Nutrition – RN Flashcards

Flashcards for NCLEX-RN level review of nutrition. Cover the answer, recall it, then check.

Macronutrients and Micronutrients

How many calories per gram do carbohydrate, protein, fat, and alcohol supply?

Carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g.

What is the baseline adult protein requirement, and how does it change with major wounds, burns, or sepsis?

About 0.8 g/kg/day at baseline, rising to roughly 1.2 to 2.0 g/kg/day with major wounds, burns, sepsis, or trauma.

Which nutrients are most critical for wound healing?

Protein for collagen synthesis, vitamin C for collagen cross-linking, vitamin A for epithelialization, zinc for cell proliferation, and adequate total calories so protein is not burned for energy.

Which vitamins are fat soluble, and what is the clinical implication?

A, D, E, and K. They are stored in liver and adipose tissue, so deficiency develops slowly, toxicity is possible with megadoses, and absorption fails in fat malabsorption, cholestasis, cystic fibrosis, and after bariatric surgery.

Why must thiamine be given before or with glucose in a client with chronic alcohol use disorder?

Glucose metabolism consumes thiamine. Administering glucose to a thiamine-depleted client can precipitate acute Wernicke encephalopathy, presenting with confusion, ataxia, and ophthalmoplegia.

What distinguishes B12 deficiency anemia from folate deficiency anemia?

Both cause megaloblastic, macrocytic anemia, but only B12 deficiency produces neurologic findings such as paresthesias, ataxia, and loss of proprioception. Treating with folate alone corrects the anemia while neurologic damage progresses.

Which common medications cause long-term vitamin B12 deficiency?

Metformin and proton pump inhibitors, along with any condition removing intrinsic factor or the terminal ileum, such as gastrectomy, pernicious anemia, and ileal resection.

What increases and what decreases non-heme iron absorption?

Vitamin C increases it. Calcium, dairy, antacids, tea, coffee, and phytates in whole grains decrease it. Heme iron from meat, poultry, and fish is absorbed best overall.

Assessment and Laboratory Values

Which serum protein best reflects short-term response to nutrition support, and why?

Prealbumin (transthyretin), normal 15 to 36 mg/dL, because its half-life is only 2 to 3 days. Albumin has a half-life of 18 to 21 days and reflects long-standing status and inflammation.

Why can albumin be misleading as a nutrition marker?

Albumin is a negative acute phase reactant. It falls with inflammation, infection, liver disease, nephrotic syndrome, and fluid overload, and rises with dehydration, independent of nutritional intake.

What magnitude of unintentional weight loss indicates significant malnutrition?

More than 5 percent of body weight in one month, or more than 10 percent in six months.

How should daily weights be obtained, and how does weight relate to fluid?

Same time each day, same scale, same clothing, after voiding, usually before breakfast. One kilogram of change equals approximately one liter of fluid, or about 2.2 pounds per liter.

What are the BMI categories?

Underweight below 18.5, normal 18.5 to 24.9, overweight 25.0 to 29.9, obesity 30.0 and above. BMI is unreliable with edema, ascites, high muscle mass, and sarcopenia.

Therapeutic Diets

How does protein prescription differ before dialysis versus on hemodialysis?

Restricted to roughly 0.6 to 0.8 g/kg/day before dialysis to limit nitrogenous waste, then increased to about 1.2 g/kg/day once dialysis begins because amino acids are lost into the dialysate.

Why must phosphate binders be taken with meals?

They bind dietary phosphorus within the gastrointestinal lumen so it is excreted in stool. Taken between meals, there is no dietary phosphorus present and the drug is ineffective.

Why are salt substitutes dangerous for certain clients?

They are potassium chloride. They can cause life-threatening hyperkalemia in clients with chronic kidney disease or those taking ACE inhibitors, angiotensin receptor blockers, or potassium-sparing diuretics such as spironolactone.

Name high-potassium foods a renal client should limit.

Bananas, oranges and orange juice, potatoes, tomatoes and tomato products, avocado, spinach, melons, dried fruit, legumes, nuts, and salt substitutes.

Contrast the fiber prescription for diverticulitis and diverticulosis.

Diverticulitis (acute inflammation) requires a low-residue, low-fiber diet during the flare, with advancement to high fiber after resolution. Diverticulosis requires a high-fiber diet to prevent future flares.

What dietary changes manage dumping syndrome?

Small frequent meals, high protein, moderate fat, low simple carbohydrate, fluids between meals rather than with meals, and reclining for 20 to 30 minutes after eating.

Which grains must be eliminated in celiac disease, and which are safe?

Eliminate wheat, rye, and barley. Safe options include rice, corn, quinoa, buckwheat, millet, amaranth, sorghum, and certified gluten-free oats. Cross-contamination from shared equipment is a common cause of persistent symptoms.

Is protein restricted in cirrhosis with hepatic encephalopathy?

No. Blanket protein restriction is outdated and worsens sarcopenia. Adequate protein and calories are provided, with sodium and often fluid restricted for ascites, and encephalopathy managed with lactulose and rifaximin.

How is hypoglycemia treated in a conscious client, and why does alcohol matter?

Rule of 15: 15 g of fast-acting carbohydrate, recheck in 15 minutes, repeat if still below 70 mg/dL, then a protein and carbohydrate snack if the next meal is more than an hour away. Alcohol without food suppresses hepatic gluconeogenesis and causes delayed hypoglycemia.

Enteral Nutrition

What is the gold standard for verifying initial placement of a blindly inserted feeding tube?

Radiographic confirmation before the first use. Auscultating an injected air bolus is unreliable and no longer recommended. Ongoing checks use the external tube marking, measured tube length, and gastric aspirate.

What is the most important aspiration precaution during enteral feeding?

Keeping the head of the bed elevated 30 to 45 degrees during the feeding and for at least 30 to 60 minutes afterward.

What is the nursing priority if a tube-fed client coughs, becomes dyspneic, and desaturates?

Stop the feeding immediately, turn the client to the side, suction, apply oxygen, assess breath sounds and saturation, and notify the provider. A chest radiograph follows.

How should feeding tubes be flushed, and what should never be used?

Water, roughly 30 mL, before and after each feeding and each medication, between medications, every 4 hours during continuous feeding, and after any interruption. Cranberry juice and cola are ineffective and worsen clogging.

Which medication formulations must never be crushed for tube administration?

Enteric-coated, sustained-release, and extended-release products, because crushing destroys the release mechanism and delivers the full dose at once. Use a liquid or an immediate-release alternative instead.

What causes diarrhea in a tube-fed client, and how is it approached?

Rapid infusion rate, hyperosmolar formula, cold formula, sorbitol-containing or hyperosmolar liquid medications, antibiotic-associated Clostridioides difficile, and low-fiber formula. Slow the rate, warm the formula to room temperature, review medications, evaluate for infection, and consider a fiber-containing formula.

When is post-pyloric (nasoduodenal or nasojejunal) feeding preferred?

With gastroparesis, high aspiration risk, persistent high gastric residuals, and pancreatitis. Post-pyloric feeding must be continuous, because the small bowel has no reservoir capacity for boluses.

Parenteral Nutrition

Why does TPN require central venous access?

TPN is hypertonic, typically more than 10 percent dextrose and above roughly 900 mOsm/L. Given peripherally it causes severe phlebitis and vein destruction. A high-flow central vein dilutes it rapidly.

What happens if TPN is stopped abruptly, and what should the nurse do?

Rebound hypoglycemia occurs because circulating endogenous insulin remains elevated. Taper the rate rather than stopping, and if the bag is empty or unavailable, hang 10 percent dextrose in water at the same rate and notify the provider.

Why is TPN never sped up to catch up a delayed infusion?

A sudden dextrose bolus causes hyperglycemia, osmotic diuresis, and dehydration. The rate is maintained as ordered and the provider is notified if a significant volume is missed.

What are the key TPN infection control measures?

Strict aseptic technique, a dedicated lumen, an in-line filter, an infusion pump, bag and tubing changed every 24 hours, no bedside additives, and site assessment every shift. New fever in a client on TPN is a catheter-related bloodstream infection until proven otherwise.

What are the signs and immediate management of venous air embolism?

Sudden dyspnea, chest pain, hypotension, tachycardia, and sometimes a churning precordial murmur. Clamp the catheter, place the client in left lateral Trendelenburg position, administer 100 percent oxygen, and call for help.

What is refeeding syndrome and what is its hallmark laboratory finding?

A dangerous intracellular shift of electrolytes when nutrition is reintroduced to a starved client. The hallmark is hypophosphatemia, accompanied by hypokalemia, hypomagnesemia, and thiamine depletion, which can cause dysrhythmias, heart failure, respiratory failure, seizures, and death.

How is refeeding syndrome prevented?

Identify at-risk clients (anorexia nervosa, chronic alcohol use, prolonged fasting or NPO status, cachexia, malabsorption), start at low calorie loads and advance over several days, replace thiamine before feeding, correct electrolytes before and during initiation, and monitor phosphorus, potassium, magnesium, cardiac rhythm, and fluid status closely.

Lifespan and Interactions

Why is folic acid recommended before conception rather than after pregnancy is confirmed?

The neural tube closes by about day 28 of gestation, usually before pregnancy is recognized. Recommended intake is 400 mcg/day for anyone capable of pregnancy and 600 mcg/day during pregnancy.

What two foods are absolutely avoided in the first 12 months of life, and why?

Honey, because of the risk of infant botulism, and cow's milk, because it causes occult gastrointestinal blood loss, is low in iron, and imposes an excessive renal solute load.

Why is dehydration the most common fluid disorder in older adults?

Thirst sensation is blunted with aging, renal concentrating ability declines, total body water is lower, and mobility, continence concerns, and cognition further limit intake. Offer fluids on a schedule rather than waiting for the client to request them.

What is the teaching point for a client on warfarin regarding vitamin K?

Keep vitamin K intake consistent rather than eliminating it. Sudden increases lower the INR and raise clot risk; sudden decreases raise the INR and bleeding risk.

Which foods cause hypertensive crisis with monoamine oxidase inhibitors?

Tyramine-containing foods: aged cheeses, cured and smoked meats, fermented soy products such as soy sauce and miso, tap and draft beer, red wine, sauerkraut, and overripe or fermented fruit.

Why does grapefruit juice matter clinically?

It inhibits intestinal CYP3A4, raising serum levels of many statins, several calcium channel blockers, and some immunosuppressants, producing toxicity at ordinary doses.

Which drugs must be separated from calcium, iron, magnesium, and antacids?

Tetracyclines, fluoroquinolones, and levothyroxine, all of which form insoluble chelates. Levothyroxine is taken on an empty stomach 30 to 60 minutes before breakfast.

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