Chapter 19: Nutrition for Neuro-Psychiatric Disorders My Nursing Test Banks

Chapter 19: Nutrition for Neuro-Psychiatric Disorders

Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. The best place for a patient with Alzheimers disease to eat would be

a.

in front of the television.

b.

at a table with a caregiver.

c.

at a table with several dining companions.

d.

alone in a quiet room.

ANS: B

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 Alzheimers disease may become confused or forget to eat if he or she is alone.

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2. An example of a meal that may be beneficial for cognitive function in patients with Alzheimers disease is

a.

baked salmon and spinach salad.

b.

scrambled eggs and whole-grain toast.

c.

cottage cheese and applesauce.

d.

calves liver and onions.

ANS: A

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 Alzheimers 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 Alzheimers disease.

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

a.

his or her resting energy expenditure.

b.

his or her appetite and interest in food.

c.

whether he or she has diarrhea and malabsorption.

d.

his or her ability to swallow.

ANS: D

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.

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4. Whenever possible, comatose patients should be fed

a.

a full liquid diet.

b.

enterally.

c.

through peripheral parenteral nutrition.

d.

through central parenteral nutrition.

ANS: B

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.

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

a.

early satiety.

b.

hunger.

c.

nausea.

d.

lethargy.

ANS: B

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.

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6. 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

a.

essential amino acids.

b.

pancreatic enzymes.

c.

vitamin D.

d.

vitamin C.

ANS: C

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.

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7. A helpful strategy to prevent development of Guillain-Barr syndrome would be to

a.

avoid sexual contact with affected individuals.

b.

drink only pasteurized milk.

c.

use gloves to avoid contact with infected blood.

d.

avoid eating home-canned food.

ANS: B

Guillain-Barr 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.

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

a.

keep a headache-food diary.

b.

evaluate blood antibody levels.

c.

use an elimination diet.

d.

avoid eating the offending foods.

ANS: A

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.

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

a.

reliance on a caregiver to prepare and serve food.

b.

the patients frustration with loss of independence.

c.

reliance on preprepared processed foods.

d.

foods being one of the few things the patient still enjoys.

ANS: C

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 patients frustration with loss of independence would not necessarily have an adverse nutritional effect unless the patient is severely depressed.

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10. As multiple sclerosis progresses, it is most important to monitor the patients

a.

ability to self-feed.

b.

blood glucose levels.

c.

the degree of depression.

d.

blood lipid levels.

ANS: A

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.

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11. During a home visit to a patient with Parkinsons disease one afternoon, your main concern would be that

a.

family members are bringing the patient home-cooked meals.

b.

the patient drinks coffee throughout the day.

c.

the patient has snacks next to his or her chair.

d.

the patient has not eaten yet that day.

ANS: D

Patients with Parkinsons 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 Parkinsons disease. Meals brought by family members and having snacks where the patient sits will help maintain adequate intake.

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12. In the clinic, a patient with newly diagnosed Parkinsons 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

a.

avoid foods with high amounts of oxalate and phytate.

b.

eat several small meals each day so as to ensure adequate protein and energy intake.

c.

reduce intake of saturated fat, cholesterol, and sodium.

d.

follow a Mediterranean diet and eat foods with high amounts of antioxidants.

ANS: D

A Mediterranean style of eating and foods high in antioxidants may help slow the progression of Parkinsons 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 Parkinsons disease.

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

a.

give them a list of high-antioxidant foods.

b.

encourage intake of fruits and vegetables with a variety of colors.

c.

recommend growing their own vegetables or buying organic vegetables.

d.

offer classes to teach patients how to prepare and cook fruits and vegetables.

ANS: B

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.

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14. The best diet for prevention of stroke is

a.

low in sodium and fat.

b.

rich in dietary fiber and olive oil.

c.

high in low-fat dairy products.

d.

mostly plant foods and fish.

ANS: D

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.

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

a.

provide encouragement, support, and assistance as needed.

b.

have a caregiver feed him to maintain adequate intake.

c.

encourage him but insist that he feed himself to relearn this skill.

d.

provide enteral feedings until adequate oral intake is established.

ANS: A

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 caregivers assistance.

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

a.

Alzheimers disease.

b.

Parkinsons disease.

c.

had a cerebrovascular accident (CVA), or stroke.

d.

had myocardial infarction, or heart attack.

ANS: C

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

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

a.

young mother working full-time outside the home.

b.

high school student with a strong core group of friends.

c.

man with a high-stress job and depression.

d.

high-achieving shy college freshman.

ANS: D

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.

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

a.

overeats at Thanksgiving and family holiday meals.

b.

skips breakfast or lunch most days and eats more at dinner.

c.

eats large amounts of food alone when stressed.

d.

adds extra workouts when he or she eats large meals.

ANS: C

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.

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19. 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

a.

anorexia nervosa.

b.

binge-eating disorder.

c.

bulimia nervosa.

d.

malnutrition.

ANS: C

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.

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20. The most important aspect of treatment for eating disorders is

a.

developing a personalized daily eating and exercise plan for each patient.

b.

making conscious food choices in response to hunger and satiety cues, as well as awareness of emotions.

c.

achieving and maintaining a healthy weight and optimal nutrient intake.

d.

redefining societal norms for body weight and personal value and success.

ANS: B

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.

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21. A diet rich in antioxidant-rich foods would be especially helpful for a patient with

a.

sleep disorder.

b.

bipolar disorder.

c.

schizophrenia.

d.

addictions.

ANS: C

A diet rich in antioxidants is helpful for everyone but especially for patients with schizophrenia. Oxidative stress plays a role in schizophrenia, and antioxidant-rich foods may be helpful. Antioxidants have general health benefits for everyone but have no specific benefit for patients with sleep disorders, bipolar disorders, or addictions.

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22. If a patient has bipolar disorder, post-traumatic stress disorder, and depression, it is important to

a.

encourage adequate intake of protein and energy.

b.

focus on underlying emotional issues rather than food.

c.

evaluate alcohol intake and potential substance abuse.

d.

decrease intake of saturated fat and sodium.

ANS: C

Patients with mood disorders and depression often try to self-medicate with alcohol and other substances, which may lead to abuse or dependence. Energy and protein intake are not usually specific concerns, although nutrient intake may sometimes be inadequate or excessive. Some nutritional interventions to improve diet quality are helpful because they are more likely to achieve remission with good nutritional status. Decreasing intake of saturated fat and sodium is important for patients with cardiovascular disease but not for those with mood disorders.

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23. Patients with depression may benefit from ensuring adequate intake of

a.

tryptophan.

b.

methionine.

c.

potassium.

d.

vitamin B12.

ANS: A

Tryptophan is a precursor of brain serotonin, levels of which are deficient in many persons with depression. Methionine, potassium, and vitamin B12 are all essential nutrients but do not have a specific role in treating depression.

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24. A depressed patient who has agoraphobia may benefit from

a.

omega-3 fatty acids.

b.

light therapy.

c.

daily exercise.

d.

zinc supplements.

ANS: B

Patients with agoraphobia are likely to stay indoors and so would benefit from light therapy to help correct vitamin D deficiencies, which may play a role in depression. Daily exercise, omega-3 fatty acids, and adequate zinc intake are all helpful for patients with depression but not specifically for patients with agoraphobia.

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25. If a patient attends a wine and cheese party and is then admitted to the emergency room with a severe headache and found to have severe hypertension, he or she may

a.

be taking a monoamine oxidase inhibitor (MAOI).

b.

be sensitive to resveratrol, an antioxidant found in red wine.

c.

have acute alcohol poisoning.

d.

be suffering from a foodborne infection.

ANS: A

A hypertensive crisis may occur when patients taking an MAOI for treatment of depression eat foods rich in tyramine, such as aged cheeses and red wine. Sensitivity to resveratrol is not common. Alcohol poisoning would present with loss of motor coordination and consciousness. A foodborne infection may cause headache, but does not usually cause hypertension.

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26. Risk of overweight and chronic disease would be elevated in a

a.

young woman who has migraine headaches every month.

b.

nurse who switches from working day shifts to working night shifts.

c.

patient with advanced Alzheimers disease.

d.

middle-aged man who loses 30 lb in 6 months.

ANS: B

Working nights is associated with weight gain and increased risk of cardiovascular diseases, diabetes, and cancer, probably because of disrupted sleep-wake cycles. Monthly migraine headaches are usually associated with hormonal changes and do not usually affect risk of overweight and chronic disease. Patients with Alzheimers disease are more likely to lose weight because of inadequate food intake. Loss of a little over 1 lb per week is a healthy rate of weight loss and would contribute to decreased risk for chronic disease.

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27. If an alcoholic person has a normal body mass index, it is likely that they

a.

is also malnourished.

b.

exercises consistently.

c.

eats a healthful diet.

d.

is currently sober.

ANS: A

If an alcoholic person has a normal body mass index, he or she is probably malnourished because energy that should be coming from nutrient-dense foods is being obtained from alcohol instead. Alcoholic people may be quite functional and may exercise consistently, but this is less likely. People with alcoholism commonly do not eat healthful diets. It is possible that the patient may not be drinking currently and therefore is not obtaining extra energy from alcohol, but this is also less likely.

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28. A supplement that may help patients with insomnia to normalize their sleep patterns is

a.

magnesium.

b.

melatonin.

c.

dopamine.

d.

caffeine.

ANS: B

Melatonin may help patients with disordered sleep. Magnesium does not have roles related to sleep. Dopamine is produced by the body but is not given as supplements. Caffeine tends to disrupt rather than promote sleep.

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29. The optimal diet to protect against depression is

a.

made up of familiar and favorite foods.

b.

high in dietary fiber and protein.

c.

a vegetarian diet.

d.

high in fruits, vegetables, and fish.

ANS: D

Foods rich in antioxidants, such as fruits and vegetables, and foods rich in omega-3 fatty acids, such as fish, are protective against depression. A vegetarian diet may contain plenty of fruits and vegetables, but unless it is a vegan diet, it may contain large amounts of high-fat dairy; also, vegetarian diets do not include fish. High protein and fiber intakes are not necessarily helpful. Eating familiar and favorite foods may be comforting in the short term but does not promote long-term health.

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30. For a patient with anorexia nervosa, enteral feedings may be helpful, when accepted, to

a.

feed the patient without his or her being aware.

b.

restore gastrointestinal function.

c.

increase the rate of weight gain.

d.

provide measurable intakes of nutrients.

ANS: C

Enteral feedings increase the rate of weight gain in patients with anorexia nervosa, which improves physical and emotional outcomes. Although enteral feedings provide measurable intake of nutrients, oral intake can still be measured and is preferred when possible. Patients who are anxious about eating may find enteral feedings easier than oral intake, but they would still be aware of the feedings. Gastrointestinal function is maintained equally by oral and enteral feedings.

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