A patient who is diabetic states that she is a "peanut butter freak." Which exchange would be equivalent to 2 tbsp peanut butter? 8 oz whole milk. 2 tbsp butter. 1/4 cup cottage cheese. 2 tbsp cream cheese. A diabetic diet is most often based on an exchange system. Foodstuffs in this system are divided into six types. Foods from within each list can be substituted for another in the same list because they have approximately the same food value. Peanut butter is in the meat exchange list, as is cottage cheese, and therefore these can be substituted for one another. Whole milk (Answer 1) is on the milk exchange list. Butter and cream cheese (Answers 2 and 4) are considered to be fats. Think "substitute" for a high-protein source. A patient is placed on an 1800-calorie diabetic diet; a typical lunch would include two meat exchanges, two bread exchanges, one vegetable exchange, one fruit exchange, one fat exchange, and one milk exchange. Given these allowances, which would be inappropriate for this patient to consume at a birthday luncheon? A piece of plain sponge cake. An 8 oz glass of Coca-Cola. A taco (tortilla, meat, cheddar cheese, lettuce). Avocado and orange salad. Given the patient's food allowances, all these foods (Answers 1, 3, and 4) would be allowed except for the Coca-Cola. All concentrated sweets and regular soft drinks are contraindicated on a diabetic diet. Try matching each exchange with the options—one will have no match. The question calls for what is not OK to eat. A patient has been placed on a high-protein diet. Which food would the nurse suggest this patient select? Rice (I cup). Eggnog (8 oz). Cheddar cheese (1 oz). Broccoli (1 cup). Eggs and milk are two sources of protein with the highest biological values (high-quality proteins). Eggnog (8 oz) contains 15 g protein. Rice (Answer 1) contains only 4 g, cheddar cheese (Answer 3) contains only 7 g, and broccoli (Answer 4) contains only 5 g. Meat, fish, and legumes contain more protein than does eggnog, but their percent of protein utilization is lower, making them almost equal in value to eggnog. With two possible choices, choose the one with more sources of protein (egg and milk). Which food would the nurse recommend be avoided by a patient experiencing dumping syndrome? Liver and bacon. Orange and avocado salad. Creamed chicken. Glazed donuts and coffee. Concentrated sugars and carbohydrates should be avoided by these patients. Likewise, fluid ingestion with meals or snacks should also be avoided to prevent rapid emptying of the stomach. Answers 1, 2, and 3 are examples of high-protein, high-fat, low-carbohydrate foods, which are appropriate. Know two things to avoid with meals— carbohydrates and fluids. Dietary restriction of protein in chronic renal failure is used to prevent the accumulation of nitrogenous wastes and resulting azotemia. Which food containing amino acids would be allowed in a diet for a patient with chronic renal failure? Roast beef. Milk and eggs. Chicken and turkey. Shellfish. The diet for patients with chronic renal failure is restricted in total amount of protein and amino acid content. Eggs and milk are generally included in the diet because they contain all the essential amino acids. Meats from animals (Answer 1), fowl (Answer 3), and fish (Answer 4) are restricted due to their sulfur-containing, nonessential amino acids. Know that an egg is considered a perfect protein, so it is often a correct choice. Which food may be more likely to cause discomfort in a patient with cholecystitis? Whole milk. Cottage cheese. Whole-grain breads. Eggs. Whole milk has a high fat content, so a patient with cholecystitis is generally advised to switch to low-fat or skim milk. Cottage cheese (Answer 2), whole-grain breads (Answer 3), and eggs (Answer 4) are allowed in a low-fat diet, although eggs may be limited to four per week. Look for the food that is not OK to have. Use a true-false approach option by option to find the item that is high fat and not OK to have. Which food should the nurse advise a patient with a colostomy to avoid? Carbonated drinks. Fresh-cooked green beans. Liver and bacon. Cooked cereals. Carbonated drinks, cabbage, sauerkraut, and nuts tend to increase flatulence, and most patients feel uncomfortable passing flatus into the colostomy bag, because it causes the bag to inflate. Onions, cheese, and fish may cause odorous drainage. Generally the initial diet following a colostomy is a low-fiber diet for several weeks. As the diet is increased, the individual patient can determine more accurately which foods cause constipation, diarrhea, flatus, or dyspepsia. Answers 2, 3, and 4 are not troublesome to most such patients. With diet and bowel disorders, look for causes of gas. A patient is a 30-year-old gravida 3 para 2 who is 4 weeks pregnant. She has been a vegetarian for 8 years. She eats no eggs or dairy products (vegan vegetarian). When assessing the adequacy of this patient's diet, to which food group would the nurse pay particular attention? Grains. Protein foods. Vitamin C—rich foods. Fruits and vegetables. Pregnant vegetarians who omit dairy foods may be unable to meet the requirement for an additional 30 g protein per day over their nonpregnant needs. Answer 1 is incorrect because individuals who have been vegetarians for some time usually have evolved diets adequate in grain intake. Answers 3 and 4 are incorrect because individuals who are vegan vegetarians usually ingest a wide variety of fruits and vegetables to meet pregnancy requirements for vitamin C, fiber, and other nutrients. Think about the food group for milk, dairy, and meat—protein. Recall protein requirements during pregnancy and lactation. A patient is a 17-year-old primigravida. At 30 weeks of gestation she is diagnosed with iron deficiency anemia. The patient takes her iron and vitamin supplements sporadically due to unacceptable GI side effects but eats many foods high in iron. In planning diet teaching which nutrient will the nurse emphasize to promote heme production? Niacin. Vitamin A. Vitamin D. Folic acid. Folic acid (folacin) is essential for increased heme production for hemoglobin and prevention of megaloblastic anemia. Answer 1 is incorrect because niacin has no direct or indirect role in erythropoiesis or heme production. Answer 2 is incorrect because vitamin A is essential for fetal bone growth and tooth development. Answer 3 is incorrect because vitamin D is essential for mineralization of bone tissue and calcium and phosphorus absorption. Know the nutritional benefit of common vitamins and minerals.