk serving), and toast with honey (bread serving) is missing fruit. A meal of turkey sausage (meat serving), hash browns with ketchup (vegetable serving), and milk (milk serving) is missing a serving of meat or bread.

DIF:Cognitive Level: ApplyingREFage 211

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19. The person who is most likely to have an inadequate calcium intake is a(n)

a.

school-age child who receives free school breakfast and lunch.

b.

toddler who prefers to drink milk rather than eat meals.

c.

adolescent boy who plays varsity football.

d.

adolescent girl who is a competitive gymnast.

ANS: D

Calcium intake is a concern for teenage girls because their intake of calcium-rich foods is often inadequate; this is especially true of girls engaged in sports such as gymnastics, who may try to limit their food intake to maintain a competitive weight. Adolescent girls and boys have the same calcium needs, but adolescent boys are more likely to have adequate intake because they eat more food; this is especially true for boys involved in sports such as football, who tend to eat large amounts of food. A toddler who drinks milk rather than eating food would have a good calcium intake but may have an inadequate iron intake. A school-aged child who receives free school breakfast and lunch would receive milk with both meals and so would be less likely to have an inadequate intake of calcium.

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20. The best way to reduce the risk of asphyxiation (choking) in toddlers is to make sure that they

a.

drink plenty of fluids with meals.

b.

avoid conversation during meals.

c.

sit down while eating and chew foods well.

d.

eat with utensils rather than with their fingers.

ANS: C

Toddlers may choke if they are too active while they are eating or if they do not chew foods properly. Therefore, sitting down while eating and chewing foods well can help prevent choking. Drinking plenty of fluids with meals will not necessarily prevent choking. Conversation should be encouraged during meals to help create a relaxed family atmosphere and to slow the pace of eating. Eating with utensils rather than fingers is not related to a risk of choking.

DIF:Cognitive Level: RememberingREFages 213-214

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21. Lead poisoning may be diagnosed at the same time as

a.

food allergies.

b.

anorexia nervosa.

c.

iron deficiency anemia.

d.

vitamin D and calcium deficiencies.

ANS: C

Lead poisoning is associated with iron-deficiency anemia, and the two may be diagnosed at the same time. Lead poisoning is not related to food allergies, anorexia nervosa, or vitamin D deficiencies. Lead poisoning may be related to calcium deficiency, but this is less obvious than iron deficiency.

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22. The lifestyle factor that would contribute most to a childs becoming overweight is

a.

attending after-school daycare.

b.

trading foods at lunchtime with friends.

c.

being raised by one or more grandparents.

d.

being home alone after school every day.

ANS: D

Many factors contribute to overweight in children. Being home alone after school every day is associated with using food as comfort and sedentary activities. After-school daycare programs are likely to provide appropriate snacks and opportunities to be active. Being raised by grandparents is not necessarily related to obesity, and trading foods at lunchtime with friends would not necessarily increase energy intake.

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23. Interventions for obese children should focus on

a.

gradual weight loss.

b.

low-fat food choices.

c.

healthy lifestyle behaviors.

d.

increased physical activity.

ANS: C

Interventions for obese children should focus on healthy lifestyle behaviors, including eating habits and activity patterns. These may include low-fat food choices and increasing physical activity, but factors contributing to obesity must be evaluated and addressed for the specific child. Gradual weight loss is not the goal. As lifestyle habits improve, a child may lose weight or maintain a fairly constant weight as height increases until he or she reaches a healthy weight for height.

DIF: Cognitive Level: Understanding REF: Page 215 TOP: Nursing Process: Planning

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24. An example of a child who is at high risk for iron deficiency anemia is the child

a.

who has allergies to milk and nuts.

b.

who lives in an African American low-income family.

c.

whose parents work full time.

d.

who eats most food away from home.

ANS: B

Iron-deficiency anemia is associated with poverty and malnutrition and is most common in African American, Hispanic American, and Native American families. A child with allergies to milk and nuts may have low intake of calcium but would probably not have low intake of iron. Working parents and eating food away from home are not known to be related to iron-deficiency anemia.

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25. As adults age, they are likely to want to add _____ to their food.

a.

less salt

b.

more salt

c.

fewer salt substitutes

d.

more salt substitutes

ANS: B

As adults age, they are likely to want to add more salt to their food. This is to compensate for their diminished sense of taste as a result of loss of taste buds. Some older adults may choose to use salt substitutes to avoid using excess sodium; however, the use of such substitutes is not widespread.

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26. Protein needs continue to increase until about age 24 years because

a.

height continues to increase.

b.

lean body mass continues to increase.

c.

protein metabolism becomes less efficient.

d.

higher protein intake prevents conversion of muscle to body fat.

ANS: B

Protein needs continue to increase until about age 24 years because lean body mass continues to increase in both men and women. This increase in lean body mass is not necessarily accompanied by an increase in height. Efficiency of protein metabolism is not diminished at this age. Exercise, rather than higher protein intake, prevents conversion of muscle to body fat.

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27. One way a 50-year-old individual can help maintain lean body mass and minimize increases in body fat is to

a.

engage in regular exercise, including strength training.

b.

use stress-reduction strategies, such as massage therapy.

c.

ensure that the diet includes adequate amounts of high-quality protein.

d.

decrease energy intake to prevent weight gain.

ANS: A

Middle-aged adults can help maintain their lean body mass and minimize increases in body fat by exercising regularly and including strength training. Stress reduction may help with other aspects of health, but not with maintaining lean body mass and controlling body fat. Adequate amounts of high-quality protein will not maintain lean body mass without regular exercise. Decreasing energy intake will help prevent increases in body fat but will not help maintain lean body mass.

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28. In comparison with the iron needs of younger women, those of older women

a.

decrease because of slower turnover of red blood cells.

b.

decrease because of menopause.

c.

increase because iron absorption becomes less efficient.

d.

increase because oxygen use is less efficient.

ANS: B

Older women require less dietary iron than do younger women because they do not lose iron with menstrual blood losses after menopause. Red blood cell turnover does not change with age. The oxygen-carrying ability of hemoglobin and myoglobin does not change with age. Iron absorption may decrease slightly with age, but iron needs are still lower for older women.

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29. If an older adult is confused, he or she may have a deficiency of

a.

iron.

b.

zinc.

c.

water.

d.

protein.

ANS: C

Confusion in older adults is often caused by dehydration (i.e., deficiency of water). Deficiency of iron may cause anemia and tiredness, deficiency of zinc may cause poor wound healing and changes in taste acuity, and deficiency of protein may cause weakness and loss of lean body mass.

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30. An older adults nutritional status may decline if he or she has arthritis because

a.

arthritis is associated with loss of appetite.

b.

the ability to prepare food may be impaired.

c.

taste changes may cause food to be unappetizing.

d.

arthritis causes an increase in protein and nutrient requirements.

ANS: B

Arthritis causes joint stiffness and pain that may make it difficult for older adults to prepare food. Arthritis does not affect appetite, sense of taste, or protein and nutrient requirements.

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31. The best way for older adults who live in cold climates to meet their increased need for vitamin D is to

a.

increase their skin exposure to sunlight.

b.

increase their intake of vitamin Dfortified dairy products.

c.

take vitamin D supplements.

d.

increase their intake of fatty fish.

ANS: C

Older adults living in cold climates usually need supplements of vitamin D. In cold climates, increasing skin exposure to sunlight is not realistic. Increasing intake of vitamin Dfortified dairy products and fatty fish would increase vitamin D intake somewhat but would be unlikely to result in intake that meet the DRI.

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32. If an older adult has lost several teeth and complains that foods are bitter or tasteless, he or she may have a deficiency of

a.

zinc.

b.

iron.

c.

vitamin C.

d.

vitamin B12.

ANS: A

Inadequate zinc intake decreases sensitivity of taste receptors. This is especially likely to occur in someone who has lost teeth because he or she may find it difficult to chew meat and other foods that are good sources of zinc. Inadequate intake of iron and vitamin B12 is associated with anemia. Inadequate intake of vitamin C causes poor wound healing.

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33. An example of someone who is at high risk for malnutrition and weight loss is a(n)

a.

21-year-old student who works part time.

b.

36-year-old single mother with three children.

c.

57-year-old man who is unemployed.

d.

88-year-old widow who lives alone.

ANS: D

Elderly adults, especially those who live alone, are at high risk for malnutrition and weight loss because of low income, physical difficulties with shopping and preparing food, and lack of social interaction at meal times. Students, single mothers, and unemployed men could have some risk factors for malnutrition if they are busy, depressed, or lacking income, but malnutrition is less common in these groups than among older adults.

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34. In adults older than 80, the greatest dietary concern is

a.

preventing weight gain.

b.

increasing lean body mass.

c.

maintaining adequate nutritional status.

d.

preventing coronary heart disease and cancer.

ANS: C

The greatest dietary concern for adults older than 80 is maintaining adequate nutritional status to promote optimal health and quality of life. At this age, weight gain is rarely a problem. It is possible but unlikely for them to increase their lean body mass. Preventing coronary heart disease and cancer is less of a concern at this age; in fact, too much concern about healthy eating can result in inadequate dietary intake.

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35. An appropriate way to maintain a healthy body weight includes

a.

eating only at set mealtimes.

b.

learning to respond to actual hunger cues.

c.

counting calories to restrict energy intake.

d.

avoiding foods that have high levels of fat and added sugar.

ANS: B

An important strategy for maintaining a healthy body weight is learning to respond to actual hunger cues, eating when hungry, and stopping when full. It is not necessary to restrict meals to set times. Counting calories may be successful but is not a realistic long-term strategy. Limiting foods that have high levels of fat and added sugar may help decrease kilocalorie intake, but it is not necessary to avoid them altogether.

DIF: Cognitive Level: Applying REF: Page 221 TOP: Nursing Process: Planning

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36. The person most likely to be eligible for the Supplemental Nutrition Assistance Program (SNAP) is a

a.

55-year-old single man who earns minimum wage.

b.

college student who works part time.

c.

single mother with three children who works part time.

d.

pregnant woman with gestational diabetes.

ANS: C

SNAP provides coupons that people with low incomes can use to buy food. Eligibility is based on income, economic resources, and family size. A single mother with three children who works part time is most likely to be eligible. Complications of pregnancy do not affect eligibility. A single man who earns minimum wage and a college student who works part time are less likely to have incomes below the required percentage of the poverty level.

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37. The program that would be most helpful for a lonely 75-year-old widow who has been gradually losing weight since her husbands death is the _____ Program.

a.

Senior Nutrition

b.

Emergency Food Assistance

c.

Supplemental Nutrition Assistance

d.

Child and Adult Care Food

ANS: A

The Senior Nutrition Program provides inexpensive meals, education, and socialization for all adults aged 60 and older. It does not specifically target disabled, low-income, or socially isolated adults. The Emergency Food Assistance Program supplements the dietary intake of low-income households through the distribution of basic commodities. The Supplemental Nutrition Assistance Program provides coupons to boost the food-purchasing power of low-income families. The Child and Adult Care Food Program provides meals and snacks to senior citizens who participate in qualified daycare programs.

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38. After going through menopause, a woman may need to pay extra attention to her food and activity habits because she is now at increased risk for

a.

osteoporosis.

b.

type 2 diabetes.

c.

bronchial asthma.

d.

iron deficiency anemia.

ANS: A

After menopause, decreased estrogen levels cause loss of bone density, which leads to osteoporosis. Risk of type 2 diabetes increases with age, especially if weight increases, but is not specifically related to menopause. Asthma is not related to menopause. Iron deficiency anemia decreases after menopause because blood is no longer lost in menstruation.

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39. Alcohol abuse is associated with poor nutritional status because

a.

alcohol intake increases basal metabolic rate.

b.

alcoholic beverages displace healthful foods from the diet.

c.

alcohol increases the desire for foods with high levels of fat and sugar.

d.

people with alcoholism often eat in bars that serve a limited number of foods.

ANS: B

Alcohol provides kilocalories but no nutrients, and it depresses appetite, which reduces intake of healthful foods. Alcohol affects nutrient absorption, metabolism, and excretion, but not basal metabolic rate. It does not increase the desire for foods with high levels of fat and sugar. Many people with alcoholism drink at home and so are not limited to foods served in bars.

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40. An example of rationalizing is

a.

restricting food intake by rationing food.

b.

coping with stress by using biofeedback techniques.

c.

identifying emotional triggers for eating.

d.

using a busy schedule to justify poor food choices.

ANS: D

Rationalizing applies reasonable explanations to behaviors: for example, using a busy schedule to justify poor food choices. Rationing food is an example of restrained eating. Coping with stress using biofeedback techniques and identifying emotional triggers for eating are useful behavioral techniques that can help promote health.

DIF:Cognitive Level: ApplyingREFages 222-223

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity

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