NUTR 2351 CHP 14 & 16

For patients on medication, nutrition intervention includes advice on managing nutrient related medication problems.

a. True

b. False

a. True

When nutrition and lifestyle changes are necessary, a care plan is created that accounts for people's current food practices and degree of motivation.

a. True

b. False

a. True

For optimal results, the health care professional should emphasize foods that patients should

avoid or greatly minimize.

a. True

b. False

b. False

Compounds in grapefruit juice can lead to increased blood concentrations and stronger

physiologic effects of some drugs.

a. True

b. False

a. True

Some foods used in a pureed diet may also be used in a mechanically altered diet.

a. True

b. False

a. True

A low-fiber diet is useful for patients with chewing problems.

a. True

b. False

b. False

Most foods that are included in a fat-restricted diet provide less than five grams of fat per

serving.

a. True

b. False

b. False

Surveys suggest that consumers find their visits to complementary and alternative medicine

(CAM) therapists as being far more pleasant that their visits to conventional health

practitioners.

a. True

b. False

b. False

Most hospitals choose not to offer selective menus to simplify operations and cut costs.

a. True

b. False

b. False

Physicians who practice integrative medicine may suggest alternative therapies in place of

conventional medical treatment.

a. True

b. False

b. False

Patient-oriented goals that are derived from nursing diagnoses are known as:

a. care plans.

b. interventions.

c. expected outcomes.

d. clinical pathways.

e. diet orders.

c. expected outcomes.

Which of the following is an intervention approach that encourages long-term dietary

changes?

a. encouraging produce intake

b. encouraging the elimination of all added sugars

c. setting an intake goal for < 50 grams of carbohydrates per day

d. making several changes to diet and activity at the same time

e. avoiding favorite foods

a. encouraging produce intake

Which of the following is not addressed in a Hazard Analysis and Critical Control Point

(HACCP) program?

a. determining which diets should be offered in a facility

b. directions for cooking dishes

c. cleaning and disinfecting of kitchen surfaces and utensils

d. food ordering and receiving protocols

e. food storage procedures

a. determining which diets should be offered in a facility

What practice is a form of traditional Chinese medicine?

a. bioelectromagnetic therapy

b. acupuncture

c. chiropractic

d. therapeutic touch

e. reflexology

b. acupuncture

Cadence has cancer and has chosen to use acupuncture in addition to the conventional

medical interventions recommended by her doctor. In this case, how would you classify the use of acupuncture in Cadence's treatment plan?

a. An alternative therapy

b. A biologically based therapy

c. A complementary therapy

d. An energy therapy

e. A mind-body practice

c. A complementary therapy

Nutrition education or counseling is typically provided by the:

a. registered nurse.

b. nursing assistant.

c. registered dietitian.

d. dietetic technician.

e. physician.

c. registered dietitian.

Which of the following is an example of a nutrition education intervention?

a. providing information about the Dietary Approaches to Stop Hypertension

(DASH) diet

b. organizing treatments that involve other health professionals

c. providing dietary supplements

d. helping the patient establish a healthy weight loss goal

e. providing information on healthier carbohydrate food sources

d. helping the patient establish a healthy weight loss goal

One of the characteristics of modified diets is:

a. they are not included in a diet manual.

b. they are always the same regardless of patient preferences.

c. they are altered in consistency or nutrient content.

d. they include all foods.

e. they typically have fewer calories than regular diets.

c. they are altered in consistency or nutrient content.

Using the Harris-Benedict equation for women (below), estimate the resting metabolic rate

of Alivia, who is 78 years old, is 160 cm tall, and weighs 62 kg.

RMR = 655.1 + [9.563 x weight (kg)] + [1.85 x height (cm)] - [4.676 x age (years)]

a. 461 kcalories

b. 1116 kcalories

c. 1179 kcalories

d. 1544 kcalories

e. 1909 kcalories

c. 1179 kcalories

Impaired swallowing indicates the need for a:

a. mechanically altered diet.

b. low-sodium diet.

c. fat-restricted diet.

d. low-fiber diet.

e. clear liquid diet.

a. mechanically altered diet.

What is the primary reason that diets for dysphagia are highly individualized?

a. There is more than one definition of dysphagia.

b. Dysphagia can occur due to many different causes.

c. Patients differ in their nutritional needs.

d. They require counseling by a dietitian prior to implementation.

e. Swallowing difficulties vary in severity and fluctuate over time.

e. Swallowing difficulties vary in severity and fluctuate over time.

The most appropriate diet for a patient whose jaw was broken in a motor vehicle accident is

a:

a. fat-restricted diet.

b. blenderized liquid diet.

c. clear liquid diet.

d. low-fiber diet.

e. low-sodium diet.

b. blenderized liquid diet.

What diet would a patient with severe burns likely benefit the greatest from?

a. low-sodium diet.

b. high-kcalorie, high-protein diet.

c. fat-restricted diet.

d. blenderized liquid diet.

e. low-fiber diet.

b. high-kcalorie, high-protein diet.

All of the following are permitted on a clear liquid diet except:

a. strawberry-flavored gelatin.

b. beef broth.

c. a clear lemon-lime carbonated soda.

d. orange juice.

e. hard peppermint candy.

d. orange juice.

Another name for a low-residue diet is a:

a. fat-restricted diet.

b. low-sodium diet.

c. blenderized diet.

d. soft diet.

e. low-fiber diet.

e. low-fiber diet.

What diet is often prescribed to minimize digestive related symptoms which often

accompany diseases of the liver, gallbladder, or pancreas?

a. low-fiber

b. fat-restricted

c. low-sodium

d. high-kcalorie, high-protein

e. blenderized

b. fat-restricted

What food would most likely be allowed or included in a low-fiber diet?

a. grapes

b. ripe bananas

c. peanut butter

d. winter squash

e. tomatoes

b. ripe bananas

A patient with dysphagia has been placed on a pureed diet. What food should NOT be

included as part of this diet?

a. mashed potatoes

b. custard

c. cottage cheese

d. hummus

e. applesauce

c. cottage cheese

Sodium restriction is difficult to implement on a long-term basis because:

a. sodium is found in large amounts in nearly all foods.

b. many patients find the diet unpalatable.

c. dehydration may result.

d. it can lead to hyponatremia.

e. it can alter electrolyte balances in the body.

b. many patients find the diet unpalatable.

Diet progression is appropriate for patients:

a. following surgery.

b. diagnosed with malnutrition.

c. in whom a reduction in fecal volume is desired.

d. prior to surgery.

e. in whom parenteral nutrition is needed.

a. following surgery.

A non per os (NPO) order would most likely be ordered for which situation?

a. an echocardiogram

b. a head CT

c. a chest X-ray

d. placement of a central venous catheter

e. an upper gastrointestinal (GI) tract study

e. an upper gastrointestinal (GI) tract study

Assuming the gastrointestinal (GI) tract is functioning normally, what is the most

appropriate method for feeding patients who are unable to meet their nutritional needs orally?

a. intravenous feeding

b. high-kcalorie, high-protein diet

c. commercial supplement

d. tube feeding

e. clear liquid diet

d. tube feeding

What information would most likely be included as part of a diet manual?

a. foods allowed and not allowed on each diet

b. principles of nutrition education

c. the method of estimating appropriate energy intakes for patients

d. an analysis of how altered intake affects nutrient content

e. the advantages and disadvantages of certain nutrients

a. foods allowed and not allowed on each diet

An advantage of selective menus in hospitals that use a room-service approach is that they:

a. are more nutritious.

b. simplify food production and preparation of foods.

c. usually have expanded delivery hours.

d. result in lower food costs to the hospital.

e. are easier to coordinate.

c. usually have expanded delivery hours.

Metta is a hospitalized patient who is recovering from a pelvic surgery she underwent three

days ago. She is a widow and has had no visitors during her stay. Although the patient has

progressed to a regular diet, the staff have noticed that Metta picks at her food and barely eats anything on her meal trays. The most likely reason for this behavior is:

a. the patient still does not tolerate regular foods.

b. the pain medication prescribed is affecting the patient's digestion.

c. the patient does not like the taste of the food.

d. the patient is not hungry during scheduled mealtimes.

e. the patient has no companionship and feels lonely.

e. the patient has no companionship and feels lonely.

Healthcare personnel can best help hospitalized patients improve their food intakes by:

a. choosing the most appropriate foods for the patient.

b. making sure there are plenty of activities going on in the room during

mealtimes.

c. assisting patients to sit up in bed after their meal tray has arrived.

d. helping patients to open containers and set up the food tray.

e. confirming patients received the correct tray after the meal.

d. helping patients to open containers and set up the food tray.

Unintentional weight gain can result from the use of:

a. antidepressant medications.

b. antihypertensive medications.

c. sedative medications.

d. antinausea medications.

e. anticonvulsant medications.

a. antidepressant medications.

Medications that reduce stomach acid may impair the absorption of:

a. vitamin C.

b. vitamin B12.

c. glucose.

d. calcium.

e. vitamin K.

b. vitamin B12.

Megestrol acetate is best described as a(n):

a. appetite enhancer.

b. weight-loss drug.

c. antidepressant.

d. pain reliever.

e. anti-inflammatory drug.

a. appetite enhancer.

Reduced stomach acid may increase the absorption of what drug?

a. Digoxin

b. Ibuprofen

c. Ketoconazole

d. Heparin

e. Atazanavir

a. Digoxin

Methotrexate interferes with the metabolism of:

a. folate.

b. iron.

c. vitamin B12.

d. calcium.

e. vitamin C.

a. folate.

Supplements of _____ are usually given to patients receiving the antituberculosis drug Isoniazid.

a. iron

b. calcium

c. vitamin B12

d. folate

e. vitamin B6

e. vitamin B6

The drug warfarin is structurally similar to:

a. vitamin C.

b. vitamin K.

c. vitamin D.

d. vitamin E.

e. vitamin A.

b. vitamin K.

Individuals taking lithium are advised to maintain consistent _______ intakes.

a. calcium

b. vitamin B12

c. folate

d. sodium

e. magnesium

d. sodium

A patient who takes a monoamine oxidase inhibitor (MAOI) should avoid which food?

a. sausage

b. yogurt

c. potato chips

d. whole grains

e. leafy greens

a. sausage

Riley has been hospitalized following a motor vehicle accident. He has several broken bones,

including his left jaw, two ribs on the left side, and a compound fracture of his left leg.

According to his medical record, he is 38 years old, his height is 5'11", and his weight is 186

pounds. His current medications include Lovastatin to lower his cholesterol and a monoamine oxidase inhibitor (MAOI) to treat depression. The most appropriate diet order for Riley is a:

a. regular diet.

b. soft diet.

c. mechanical soft diet.

d. blenderized diet.

e. low-fiber diet.

d. blenderized diet.

Riley will need a higher _____ intake to meet his nutritional needs for recovery.

a. potassium

b. kcalorie

c. iron

d. vegetable

e. fiber

b. kcalorie

What food should be excluded from Riley's diet for the time being?

a. nuts

b. ice cream

c. pudding

d. potatoes

e. fruit juice

a. nuts

Before leaving the hospital, Riley will need nutrition education on:

a. how to use a blender.

b. food-medication interactions.

c. a pureed diet.

d. weight gain.

e. iron deficiency.

b. food-medication interactions.

What factor is most important to consider when providing nutrition education to Riley?

a. weight

b. gender

c. literacy level

d. marital status

e. race

c. literacy level

What should Riley avoid because he is taking Lovastatin?

a. orange juice

b. cheddar cheese

c. green leafy vegetables

d. yogurt

e. grapefruit juice

e. grapefruit juice

What alternative medical approach is rooted in the theory that a substance which causes a

particular set of symptoms can be used to cure a disease that has similar symptoms?

a. homeopathic medicine

b. naturopathic medicine

c. bioelectrical medicine

d. chiropractic medicine

e. faith healing medicine

a. homeopathic medicine

An approach to healthcare based on the concept that illness can be cured by enhancing the flow of energy within a person's body is:

a. bioelectromagnetic therapy.

b. naturopathy.

c. homeopathic medicine.

d. traditional Chinese medicine.

e. osteopathic medicine.

d. traditional Chinese medicine.

The most common biologically based therapy is the use of:

a. vitamin and mineral supplements and herbal remedies.

b. chiropractic medicine.

c. massage therapy.

d. aromatherapy.

e. acupuncture.

a. vitamin and mineral supplements and herbal remedies.

One example of a complementary and alternative medicine (CAM) therapy where

individuals are instructed in techniques that allow for them to gain voluntary control over

certain physiological processes to reduce stress and anxiety is:

a. aromatherapy.

b. qi gong.

c. therapeutic touch.

d. biofeedback.

e. chiropractic.

d. biofeedback.

Phagocytes engulf microorganisms and destroy them with reactive forms of oxygen and hydrolytic enzymes.

a. True

b. False

a. True

The body's stress response is designed to conserve energy so heart rate, respiration, and blood pressure will decrease.

a. True

b. False

b. False

The symptoms associated with the initial inflammatory response are collectively called the systemic inflammatory response syndrome. a. True

b. False

b. False

If the reduction in blood flow from inflammation is severe enough to deprive the body's tissues of oxygen and nutrients, systemic inflammatory response syndrome (SIRS) can result.

a. True

b. False

b. False

An excessive response to metabolic stress can worsen illness and lead to death.

a. True

b. False

a. True

Recovery from an injury or illness can be hastened by hypermetabolism and positive nitrogen balance.

a. True

b. False

b. False

When a patient is critically ill, overfeeding increases the risk of refeeding syndrome which is associated with hypoglycemia.

a. True

b. False

b. False

Chronic bronchitis is characterized by the breakdown of the lungs 'elastic structure and destruction of the walls of the smallest bronchioles and alveoli which significantly reduce the surface area for respiration.

a. True

b. False

b. False

The high nutrient requirements of acutely stressed patients often require them to be fed via the enteral or parenteral route to meet their nutritional needs.

a. True

b. False

a. True

The primary risk factor for chronic obstructive pulmonary disease (COPD) is an inherited disorder known as alpha-1-antitrypsin deficiency. a. True

b. False

b. False

Which of the following is NOT a systemic effect that is typically associated with the acute phase response?

a. The liver increases production of blood-clotting proteins.

b. Pulse rate and blood pressure may increase. c. Plasma concentrations of iron and zinc decrease.

d. Muscle catabolism makes amino acids available for glucose production.

e. Metabolic rate decreases.

e. Metabolic rate decreases.

What condition is common when people are critically ill due to the combined effects of the hormones released?

a. hyperglycemia

b. weight gain

c. hyponatremia

d. hypotension

e. hyperkalaemia

a. hyperglycemia

All of the following are classic signs of inflammation that accompany altered blood flow except for:

a. pain.

b. swelling.

c. heat.

d. high blood glucose.

e. redness.

d. high blood glucose.

Sources of underlying stress that need to immediately be addressed in a critically ill patient include all of the following except:

a. abscesses.

b. high blood glucose.

c. infections.

d. wounds.

e. dead tissue from injuries.

b. high blood glucose.

What is a side effect associated with the use of inhaled corticosteroids?

a. dry mouth

b. constipation

c. low bone density

d. mild hypokalemia

e. urinary retention

c. low bone density

The increase in metabolic rate as a part of the stress response can be attributed to:

a. catecholamines.

b. cortisol.

c. eicosanoids.

d. cytokines.

e. hepcidin.

a. catecholamines.

Protein breakdown during periods of stress is attributed to:

a. cortisol.

b. eicosanoids.

c. glucagon.

d. catecholamines.

e. aldosterone.

a. cortisol.

What is released during the inflammatory process that causes vasodilation and capillary permeability?

a. hepcidin

b. cortisol

c. antidiuretic hormone

d. cytokines

e. histamines

e. histamines

What are eicosanoids derived from in the inflammatory process?

a. cytokines

b. endothelial cells

c. mast cells

d. phagocytes

e. arachidonic acid

e. arachidonic acid

What compound is produced by white blood cells (WBCs) and regulate various aspects of immune function?

a. glucagon

b. catecholamines

c. cytokines

d. cortisol

e. aldosterone

c. cytokines

What complication is most closely associated with severe cases of systemic inflammatory response syndrome (SIRS) or sepsis?

a. hypertension

b. fluid retention

c. hypertriglyceridemia

d. poor glucose control e. intestinal bleeding

b. fluid retention

When caring for a patient who is suffering from acute illness and metabolic stress, how would clinicians best estimate protein and energy needs?

a. Adjust nutrient intakes according to patient responses.

b. Underfeed the patient to minimize tissue loss. c. Maintain the patient at Nil Per Os (NPO) status to promote bowel rest.

d. Overfeed the patient to prevent hypoglycemia.

e. Increase carbohydrate intake to promote weight gain and appropriate energy use.

a. Adjust nutrient intakes according to patient responses.

What describes the immediate care concerns of the clinician during patients 'times of severe stress?

a. educating the patient about nutrient needs

b. providing psychological counseling

c. determining the level of the patients 'understanding about their condition

d. providing nutrition therapy

e. restoring fluids and electrolytes

e. restoring fluids and electrolytes

A 25-year-old woman is critically ill after surviving a motor vehicle accident. The patient is 5'4" and weighs 120 pounds (54.5 kg). Based on kcal/kg of body weight per day, what are her approximate energy needs (rounded to the nearest whole number)?

a. 1199 to 1363 kcalories

b. 600 to 763 kcalories

c. 1363 to 1635 kcalories

d. 763 to 1199 kcalories

e. 1635 to 1908 kcalories

c. 1363 to 1635 kcalories

What is used to estimate the resting metabolic rate (RMR) in critically ill patients?

a. skinfold measurement

b. body mass index (BMI)

c. the stress factor equation

d. indirect calorimetry

e. a clinical body weight growth chart

d. indirect calorimetry

What method was developed for estimating energy needs in a ventilator-dependent patient? a. Penn State equation

b. Jackson/Pollock method

c. Harris-Benedict equation

d. Lund-Browder formula

e. Ireton-Jones energy equation

a. Penn State equation

The protein needs of a non-obese critically ill patient would be:

a. 0.8 to 1.0 g/kg body weight per day.

b. 1.0 to 1.2 g/kg body weight per day.

c. 1.2 to 2.0 g/kg body weight per day.

d. 2.0 to 2.5 g/kg body weight per day.

e. 2.5 to 3.0 g/kg body weight per day.

c. 1.2 to 2.0 g/kg body weight per day.

Malika is a critically ill patient. She is 5'6" tall and weighs 150 pounds. Which of the following protein amounts falls within Malika's estimated daily protein needs?

a. 43 g

b. 54 g

c. 78 g

d. 112 g

e. 142 g

d. 112 g

Which amino acid has been shown to reduce infectious complications, increase muscle mass, and reduce mortality rates in critically ill patients in some studies?

a. leucine

b. glutamine

c. valine

d. isoleucine

e. phenylalanine

b. glutamine

Which amino acid may have adverse effects when given as a supplement to patients with sepsis?

a. tryptophan

b. tyrosine

c. arginine

d. phenylalanine

e. leucine

c. arginine

A parenteral feeding should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute to prevent hyperglycemia in critically ill patients.

a. one

b. two

c. three

d. four

e. five

a. one

In critically ill patients, a high intake of _____ may suppress immune function and promote hypertriglyceridemia.

a. fat

b. dextrose

c. protein

d. zinc

e. vitamin A

a. fat

What micronutrient plays a role in immunity and wound healing?

a. zinc

b. choline

c. selenium

d. vitamin K

e. iron

a. zinc

Once patients can tolerate oral feedings, what type of diet is often prescribed?

a. high-fiber

b. low sodium

c. high-kcalorie, high-protein

d. low-fat

e. low carbohydrate

c. high-kcalorie, high-protein

Nutrition therapy for management of chronic obstructive pulmonary disease (COPD) involves: a. promoting weight gain.

b. supporting wound healing.

c. improving food intake.

d. relieving chronic cough.

e. decreasing supplemental oxygen needs.

c. improving food intake.

Emphysema associated with chronic obstructive pulmonary disease (COPD) is most often diagnosed by:

a. serial chest X-rays.

b. clinical signs and lung function tests.

c. oxygen saturation readings.

d. 24-hour halter monitoring.

e. culture and sensitivity of mucus samples.

b. clinical signs and lung function tests.

A chronic obstructive pulmonary disease (COPD) patient who complains of abdominal discomfort and dyspnea may benefit from:

a. small, frequent meals.

b. a low-fat diet.

c. a high-fiber diet.

d. consuming more liquids.

e. increased energy consumption.

a. small, frequent meals.

Adequate fluid intake will help the person with chronic obstructive pulmonary disease (COPD) by:

a. decreasing carbon dioxide output.

b. preventing the secretion of overly thick mucus.

c. aiding in weight loss.

d. improving oxygen consumption.

e. reducing abdominal distention.

b. preventing the secretion of overly thick mucus.

Excessive kcalorie intake in chronic obstructive pulmonary disease (COPD) patients may:

a. interfere with catabolic processes.

b. alter taste perception.

c. interfere with drug therapy.

d. increase gas formation.

e. increase respiratory stress.

e. increase respiratory stress.

The most common risk factor associated with development of chronic obstructive pulmonary disease (COPD) is:

a. alpha-1-antitrypsin deficiency.

b. environmental exposure to pollutants.

c. lung cancer.

d. cigarette smoking.

e. cystic fibrosis.

d. cigarette smoking.

Angel is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Angel is 5'2" tall and weighs 115 pounds. 41. The stress of Angel's condition places her at risk of hypermetabolism. What kind of complication is most closely associated with hypermetabolism as a result of stress?

a. wasting

b. fractures

c. kidney failure

d. bone pain

e. pulmonary edema

a. wasting

What are Angel's estimated energy needs based on kcal/kg of body weight per day (rounded to whole numbers)?

a. 1308 to 1569 kcalories

b. 1151 to 1308 kcalories

c. 575 to 732 kcalories

d. 941 to 1151 kcalories

e. 1569 to 1831 kcalories

Aa. 1308 to 1569 kcalories

What are Angel's estimated protein needs per day?

a. 42 to 63g

b. 63 to 105g

c. 31 to 52g

d. 105 to 131g

e. 78 to 105g

b. 63 to 105g

As a result of the acute-phase inflammatory response, Angel's plasma concentrations of _____ would be expected to decrease.

a. glucose and cholesterol

b. sodium and potassium

c. iron and glucose

d. albumin and iron

e. magnesium and chloride

d. albumin and iron

To decrease the risk of infection, it will be important to keep Angel's _____ under control while she is recovering.

a. serum albumin

b. blood glucose

c. blood pressure

d. serum prealbumin

e. nitrogen

b. blood glucose