Final TB 23 & 24

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Nutrition and Diet Therapy
Chapters 23, 24
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1

Acquired immunodeficiency syndrome (AIDS) has been transmitted through all except one of the following means. Identify the exception.

heterosexual contact

dishes and utensils contaminated the infected client

prenatal infection of the fetus

needle punctures or scalpel wounds of health-care workers

b

2

The major nutrition-related problems in clients with AIDs are caused by:

gastrointestinal changes

lack of cleanliness in the cooking area

poor hand-washing technique

low-protein diets

a

3

If a lactose-free diet is required, the client will receive limited amounts of:

eggs and poultry

fruits and grains

milk and yogurt

organ meats and saturated fats

c

4

Medium-chain triglyceride (MCT) oil can be used in salad dressing and baked goods to:

A)

delay the absorption of fats

B)

increase the total amount of fat absorbed

C)

act as a lubricant for swallowing difficulties

D)

reduce serum triglyceride levels

b

5

Which of the following diet modifications is designed to compensate for the limited absorptive capacity of the gut in AIDS clients?

giving buttermilk and ice cream regularly

washing fresh fruit thoroughly

dividing intake into six small servings

serving protein foods hot and cooking them thoroughly

c

6

Which of the following is the correct sequence to introduce the following types of feedings?

oral, PPN or TPN, tube feeding

oral, tube feeding, PPN or TPN

PPN or TPN, tube feeding, oral

tube feeding, PPN or TPN, oral

b

7

A person who is HIV-positive should use good hygiene to decrease the risk of:

Kaposi's sarcoma

gut failure

hepatomegaly

pneumocystis pneumonia

d

8

If a person with AIDS suffers from anemia related to treatment with zidovudine (AZT), in addition to blood therapy, which of the following nutrients should be available to the body when the bone marrow recovers function?

vitamin B12 and folic acid

iron and zinc

protein and vitamin C

all of the above

d

9

A client with AIDS is anorectic. Which of the following interventions might enhance food intake?

Offer a large breakfast, light lunch, and moderate dinner.

Refer the client to a member of the clergy.

Serve food on festive paper plates.

Suggest a friend visit the client at mealtimes.

d

10

Protection from a disease, especially an infectious disease, usually induced by antibody production in response to an antigen or a microorganism is:

inapparent infection

inherent resistance

immunity

vaccination

c

11

The type of isolation precaution that assumes that all body fluids are contaminated is called ______.

body substance isolation

contact isolation

strict isolation

universal precautions

a

12

______ dictate(s) that every client and every client's blood be considered contaminated and treated as such. Protective equipment should be used as needed.

Body substance isolation

Contact isolation

Strict isolation

Standard precautions

d

13

A central nervous system disorder caused by HIV is:

AIDS dementia complex

immune deficiency psychosis

premature senility

stress-induced neurosis

a

14

Which of the following factors frequently contributes to nutrient malabsorption in the client with AIDS?

food infections and poisonings

allergies and food intolerances

mucosal atrophy and decreased digestive enzyme action

poor choices and unwise combinations of dietary components

c

15

The client with AIDS who suffers from chronic diarrhea is at risk of:

carbohydrate malabsorption

increased susceptibility to vitamin toxicities

rickets due to excessive loss of vitamin D

hypercholesterolemia

a

16

A disease that occurs with much greater frequency in clients with AIDS than in other population groups is ______.

brucellosis

scarlet fever

staphylococcal food poisoning

tuberculosis

d

17

A causative agent of thrush that can affect the gastrointestinal or vaginal tract is ______.

Epstein-Barr virus

Candida albicans

Escherichia coli

varicella-zoster virus

b

18

All of the following except one are early signs of decreased nutritional status. Indicate the exception.

decreased body mass index

increased blood albumin

decreased percentage of body fat

decreased body weight

b

19

The most plausible explanation for the increased incidence and high prevalence of HIV in the African population is:

lack of educational opportunities

poverty

increased number of disease-spreading mosquitoes

a genetic mutation that originally evolved to protect against malaria

d

20

Every client with an HIV diagnosis should be educated about:

lactose intolerance

fat malabsorption

food safety

a high-protein diet

c

21

Which of the following foods is sometimes helpful in repopulating the intestine, which has had its normal flora disrupted by antibiotic therapy?

active cultures of yogurt

blue cheese

red wine

garlic

a

22

The decision regarding aggressive nutritional support for a competent client is made by the:

client

dietitian

family

physician

a

23

Dietary modifications for clients with AIDS are based on:

the standards of the Centers for Disease Control and Prevention

an individualized assessment

the client's food habits

the physician's orders

b

24

In cases of severe malabsorption, which of the following preparations may be the most helpful?

a complete nutritional supplement of intact nutrients

a supplement of protein only

an elemental formula of predigested nutrients

three between-meal feedings incorporating medium chain triglycerides oil

c

25

Deficiencies of which of the following nutrients are associated with immunologic changes?

iron and zinc

pyridoxine and vitamins C and A

folic acid and vitamin B12

all of the above

d

26

Which of the following statements is true?

Malnutrition can be caused by AIDS and can worsen the effects of the disease.

Optimal nutrition can overcome the symptoms of AIDS.

Gastrointestinal symptoms, such as diarrhea, always precede malabsorption problems.

Vitamin supplementation is not recommended for clients with AIDS.

a

27

Mr. P, a client with AIDS, has returned to his mother's home for care. She asks for advice about protecting herself from the disease. Which of the following is the best answer to give?

Avoid direct contact with blood or body fluids.

Discard food from serving dishes that were on the table when Mr. P ate.

Keep Mr. P's serving dishes separate from those that are used for the rest of the household.

Use bleach solution daily on the bathroom fixtures.

a

28

Mr. P, a client with AIDS, has returned to his mother's home for care. She asks for advice about foods to offer her son. Which of the following is the best answer to give?

“Give him whatever he wants because he does not have long to live.”

“If he is on many medications, he may be permitted only a special formula for nutrition.”

“Avoid fresh fruits and vegetables that are eaten without paring or cooking.”

“A well-balanced, varied diet is best unless he develops intolerances to foods.”

d

29

Mr. D, a client with AIDS, has lost 20 lb in the last 4 months. Which of the following laboratory tests would best assist in determining the appropriate supplement to recommend?

red blood cell count

serum albumin

glucose tolerance test

white blood cell count

b

30

Mr. P, a client with AIDS and tuberculosis, is living with his mother. She asks for advice about protecting herself from the diseases. Which of the following is not an appropriate answer for the nurse to give?

Wash your hands frequently.

Be sure Mr. P covers his mouth and nose when he coughs or sneezes.

Use disposable tableware for Mr. P's meals.

See that Mr. P takes every dose of antitubercular medication as prescribed.

c

31

Which of the following snacks would most likely be tolerated by a client with a fat intolerance?

microwave popcorn

milkshake

Carnation Instant Breakfast Bar

fruit punch with powdered pasteurized egg whites

d

32

Which of the following snacks would most likely be tolerated by a client with disaccharide intolerance?

milk

bread

Ensure

sliced turkey

d

33

Which of the following snacks would most likely be tolerated by a client with oral thrush?

fresh orange

flavored yogurt

potato chips

popcorn

b

34

Clients with severe malabsorption caused by intestinal infection often require supplementation with which of the following vitamins?

folic acid

vitamin C

vitamin D

vitamin B12

d

35

Which of the following statements is true?

The benefits of overrestricting a client's diet may not suffice to offset the resulting loss in comfort for a client with terminal AIDS.

The nurse is in the best position to decide whether dietary restrictions are necessary.

Decisions made about the need to severely restrict a client's diet in an incurable situation are best made by the physician.

Dietary therapy should not be considered for the client in an incurable situation.

a

36

Thrush can cause:

oral ulcers

gastrointestinal inflammation

inability to tolerate salty and spicy foods

frequent fevers

abcd

37

The following statement(s) are true about the HIV epidemic:

The epidemic increasingly affects women, minorities, and the poor in the United States.

More than 95% of new infections occur in third-world countries.

The epidemic started about 50 years ago.

With medication, the disease is a now considered only a minor inconvenience.

ab

38

Current recommendations about HIV-positive women breastfeeding include the following:

HIV-positive women should never be encouraged to breastfeed.

The Centers for Disease Control and Prevention recommend that HIV-positive women in the United States refrain from breastfeeding.

The World Health Organization still advises women to breastfeed in developing countries.

HIV cannot be transmitted through breast milk.

bc

39

The discomfort associated with dysphagia may be minimized if the client:

brushes the teeth and gums three times a day to keep the oral cavity clean

avoids hot foods

eats soft foods

uses a straw

bcd

40

Good nutritional status may influence response to medications by:

decreasing the incidence of adverse drug reactions

supporting organ function

providing necessary raw materials for reactions

suppressing CD4 counts

abc

41

Which of the following roles is most important in the care of a terminally ill client?

A)

care provider

B)

client advocate

C)

counselor

D)

teacher

b

42

Which of the following is not a sign that death is approaching?

cessation of eating

cyanosis and dyspnea

muscle weakness

polyuria and incontinence

d

43

Ms. L is actively dying and has refused oral intake. Her caregiver is concerned that Ms. L has a fever. Which of the following responses would be the most helpful to the caregiver?

“Offer her fluids every hour, but respect her right to refuse.”

“Let's see if we can obtain an order for an antipyretic suppository.”

“Evidence is accumulating that dehydration is not painful and eases the passage from life. Offer sips of fluid upon request.”

“Put some fluid into her mouth every half hour and see if she will swallow it.”

c

44

Which of the following measures is not recommended to treat dry mouth in the actively dying client?

forcing fluids

oral care

ice chips

lubricant to the lips

a

45

The goal of nutritional care for the terminally ill client is to do which of the following?

Alleviate discomfort and relieve symptoms.

Maximize intake of a balanced diet.

Compensate for malabsorption problems.

Substitute a liquid complete nutritional supplement for solid food.

a

46

Which of the following statements by a caregiver indicates a need for additional hospice support?

“I can't bear not to feed her. I just can't let her go.”

“We talked for a long time yesterday, remembering the good times.”

“We had a family conference and agreed on respite care.”

“I don't agree with her choice, but I will abide by her wishes.”

a

47

An assessment question about fat in the diet of a terminally ill client is appropriate if the client has complained about:

constipation

dyspnea

ravenous hunger

steatorrhea

d

48

Mr. F, a registered nurse giving hospice care to Mr. J, now learns Mr. J wishes to discontinue his gastrostomy feedings and just “let go.” Mr. F's best course of action is to do which of the following?

Restrain Mr. J's hands and give the feeding as ordered.

Obtain written permission from Mr. J's next of kin to proceed with the feeding.

Call the dietitian for instructions.

Ask Mr. J to accept the feeding until the hospice treatment team can meet about the issue, but respect his right to refuse the feeding if he insists.

d

49

Which of the following statements is true?

A)

Nutrition support is medically optional except for comatose clients.

B)

Hydration is medically mandatory as long as a client can swallow.

C)

State laws vary as to the obligation to provide hydration and nutrition.

D)

Federal statutes require both nutrition and hydration be provided as long as life persists.

c

50

In some states, a charge of ______ can be brought if a client is fed artificially against his or her wishes.

A)

assault

B)

battery

C)

malpractice

D)

negligence

b

51

In some states, a charge of ______ can be brought if a client is allowed to intentionally starve himself or herself to death.

assault

battery

malpractice

negligence

d

52

Ms. I is a 60-year-old client whose disease required strict regulation of food intake for the past 10 years. She is now under hospice care. Which of the following principles should guide her nutritional care?

Changing Ms. I's food habits at this time would be stressful for her.

Following the Food Pyramid is appropriate for everyone.

Ms. I should eat foods that were restricted, if that is her wish and she is actively dying.

The strict diet should continue because it kept her alive this long.

c

53

Care that is intended to relieve symptoms without curing the disease is called ______.

hospice

minimal

palliative

voluntary

c

54

Dryness of the mouth caused by an abnormal reduction in salivary secretion is:

A)

dysgeusia

B)

parotitis

C)

stomatitis

D)

xerostomia

d

55

Impairment or perversion of gustatory sense wherein normal tastes are perceived as unpleasant is:

dysgeusia

parotitis

stomatitis

xerostomia

a

56

Pruritus is:

excessive hair growth

severe itching

hives

inflammation of the skin

b

57

Discoloration (blue, gray, or purple) of the skin or mucous membranes due to lack of oxygen in the blood is called ______.

A)

petechiae

B)

contusions

C)

cyanosis

D)

purpura

c

58

The goal of nutrition screening for the client under hospice care is which of the following?

Recognize areas for improvement in diet.

Identify food-related concerns.

Gather data to correlate long-term nutritional habits with the onset of disease.

Distinguish food-handling practices that are suboptimal.

b

59

A client is terminally ill when he or she has an irreversible lethal disease and death is expected within ______.

A)

2 months

B)

3 months

C)

6 months

D)

1 year

c

60

Mr. W, a hospice client, wishes to treat his anemia so he will not feel so fatigued. One of the following interventions is inappropriate for this purpose. Which is it?

iron-fortified cereals

citrus fruits with every meal

chicken breasts every other day

raisins and prunes for snacks

b

61

Ms. D has been under the care of hospice for 4 months. For the past few days she has taken only one-fourth of her usual food. Her caregiver is greatly concerned. What advice is inappropriate?

“Offer her tasty foods to show you love her.”

“Be firm like a parent and insist that she increase her intake.”

“See if she would take just an ounce of complete supplement every hour.”

“Ask her what she wants from you. It may be just companionship.”

b

62

Ms. L has an abdominal cancer that is causing a partial bowel obstruction. She is able to take oral nourishment and has refused a feeding tube. All of the following interventions but one could be appropriate. Which is not?

Citrotein liquid supplement

a good source of dietary fiber with every meal and feeding

clear liquids

lean, tender chicken or turkey

b

63

Many foods taste bitter and metallic to a client. Which of the following suggestions would be expected to help alleviate this problem?

adding cocoa to coffee for a mocha flavor

marinating beef in vinegar sauce before cooking

sprinkling coarse salt on the fish before baking

using glass cooking utensils

d

64

For a client with hiccoughs, only one of the following interventions is recommended. Which is it?

avoiding peppermint flavorings

swallowing a teaspoonful of granulated sugar

increasing the amount of fluid consumed at each meal

using straws to ingest liquids and semisolids

b

65

Ms. N is a hospice client who has had IDDM for many years. The visiting nurse asks the client and caregiver to relate the client's history of clinical signs and symptoms of hypoglycemia. The nurse is concerned because of which of the following reasons?

Often no signs and symptoms of impending coma are shown due to epinephrine deficiency.

With approaching death, hyperglycemia needs to be steadfastly avoided.

Ketoacidosis is particularly hazardous for the client with a terminal illness.

A change in type or dose of insulin may be required to counterbalance the client's hypersensitivity to the drug.

a

66

Ms. N is a hospice client who has had IDDM for many years. The visiting nurse instructs the caregiver to feed Ms. N 30 to 50 g of carbohydrate every 3 hours:

to prevent starvation ketosis

for the water resulting from its metabolism

to spare fat for weight gain

as a symbol of loving care and concern

a

67

Mr. C is a hospice client who is still active in his family life. A recent onset of incontinent episodes is distressing to him. Which of the following statements by the caregiver indicates a need for additional teaching?

“He is just as satisfied with decaffeinated coffee as regular.”

“I am encouraging him to drink the most early in the day.”

“He drinks three cans of diet lemon-lime soda every day.”

“I am limiting his intake of liquids to 5 cups/day.”

d

68

Ms. O is a hospice client suffering from nausea and vomiting every day. Which of the following should be corrected to help alleviate the nausea and vomiting?

Remove the partially filled emesis basin next to her lunch tray.

Post a daily schedule showing exercise periods following breakfast, lunch, and dinner.

Provide a lunch tray containing foods from all the groups in the Food Pyramid.

Do not serve liquids with the meal.

a

69

A particularly bothersome symptom for Mr. Z is itching all over his body. The home health nurse notes scratch marks on his exposed skin. The nurse recommends limiting caffeine and alcohol intake:

because they frequently contain allergens

to avoid peripheral vasodilation

to permit the client better voluntary control of his responses

to limit total fluid intake

b

70

The intake of ice chips, Popsicles, ice cream, and sherbet are recommended for:

anemia and cachexia

dry mouth and fever

fluid accumulation and hiccoughs

jaundice and pressure ulcer

b

71

The following recommendation will not help to alleviate a migraine headache:

missed meals

avoidance of known food allergy foods

encouragement of fluids for clients receiving antihistamines

avoidance of caffeine

a

72

Mr. J, a hospice patient, has an open infected area on his coccyx and diarrhea. He is willing to do anything to alleviate his discomfort. The following may be helpful:

a clear liquid supplement

a tube feeding

nothing by mouth

TPN

a

73

A client has dyspnea and has read that caffeine helps break up and expel secretions. The client asks you for a recommendation. An appropriate response would be which of the following?

Some research has shown this to be true.

Consumption of caffeine is never recommended.

Milk will help prevent osteoporosis.

Fruit juice will work just as well.

a

74

A client with migraine headaches is highly motivated to try to use a nutritional intervention to alleviate pain. The nurse could recommend:

ample caffeine to increase blood flow to the brain

keeping a food diary and recording the onset of headaches

a low-fat diet

a low-carbohydrate diet

b

75

The following is true:

A)

Every client with a terminal illness benefits from dietary manipulation.

B)

The rejection of food should be considered a bad sign.

C)

Even if a client refuses to eat, health-care workers should remain supportive.

D)

Almost all clients who are actively dying continue to eat three well-balanced meals each day.

c

76

The following usually indicate that death is imminent:

decrease in body temperature

decreased verbalization

increase in pulse rate

a fall in blood pressure

acd

77

Hospice workers taking care of terminally ill clients have frequently reported the following:

Dehydration results in less vomiting and diarrhea.

Intravenous solutions provide comfort and a sense of well-being.

Tube feedings prolong life.

Dehydration results in less dyspnea and peripheral edema.

ad

78

All of the following are appropriate questions to ask clients on hospice during the screening process:

Do you have any concerns about your food intake or body weight?

Do you feel your symptoms could be decreased/controlled through diet?

Do you find eating enhances comfort?

When was the last time you had a complete blood work-up?

abc

79

What are appropriate suggestions if a client has a bothersome cough?

Encourage a greater protein intake to build respiratory muscle mass.

Encourage fluids and ice chips.

Recommend hard candy including sour balls.

Have the client try tea and coffee to dilate pulmonary vessels.

bcd

80

Diarrhea may be minimized by the following:

a low-residue diet

dry feedings

a clear-liquid diet if severe

a decrease in dietary fiber intake

abcd