Nutrition chapter 12

According to the Dietary Supplement Health and Education Act (DSHEA) of 1994, dietary supplements are considered a. foods. b. drugs. c. nutrients. d. food additives.

A DSHEA considers dietary supplements to be foods, not drugs, nutrients, or food additives

Feeding tubes should be placed into the small intestine rather than the stomach if a. the patient is comatose. b. a regular polymeric formula is being used. c. the patient prefers not to have a tube passing through his or her nose. d. the patient is expected to resume oral feedings within 1 to 2 weeks

A Feeding tubes should be placed into the small intestine rather than the stomach if the patient is not alert and does not have an intact gag reflex; such patients include comatose patients. Regular polymeric formulas can be administered into the stomach or duodenum, but not the jejunum. Feeding tubes can be passed through the nose or through a stoma into the stomach or into the small intestine; the nose is usually used only if the feeding tube will be needed for less than 1 or 2 weeks. The time frame within which the patient is expected to resume oral feedings affects whether the nose or surgical placement is used, but it does not affect whether feedings are administered into the stomach or small intestine

A patient who is an orthodox Jew would not eat a. chicken in cream sauce. b. a hamburger and fries. c. a grilled cheese and tomato sandwich. d. scrambled eggs and hash browns.

A Kosher food laws prohibit consumption of meat and dairy products at the same meal, so chicken (meat) in cream sauce (dairy) would not be allowed. A hamburger and fries contain meat, but not dairy (as long as the burger is not a cheeseburger); a grilled cheese sandwich contains dairy but no meat. Scrambled eggs and hash browns contain neither dairy nor meat

A patient has undergone several gut resections because of cancer and is unlikely to resume adequate oral intake of nutrients. The best way to feed this patient would be via a. central parenteral nutrition. b. peripheral parenteral nutrition. c. a PEG tube. d. jejunal enteral feedings.

A Long-term parenteral nutrition must be administered centrally because peripheral veins cannot handle high enough concentrations of nutrients to provide long-term nutrient needs. Administration of enteral nutrition via a PEG tube or jejunal feedings is not appropriate because this patient does not have sufficient gut function

Nurses should ask patients about their use of over-the-counter medications because a. those medications may cause drug-drug or nutrient-drug interactions. b. the medical staff has a legal responsibility to know what patients are using. c. they may be able to advise patients about cheaper generic forms of drugs. d. patients should not take prescription and over-the-counter drugs at the same time.

A Over-the-counter medications are just as likely as prescription medications to cause drug-drug or nutrient-drug interactions. It is important to ask patients, but medical staff are not legally required to know what patients are using, especially if patients do not offer this information. It would be more appropriate for a pharmacist to advise patients about generic forms of drugs. Prescription and over-the-counter drugs may be taken at the same time, but it is important for the medical staff to know what patients are taking to avoid harmful interactions

If a patient with cystic fibrosis and pancreatic insufficiency requires enteral feedings, he or she should be fed a(n) a. elemental formula. b. modular formula. c. formula specially formulated for critically ill patients. d. lactose-free formula.

A Patients with pancreatic insufficiency are unable to properly digest nutrients, and so they should be fed an elemental formula, in which the nutrients are predigested or hydrolyzed. A modular formula contains intact nutrients; separate formulas contain carbohydrate, protein, and fat, but they all still must be digested. Specialty formulas for critically ill patients are intended for patients with burns or acute physical stress. A lactose-free formula still contains intact nutrients and would require digestion

During transitions from parenteral or enteral tube feedings to oral feedings, patients should be monitored to ensure that a. they do not develop hypoglycemia. b. total nutritional intake is adequate. c. their weight does not increase rapidly. d. they do not experience nausea and vomiting

ANS: B When patients transition from parenteral or enteral feedings to oral feedings, it is important to ensure that they achieve adequate nutrient intakes. Hypoglycemia may develop if parenteral nutrition is discontinued too quickly, but not after enteral feedings are stopped. Most patients struggle initially to maintain adequate oral intake, so weight gain is not a concern. Nausea and vomiting are not common, especially if oral feedings are resumed gradually

The best way to maintain the integrity and function of the gut in someone who is receiving parenteral nutrition is to a. supplement parenteral nutrition with probiotics. b. encourage patients to smell foods to stimulate gastric juices. c. use enemas to keep fluids in the gut without using the oral route. d. give the patient small sips of diluted fruit juice if possible

ANS: D Minimal enteral intake, even small sips of diluted juice, can help maintain normal gastrointestinal tract physiology and gut mucosal immunity. Probiotics may be used in patients who are being fed enterally or orally, but not parenterally. Smelling food may stimulate production of digestive secretions, but it has not been shown to protect the gut. Enemas would reach only the rectum and lower colon and would not maintain gut function

A one-a-day multivitamin or multimineral supplement at 100% or less of the Dietary Reference Intake (DRI) is probably most beneficial for a(n) a. young adult who lifts weights before work every morning. b. older adult living at home alone. c. business executive with a high-stress job. d. newly retired, socially active woman.

B A multivitamin or multimineral supplement that contains 100% or less of the DRIs for most micronutrients may help provide a nutritional "safety net" for groups at high risk for nutritional insufficiency, including older adults who live alone. Young adults who are physically active and socially active new retirees are likely to meet their nutritional needs through food. Psychological and emotional stress does not significantly alter nutrient needs

Bolus enteral feedings would be appropriate for a patient who a. has had a gastrectomy. b. has a PEG tube. c. is being fed via a nasoduodenal tube. d. has a history of aspiration-related pneumonia.

B Bolus feedings should be administered only into the stomach because a larger volume is administered at one time and the duodenum and jejunum cannot hold this larger volume. Patients at high risk for aspiration should not receive bolus feedings because the fullness of the stomach is more likely to cause regurgitation. A patient who has had a gastrectomy does not have a stomach to receive the bolus

If a patient starts to experience diarrhea 12 hours after starting enteral feedings, the first course of action the medical staff would try is a. switching to a lactose-free formula. b. decreasing the rate of the formula feeding. c. switching to an elemental formula. d. stopping the feeding until the diarrhea resolves.

B For patients who experience diarrhea when they begin a tube feeding, the first course of action should be to decrease the rate of the formula feeding. If this does not work, a lactose-free formula may be helpful. An elemental formula would be used only if the patient's ability to digest food is compromised. The feeding should not be stopped unless absolutely necessary because it is important for the patient to have a supply of nutrients. It is possible that the diarrhea is caused by infection, medications, or other causes other than the enteral formula

If a patient is receiving radiation to the mouth and neck area and has a sore mouth, the most appropriate type of diet while he or she is in hospital would be a _____ diet. a. regular b. mechanical soft c. full liquid d. clear liquid

B For someone with a sore mouth, a mechanical soft diet would be easier to eat without pain than would a regular diet. The patient can probably tolerate soft foods; a full or clear liquid diet would be overly restrictive and more likely to result in inadequate nutrient intake

Using a margarine fortified with plant sterol and stanol esters to help decrease blood cholesterol levels is an example of using a a. probiotic. b. functional food. c. dietary supplement. d. complementary food

B Margarine fortified with physiologically active food components, such as plant sterol and stanol esters, is considered a functional food. Probiotics contain live microorganisms thought to be beneficial to the body. Dietary supplements contain natural or synthetic nutrients in an isolated form. Complementary is a term used to describe nontraditional therapies used alongside conventional treatments, rather than to describe foods

A food restriction shared by both Muslims and Jews is a. not combining meat and dairy at the same meal. b. not eating pork or any food products from pigs. c. avoiding coffee, tea, and alcohol. d. eating fish with fins and scales but not shellfish.

B Neither observant Muslims nor observant Jews eat pork or foods from pigs. Observant Jews do not combine meat and dairy at the same meal and do not eat shellfish. Observant Muslims avoid coffee, tea, and alcohol

A patient should be discouraged from using echinacea to help reduce the duration of colds if he or she is using a. anticoagulant drugs to prevent formation of blood clots. b. immunosuppressant drugs after organ transplantation. c. oral contraceptives or hormone replacement therapy. d. oral hypoglycemic agents for treatment of diabetes.

B Patients should not use echinacea if they are taking immunosuppressant drugs because Echinacea may decrease the immunosuppressant effect. Echinacea is not known to interfere with anticoagulant effects, hormone treatments, or oral hypoglycemic agents

If a patient receiving parenteral nutrition has a fluid restriction, he or she would need to be fed via _____ parenteral nutrition. a. peripheral b. central c. peritoneal d. cyclical

B Patients with fluid restrictions need more concentrated nutrient solutions, which are hypertonic and need to be administered via a central vein. Parenteral nutrition is not administered via the peritoneum and is not usually administered cyclically

If a patient starts vomiting immediately after eating seafood and states that the one other time he or she ate seafood, he or she had a similar reaction, the patient probably has a. food poisoning. b. celiac disease. c. an allergy to seafood d. a viral infection.

C A food allergy may cause vomiting immediately after the offending food is eaten; because the same thing happened when the patient ate seafood before, an allergy is even more likely. A viral infection or food poisoning would not occur every time the patient ate seafood. Celiac disease is caused by an immunologic reaction to gluten, which is not found in seafood

Intravenous lipid emulsions are used as part of parenteral nutrition to prevent fatty acid deficiency and to a. increase patient satiety. b. provide a source of fat-soluble vitamins. c. add kilocalories without increasing osmolality. d. add kilocalories with minimal expense.

C Intravenous lipid emulsions are used to add kilocalories to parenteral nutrition without increasing osmolality. Amino acids and dextrose can add kilocalories, but they are very hypertonic. Lipids may contribute to patient satiety, but this effect is limited because they do not pass through the gastrointestinal tract. Intravenous lipid emulsions do not contain vitamins; these are added separately. Lipids are not necessarily less expensive than other parenteral nutrients

To reduce the risk of aspiration, patients who are receiving enteral tube feedings should be positioned a. sitting upright. b. lying on their side. c. with the head of the bed elevated 30 to 45 degrees. d. with the head of the bed elevated 45 to 60 degrees.

C Patients who are receiving enteral tube feedings should be positioned with the head of the bed elevated 30 to 45 degrees to help prevent aspiration. They do not need to sit upright. Lying on their side does not reduce the risk of aspiration

If a patient with depression takes a selective serotonin reuptake inhibitor (SSRI), the nurse may want to ask about use of herbal products because of potential interactions if the patient is using a. ginseng. b. ginkgo biloba. c. St. John's wort. d. evening primrose oil.

C St. John's wort may be used to treat depression and may interact with SSRIs to cause serotonin syndrome (sweating, agitation, and tremor). Ginseng, ginkgo biloba, and evening primrose oil are not known to interact with SSRIs

If a patient is to receive enteral feedings for several weeks because of esophageal surgery but is otherwise generally healthy, he or she may be fed through a _____ tube. a. nasogastric b. nasoduodenal c. percutaneous endoscopic gastrostomy (PEG) d. jejunostomy

C The patient would probably be fed through a PEG tube; more permanent placement is appropriate for feedings over several weeks; the patient should be at low risk for aspiration, and so the gastric feedings are appropriate. A feeding tube would not be passed through the nose and down the throat if the patient is having esophageal surgery. A jejunostomy tube would be needed only if the patient had a higher risk of aspiration

The most important thing a nurse can do to prevent the spread of foodborne illness among hospitalized patients is to a. discard any food that is uneaten within 30 minutes of being served. b. wear a mask when serving food or helping feed patients. c. wash hands thoroughly before serving food and after using the bathroom. d. discourage friends and family members from bringing in food for the patient.

C Thorough and frequent hand washing is most important to prevent the spread of foodborne disease. Wearing a mask may be helpful for immunocompromised patients but is less important than hand washing. Uneaten food should be refrigerated and, if it is not eaten within 24 hours, discarded. Bringing in favorite foods can help improve nutrient intake and is not necessarily dangerous if the food is eaten immediately or refrigerated and kept for no more than 24 hours

If a physician orders a "diet as tolerated" for a patient, the nurse should a. make food selections for the patient in accordance with the patient's symptoms. b. determine the appropriate type of diet for the patient in accordance with the patient's condition. c. consult the registered dietitian to determine when the diet should be advanced. d. encourage the patient to normalize the diet as his or her appetite and symptoms allow.

D A "diet as tolerated" order allows patients to select foods according to their appetite and symptoms; the nurse should encourage gradual progression to normal eating as they are able. The registered dietitian does not need to be consulted to advance the diet. The nurse should work with such patients and allow them to make food selections themselves to encourage adequate nutrient intake; the nurse should not make food selections for patients

If a patient has had a stroke and needs enteral feedings because he or she cannot chew or swallow but has no other medical problems, he or she can be fed with a(n) _____ formula. a. isotonic b. modular c. elemental d. polymeric

D A patient whose digestive system works normally and who has no other medical problems besides an inability to chew and swallow can receive enteral feedings with a standard polymeric formula. Such formulas are not necessarily isotonic; isotonic formulas may be used if a patient develops diarrhea. Modular formulas are used for specific medical conditions necessitating more or less of one or more macronutrients. Elemental formulas are used if the patient has difficulties digesting the formula or if the formula is administered into the jejunum rather than the stomach

A clear liquid diet would be most appropriate for a. someone who has had several teeth removed and is unable to chew. b. a pregnant woman with persistent nausea. c. someone who has had a stroke and has difficulty swallowing. d. a patient who has had major surgery within the past 18 hours.

D Clear liquid diets are appropriate for patients who have just undergone surgery. Patients who are unable to chew can be given mechanically altered diets but can still eat foods that do not need to be chewed. Clear liquid diets do not necessarily help with nausea and would not provide the nutrients needed to support a healthy pregnancy. Patients who have difficulty swallowing often have the most trouble swallowing liquids, and so a clear liquid diet could be unsafe

If a patient drools, takes a long time to eat, and often gags during meals, he or she may have a. dementia. b. esophageal cancer. c. regurgitation. d. dysphagia.

D Drooling, taking a long time to eat, and frequent gagging are signs of dysphagia, or difficulty swallowing. Esophageal cancer may or may not cause dysphagia. Dementia and regurgitation are not necessarily associated with these symptoms

For patients who are taking prescription or over-the-counter drugs, herbal preparations a. should all be avoided. b. can be considered safe. c. should be taken separately from drugs. d. may cause dangerous herb-drug interactions.

D For patients who take prescription or over-the-counter drugs, herbal preparations can cause dangerous herb-drug interactions. They cannot be considered safe simply because they are "natural." They do not necessarily need to be avoided, but their use should be discussed with a physician or pharmacist. Taking the herbal preparation separately from drugs may not help, depending on how long each drug and each herb remain active in the body

During a home visit to a patient receiving home enteral nutrition, the greatest source of concern would be if the a. patient were receiving enteral feedings only during the night. b. patient has gained 1 pound during the past month. c. family complains that they miss being able to eat meals together. d. family is blending family meals to make their own formula.

D Home-blended tube feedings would be a concern because their nutrient composition, osmolality, and consistency are inconsistent; because they can easily become contaminated and cause foodborne illness; and because they may clog feeding tubes. Receiving enteral feedings at night can provide adequate nutrition without the inconvenience of being attached to a feeding tube during the day. If the family misses eating meals together, they can be encouraged to play board games and enjoy other activities together instead. Gaining 1 pound in a month is not a concern. If weight gain continues, the amount of formula can be adjusted slightly

Registered dietitians may encourage patients to use specific herbal supplements a. that are less expensive than conventional medications. b. that they have used themselves and found to be helpful. c. that are approved by the U.S. Department of Agriculture (USDA). d. for which efficacy and safety have been scientifically studied and documented.

D Registered dietitians may encourage patients to use specific herbal supplements for which efficacy and safety have been scientifically studied and documented. They would probably also want to make sure that the supplements are safe to use in combination with any other medications the patient uses. Herbal supplements are not necessarily less expensive than conventional medications. Health practitioners should not rely on their own anecdotal experience when making recommendations to patients. Herbal supplements are regulated by the U.S. Food and Drug Administration (FDA), not by the USDA

If an individual has back pain and seeks treatment with acupuncture, as well as a physician at a traditional spine clinic, this would be an example of using _____ medicine. a. traditional b. integrative c. alternative d. complementary

D This is an example of complementary medicine: combining a non-Western healing approach (acupuncture) at the same time as conventional medicine (spine clinic). Traditional medicine would mean using only the spine clinic and perhaps physical therapy. Integrative medicine merges conventional medicine with complementary and alternative therapies for which efficacy and safety have been established through scientific methods. Alternative medicine replaces traditional Western methods with non-Western healing approaches

To determine the nutritional adequacy of a tube feeding, a. the patient's actual formula intake and body weight should be recorded daily. b. intake and output records should be completed during each nursing shift. c. urine glucose levels, gastric residuals, and bowel movements should be recorded. d. anthropometric, biochemical, and clinical indexes should be assessed weekly.

D To determine nutritional adequacy of enteral or any other feedings, anthropometric, biochemical, and clinical indexes should be measured weekly. These indexes show how feedings are affecting the patient's weight and nutritional status. Daily recording of weight can help assess fluid shifts and may give some indication of kilocalorie adequacy over time. Measurement of actual formula intake, use of intake and output records, assessment of urinary glucose level, measurement of gastric residuals, and records of bowel movements may help evaluate formula tolerance and ensure that the patient is receiving the prescribed amount of formula but do not demonstrate adequacy

One advantage of a full liquid diet is that it a. has low levels of saturated fat and high levels of fiber. b. is suitable for patients with lactose intolerance. c. is likely to be tolerated by patients with dysphagia. d. can provide an adequate diet if very carefully planned.

D With careful planning, a full liquid diet can provide adequate nutrition. However, full liquid diets tend to have high levels of saturated fat (from dairy products) and low levels of fiber (because whole foods are not eaten). It is not suitable for patients with lactose intolerance unless it is highly modified because it includes considerable amounts of dairy products. It is not well tolerated by patients with dysphagia, who often have difficulty swallowing liquids