Exam 2: NR228 / NR 228 (Latest Update 2024/2025) Nutrition, Health & Wellness: |Complete Guide with Questions and Verified Answers| 100% Correct -Chamberlain
Exam 2: NR228 / NR 228 (Latest Update
2024/2025) Nutrition, Health & Wellness:
|Complete Guide with Questions and Verified
Answers| 100% Correct -Chamberlain
Q: Thiamine (B1) function
Answer:
Coezyme in energy metabolism. role in nerve function- ing related to muscle actions.
Q: Thiamine (B1) sources
Answer:
lean pork, whole or enriched grains and flours, legumes, seeds, and nuts
Refined flour and rice are thiamine enriched
Q: Thiamine (B1) Deficiency
Answer:
Psychologic distrubances, headaches, fatigue, irri- tability
Beriberi Ataxia and Tachycardia
Wernicke-Korsakoff syndrome – a cerebral form (chronic alcoholism)
Q: Riboflavin (B2)Function and sources
Answer:
Coenzyme in energy release milk is a major source, whole and enriched grains, meats, fish,
poultry, eggs, broccoli, dark leafy greens, asparagus
Q: Riboflavin (B2) deficiency
Answer:
Ariboflavinosis – Cheilosis (swollen lips; cracks in corner of mouth)
Glossitis: Toungue inflamed swollen, purple, red color seborrheic (scalp) dermatitis
Roboflaxin: Very sensitive, lost in cooking water.
Q: Niacin (B3) Function
Answer:
coenzyme for many enzymes, especially energy metab- olism; critical for glycolysis and
tricarboxylic acid (TCA) cycle
Q: Niacin (B3) Sources
Answer:
protein-containing foods (meats, poultry, fish, legumes, enriched cereals, milk, coffee, tea)
Q: Niacin (B3) deficiency
Answer:
pellagra: 3 Ds (Diarrhea, Dermatitis, Dementia) Risk Factor Alcoholism
Q: Pyridoxine (B6) Function
Answer:
Acts as a coenzyme in metabolism of amino acids and proteins
Necessary for hemoglobin synthesis
Required for conversion of trytophan to niacin coenzyme for fatty acid and carbohydrate
metabolism
Q: Pyridoxine (B6) sources
Answer:
widespread in foods, especially whole grains and cereals, legumes, chicken, fish, pork, and eggs
Q: Pyridoxine (B6) deficiency
Answer:
rare to occur alone; accompanies low intake of other B vitamins.
Dermatitis, altered nerve function, weakness, poor growth, convulsions, and micro- cytic anemia
Some drugs that affect the biovailability and metabolism: oral contraceptics, isoni- azid,
penicillamine, cycloserine, and hydralazine.
Q: Folate (B9) functions
Answer:
Coenzyme in one-carbon transfer during metabolism; Required for the synthesis of amino acids,
deoxyribonucleic acid (DNA), ribonucleic acid (RNA); Consists of the heme portion of
hemoglobin; Role in proper formation of fetal neural tubes, which affects brain and spinal cord
development; helps prevent spina bifida and anencephaly
Q: Folate (B9) Sources
Answer:
leafy green vegetables, legumes, some fruits, fortified cereal grains
Q: Folate (B9) deficiency
Answer:
megaloblastic anemia, glossitis, diarrhea, irritability, absent mindedness, depression, anxiety
Deficiency during pregnancy = increased risk for neural tube defects = increase from
400 to 600 during pregnancy)
May mak the presence of pernicious anemia
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Fat soluble vitamins
A, D, E, K
Risk for toxicity
Dependent on cellular process of absorption
They can be stored in the body as fat
Transportation, metabolization, and elimination are all steps in the process of moving.
Fat soluble vitamins to the cells
Unique characteristics of fat soluble vitamins
Absorved with lipids and high risk of toxicity
Vitamin A
ACtive form is called retinol, has a yellow color pigment.
Helped with the growth of teeth and bone
Boosts immune system
Keep cell healthy
help rods and cones in the eyes
decrease probability of skin cancer
Vitamin A Physiological actions:
maintains epithelial tissues (skin and mucous membranes)
formation of rhodopsin (purplish-red, light-sensitive pigment present in the retina) for vision
bone growth and reproduction
Vitamin A deficiency causes
Night blindness
Xerophthalmia
keratomalcia
blindness
Vitamin A is found in
Green, yellow and orange fruits and vegetables, broccoli and carrots and animal, milk and liver.
Vitamin A in excess may cause
Weakness, anorexia, vomiting, and an enlarged spleen and liver. However, toxicity is rare with healthy food consumption.
Vitamin D Physiological actions
regulates calcium and phosphorus
assists with bone mineralization and regulation of blood calcium levels
Vitamin D deficiency causes
rickets in children
osteomalacia in adults
Vitamin D toxicity manifests as
Hypercalcemia and hypercalciuria
Vitamins D comes from
Sun exposure
healthy diet and animal sources, such as butter, egg yolks, fatty fish, liver, and fortified milk.
Salmon, mackerel, eggs, sardines, caviar
Vitamin E Physiological actions
Protects cell walls
Antioxidant properities
Vitamins Deficiency causes
Primary deficiencies are rare.
Secondary deficiencies cause metabolic and neurological deficits.
Vitamin E can be found in
Foods such as plant-based vegetables oils, whole grains, seeds, nuts, and green, leafy vegetables.
Vitamin E toxicity
Are rare. Hovewer, supplement use is contraindicated with anticoagulant drugs (risk for bleeding)
Vitamin E Deficiency signs and symptoms
Anemia
Hair loos
Muscle weakness
Leg cramps
Cancer
Blindness
Dry skin
Fertility problems
immune impairment
Vitamin K Physiological actions
required for synthesis of prothrombin and other clotting factors (VII, IX, and X)
formation of protein
produced in the intestinal tract by bacteria
warfarin overdose (reversal agent used)
Vitamin K Deficiency causes
New born
Toxic levels of vitamin K
most often from injection reactions in infants, causing hemolytic anemia and hyperbilirubinemia.
Vitamin K sources
green, leafy vegetables, such as kale, collard greens, and spinach, and in green vegetables, such as broccoli, brussels sprouts, and asparagus. It is also produced in the intestinal tract by bacteria.
Fact about vitamin K
It is produced by our own intestinal bacteria, often in adequate amounts, as required for our metabolic needs. Therefore, supplement use is rarely needed
Thiamine (B1) function
Coezyme in energy metabolism. role in nerve functioning related to muscle actions.
Thiamine (B1) sources
lean pork, whole or enriched grains and flours, legumes, seeds, and nuts
Refined flour and rice are thiamine enriched
Thiamine (B1) Deficiency
Psychologic distrubances, headaches, fatigue, irritability
Beriberi Ataxia and Tachycardia
Wernicke-Korsakoff syndrome – a cerebral form (chronic alcoholism)
Riboflavin (B2)Function and sources
Coenzyme in energy release
milk is a major source, whole and enriched grains, meats, fish, poultry, eggs, broccoli, dark leafy greens, asparagus
Riboflavin (B2) deficiency
Ariboflavinosis – Cheilosis (swollen lips; cracks in corner of mouth)
Glossitis: Toungue inflamed swollen, purple, red color
seborrheic (scalp) dermatitis
Roboflaxin: Very sensitive, lost in cooking water.
Niacin (B3) Function
coenzyme for many enzymes, especially energy metabolism; critical for glycolysis and tricarboxylic acid (TCA) cycle
Niacin (B3) Sources
protein-containing foods (meats, poultry, fish, legumes, enriched cereals, milk, coffee, tea)
Niacin (B3) deficiency
pellagra: 3 Ds (Diarrhea, Dermatitis, Dementia)
Risk Factor Alcoholism
Pyridoxine (B6) Function
Acts as a coenzyme in metabolism of amino acids and proteins
Necessary for hemoglobin synthesis
Required for conversion of trytophan to niacin
coenzyme for fatty acid and carbohydrate metabolism
Pyridoxine (B6) sources
widespread in foods, especially whole grains and cereals, legumes, chicken, fish, pork, and eggs
Pyridoxine (B6) deficiency
rare to occur alone; accompanies low intake of other B vitamins.
Dermatitis, altered nerve function, weakness, poor growth, convulsions, and microcytic anemia
Some drugs that affect the biovailability and metabolism: oral contraceptics, isoniazid, penicillamine, cycloserine, and hydralazine.
Folate (B9) functions
Coenzyme in one-carbon transfer during metabolism;
Required for the synthesis of amino acids, deoxyribonucleic acid (DNA), ribonucleic acid (RNA); Consists of the heme portion of hemoglobin; Role in proper formation of fetal neural tubes, which affects brain and spinal cord development; helps prevent spina bifida and anencephaly
Folate (B9) Sources
leafy green vegetables, legumes, some fruits, fortified cereal grains
Folate (B9) deficiency
megaloblastic anemia, glossitis, diarrhea, irritability, absent mindedness, depression, anxiety
Deficiency during pregnancy = increased risk for neural tube defects = increase from 400 to 600 during pregnancy)
May mak the presence of pernicious anemia
Biotin (B7) function
important role in CHO, fat, and protein metabolism
Biotin (B7) sources
Richest sources are liver, kidney, peanut butter, egg yolks, and yeast
Biotin (B7) deficiency
Unknown if typical North American diet is consumed, but possible with intravenous feedings and long-term antibiotic use
Cobalamin (B12) Functions
Modifies folate coenzymes to active forms;
Required for metabolism of fatty acids and amino acids; Develops and maintains myelin sheaths around nerve fibers; Role in supporting functions such as DNA and RNA synthesis
Cobalamin (B12) Sources
Only animal derived foods (meat, fish, poultry, eggs, dairy)
Cobalamin (B12) deficiency
Usually, secondary; Lack of intrinsic factor may result in pernicious anemia; May result in megaloblastic anemia; Additional neurologic due to myelin sheath breakdown; Neuropsychiatric effects include delusions and hallucinations;
Vegetarians/vegans at risk
Older adults at risk; May be misdiagnosed as senility and masked by folate levels
Pantothenic Acid
Required for metabolism of carbohydrates, fats, and protein
Pantothemic acid source
widespread in foods, especially whole grain cereals, legumes, meat, fish, poultry
Pantothenic acid toxicity
May produce diarrhea or water retention
Choline function and sources
synthesis of acetylcholine (a neurotransmitter) and lecithin (the phospholipid)
Sources: Milk eggs, peanuts
Choline toxicity
sweating, fishy body odor, vomiting, liver damage, reduced growth, and hypotension
Vitamin C (ascorbic acid) Function
Antioxidant and coenzyme; Collagen formation (teeth and bones); Wound healing (new tissues require Vit C); As antioxidant, may prevent damage to vascular walls by free radicals, thereby limiting atherosclerosis; Enhances absorption of nonheme iron
Vitamin C (ascorbic acid) Sources
fruits and vegetables; include citrus fruits, red and green peppers, strawberries, tomatoes, potatoes, broccoli, green leafy vegetables, and fortified foods
Vitamin C deficiency symptoms
Scurvy: extreme vitamin C deficiency: gingivitis, joint and limb aches, bruising, hemorrhages, plaques, and death
Marginal deficiency: poor wound health, gingivitis, inadequate tooth and bone growth/ maintenance, increased risk of infection
Vitamin C toxicity
Chronic supplement megadose intake of 1 to 15 g may result in cramps, diarrhea, nausea, kidney stones, and gout and may interfere with action of anticlotting medication
sodium deficiency
Hyponatremia – Caused by dehydration or excessive diarrhea;
Symptoms
Muscle cramps, weakness, confusion, reduced ability to concentrate, memory loss, headache, and appetite loss
sodium toxicity
Hypernatremia – Hypertension and edema; Kidneys responsible for excess excretion
Potasium sources
unprocessed foods, potatoes, tomatoes, bananas, oranges, other fruits, vegetables, dairy products, legumes
Potassium deficiency
Hypokalemia – Causes: dehydration from vomiting or diarrhea, diuretics, and misuse of laxatives
Symptoms: muscle weakness, confusion, appetite loss, and, in severe cases, cardiac dysrhythmias
potassium toxicity
Hyperkalemia – Caused by dehydration or supplement use
Symptoms: muscle weakness, vomiting, and, at excessively high levels, cardiac dysrhythmia/arrest
Calcium function
Structure and storage (99% of calcium is in bones); 1% in body fluids; play a role in central nervous system function, muscle contraction & relaxation, blood clotting, & BP regulation
Calcium Sources
Dairy products (milk and milk-based products) not cottage cheese; Broccoli, kale, mustard greens
Small fish with small bones (canned salmon and sardines)
Fortified foods (soy milk, orange juice, tofu)
Legumes (navy beans are the highest)
Calcium deficiency
Reduced bone density
osteoporosis
Calcium Toxicity
Constipation; urinary stones; reduced iron and zinc absorption
Phosphorus functions
Bone and tooth formation; energy metabolism; acid-base balance
Phosphorus Source
widely available in foods, especially protein-rich foods;
Meat, fish, poultry, dairy, eggs, and cereal grains (also available in soda [the fizzy part])
phosphorus toxicity
Excessive phosphorus, usually from supplements, causes calcium excretion
Magnesium function
Structural and storage function in bones;
Regulates nerve and muscle function, including heart; Assists enzymes for many bodily functions’ Role in blood-clotting process and immune system
Magnesium Sources
unprocessed foods, whole grains, legumes, leafy green vegetables, broccoli, hard water
Magnesium deficiency
Usually due to secondary cause; Excessive vomiting and diarrhea;
Gastrointestinal disorder; Kidney disease; Alcoholism and malnutrition; Symptoms: muscle twitching, weakness, convulsion
Sulfur functions
Present in all cells and a component of protein structures
Sulfur sources
all protein containing foods
Chloride
Extracellular anion that maintains fluid inside and outside cells; Component of hydrochloric acid (HCL) in gastric juice
chloride toxicity
imbalance caused by dehydration
Chloride sources
Table salt and food with sodium
Iron Functions
Distributes oxygen in hemoglobin and myoglobin; growth
Iron sources
Heme source: meat, fish, poultry, egg yolks
Nonheme source: vegetables, legumes, whole grains, enriched grains
iron deficiency
Microcytic anemia (women & children at risk);
Dont take with Antacids and milk inhibit absorption
Iron toxicity
Hemosiderosis – iron builds up in the tissue’s; hemochromatosis
Vitamin C enhances absorption
Iodine function
Thyroxine synthesis regulates growth and development; regulation of BMR
Iodine Source
iodized salt, seafood
Iodine deficiency
Decreases thyroxine, causing sluggishness and weight gain, goiter, cretinism (if during pregnancy)
Iodine Toxicity
Thyrotoxicosis: iodine-induced goiter
Antioxidants
work against free radicals in our body and are believed to help decrease the risk of certain diseases, enhance health, and promote overall wellness. Antioxidants can protect against the cell damage that free radicals cause, known as oxidative stress.
Antioxidant vitamin A
may decrease the risk of various cancer-types and cardiovascular disease.
green, yellow, and orange fruit and vegetables, such as sweet potatoes, squash, broccoli and carrots
animal fat sources, such as whole milk and liver
Antioxidants Vitamin C
may decrease the risk of various cancer-types and cardiovascular disease.
Antioxidant Vitamin E
Vitamin E may decrease the risk of various cancer-types. It may prevent or delay cataracts.
Major Food Sources
plant-based vegetable oils
whole grains, seeds
nuts
green, leafy vegetables
Antioxidants: Selenium
Selenium prevents cellular and lipid damage.
Major Food Sources
meat
fish
eggs
whole grains
spinach
mushrooms
RDA: no more the 200ug
Factors that lead to oxydative stress
Smoking
Environmental pollution
Ischemia
Exposure to drugs
Processed foods
radiation
exposure to chemicals
Industrial solvents
Ozone
Food additives
Excessive exercise
People are at higuer risk factor for serious foodborne illnesses.
children under 5 years
adults aged 65 and older
people with weakened immune systems
pregnant women
BMI <18.5
underweight
BMI 18.5-24.9
normal weight
BMI 25-29.9
overweight
Undernutrition wasting
Low weight for height.
Caused by a lack of food or disease that cause diarrhea and weight loss.
Treatment is possible but there is a high chance of death
stunting
low height for age,
It is chronic undernutrition associated with poor socioeconomic, poor maternal health and nutrition, frequent illness, and/or inapropriate infant and young child feeding
It can be areson for physical and cognitive delays
The nurse midwife should refer which prenatal clients for nutritional counseling with a registered dietitian?
A client with obesity
Client with twin pregnancy
Client who identifies themselves as vegan
client with gestational diabetes
teach pregnant women about nutrition on this
Inrease protein requirements
Prenatal multivitamins and food high in: folate, B12, Iron,
Avoid: Raw foods
If the pregnant client is obese
Risk for
Preclampsia
Gestational diabetes
Cesarian delivery
Women >35 of age are at high risk for poor pregnancy outcome
-Nutritional evaluation
-Gestational diabetes
-Potential long-term use of oral contraceptives (may affect folate levels)
-Longer medical history
Adolescent Pregnancy
-Dietary factors
-Lack of economic resources
-Potential delay in seeking medical care
-Preoccupation of weight gain
-Psychologic maturity
Preclampsia
-Leading Cause of Prematurity, Maternal/Fetal Death
-Progress To Eclampsia/Seizures
Pregnancy concerns with diabetes mellitus
-Maternal Gestational Diabetes
‣Screening In Second Trimester
-Infant Macrosomia
-Infant Hypoglycemia
-Infant Hyperbilirubinemia