Chapter 05: Fats

Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A

Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. Of the following, the food that would provide the most energy per ounce is
a. butter.
b. tuna.
c. pasta.
d. hard candy.
ANS: A
Butter would provide the most energy per ounce because fat is the densest energy source. Fat
provides 9 kcal/g; protein and carbohydrate each provide 4 kcal/g. Tuna is mostly protein with
just a small amount of fat, pasta is mostly carbohydrate, and hard candy is only carbohydrate,
and so all of these would provide fewer calories per ounce than would butter.

DIF: Cognitive Level: Applying REF: Page 74 | Page 81

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity

2. The most beneficial function of cholesterol in the body is

a. formation of sex hormones, bile, and vitamin D.
b. depositing plaques in arteries.
c. being part of cell membrane structure.
d. solubility in both water and fat.
ANS: A
The body uses sterols such as cholesterol to make sex hormones, bile, and vitamin D.
Cholesterol does contribute to deposition of arterial plaques, but this is not beneficial to the
body. Cell membrane structure and solubility in both water and fat are functions of
phospholipids; cholesterol is a sterol, not a phospholipid.

DIF: Cognitive Level: Applying REF: Pages 77-78

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

3. If a patient receiving parenteral nutrition develops eczema, the patient probably has
a. vitamin C deficiency.
b. essential fatty acid deficiency.
c. protein-energy malnutrition.
d. phospholipid and sterol deficiency.
ANS: B
In a patient receiving fat-free parenteral nutrition, eczema may be a sign of essential fatty acid
deficiency. Eczema is not caused by vitamin C deficiency; symptoms of vitamin C deficiency
include bleeding gums and breakdown of scar tissue. Eczema is not a sign of protein-energy
malnutrition. The body makes phospholipids and sterol, and so deficiency does not occur.

DIF: Cognitive Level: Applying REF: Page 74 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Physiological integrity
4. If a food that is usually made with hydrogenated oil is made with vegetable oil instead, one
potential concern is that the
a. flavor will be significantly different.
b. food will feel oily to the touch.
c. food will contribute more to cardiovascular risk.
d. food will have a shorter shelf life.
ANS: D
Hydrogenation of vegetable oils increases their shelf life because the double bonds are
removed, which renders the fatty acids less vulnerable to oxidation; therefore, a food made
with vegetable oil may have a shorter shelf life. Use of vegetable oil does not necessarily
result in a different flavor from use of hydrogenated fat and does not make the food feel more
oily. Foods made with vegetable oils are less likely to contribute to cardiovascular disease
than those made with hydrogenated fats, which contain saturated and trans fatty acids.

DIF: Cognitive Level: Understanding REF: Page 82 | Page 84

TOP: Nursing Process: Implementation
MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care
environment

5. A triglyceride is a compound composed of

a. glycerol with two fatty acids attached.
b. glycerol with three amino acids attached.
c. glycerol with three fatty acids attached.
d. organic molecules formed in triangular chains.
ANS: C
Triglycerides are compounds made up of glycerol and three fatty acids. The compound of
glycerol plus two fatty acids is a diglyceride. Glycerol does not combine with amino acids.
Triglycerides do not form in triangular chains.

DIF: Cognitive Level: Remembering REF: Page 75

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

6. To decrease intake of saturated fatty acids and increase intake of polyunsaturated fatty acid,
one dietary change would be from using _____ to using _____ oil.
a. shortening; coconut
b. margarine; olive
c. soybean oil; canola
d. butter; sunflower
ANS: D
Sunflower oil is rich in polyunsaturated fatty acids, and butter is rich in saturated fatty acids;
therefore, this switch would have the best effect. Shortening actually has higher amounts of
polyunsaturated fatty acids and lower amounts of saturated fatty acids than does coconut oil.
Olive oil contains lower amounts of saturated fatty acids than does margarine, but it is rich in
monounsaturated fatty acids, not polyunsaturated fatty acids. Both canola oil and soybean oil
have relatively low amounts of saturated fatty acids; canola oil contains mostly
monounsaturated fatty acids, whereas soybean oil is rich in polyunsaturated fatty acids.

DIF: Cognitive Level: Applying REF: Page 76 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance
 7. If a client wants to lose 1 lb of body fat each week, he or she would need to make sure that the
daily calorie intake was lower than the daily energy needs by _____ kcal/day.
a. 350
b. 500
c. 900
d. 3500
ANS: B
One pound of body fat contains 3500 kcal. To create a weekly deficit of 3500 kcal, daily
energy intake would need to be less than daily energy expenditure by 500 kcal (3500 ÷ 7).

DIF: Cognitive Level: Applying REF: Page 74 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

8. Of the following fats, the one that is most likely to be liquid is

a. milk fat.
b. beef drippings.
c. coconut oil.
d. peanut oil.
ANS: D
In general, plant oils are more liquid and animal fats tend to be solid. Both milk fat (butter)
and beef drippings (lard) have high amounts of saturated fatty acids and tend to be solid fats.
Coconut oil is a plant oil, but it has high amounts of saturated fatty acids, and so it is usually
solid. Peanut oil has high amounts of unsaturated fatty acids and is a liquid oil.

DIF: Cognitive Level: Understanding REF: Pages 75-77 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

9. The number of double bonds present in the fatty acid chain determines the
a. number of fatty acids attached to the glycerol molecule.
b. number of glycerol molecules attached to a fatty acid.
c. degree of saturation or unsaturation of a fatty acid.
d. degree of saturation or unsaturation of the glycerol molecule.
ANS: C
The number of double bonds in a fatty acid chain determines the degree of saturation or
unsaturation of a fatty acid. The number of fatty acids attached to the glycerol molecule
determines whether it is a monoglyceride (one fatty acid), a diglyceride (two fatty acids), or a
triglyceride (three fatty acids). There is never more than one glycerol molecule attached to a
fatty acid, and glycerol molecules do not vary in the degree of saturation or unsaturation.

DIF: Cognitive Level: Understanding REF: Pages 75-77

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

10. A client who wishes to avoid blood clots may benefit from regular intake of
a. fish oil capsules.
b. salmon.
c. lecithin.
d. olives and olive oil.
 ANS: B
Omega-3 fatty acids help decrease risk of blood clots. The best source of omega-3 fatty acids
is fatty fish, such as salmon; fish oil capsules are not recommended because large doses may
decrease immunity. Lecithin and the monounsaturated fatty acids found in olive oil do not
decrease risk of blood clotting.

DIF: Cognitive Level: Applying REF: Pages 75-77 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity

11. Overall energy intake can be greatly affected by relatively small changes in intake of
a. protein.
b. carbohydrate.
c. fat.
d. alcohol.
ANS: C
Fat contains more energy per gram than any other nutrient (9 kcal/g versus 4 kcal/g for protein
and carbohydrate and 9 kcal/g for alcohol). Therefore, relative small increases or decreases in
fat intake can result in significant increases or decreases in energy intake.

DIF: Cognitive Level: Understanding REF: Page 74 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity

12. The number of kilocalories provided by 23 g of fat is

a. 92.
b. 161.
c. 207.
d. 230.
ANS: C
Fat contains 9 kcal/g. Therefore, 23 g fat contain 207 kcals (23 ´ 9).

DIF: Cognitive Level: Applying REF: Page 74

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

13. If dietary analysis shows that fat provides 31% of an individual’s energy intake, their fat
intake would be
a. considered below the recommended range.
b. considered within the recommended range.
c. considered above the recommended range.
d. generally recognized as safe.
ANS: B
The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of kilocalories;
therefore, 31% is within the recommended range. “Generally recognized as safe” is a term
used for food additives.

DIF: Cognitive Level: Applying REF: Page 80

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

14. Sources of invisible fat include

a. pastries and pies.
 b. bacon and chicken with skin.
c. butter and sour cream.
d. oil and vinegar salad dressing.
ANS: A
In baked goods such as pastries and pies, the fat cannot be seen; it is absorbed into the flour,
which makes it invisible. Bacon has visible strips of white fat, chicken skin is visibly fatty,
butter and sour cream can be seen unless they are melted into toast or potatoes, and oil can be
seen floating on top of the vinegar in salad dressing.

DIF: Cognitive Level: Applying REF: Pages 81-83

TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance

15. An example of emulsification is

a. chewing of food in the mouth.
b. use of egg yolk to make mayonnaise.
c. commercial hydrogenation of liquid oils.
d. digestion of fat in the small intestine.
ANS: B
The lecithin in egg yolk acts as an emulsifier in the making of mayonnaise. Chewing of food
is mastication. Hydrogenation of liquid oils does not emulsify them. In the small intestine, bile
emulsifies fat to increase the surface area for digestion, but the fat is not actually digested
there.

DIF: Cognitive Level: Applying REF: Page 78

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

16. For someone with coronary heart disease, what would be the most helpful piece of
information on a food label?
a. Total calories per serving
b. Milligrams of cholesterol per serving
c. Grams of saturated fat per serving
d. Grams of total fat per serving
ANS: C
Saturated fat intake has the greatest influence on blood cholesterol levels and coronary heart
disease. Intakes of total fat and total energy are important, but not as important as saturated
fat. Intake of cholesterol is less important because most cholesterol is made by the body, and
dietary sources contribute relatively little.

DIF: Cognitive Level: Applying REF: Page 82 | Pages 84-86 | Page 88

TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

17. If a salad dressing is made with olive oil, it would contain mostly _____ fatty acids.
a. trans
b. saturated
c. polyunsaturated
d. monounsaturated
ANS: D
 Olive oil is rich in monounsaturated fatty acids. Trans fatty acids are found in hydrogenated
fats. Polyunsaturated fatty acids are found mostly in other liquid vegetable oils. Saturated fatty
acids are found in dairy, meat fats, and coconut and palm oil.

DIF: Cognitive Level: Applying REF: Page 76 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

18. The best description of a fat with high amounts of trans fatty acids is that it is
a. liquid at room temperature.
b. found naturally in tropical oils.
c. easily transformed from one state to another.
d. produced by hydrogenation of plant oils.
ANS: D
Trans fatty acids are formed when liquid plant oils are hydrogenated to form a hard fat, such
as margarine or shortening. Trans fatty acids are not naturally present in any fats or oils, and
fats with high amounts of trans fatty acids tend to form solid, rather than liquid, fats at room
temperature. Trans fatty acids are shelf stable and so are not easily transformed.

DIF: Cognitive Level: Remembering REF: Page 82 | Page 84

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

19. An alternative to hydrogenation to increase the shelf life of polyunsaturated fat is the addition
of
a. vitamin E.
b. vitamin D.
c. hydrogen.
d. zinc.
ANS: A
Antioxidants provide a way to preserve unsaturated fats without hydrogenation. Vitamin E is
an example of an antioxidant that may be added to unsaturated fats. Vitamin D and zinc do not
have antioxidant properties. Hydrogen is added during hydrogenation.

DIF: Cognitive Level: Applying REF: Pages 84-85

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

20. The most important property of phospholipids that makes them valuable both in foods and in
the body is that they
a. carry fat-soluble vitamins.
b. are useful as low-energy fat substitutes.
c. are soluble in water and fat at the same time.
d. function as natural antioxidants.
ANS: C
Phospholipids are valuable in foods and in the body because they are soluble in water and fat
at the same time. This makes them useful emulsifiers and important components of cell
membranes. Phospholipids have no particular role in carrying fat-soluble vitamins. They are
not used as fat substitutes. They do not function as antioxidants.

DIF: Cognitive Level: Understanding REF: Pages 77-78 TOP: Nursing Process: Planning
 MSC: Client Needs: Physiological integrity

21. Most fat enters the lymphatic system after

a. absorption.
b. circulation.
c. metabolism.
d. hydrogenation.
ANS: A
Most fat is absorbed into the lymphatic system from the small intestine. It then passes into the
circulation. Therefore, circulation and metabolism occur after, not before, fat enters the
lymphatic system. Hydrogenation occurs during food production and is not connected to
processing of fat in the body.

DIF: Cognitive Level: Applying REF: Page 78

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

22. Jacob usually eats a sandwich with salami, mayonnaise, lettuce, and tomato on wheat bread
for lunch. What change would be most helpful in decreasing his risk of cardiovascular
disease?
a. Add sprouts instead of tomato.
b. Switch to whole-wheat bread.
c. Omit the mayonnaise.
d. Replace the salami with turkey.
ANS: D
Replacing the salami with turkey would be most beneficial because salami has high amounts
of saturated fatty acids, which tend to increase blood cholesterol levels. Turkey also contains
saturated fatty acids but has low amounts of fat overall. Switching the whole-wheat bread
would increase dietary fiber intake, which would also help decrease blood cholesterol level,
but the effect would not be as great as a decrease in saturated fat. Omitting the mayonnaise
would help decrease overall fat intake, but the fat in mayonnaise is mostly unsaturated and so
it would be less beneficial than using a lower fat meat. Both sprouts and tomatoes add vitamin
C and other nutrients, and so this change would make very little difference nutritionally.

DIF: Cognitive Level: Applying REF: Page 76 | Pages 80-83

TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity

23. High levels of low-density lipoprotein cholesterol (LDLc) are associated with an increased
risk of
a. diabetes mellitus.
b. high levels of high-density lipoprotein cholesterol (HDLc).
c. coronary artery disease.
d. high blood pressure and stroke.
ANS: C
High levels of low-density lipoprotein cholesterol are associated with increased risk of
coronary artery disease. They do not have a direct effect on risk for diabetes mellitus or high
blood pressure and stroke. LDLc and HDLc levels are not necessarily related.

DIF: Cognitive Level: Remembering REF: Page 82 | Pages 84-85

 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance

24. A client who is trying to follow a low-fat eating pattern tells you that he or she has
experienced diarrhea. You may want to find out whether he or she has
a. eaten foods made with the fat substitute carrageenan.
b. eaten foods made with the fat substitute olestra.
c. greatly increased intake of fish and seafood.
d. developed essential fatty acid deficiency.
ANS: B
Olestra is a fat substitute that is not digested or absorbed and may cause diarrhea if eaten in
large quantities. Carrageenan is a carbohydrate that is digested and does not cause diarrhea.
Fish and seafood consumption and essential fatty acid deficiency are not associated with
diarrhea.

DIF: Cognitive Level: Applying REF: Page 74 | Page 77 | Page 86

TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

25. The client most likely to benefit from use of medium-chain triglycerides is one who
a. has essential fatty acid deficiency.
b. has malabsorption because of removal of part of the small intestine.
c. needs to gain weight after surgery and chemotherapy to treat bowel cancer.
d. has high levels of both serum total cholesterol and low-density lipoprotein
cholesterol.
ANS: B
Medium-chain triglycerides are beneficial for patients with malabsorption because they are
relatively easily absorbed. They do not contain essential fatty acids. They contain the same
amount of energy as other fatty acids, and so they would not be especially beneficial for a
client who needs to gain weight. They do not influence serum cholesterol levels.

DIF: Cognitive Level: Applying REF: Page 74 | Page 78 | Pages 85-86

TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance

26. A good lunch choice for someone who wants to increase intake of omega-3 fatty acids would
be
a. peanut butter and jelly sandwich.
b. lentil soup.
c. salad with olive oil dressing.
d. grilled tuna sandwich.
ANS: D
Fatty fish, such as tuna, are an excellent source of omega-3 fatty acids, and so the grilled tuna
sandwich would be the best choice. Peanut butter and olive oil have high amounts of
monounsaturated fatty acids but are not good sources of omega-3 fatty acids. Lentil soup is
likely to have low amounts of fat.

DIF: Cognitive Level: Applying REF: Pages 76-77 TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

27. If a person did not produce bile,

a. fats would pass through the intestines undigested.
 b. fats would be digested and absorbed too quickly.
c. fat digestion may occur more slowly.
d. digestion of fat would be unaffected.
ANS: C
Bile emulsifies dietary fats to increase their surface area for action of digestive enzymes.
Therefore, without bile, digestion of fat would occur more slowly. Because of mixing and
churning of chyle with digestive secretions and enzymes in the small intestine through
peristalsis and segmentation, digestion would still occur, but more slowly.

DIF: Cognitive Level: Applying REF: Pages 78-79

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

28. A client who is a bodybuilder eats large quantities of tuna, chicken, and lean meats every day.
Any extra energy from these foods that the client’s body does not need will be stored as
a.adipose tissue.
b.essential body fat.
c.muscle tissue.
d.glycogen.
ANS: A
Extra energy from any source is stored as fat in adipose tissue. Muscle is developed in
response to exercise; it requires some protein, but extra protein cannot be stored as muscle
tissue. Glycogen stores in the body are limited. Essential body fat is the fat that protects
organs and nerve cells; its amount does not increase with dietary excess.

DIF: Cognitive Level: Applying REF: Pages 75-76 | Pages 79-80

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

29. A healthy daily fat intake for someone who eats 3000 kcal per day is _____ g.
a. 100
b. 33 to 83
c. 67 to 117
d. 600 to 1050
ANS: C
The Acceptable Macronutrient Distribution Range for fat is 20% to 35% of energy intake. Of
3000 kcal, 20% to 35% is 600 to 1050 kcal. Fat contains 9 kcal per gram, and so this
represents approximately 67 to 117 g (600/9 to 1050/9 g) of fat daily.

DIF: Cognitive Level: Applying REF: Page 80

TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance | Client Needs: Physiological integrity

30. A client grew up on a farm and learned to prepare foods with butter and lard produced by the
farm animals. She is now in her 60s and has just learned that she has coronary artery disease.
To best meet her physical needs, as well as psychological needs, the health practitioner should
a. suggest that she adopt a low-fat vegetarian dietary pattern.
b. ask how she usually prepares foods and suggest ways to reduce the use of animal
fat.
c. advise her to eat more fruits and vegetables and to replace some of the animal fat
with palm and coconut oil.
d. advise her to avoid adding fat to foods and eat only very lean poultry and fish.
ANS: B
The health practitioner should start with the ways the client usually prepares food and suggest
ways in which she can use less animal fat and more heart-healthy unsaturated fats without
making dramatic or arbitrary changes. A low-fat vegetarian dietary pattern is not necessary
and may be unacceptable to the client. Eating more fruits and vegetables may be beneficial,
but palm and coconut oil are high in saturated fat, which would not be helpful. It is probably
not necessary for her to avoid adding any fat to foods and to eat only very lean poultry and
fish; such drastic changes might not be maintained by the client.

DIF: Cognitive Level: Analyzing REF: Page 76 | Pages 81-84 | Pages 87-88
TOP: Nursing Process: Implementation MSC: Client Needs: Health promotion and maintenance