Question 1

Whenever possible,comatose patients should be fed

Accepted Answer

Comatose patients should be fed enterally whenever possible to maintain integrity of the gut.Parenteral nutrition is expensive,less physiologically sound,and unnecessary for most patients.Unconscious patients cannot be fed orally.

Question 2

The most important aspect of treatment for eating disorders is

Accepted Answer

Treatment of eating disorders should focus on helping patients be aware of and respond to hunger and satiety cues,helping them be aware of their emotions and find healthy coping mechanisms,and helping them make conscious food choices.Developing a personalized eating and exercise plan may be helpful,but if it is too rigid,it will reinforce the eating disorder rather than treating it.As eating patterns become healthier,weight and nutrient intake should also become healthier,but these concerns are secondary to treating the underlying eating disorder.Redefining societal norms may help prevent eating disorders,but it will not happen quickly enough to treat existing eating disorders.

Question 3

If a college-age woman tells you that she often uses laxatives or diuretics to make sure she has a flat stomach and goes without meals or exercises for several hours before special events to make sure she fits into some of her favorite clothes,she probably has

Accepted Answer

Purging with laxatives,diuretics,and exercise is a hallmark of bulimia nervosa.Anorexia nervosa is characterized by extreme restriction in food intake,usually without purging.Patients with binge-eating disorder frequently struggle with out-of-control consumption of very large amounts of food.Any eating disorder may result in malnutrition,but this is not necessarily the case.

Question 4

If a 78-year-old man has had a stroke and has difficulty feeding himself,the best strategy is to

Accepted Answer

When someone has had a stroke and has difficulty feeding himself,he should be encouraged to self-feed but given assistance as needed;the goal is to foster independence and relearning but also to ensure adequate nutrient intake to aid recovery.If the caregiver takes over feeding,the patient will not relearn the skill,and if he is left to feed himself,he may not achieve adequate intake.Enteral feedings are sometimes necessary but should not be begun unless adequate oral intake cannot be achieved by the patient with the caregiver's assistance.

Question 5

A helpful strategy to prevent development of Guillain-Barré syndrome would be to

Accepted Answer

Guillain-Barré syndrome often occurs after infection with Campylobacter jejuni;common sources of this infection are unpasteurized milk,undercooked poultry,and contaminated water.The syndrome is not spread by sexual contact or via infected blood.Home-canned foods may be infected with Clostridium botulinum,not C.jejuni.

Question 6

As multiple sclerosis progresses,it is most important to monitor the patient's

Accepted Answer

Ability to self-feed will have the greatest effect on nutritional status in patients with multiple sclerosis.Depression may also influence food intake but to a lesser degree.Blood glucose and lipid levels are not usually a primary concern.

Question 7

If a patient with amyotrophic lateral sclerosis (ALS)is having difficulty speaking and is losing weight,it would be important to evaluate

Accepted Answer

As ALS progresses,many affected patients have difficulty swallowing;difficulty speaking may be associated with loss of function of nerves in this area.It may be helpful to measure resting energy expenditure,but this would be secondary to evaluating their ability to swallow.The patient may have diminished appetite,but whether they should be encouraged to eat depends on whether they have dysphagia.Diarrhea and malabsorption do not usually occur in patients with ALS.

Question 8

In the clinic,a patient with newly diagnosed Parkinson's disease tells you that he or she wants to do whatever is possible to slow the progression of the disease.The best dietary advice you could give would be to

Accepted Answer

A Mediterranean style of eating and foods high in antioxidants may help slow the progression of Parkinson's disease.Avoiding foods with high oxalate levels is recommended only for patients who develop calcium oxalate kidney stones;avoiding foods with high amounts of phytate is not usually recommended.Maintaining adequate energy and protein intake would help the patient maintain strength and nutritional status but would not necessarily slow the progression of the disease.Limiting intakes of saturated fat,cholesterol,and sodium would be beneficial for a patient with cardiovascular disease but not for a patient with Parkinson's disease.

Question 9

A client would be considered to have binge eating disorder if he or she

Accepted Answer

A characteristic of binge eating disorder is rapid,out-of-control,secretive eating in response to stress.Eating more than usual at holiday meals is part of normal social behavior.Eating more at dinner after skipping breakfast or lunch is not healthy,but this is not disordered eating.Adding extra workouts after a large meal may be a healthy strategy or,in extreme cases,may develop into bulimia nervosa.

Question 10

The easiest way to help patients increase their intake of antioxidants is to

Accepted Answer

The best way to get a variety of antioxidants is to eat plenty of fruits and vegetables with a variety of colors.Giving patients a long list of foods,growing vegetables at home,or teaching classes may be helpful but would necessitate more work for patients.Organic vegetables do not necessarily have higher amounts of antioxidants.

Question 11

The best diet for prevention of stroke is

Accepted Answer

All of these recommendations may be of some value in preventing cardiovascular disease and reducing risk of stroke.Omega-3 fatty acids,fruits and vegetables with high levels of antioxidants,and whole grains are especially helpful for prevention of thrombotic strokes.

Question 12

If a patient suspects that her migraine headaches are triggered by certain foods,the first step would be to

Accepted Answer

The first step in evaluating causes of migraines would be to keep a headache-food diary.Patients should not avoid or eliminate nutrient-rich foods unless they are shown to be causative.Testing of blood antibody levels may be helpful if food allergies are suspected,but this would follow keeping the diary.

Question 13

When you evaluate a patient with multiple sclerosis,your greatest nutrition-related concern would be

Accepted Answer

Reliance on preprepared processed foods would be a concern because processed foods tend to have high levels of sodium,which can promote inflammatory and autoimmune responses.The availability of a caregiver to prepare and serve food and the possibility that food is one of the few things the patient still enjoys usually have a positive effect on nutritional status.The patient's frustration with loss of independence would not necessarily have an adverse nutritional effect unless the patient is severely depressed.

Question 14

During a home visit to a patient with Parkinson's disease one afternoon,your main concern would be that

Accepted Answer

Patients with Parkinson's disease often struggle to meet their dietary needs because energy expenditure is increased as a result of tremors,dyskinesias,and rigidity;also,preparing and eating meals become more difficult.If the patient has not eaten anything by the afternoon,he or she is unlikely to achieve adequate intake.Drinking coffee is not a specific concern for patients with Parkinson's disease.Meals brought by family members and having snacks where the patient sits will help maintain adequate intake.

Question 15

An example of a meal that may be beneficial for cognitive function in patients with Alzheimer's disease is

Accepted Answer

Foods with high levels of antioxidants (e.g.,spinach)and omega-3 fatty acids (e.g.,salmon)may help improve cognitive function in patients with Alzheimer's disease.Patients do not need to be restricted to soft foods.Calves' liver is a good source of iron but has no specific benefit for Alzheimer's disease.

Question 16

If a child is following a ketogenic diet for treatment of epilepsy,the nurse would want to ensure that the child is receiving supplements of

Accepted Answer

Low-dose vitamin D supplements are important for reducing the increase risk of bone fracture in children who follow ketogenic diets.They have no need for additional amino acids.Digestion is not impaired,and so pancreatic enzymes are not needed.Extra vitamin C is not specifically needed by this population.

Question 17

The best place for a patient with Alzheimer's disease to eat would be

Accepted Answer

Eating at a table with a caregiver is most likely to encourage adequate nutritional intake.Other dining companions or television may distract the patient and decrease food intake.A patient with Alzheimer's disease may become confused or forget to eat if he or she is alone.

Question 18

A child who is following a ketogenic diet to help control seizures is most likely to need help in coping with

Accepted Answer

Children following a ketogenic diet and their families are likely to need support in dealing with hunger because ketogenic diets are low in volume and energy intake is usually restricted.They are unlikely to experience early satiety with the small amount of food;nausea and lethargy are not common problems.

Question 19

If a client is suddenly unable to speak,seems confused,and has trouble walking,it is most likely that he or she has

Accepted Answer

These symptoms are consistent with a CVA.A heart attack would produce chest pain radiating down the left arm and shortness of breath.Alzheimer's disease and Parkinson's disease may produce similar symptoms,but the onset is gradual rather than sudden.

Question 20

The person who would be most likely to develop anorexia nervosa is a

Accepted Answer

Anorexia nervosa is often found in introverted,perfectionistic,insecure high school students and college students.Stress and depression are more likely to be associated with overeating;anorexia nervosa in this setting is rare.Young mothers working full-time are not a group at high risk group for anorexia nervosa.Having a good core group of friends in high school would decrease likelihood of anorexia nervosa.

Quiz 19: Nutrition for Neuro Psychiatric Disorders