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Chapter 07: Vitamins

Terms in this set (2)

1. A secondary deficiency of a vitamin occurs when

a. dietary intake of two or more vitamins is inadequate.
b. absorption is inadequate or excessive amounts are excreted.
c. dietary intake is less than the physiologic need of the individual.
d. the vitamin deficiency is accompanied by protein-energy malnutrition.

ANS: B
Secondary deficiency of a vitamin occurs when absorption is inadequate or excretion is excessive. Inadequate dietary intake of two or more vitamins causes multiple primary deficiencies. Dietary intake below physiologic needs is primary deficiency. Vitamin deficiency almost always occurs when an individual has protein-energy malnutrition.

DIF: Cognitive Level: Knowledge REF: Page 123
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

2. An example of someone who has a relatively high risk for vitamin deficiencies is a(n)

a. teenage competitive athlete.
b. elderly man living independently.
c. college-age girl living with roommates.
d. newborn breastfed infant.

ANS: B
Subgroups of the population at risk for vitamin deficiencies include older adults because of decreased vitamin absorption and limited physical and economic resources to purchase and prepare food. Teenage athletes and college students usually consume enough food to ensure adequate vitamin intake. Vitamin deficiencies are rare among breastfed newborn infants.

DIF: Cognitive Level: Application REF: Page 123
TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance

3. Deficiencies are likely to develop most rapidly with low intakes of vitamin

a. A.
b. C.
c. D.
d. E.

ANS: B
Vitamin C is water soluble; vitamins A, D, and E are fat soluble. Deficiencies of water-soluble vitamins develop more rapidly because they are not stored in the body.

DIF: Cognitive Level: Application REF: Page 125
TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance

4. The best way to ensure intake of a variety of phytochemicals is to

a. take a daily multivitamin supplement that includes phytochemicals.
b. increase intake of soy-based foods, such as soy milk, tofu, and soy flour.
c. choose whole grains and include at least five servings of fruits and vegetables daily.
d. include at least three servings of dairy products daily and use a variety of herbs and spices.

ANS: C
The best way to ensure intake of a variety of phytochemicals is to eat a variety of plant-based foods, including whole grains, fruits, and vegetables. Multivitamin supplements do not necessarily contain phytochemicals. Soy-based foods contain only a limited selection of phytochemicals. Dairy products do not contain phytochemicals; herbs and spices may provide some but are used in small quantities and so would not provide significant amounts.

DIF: Cognitive Level: Application REF: Pages 125, 127
TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

5. The amount of thiamine that the body needs is related to

a. dietary intake of protein.
b. exposure of the skin to sunlight.
c. the amount of energy expended.
d. physiologic and emotional stress.

ANS: C
Thiamine needs are related to metabolic rate (i.e., energy expenditure) because thiamine is a coenzyme in energy metabolism. Thiamine is not directly involved in protein metabolism. The vitamin where requirements are inversely related to skin exposure to sunlight is vitamin D. Physiologic and emotional stress do not affect thiamine needs.

DIF: Cognitive Level: Application REF: Page 127
TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

6. Deficiency of thiamine is characterized by

a. muscle weakness, loss of coordination, and tachycardia.
b. dermatitis, altered nerve function, and convulsions.
c. skin rash, hair loss, loss of appetite, and depression.
d. gingivitis, poor wound healing, and increased risk of infection.

ANS: A
Symptoms of deficiency of thiamine include muscle weakness, loss of coordination, and tachycardia. Dermatitis, altered nerve function, and convulsions are symptoms of vitamin B6 deficiency. Skin rash, hair loss, loss of appetite, and depression are symptoms of biotin deficiency. Gingivitis, poor wound healing, and increased risk of infection are symptoms of vitamin C deficiency

DIF: Cognitive Level: Knowledge REF: Pages 127, 130, 134-136
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

7. The riboflavin in milk is protected by

a. pasteurization.
b. homogenization.
c. storing milk under refrigeration.
d. using nontransparent containers.

ANS: D
Riboflavin is destroyed by ultraviolet light, so it is protected by use of nontransparent containers. Pasteurization destroys pathogenic bacteria. Homogenization prevents separation of milk and cream. Refrigerated storage increases the shelf life of milk.

DIF: Cognitive Level: Application REF: Page 128
TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance

8. The most significant source of riboflavin in the United States is

a. milk.
b. eggs.
c. meats.
d. whole grains.

ANS: A
The most significant source of riboflavin in the United States is milk. Eggs, meats, and whole grains are all good but lesser sources of riboflavin.

DIF: Cognitive Level: Knowledge REF: Page 128
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Health promotion and maintenance

9. Historically, deficiency of niacin was sometimes misdiagnosed as

a. alcoholism.
b. mental illness.
c. viral infection.
d. iron deficiency anemia.


ANS: B
Niacin deficiency was sometimes misdiagnosed as mental illness because of it causes symptoms of dementia. Alcoholism may contribute to niacin deficiency. Niacin deficiency is not generally related to viral infection or iron deficiency anemia.

DIF: Cognitive Level: Knowledge REF: Page 129
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity

10. Niacin can be manufactured by the body from the amino acid

a. alanine.
b. arginine.
c. tryptophan.
d. phenylalanine.

ANS: C
Niacin can be manufactured by the body from tryptophan, but not from alanine, arginine, or phenylalanine.

DIF: Cognitive Level: Knowledge REF: Page 129
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Physiological integrity

11. Pyridoxine functions in the body as a coenzyme in metabolism of

a. fat.
b. protein.
c. carbohydrate.
d. energy.

ANS: B
The active form of pyridoxine, pyridoxal phosphate, functions in the body as a coenzyme in the metabolism of protein and amino acids. It is not involved in metabolism of fat, protein, or energy.

DIF: Cognitive Level: Knowledge REF: Page 130
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

12. A disorder in infants that is associated with inadequate intake of folate during pregnancy is

a. spina bifida.
b. cystic fibrosis.
c. Down syndrome.
d. macrocytic anemia.

ANS: A
Inadequate intake of folate during pregnancy is associated with spina bifida in infants. Cystic fibrosis and Down syndrome are genetic disorders. Macrocytic anemia is caused by an overt deficiency of folate, but is not usually found in infants in association with poor maternal intake during pregnancy.

DIF: Cognitive Level: Knowledge REF: Page 131
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

13. Adequate intake of folic acid is especially important for

a. competitive athletes.
b. infants and young children.
c. women of childbearing age.
d. pregnant and lactating women.

ANS: C
Adequate intake of folic acid is especially important for women of childbearing age because adequate folate status during the first month of pregnancy helps prevent neural tube defects (spina bifida). Pregnant and lactating women have higher folic acid needs than nonpregnant women, but it is important to encourage adequate folic acid intake in all women of childbearing age because neural tube defects occur very early in pregnancy, before most women even realize they are pregnant. Competitive athletes, infants, and young children do not have special needs related to folic acid.

DIF: Cognitive Level: Comprehension REF: Page 131
TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

14. An example of a high-folate meal is

a. fish, French fries, and coleslaw.
b. spinach salad with orange segments.
c. oatmeal with brown sugar and raisins.
d. pork chops with applesauce.

ANS: B


Good sources of folate include leafy green vegetables (including spinach), legumes, ready-to-eat cereals, and some fruits and juices (including orange). Fish, oatmeal, raisins, pork, and applesauce are not good sources of folate.

DIF: Cognitive Level: Application REF: Page 132
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Health promotion and maintenance

15. The type of anemia associated with folate deficiency is _____ anemia.

a. microcytic
b. pernicious
c. megaloblastic
d. iron deficiency
ANS: C
The type of anemia associated with folate deficiency is megaloblastic anemia. Microcytic anemia is associated with iron deficiency. Pernicious anemia is associated with vitamin B12 deficiency. Iron deficiency anemia is (as its name suggests) associated with deficiency of iron, not folate.

DIF: Cognitive Level: Knowledge REF: Pages 132-133, 169
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

16. The substance produced by the stomach that is necessary for absorption of cobalamin is

a. intrinsic factor.
b. pernicious factor.
c. hydrochloric acid.
d. pyridoxal phosphate.

ANS: A
The substance produced by the stomach that is necessary for absorption of cobalamin is intrinsic factor. Pernicious factor does not exist; pernicious anemia is caused by cobalamin deficiency. Hydrochloric acid is produced by the stomach, but is used to activate the enzyme pepsin (which helps digest proteins). Pyridoxal phosphate is the active form of pyridoxine or vitamin B6; it is not produced by the stomach or related to absorption of cobalamin.

DIF: Cognitive Level: Knowledge REF: Pages 51, 130, 133
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

17. Deficiency of vitamin B12 may cause damage to the

a. skin.
b. eyes.
c. heart.
d. nerves.

ANS: D
Deficiency of vitamin B12 may cause damage to the brain, optic nerves, and peripheral nerves. Vitamin B12 deficiency is not associated with damage to the skin, eyes, or heart.

DIF: Cognitive Level: Knowledge REF: Page 133
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
18. An example of a meal high in biotin is a

a. cheese and tomato sandwich.
b. roast beef and mustard sandwich.
c. peanut butter and jelly sandwich.
d. vegetarian sandwich with avocado and alfalfa sprouts.

ANS: C
The richest sources of biotin include liver, kidney, peanut butter, egg yolks, and yeast.

DIF: Cognitive Level: Application REF: Page 133
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Health promotion and maintenance

19. Pantothenic acid is required for

a. absorption of amino acids.
b. conduction of nerve impulses.
c. regulation of body temperature.
d. metabolism of carbohydrates, fats, and protein.

ANS: D
Pantothenic acid is part of coenzyme A, required for metabolism of carbohydrates, fats, and protein. It is not involved in absorption of amino acids, conduction of nerve impulses, or regulation of body temperature.

DIF: Cognitive Level: Knowledge REF: Page 134
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

20. Some choline can be synthesized by the body from

a. glycerol.
b. cholesterol.
c. tryptophan.
d. methionine.

ANS: D
The body can synthesize some choline from methionine, but not enough to meet the needs of the body. The body cannot synthesize choline from glycerol, cholesterol, and tryptophan.

DIF: Cognitive Level: Knowledge REF: Page 134
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

21. Vitamin C deficiency causes scurvy, which is characterized by

a. weakening of connective tissues.
b. diarrhea, dermatitis, and dementia.
c. degeneration of nerves and muscles.
d. iron deficiency anemia and weight loss.

ANS: A
Vitamin C deficiency causes breakdown of connective tissues. Diarrhea, dermatitis, and dementia are characteristic of niacin deficiency. Degeneration of nerves and muscles are not associated with deficiency of a specific vitamin. Vitamin C deficiency may be associated with iron deficiency anemia because vitamin C enhances absorption of nonheme iron. Vitamin C deficiency is not generally associated with weight loss.

DIF: Cognitive Level: Knowledge REF: Pages 134-136
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

22. Lifestyle behaviors that increase vitamin C requirements include

a. shift work.
b. vegan diet.
c. high fat intake.
d. smoking cigarettes.

ANS: D
Smokers require more vitamin C than nonsmokers. Shift work, vegan diet, and fat intake do not affect vitamin C needs.

DIF: Cognitive Level: Knowledge REF: Page 135
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

23. Vegetables are likely to be highest in vitamin C if they are

a. boiled.
b. canned.
c. stir-fried.
d. oven roasted.

ANS: C
Vegetables are likely to be highest in vitamin C if they are stir-fried. Heat destroys vitamin C, so cooking for the minimum amount of time preserves vitamin C. Vitamin C is water-soluble, so cooking methods that use water cause loss of vitamin C into the cooking liquid. Stir-frying cooks vegetables quickly without adding water. Boiling and canning both cause loss of vitamin C because of use of water. Oven roasting is a slow cooking method so more vitamin C is lost.

DIF: Cognitive Level: Application REF: Pages 135-136
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Health promotion and maintenance

24. Vitamin A may be obtained by the body from precursors called

a. calciferols.
b. carotenoids.
c. rhodopsins.
d. tocopherols.

ANS: B
The body can form vitamin A from carotenoids. Calciferols have vitamin D activity. Tocopherols have vitamin E activity. Rhodopsin is a substance formed from vitamin A in the retina.
DIF: Cognitive Level: Knowledge REF: Pages 136-141
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Physiological integrity

25. An eye disorder associated with vitamin A deficiency is

a. myopia.
b. retinopathy.
c. double vision.
d. xerophthalmia.

ANS: D
Vitamin A deficiency causes xerophthalmia. Myopia (near sight), retinopathy, and double vision are not related to vitamin deficiencies.

DIF: Cognitive Level: Knowledge REF: Pages 136-138
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

26. Vitamins that function as antioxidants in the body include

a. vitamins C and E.
b. vitamins D and K.
c. pyridoxine and biotin.
d. folate and vitamin B12.

ANS: A
The two vitamins that function as antioxidants in the body are vitamins C and E.

DIF: Cognitive Level: Knowledge REF: Pages 134, 139, 141, 143
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

27. The Adequate Intake (AI) for vitamin D increases in older adults because

a. their ability to absorb dietary vitamin D is diminished.
b. conversion of vitamin D to its active forms is less efficient.
c. their skin is less efficient in synthesizing vitamin D during sun exposure.
d. they require more vitamin D than younger adults to maintain bone health.

ANS: C
Older adults need more dietary vitamin D because their skin is less efficient in synthesizing vitamin D during sun exposure. Their ability to absorb vitamin D and convert vitamin D to its active form has less effect of vitamin D needs. They do not necessarily require more total vitamin D than younger adults for bone health; they need more from foods because their skin manufactures less.

DIF: Cognitive Level: Comprehension REF: Page 140
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

28. Symptoms of vitamin D toxicity include

a. lethargy and loss of coordination.
b. rickets, osteomalacia, and osteoporosis.
c. blistered skin, joint pain, and liver damage.
d. high levels of calcium in the blood and urine.

ANS: D
Vitamin D toxicity causes high levels of calcium in the blood and urine because vitamin D enhances calcium absorption. Lethargy and loss of coordination indicates thiamine deficiency. Rickets, osteomalacia, and osteoporosis indicate vitamin D deficiency (not toxicity). Blistered skin, joint pain, and liver damage are signs of vitamin A toxicity.

DIF: Cognitive Level: Knowledge REF: Pages 127, 140-141
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological integrity | Client Needs: Safe and effective care environment

29. Vitamin E requirements are related to intake of

a. protein.
b. vitamin C.
c. polyunsaturated fats.
d. monounsaturated fats.

ANS: C
Vitamin E needs are related to intake of polyunsaturated fats because vitamin E prevents their oxidation. Vitamin E needs are not related to intakes of protein, vitamin C, and monounsaturated fats.

DIF: Cognitive Level: Knowledge REF: Page 141
TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

30. An example of a meal high in vitamin K is

a. grilled shrimp with rice and green beans.
b. eggs, bacon, and hash browns.
c. stir fried beef with broccoli.
d. bacon, lettuce and tomato sandwich.

ANS: C
The best source of vitamin K is green leafy vegetables, such as broccoli. Dairy products, meats, cereals, and fruit provide smaller amounts.

DIF: Cognitive Level: Application REF: Page 142
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Health promotion and maintenance

31. Long-term antibiotic use may be associated with vitamin K deficiency because antibiotics

a. prevent absorption of vitamin K.
b. kill gut bacteria that synthesize vitamin K.
c. break down dietary vitamin K in the intestines.
d. impair blood clotting and increase vitamin K requirements.

ANS: B
Antibiotics kill gut bacteria that synthesize vitamin K, so long-term use of antibiotics may cause vitamin K deficiency. Antibiotics do not interfere with vitamin K absorption, break down dietary vitamin K in the intestines, impair blood clotting, or increase vitamin K requirements.

DIF: Cognitive Level: Application REF: Page 142
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Physiological integrity

32. The first step to ensuring adequate intake of vitamins is to

a. use a daily multivitamin supplement.
b. increase fortification of key foods in the food supply.
c. target specific supplements for specific subgroups of the population.
d. ensure that the diet includes a variety of foods from all of the food groups.

ANS: D
The best way to ensure adequate intake of vitamins is to start with a diet that includes a variety of foods from all the food groups. Reliance on supplements and food fortification do not result in an overall optimal diet. Use of supplements by specific subgroups of the population may be a second step in ensuring dietary adequacy, but would not be the first step.

DIF: Cognitive Level: Application REF: Pages 143-144
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Health promotion and maintenance

33. Many Americans use vitamin supplements on a regular basis because

a. supplements taste better than food.
b. this practice is necessary for good health.
c. it is cheaper than consuming an adequate diet.
d. it is easier than making dietary and behavioral modifications.

ANS: D
It is often easier to take vitamin supplements than to make dietary and behavioral modifications to ensure that the diet provides adequate nutrients. Supplements do not taste good, and supplements are not necessary for good health for most people. Supplements are also not necessarily cheaper than foods containing a variety of nutrients.
DIF: Cognitive Level: Comprehension REF: Pages 143-144
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity