Question 1

The guideline for use of a percutaneous endoscopic gastrostomy (PEG) in patients with neurologic disease or disorders is to use&#10;A)whenever there is a risk of aspiration pneumonia.&#10;B)with patients whose swallowing function will not ensure adequate nutritional intake.&#10;C)with patients who refuse a central line for total parenteral nutrition.&#10;D)with patients who are expected to resume oral alimentation within 7 days.

Accepted Answer

In patients with neurologic conditions, PEG placement is reserved for those whose swallowing is so affected that adequate nutritional intake cannot occur.Dysphagia places patients at risk for aspiration, so use of enteral nutrition is usually a temporary means of providing adequate nutrition while swallowing ability is reestablished.This may take several weeks to months to occur.However, because PEG feeding provides enteral formula to the stomach, appropriate positioning of the patient is necessary to prevent potential reflux and aspiration.

Question 2

Sensory deficits of limbs on the opposite of the body that result from an occlusion of the middle cerebral artery on one side of the brain are known as&#10;A)hemiparesis.&#10;B)hemiplegia.&#10;C)hemianopsia.&#10;D)hemi-inattention.

Accepted Answer

Hemiparesis is a weakness or deficit of sensation on one side of the body that is associated with damage or impairment of the brain on the opposite side.Hemiplegia is a condition of paralysis associated with half of the body.Hemianopsia is blindness in one eye that causes a person to only see half of the visual field.Hemi-inattention is the neglect of one side of the body because the patient is not able to sense that side of the body.

Question 3

Damage to which of the following cranial nerves will likely affect the ability to eat food?&#10;A)Olfactory (I) nerve&#10;B)Abducens (VI) nerve&#10;C)Glossopharyngeal (IX) nerve&#10;D)Vagus (X) nerve

Accepted Answer

The glossopharyngeal or IX cranial nerve controls swallowing and the gag reflex, and it is involved with palatal, glossal, and oral sensations.The olfactory nerve affects the sensation of smell but has no control of motor function in relation to eating.The abducens nerve affects eye movement.The vagus nerve controls gastrointestinal (GI) activity and sensation of taste on the posterior third of the tongue; however, stimulation of GI activity depends on eating.

Question 4

Which of the following neurologic conditions is associated with over- or excessive nutritional intake?&#10;A)Wernicke-Korsakoff syndrome&#10;B)Stroke&#10;C)Multiple sclerosis&#10;D)Alzheimer's disease

Accepted Answer

Risk of stroke is increased in people who are obese or have who have hyperlipidemia.Wernicke-Korsakoff syndrome results from thiamin deficiency and may be preceded by chronic alcoholism.Multiple sclerosis is a chronic central nervous system disease characterized by demyelination, but the cause is unknown.Alzheimer's disease is a neurodegenerative disease, but nutrition is not involved in its development.

Question 5

Which of the following is NOT true of head-injured patients&#10;A)They have profound urinary nitrogen loss.&#10;B)Their energy needs are related to the Glasgow Coma Scale.&#10;C)They are hypermetabolic.&#10;D)They have decreased energy needs.

Accepted Answer

Head injury results in hypermetabolism evidenced by increased energy expenditure and profound urinary nitrogen loss.Correlations between the severity of brain injury as measured by the Glasgow Coma Scale and energy requirements have been shown.

Question 6

Because of potential drug-nutrient interactions, it would be more beneficial to provide the majority of their dietary protein to patients with Parkinson's disease&#10;A)during breakfast.&#10;B)at the noon meal.&#10;C)evenly throughout the day.&#10;D)with the evening meal.

Accepted Answer

L-dopa is given to patients with Parkinson's disease to help control the tremors, rigidity, and bradykinesia associated with the disease.However, large neutral amino acids compete with l-dopa for absorption, and this is thought to alter the rate of entry of l-dopa into the circulation and its uptake into the brain.To reduce the presence of symptoms during the day when the patient is most active, dietary protein should be minimized at breakfast and lunch and added with the evening meal.This improves mobility of the patient during the day.

Question 7

How may phenobarbital, used for anticonvulsant therapy, interfere with the intestinal absorption of calcium?&#10;A)It increases metabolism of vitamin D in the liver.&#10;B)It prevents absorption of vitamin D in the intestinal mucosa.&#10;C)It induces diarrhea and loss of electrolytes.&#10;D)It damages the mucosal cells lining the intestinal wall.

Accepted Answer

Phenytoin, phenobarbital, and primidone increase the metabolism of vitamin D in the liver.The result is that dietary calcium absorption is impaired.Long-term use of these medications places children at risk for rickets and adults at risk for osteomalacia.To prevent this, vitamin D supplementation is recommended.

Question 8

Which of the following can result from thiamin deficiency?&#10;A)Pernicious anemia&#10;B)Wernicke-Korsakoff syndrome&#10;C)Pellagra&#10;D)Adrenomyeloleukodystrophy

Accepted Answer

Thiamin deficiency is the primary cause of Wernicke-Korsakoff syndrome.This is a potential side effect of alcoholism, and the syndrome manifests with encephalopathy, involuntary movement of the eyeballs, and impaired gait.Pernicious anemia is associated with vitamin B₁₂ deficiency and manifests with general weakness and tingling in the hands and feet.Pellagra results from niacin deficiency and is associated with dementia.Adrenomyeloleukodystrophy is a congenital enzyme deficiency that results in the accumulation of very-long-chain fatty acids.This disorder manifests with dementia, aphasia, apraxia, dysarthria, and blindness.

Question 9

Which of the following requires the greatest coordination and control in order to swallow?&#10;A)Solid foods&#10;B)Liquids of thin consistency&#10;C)Soft foods with high water content&#10;D)Thick, viscous liquids

Accepted Answer

Impairments in swallowing make the intake of thin liquids dangerous because the swallowing of these cannot be controlled.Aspiration of liquids may result.To improve swallowing of liquids, thickening agents are added to provide consistency that is easier to control.Solid foods or soft foods with high water content are easier to control than liquids; however, this ease depends on factors such as texture and the ability to form a bolus.

Question 10

Which of the following foods is easiest to swallow for patients experiencing difficulty swallowing?&#10;A)Thin liquids&#10;B)Room temperature cream soups&#10;C)Lukewarm cooked cereals diluted with milk&#10;D)Cool, soft textured foods with sauce or gravy

Accepted Answer

Swallowing is improved by improving the taste, texture, and temperature of the food.Thin liquids cannot be controlled during the swallowing process.By providing texture and adding sauce or gravy, foods can form a bolus, which is easier to control during swallowing.Additionally, cool and cold items are better tolerated in regard to swallowing.

Question 11

Which of the following is the inability to perform purposeful, complex movements, although no sensory or motor impairment is evident?&#10;A)Apraxia&#10;B)Aphasia&#10;C)Anosmia&#10;D)Agnosia

Accepted Answer

The answer of Which of the following is the inability...

Question 12

Which of the following can occur with impaired swallowing?&#10;A)Aspiration pneumonia&#10;B)Hemiparesis&#10;C)Dysgeusia&#10;D)Comminution

Accepted Answer

The answer of Which of the following can occur with...

Question 13

What is dysphagia?&#10;A)Inhalation of a foreign object into the lungs&#10;B)Impaired taste&#10;C)Difficulty swallowing&#10;D)Impairment of the tongue or other muscles essential to speech

Accepted Answer

The answer of What is dysphagia?&#10;A)Inhalation of a foreign object...

Question 14

A patient with amyotrophic lateral sclerosis (ALS) has a rating of 3 or 4 on the swallowing scale of the ALS severity scale.Which of the following interventions would be recommended in the medical nutrition therapy plan?

A)A regular diet with small, frequent feedings
B)Modification of dietary consistency and texture
C)Supplemental tube feedings
D)Nothing by mouth (NPO)

Accepted Answer

The answer of A patient with amyotrophic lateral sclerosis (ALS)...

Question 15

During which phase of swallowing does bolus formation occur?&#10;A)Oral phase&#10;B)Early pharyngeal phase&#10;C)Middle pharyngeal phase&#10;D)Esophageal phase

Accepted Answer

The answer of During which phase of swallowing does bolus...

Question 16

Which of the following is characterized by a cholesterol plaque within an artery that ruptures and promotes platelet aggregation to clog an already narrowed artery?&#10;A)Intracranial hemorrhage&#10;B)Embolic stroke&#10;C)Thrombotic stroke&#10;D)Transient ischemic attack

Accepted Answer

The answer of Which of the following is characterized by...

Question 17

For which condition might a ketogenic diet be used in treatment?&#10;A)Myasthenia gravis&#10;B)Migraine headache&#10;C)Epilepsy&#10;D)Guillain-Barr&#233; syndrome (GBS)

Accepted Answer

The answer of For which condition might a ketogenic diet...

Question 18

What is the guideline for accepted weight adjusted for tetraplegia?&#10;A)Ideal body weight (IBW) as determined by the Hamwi formula&#10;B)10 to 15 pounds less than IBW as determined by the Hamwi formula&#10;C)10 to 15 pounds less than ideal body mass index (BMI)&#10;D)15 to 20 pounds less than ideal BMI

Accepted Answer

The answer of What is the guideline for accepted weight...

Question 19

Which vitamin is being actively researched as protective in memory disorders such as Alzheimer's disease because of its role cell lipid membrane structure?&#10;A)Vitamin E&#10;B)Choline&#10;C)Vitamin C&#10;D)Pyridoxine

Accepted Answer

The answer of Which vitamin is being actively researched as...

Question 20

On the Dysphagia Outcome and Severity Scale, at what level is total assistance for the patient necessary?&#10;A)Level 7&#10;B)Level 5&#10;C)Level 3&#10;D)Level 1

Accepted Answer

The answer of On the Dysphagia Outcome and Severity Scale,...

Deck 41: Medical and Nutrition Therapy for Neurologic Disorders