Final TB 23 & 24
Acquired immunodeficiency syndrome (AIDS) has been transmitted through all except one of the following means. Identify the exception.
dishes and utensils contaminated the infected client
prenatal infection of the fetus
needle punctures or scalpel wounds of health-care workers
The major nutrition-related problems in clients with AIDs are caused by:
lack of cleanliness in the cooking area
poor hand-washing technique
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
Medium-chain triglyceride (MCT) oil can be used in salad dressing and baked goods to:
delay the absorption of fats
increase the total amount of fat absorbed
act as a lubricant for swallowing difficulties
reduce serum triglyceride levels
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
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
A person who is HIV-positive should use good hygiene to decrease the risk of:
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
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.
Protection from a disease, especially an infectious disease, usually induced by antibody production in response to an antigen or a microorganism is:
The type of isolation precaution that assumes that all body fluids are contaminated is called ______.
body substance isolation
______ 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
A central nervous system disorder caused by HIV is:
AIDS dementia complex
immune deficiency psychosis
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
The client with AIDS who suffers from chronic diarrhea is at risk of:
increased susceptibility to vitamin toxicities
rickets due to excessive loss of vitamin D
A disease that occurs with much greater frequency in clients with AIDS than in other population groups is ______.
staphylococcal food poisoning
A causative agent of thrush that can affect the gastrointestinal or vaginal tract is ______.
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
The most plausible explanation for the increased incidence and high prevalence of HIV in the African population is:
lack of educational opportunities
increased number of disease-spreading mosquitoes
a genetic mutation that originally evolved to protect against malaria
Every client with an HIV diagnosis should be educated about:
a high-protein diet
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
The decision regarding aggressive nutritional support for a competent client is made by the:
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
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
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
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.
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.
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.”
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
glucose tolerance test
white blood cell count
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.
Which of the following snacks would most likely be tolerated by a client with a fat intolerance?
Carnation Instant Breakfast Bar
fruit punch with powdered pasteurized egg whites
Which of the following snacks would most likely be tolerated by a client with disaccharide intolerance?
Which of the following snacks would most likely be tolerated by a client with oral thrush?
Clients with severe malabsorption caused by intestinal infection often require supplementation with which of the following vitamins?
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.
Thrush can cause:
inability to tolerate salty and spicy foods
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.
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.
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
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
Which of the following roles is most important in the care of a terminally ill client?
Which of the following is not a sign that death is approaching?
cessation of eating
cyanosis and dyspnea
polyuria and incontinence
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.”
Which of the following measures is not recommended to treat dry mouth in the actively dying client?
lubricant to the lips
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.
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.”
An assessment question about fat in the diet of a terminally ill client is appropriate if the client has complained about:
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.
Which of the following statements is true?
Nutrition support is medically optional except for comatose clients.
Hydration is medically mandatory as long as a client can swallow.
State laws vary as to the obligation to provide hydration and nutrition.
Federal statutes require both nutrition and hydration be provided as long as life persists.
In some states, a charge of ______ can be brought if a client is fed artificially against his or her wishes.
In some states, a charge of ______ can be brought if a client is allowed to intentionally starve himself or herself to death.
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.
Care that is intended to relieve symptoms without curing the disease is called ______.
Dryness of the mouth caused by an abnormal reduction in salivary secretion is:
Impairment or perversion of gustatory sense wherein normal tastes are perceived as unpleasant is:
excessive hair growth
inflammation of the skin
Discoloration (blue, gray, or purple) of the skin or mucous membranes due to lack of oxygen in the blood is called ______.
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.
A client is terminally ill when he or she has an irreversible lethal disease and death is expected within ______.
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?
citrus fruits with every meal
chicken breasts every other day
raisins and prunes for snacks
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.”
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
lean, tender chicken or turkey
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
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
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.
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
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.”
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 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
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
The following recommendation will not help to alleviate a migraine headache:
avoidance of known food allergy foods
encouragement of fluids for clients receiving antihistamines
avoidance of caffeine
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
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 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
The following is true:
Every client with a terminal illness benefits from dietary manipulation.
The rejection of food should be considered a bad sign.
Even if a client refuses to eat, health-care workers should remain supportive.
Almost all clients who are actively dying continue to eat three well-balanced meals each day.
The following usually indicate that death is imminent:
decrease in body temperature
increase in pulse rate
a fall in blood pressure
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.
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?
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.
Diarrhea may be minimized by the following:
a low-residue diet
a clear-liquid diet if severe
a decrease in dietary fiber intake