Nutrition Pre Class Quizzes 5-9

Some patients require varying levels of feeding assistance during meals. Which of the following practices should be avoided when providing feeding assistance?

When hand feeding a cognitively impaired individuals, sit at eye level and mix together the pureed peas and mashed potatoes to facilitate intake

Early satiety in the older adult can have a negative impact on nutrition status. List one nursing intervention to improve dietary intake that you could suggest to a patient who is experiencing this symptom.

A nursing intervention to improve dietary intake of a patient who is experiencing early satiety would be to provide nutrient dense foods that have more calories in each bite. Giving them higher calorie lower volume foods will allow them to eat less volumes of food while still meeting their caloric needs for the day.

During adulthood, the daily recommended intake for some nutrients increases after age 50 years. Fill in the blanks and list two nutrients that fit this description.

After age 50 years, the daily recommended intake for calcium and vitamin D increases.

A patient who cannot swallow is on a tube feeding and their oral medications will have to be adjusted as a result. Which of the following scenarios presents a problematic example of why the nurse may need to consult with a pharmacist regarding drug administration when caring for a patient being tube fed?

All are problematic: - giving dilantin via a J tube, flushing a feed tube with water following the administration of an antibiotic and then restarting the feeding, giving an enteric coated drug orally, crushing extended release

Gastric bypass surgery, also known as Roux-en-Y or Billroth II, has the potential to cause poor nutritional status of some micronutrients. Patients who have had this surgery require life-long monitoring or supplementation of several micronutrients. Name one nutrient deficiency that these patients at risk of developing.

B-12 B12 calcium Ca vitamin B-12 iron Fe Vitamin B12 b12 vitamin B12 Iron b-12 Calcium

A patient on a clear liquid diet needs to understand what is considered a clear liquid and what is not a clear liquid. The nurse would need to re-educate the patient who is found consuming one of the following items. Which item is not part of clear liquid diet?

Black tea with a teaspoon of skim milk - Milk is not a clear liquid - you cannot see through it - and is not part of a clear liquid diet. Black tea with milk would not be included on this diet. The care team should be notified if the patient was prescribed a clear liquid diet as part of a bowel preparation in case the milk consumption affects an upcoming procedure.

A patient with cirrhosis asks the nurse about using an herbal supplement that they read about online as having healing properties for liver disease. Briefly explain an appropriate response by the nurse that addresses the question and provides education to the patient.

Buyer beware! Because there is no pre-market safety testing for dietary supplements and because there have been too many case reports of adulteration and contamination of supplements, there is no way to assure that it is safe to take a dietary supplement. And, because many dietary supplements are metabolized in the liver, just as drugs are, the risk is high that a supplement could affect hepatic health. On top of that, there is research showing that some supplements are associated with risk of liver failure - see p 536 in textbook and the Livertox link in Canvas resource page.

The gold standard for determining energy expenditure is indirect calorimetry, but that technology is expensive and not always available in every setting. There are multiple equations that are used to determine energy expenditure. Online apps and tools use some of these formula as do clinicians who do not have access to indirect calorimetry. Which of the following is a limitation or drawback to using these equations?

Equations have a high margin of error because they were developed for a set population but are used on the general population - Research was limited to set populations - such as fit, healthy weight people - and then the formula are used in populations such as the critically ill or the obese where there has been limited validation of the equations.

Sarcopenic obesity is considered a nutritional challenge in the older adult. Any older adult with sarcopenic obesity should receive nutrition education about how to lose weight.

False - Each patient should be individually assesses to determine whether or not the benefits to losing weight are greater than any associated risks. In the older adult, too much or too quick of a weight loss could result in loss of muscle and worsened sarcopenia that could lead to functional decline. Additionally, a restrictive diet could lead to diminished nutrient intake.

Administration of a 15% intravenous dextrose solution (D15W) via a peripheral vein is an advisable way to provide carbohydrate calories to the patient who on PPN (peripheral parenteral nutrition).

False - Intravenous dextrose solutions above a 10% concentration (D10W) will cause an influx of fluid into a peripheral vein and 'blow the vein' as it is called - leading to phlebitis. In some patients, even the 10% solution is problematic

Clogged enteral feeding tubes are a nuisance and can happen easily. Which of the following practices by the nurse will help to decrease the risk of a feeding tube becoming clogged?

Flushing the feeding tube with water before and after administration of medications - This practice is important. If residual feeding formula is in the tube, it can form a precipitate with medications. The opposite is also true - if residual medication is in the tube and feedings are resumed, a precipitate can form. Flushing with water reduces the chance of a precipitate forming and clogging the tube

Gastroparesis is a condition that results in slowed gastric emptying. List one dietary interventions that the nurse should suggest to a patient who has been diagnosed with this condition.

Good glycemic control in patients who have diabetes Small frequent meals - a smaller volume will take less time to empty than a larger volume Low fat - fat causes slowed gastric emptying Low fiber - fiber increases the risk of bezoars, an undigested food mass that can lead to an intestinal blockage Solid food may be tolerated earlier in the day and a switch to more liquid meals later in the day- this advice is reserved for more extreme symptoms where gastric emptying is very prolonged. Some patients tolerate solid foods at the start of the day and then gastric emptying slows later in the day. Liquids empty more quickly from the stomach than do solids Liquid or pureed food items - this advice is reserved for more extreme symptoms where gastric emptying is very prolonged. Liquids empty more quickly from the stomach than do solids Oral liquid nutrition supplements or a tube feeding in more extreme cases- in some circumstances a feeding tube is placed that extends into the duodenum to bypass the stomach to avoid the issue of delayed gastric emptying

A client has gastroesophageal reflux (GERD) and is complaining of increased symptoms at night when going to bed despite acid reduction medications. The nurse suspects that one of the following new habits is responsible for the symptoms. Which habit should the nurse advise the patient to stop?

Having a beer after dinner each night while watching television

List one example of a risk factor for iatrogenic malnutrition - either list something that you can think of based on your reading or have seen occur in the clinical setting.

Iatrogenic malnutrition means 'caused by medicine' - so it is malnutrition that happens because of a stay in the hospital, medical treatment or poor clinical practices. Examples include missed meals for procedures or because of interruptions, tube feedings that are held, prolonged NPO status, a diet that does not meet the patient's personal preferences and results in diminished intake, side effects from a drug or treatment that impact nutritional intake. The list can go on- keep your eyes open and alert for what you can preven

A patient is scheduled to have an assessment of their energy expenditure using indirect calorimetry. Which of the following statements by the nurse is NOT accurate advice to give the patient as they prepare for this assessment?

If you are going to smoke, have your last cigarette no closer than one hour before the assessment - Correct - this is NOT good advice! Nicotine elevates basal metabolic rate and it is recommended that the patient not smoke/ use nicotine patch or other form of nicotine for at least 140 minutes before the test.

"Nutrients of concern" exist with each lifespan population and should be a focus when conducting a nutritional assessment. When conducting a nursing assessment of a woman of childbearing age who hopes to have a child soon, what is one vitamin or mineral that is a "nutrient of concern" that you should be sure to address in the nutrition portion of your assessment?

Iron folic acid iron calcium folate Calcium

A client who had gastric bypass surgery to treat morbid obesity is experiencing Dumping Syndrome. What suggestion can the nurse make to the patient to help lessen symptoms?

Lying down helps to combat the effects of gravity on gastric emptying.

Malnutrition is an important concern that can impact patient outcomes. Which of the following statements is untrue about the effects of malnutrition in the hospitalized adult?

Malnutrition is linked with an altered BMI-for age - What is true: malnutrition is linked with altered pharmacokinetics, increased length of hospital stays, increased risk of infection

List one nursing intervention that you could practice when feeding a cognitively impaired older adult.

One nursing intervention that I could practice when feeding a cognitively impaired older adult would be to be aware of the alterations in taste in smell that occur in these people. Since taste perception and olfactory sensation both decline with aging, there comes decreased pleasure with eating. As a nurse, I would make sure to implement adequate mouth care when the patient begins to expierience a bitter/metallic taste from food. I could also do things like add color to foods, altering the texture of the food to their liking, and adding flavors/spices that the patient likes.

A patient with hepatitis read online that high protein intake can lead to hepatic encephalopathy and so has cut back on consumption of protein-containing foods. When the patient shares this information with the nurse, what is the best response for the nurse to give?

Reduced protein intake will lead to breakdown of skeletal muscle and other proteins in the body, which can impair the repair of inflamed hepatocytes in this patient - Any condition with 'itis' means inflammation - and an inflamed liver requires healing in order to help prevent the development of scar tissue (which is what cirrhosis is - scar tissue in place of healthy hepatocytes). So, a patient who has hepatitis needs a high protein/ calorie diet to meet the needs for healing. Plus, it will compromise all the other important functions of protein in wellness.

List one suggestion that the nurse can offer to help improve nutrition intake using oral liquid nutrition supplements (such as Ensure or Boost).

Serve liquid supplements cold - not a room temperature Serve liquid supplements at least an hour away from any meal time Use liquid supplements in place of other fluids when passing medications - as long as there is not a drug-supplement interaction (careful!) Vary flavors of liquid supplements to avoid taste fatigue

"If the gut work, use it!" is a statement that describes the advice to use the gastrointestinal (GI) tract to feed a patient when possible instead of parenteral (intravenous) nutrition. What is the rationale for this advice?

The intestinal barrier becomes permeable when the gut is not used and bacteria can travel from the GI tract to the peritoneal cavity - Bacterial translocation is when bacteria move from the gut to the peritoneal cavity or to organs and can cause inflammation and infection. Not using the GI tract causes the gut wall to be 'leaky' and allow the bacteria to travel

The majority of probiotics are regulated as dietary supplements - not medications - and are touted in the popular press as treatment for many conditions. Which of the following is a true statement about the scientific evidence available for probiotic use?

The majority of research findings on probiotics are in agreement that probiotics are effective in treating diarrhea associated with antibiotic use

In general, older adults are at increased risk of dehydration compared to younger adults. Which of the following describes a primary reason for this risk in the older adult population?

The older adult has lowered total body water because of sarcopenia - True! Less muscle mass results in less total body water. The older adult has less total body water than a younger counterpart and therefore more easily can slip into dehydration when any increase fluid losses or lowered intake occurs - such as with GI losses, extreme heat and increased sweating, or diminished intake.

Guidelines and diet texture alterations for dysphagia are individualized according to the patient's ability to swallow. In general, some textures and consistencies are more difficult to swallow or have a higher risk of aspiration than do others. Which liquid consistency is associated with the highest risk of aspiration compared with other liquid consistencies?

Thin liquids (consistency of water) - Correct, in general, thin liquids are most easily aspirated compared with other liquids because of how they are handled in the mouth during the ingestion and swallowing processes

Joking around about weight and making weight comments to a child or adolescent can contribute to later risk of disordered eating and eating disorders in the person.

This effect is true. A weight focused environment - whether presented as jokes, teasing or even lots of body talk/ diet talk - sets the stage for risk of all types of disordered eating/eating disorders.

Lactose intolerance is a common condition. What is the best initial dietary advice the nurse can offer to the patient who complains of feeling sick after drinking a glass of milk?

Try consuming a small amount of yogurt instead of milk - Correct! Since lactase enzyme activity is use-it-or-lose it, consuming a small amount of food that is a fermented food with lactose is an often well-tolerated way to maintain some level of lactose tolerance

A gluten-free diet is the only treatment for celiac disease. Which of the following foods is allowed on a gluten-free diet?

Winter squash baked with quinoa

It is suggested that the daily recommended intake for vitamin B12 in the adult over age 50 years be met by consuming a synthetic form of vitamin B12, such as is found in a dietary supplement or fortified food. What is the rationale for recommending a synthetic form of this vitamin?

gastric acid production diminishes with age and synthetic vitamin B-12 absorption does not require an aciditic gastric environment - This statement is correct. Gastric acid product does diminish with age. And, an acid stomach is needed to cleave the B12-protein bond found in natural sources of vitamin B12. Synthetic sources do not have this bond.

Someone's basal metabolic rate (BMR) is influenced by many factors. What factor influences BMR more than any other factor?

lean body mass leanness muscle mass muscle LBM body size body weight - Muscle or lean body mass is what contributes the most to our basal metabolic rate. Someone's body size may indirectly influence BMR for this reason but not all people of the same size have the same amount of muscle. Energy expenditure or physical activity are not part of BMR since basal metabolic rate is defined as the energy expended for body functions/ organ functions while at complete rest.

Health promotion and disease prevention are important nutritional health goals in adulthood. List the name of one dietary pattern or diet that is associated with a decreased risk of chronic diseases.

plant-based plant based diet vegetarian Mediterranean diet DASH diet dash vegetarian diet plant-based diet DASH Mediterranean plant based

A clear liquid diet contains adequate calories to meet the needs of most hospitalized adults and can be prescribed for up to one week without concern

this statement is false. A clear liquid diet provides fluid for hydration and some carbohydrate to keep the patient out of ketosis. It is nutritionally deficient and should not be prescribed for a week without seeking a nutrition consult in the interim.