Chapter 12: Promoting Nutrition

Chapter 12: Promoting Nutrition

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The patient has weakness of the left arm and hand after a stroke. Which is the best nursing intervention to help maintain the patient’s self-esteem during feeding?

a.	Delegate feeding to nursing assistive personnel (NAP) to minimize the amount of food spilled.
b.	Encourage the patient to self-feed as much as possible.
c.	Ensure that foods are pureed so they may be consumed through a straw.
d.	Collaborate with speech therapist to improve the patient’s communication.

 

 

ANS:  B

The nurse maintains and enhances the patient’s self-esteem by encouraging the patient with positive reinforcement, acknowledging the patient’s progress with self-feeding, and engaging him or her in conversation during feeding. Feeding the patient may reinforce feelings of inadequacy, worthlessness, or embarrassment. Taking food by straw may be contraindicated and increase the risk of aspiration, depending on the patient’s neuromuscular coordination for chewing and swallowing. Ensuring effective patient communication is expected nursing care for any patient in any setting; however, speech therapy is not indicated.

 

DIF:    Cognitive Level: Apply                   REF:   Page 288

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

2. A patient has not eaten since admission to the long-term care facility 2 days ago. Which is the best initial intervention for the nurse to prevent malnutrition in this patient?

a.	Make a diet request to the healthcare provider for full liquids.
b.	Ask the patient’s daughter why the patient will not eat.
c.	Remind the patient that nutrition is essential to better health.
d.	Assess the patient for possible reasons for the lack of intake.

 

 

ANS:  D

The nurse gathers additional information by using the nursing process to prevent malnutrition for a new patient in the long-term care facility. Identifying barriers to nutrition begins with obtaining objective and subjective data by which the nurse gathers valuable nutritional information, including muscle function, teeth, cognition, and patient food preferences. Requesting a diet change is premature and not based on assessment data. Asking the daughter for information reveals the daughter’s opinion, anecdotal information, and possibly biased observations about the patient. The use of the word “why” is also not therapeutic. Reminding the patient about nutrition may be a useless intervention if his or her cognition is low, if he or she has a sensory or communication disorder, or if he or she is depressed. In addition, the patient can interpret this as an insult to his or her intelligence.

 

DIF:    Cognitive Level: Analyze                REF:   Page 285, Table 12-1

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

3. A patient with a neurological disease has difficulty swallowing. Which should the nurse include in the plan of care?

a.	Limit oral intake to clear liquids.
b.	Allow adequate time for the feeding.
c.	Ask family members to coach the patient.
d.	Maintain low-Fowler’s position for meals.

 

 

ANS:  B

The nurse plans an adequate amount of time for patient feeding to address complications from impaired swallowing. With nursing supervision and encouragement and in a relaxed manner, the food is prepared properly; the patient chews food thoroughly, swallows as necessary, and takes short breaks while feeding. Clear liquids may be contraindicated for the patient. Thickener may need to be added, depending on the patient’s status. Family coaching may pressure, misdirect, or shame the patient; increase the risk of aspiration or choking; and decrease the patient’s appetite. Low-Fowler’s position is contraindicated for swallowing difficulties and feeding because an upright position facilitates swallowing.

 

DIF:    Cognitive Level: Apply                   REF:   Page 295

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

4. The nurse plans care for a patient with impaired swallowing. Which outcome would be appropriate for the nurse to include in the patient’s plan of care?

a.	The patient holds food in the pockets of the mouth.
b.	The nurse observes no movement of the larynx during swallowing.
c.	The patient maintains a stabilized weight for 3 consecutive days.
d.	The patient swallows four times after each mouthful.

 

 

ANS:  C

A suitable outcome for a patient with impaired swallowing is that weight stabilizes over 3 days. This indicates that the patient is ingesting and absorbing sufficient nutrients to avoid weight loss. Holding amounts of food in the pockets of the mouth indicates difficultly moving the food for chewing and swallowing. Movement of the larynx normally occurs during swallowing. Swallowing four times for each mouthful is not a desirable outcome of nursing care because this behavior is consistent with neuromuscular dysfunction of chewing or swallowing.

 

DIF:    Cognitive Level: Apply                   REF:   Page 294

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning