Chapter 13: Nutrition for Disorders of the Gastrointestinal Tract My Nursing Test Banks

Chapter 13: Nutrition for Disorders of the Gastrointestinal Tract

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

MULTIPLE CHOICE

1. If a patient with multiple sclerosis starts coughing frequently during meals and starts to eat significantly less food than normal, the patient may have

a.

pneumonia.

b.

gastroesophageal reflux disease.

c.

peptic ulcer.

d.

dysphagia.

ANS: D

Patients with multiple sclerosis may develop dysphagia; coughing during meals and eating less than usual are common symptoms. Dysphagia may cause pneumonia if food enters the lungs and causes infection. Gastroesophageal reflux disease causes burning and pain but typically not coughing. Peptic ulcer causes intestinal pain but not coughing.

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2. For a patient with dysphagia, the food that would be most difficult to swallow is

a.

applesauce.

b.

mashed potatoes.

c.

chocolate pudding.

d.

chicken noodle soup.

ANS: D

Patients with dysphagia often have difficulty swallowing thin liquids, such as chicken noodle soup. Thicker, pureed foods such as applesauce, mashed potatoes, and chocolate pudding are usually easier to swallow.

DIF:Cognitive Level: ApplyingREFages 290-291

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3. If a patient has difficulty swallowing, the best position for eating is

a.

propped up in bed with a caregiver by the bedside.

b.

sitting upright opposite a caregiver.

c.

sitting at a dining table with social dining companions.

d.

lying on the left side, with a caregiver by the side.

ANS: B

The safest eating position for someone who has trouble swallowing is sitting upright; the caregiver should sit opposite to help provide cues and reminders while the patient is eating. It is usually best for patients with dysphagia not to interact socially during mealtimes because talking may make swallowing more difficult. Sitting propped up in bed and leaning back would make it easier for food to enter the airway. Lying on ones side while eating is very likely to cause aspiration.

DIF:Cognitive Level: ApplyingREFages 290-291

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4. The most acute risk for patients with dysphagia is

a.

constipation.

b.

dehydration.

c.

dry mouth.

d.

panic attacks.

ANS: B

An acute daily concern for patients with dysphagia is dehydration. Patients are not usually allowed to drink fluids without supervision, and so fluid intake must be monitored throughout the day. Constipation and dry mouth may occur with poor fluid and food intake but are less acute. Patients with dysphagia may experience feelings of panic, but this is not the most acute concern.

DIF:Cognitive Level: ApplyingREFages 290-291

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5. The most helpful recommendation for a client who often experiences heartburn at night would be to

a.

avoid eating within 4 hours of going to bed.

b.

increase the fiber content of the diet.

c.

decrease the fiber content of the diet.

d.

take antacid medications before going to bed.

ANS: A

Gastroesophageal reflux disease (GERD) usually occurs 1 to 4 hours after eating; therefore, waiting at least 4 hours after eating before going to bed would help prevent heartburn at night. Antacid medications may be helpful but should not be used on a regular basis before other strategies have been tried. Fiber content of the diet does not affect heartburn.

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6. An example of a meal that is likely to relax the lower esophageal sphincter and allow gastroesophageal reflux is

a.

pasta with marinara sauce and sourdough bread.

b.

ham with rice pilaf.

c.

fried chicken and pasta salad.

d.

chicken and spinach tortilla wrap and salsa.

ANS: C

High-fat foods and beverages relax the lower esophageal sphincter (allowing stomach contents to back up). Both fried chicken and pasta salad are high in fat and would exacerbate gastroesophageal reflux. The other meals are relatively low in fat and would be much less likely to cause reflux.

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7. Peptic ulcer disease (PUD) would be most like to occur in someone who uses medication to treat

a.

gastroesophageal reflux disease.

b.

constipation.

c.

celiac disease.

d.

joint pain or arthritis.

ANS: D

Risk of PUD increases with chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), often used to treat joint pain or arthritis. Use of antacids to treat GERD would decrease risk of PUD. Laxatives and stool softeners used to treat constipation do not affect risk of PUD. Celiac disease is treated by avoiding dietary sources of gluten, not with medications.

DIF: Cognitive Level: Analyzing REF: Pages 293-295 | Pages 297-299

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8. Nutrition therapy for peptic ulcers should be individualized, depending on

a.

type of drug treatment.

b.

location of the ulcer.

c.

patient tolerance.

d.

the cause of the ulcer.

ANS: C

There are no specific dietary recommendations for treatment of peptic ulcer, and so foods eaten depend on the patients symptoms and tolerance. The type of drug treatment and location of the ulcer do not significantly affect food tolerance. Factors that contribute to formation of peptic ulcers are mostly nonnutritional (stress, skipping meals, chronic use of use of NSAIDs), and so dietary intake is not a significant factor in treatment.

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9. If a patient who has undergone gastric bypass surgery for treatment of extreme obesity experiences sudden sweating, nausea, and stomach cramps after meals, the patient may have

a.

gastroesophageal reflux.

b.

pancreatitis.

c.

peptic ulcer disease.

d.

dumping syndrome.

ANS: D

Patients who have undergone gastric bypass may experience dumping syndrome as a large volume of hyperosmolar food is dumped into the small intestine because the stomach reservoir is missing or too small. GERD and peptic ulcers are not necessarily more common after gastrectomy. Pancreatitis causes extreme pain and vomiting but is not related to gastric bypass.

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10. An appropriate meal for someone with dumping syndrome would be

a.

a small vanilla milkshake.

b.

cream of mushroom soup.

c.

half a turkey sandwich.

d.

popcorn and sugar-free soda.

ANS: C

Individual tolerances vary, but the turkey half-sandwich would probably be tolerated best. Half a sandwich is probably small enough not to cause symptoms. A milkshake is high in sugar and probably too cold. Cream of mushroom soup is probably too hot, and liquids should be taken between rather than with meals. The carbonation in the soda may increase gastrointestinal distention because of gas.

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11. If a patient has esophagitis and also has worn tooth enamel, he or she may have

a.

a hiatal hernia.

b.

fluoride deficiency.

c.

an eating disorder.

d.

gastroesophageal reflux disease.

ANS: C

The eating disorder bulimia nervosa causes esophagitis and eroded tooth enamel because of the effects of stomach acid being vomited back into the esophagus and mouth. A hiatal hernia and GERD may cause esophagitis, but stomach contents would enter only the esophagus, not the mouth, and so the teeth would not be worn. Fluoride deficiency may cause loss of tooth enamel but would not cause esophagitis.

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12. An example of a meal that may contain gluten is

a.

baked chicken breast with herbed rice.

b.

pork chop with sweet potatoes and butter.

c.

grilled steak with baked potato and sour cream.

d.

roast beef with mashed potatoes and gravy.

ANS: D

Gravy is often made with wheat flour, which contains gluten. Rice, potatoes, and sweet potatoes do not contain gluten. Baked chicken, pork chops, and grilled steak do not contain gluten unless they are breaded or coated with wheat flour before being cooked.

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13. A patient with lactose intolerance would be most likely to experience symptoms if he or she ate a

a.

cup of pudding.

b.

turkey sandwich with Swiss cheese.

c.

biscuit with butter and honey.

d.

cup of sherbet.

ANS: A

A cup of pudding would contain a cup of milk; most individuals with lactose intolerance can only tolerate  to  cup milk at one time. Sherbet, Swiss cheese, biscuits, and butter all have low levels of lactose.

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14. Milk may be made suitable for patients with lactose intolerance by treating it with tablets that contain

a.

yogurt.

b.

lactase enzyme.

c.

vitamin D and calcium.

d.

Lactobacillus acidophilus.

ANS: B

Lactase enzyme tables may be added to milk 24 hours before it is drunk to digest the lactose; this makes the milk suitable for patients with lactose intolerance. Lactobacillus acidophilus and yogurt are not necessarily better tolerated than regular milk. Vitamin D and calcium do not affect lactose intolerance, although patients with lactose intolerance may benefit from supplements of these nutrients if their intake is low because they avoid milk.

DIF:Cognitive Level: UnderstandingREFage 300

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15. For patients with inflammatory bowel disease, nutrition therapy is

a.

the primary mode of treatment.

b.

rarely necessary.

c.

an important adjunct to drugs and surgery.

d.

highly specialized.

ANS: C

Nutrition therapy is important to help maintain nutritional status of patients with inflammatory bowel disease, but is used in conjunction with drug and surgical treatments; it is not the primary mode of treatment. Nutrition therapy is often needed to maintain weight and micronutrient status. Awareness of deficiencies that occur in these patients is important, but the RD does not need specialized knowledge to work with patients with IBD.

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16. Because patients with active Crohns disease have intestinal inflammation, they benefit from high intake of

a.

fat.

b.

dietary fiber.

c.

simple sugars.

d.

protein.

ANS: D

Patients with inflammatory bowel disease benefit from a diet high in protein to compensate for malabsorption. Fat intake should be moderate to provide adequate kilocalories within a healthful diet; high fat intake may cause steatorrhea. Dietary fiber may irritate the inflamed gut. Simple sugars provide a readily digested and absorbed source of energy but no other nutrients.

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17. Patients with inflammatory bowel disease may benefit from a high-fiber diet during

a.

acute episodes.

b.

times of remission.

c.

recovery from surgery.

d.

preparation for surgery.

ANS: B

A high-fiber diet may help stimulate peristalsis during times of remission in patients with inflammatory bowel disease. During acute episodes, the diet should be low in fiber and should promote bowel rest. In general, the diet should be high calorie, high protein, and nutrient dense to compensate for malabsorption.

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18. Fluid loss is most likely to be a problem for a patient with

a.

a colostomy.

b.

a hiatal hernia.

c.

an ileostomy.

d.

Crohns disease.

ANS: C

Fluid loss is most likely to be a problem for a patient with an ileostomy because food exits the intestines before water is absorbed in the colon. A colostomy may cause some fluid loss, depending on where the colostomy is located and how much of the colon the intestinal contents pass through for fluid absorption. A hiatal hernia does not cause fluid loss. Crohns disease may cause some fluid loss during acute periods of inflammation because of malabsorption.

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19. The most significant nutritional concern for a patient with an ileostomy is

a.

fat malabsorption and steatorrhea.

b.

dumping syndrome.

c.

loss of fluid and electrolytes.

d.

malabsorption of protein and carbohydrates.

ANS: C

For a patient with an ileostomy, digestive output exits the body instead of passing through the colon, the major site of absorption of water and electrolytes. Digestion and absorption of protein, carbohydrate, and fat are not usually affected. Dumping syndrome is caused by a partial or total gastrectomy.

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20. For patients with ostomies, a lower amount of output occurs

a.

if the ostomy is closer to the rectum.

b.

if the ostomy is closer to the rectum.

c.

with high fiber intake.

d.

with high fat intake.

ANS: A

As effluent progresses through the colon, water is absorbed, and the effluent becomes more solid; therefore, an ostomy closer to the rectum would have a smaller volume. Fiber intake may increase output slightly, but less so than the site of the ostomy; fat intake does not significantly affect the amount of output.

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21. If a patient has had a large portion of their small intestine removed because of cancer and is unable to maintain a stable weight, a feeding regimen that would be most appropriate is

a.

enteral feedings into the stomach.

b.

enteral feedings into the jejunum.

c.

parenteral nutrition only.

d.

supplemental parenteral nutrition.

ANS: D

Patients who have undergone removal of large portions of the small intestine and are unable to maintain their weight should receive supplemental parenteral nutrition. Enteral feedings would not be more effective than oral feedings because these patients have a limited amount of gut to absorb the nutrients. Parenteral nutrition should not be used alone because some oral feeding helps stimulate recovery of gut function and maintain gut integrity.

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22. If a patient receiving chemotherapy is struggling with nausea and vomiting, helpful suggestions may include

a.

drinking acidic fruit juices to stimulate gastric juices.

b.

being active before and after meals to improve appetite.

c.

eating frequent small meals throughout the day.

d.

eating foods with plenty of flavor and aroma.

ANS: C

Patients receiving chemotherapy who have nausea and vomiting are most likely to maintain adequate nutritional intake if they eat several small meals throughout the day. Rest before and after meals is more likely than activity to help control nausea. Acidic fruit juices may increase feelings of nausea. Bland foods are likely to be better tolerated than flavorful and aromatic foods.

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23. The best way to prevent formation of diverticula in the colon is to

a.

eat plenty of fruits, vegetables, and whole grains.

b.

avoid foods with rough hulls, such as nuts and seeds.

c.

use stool softeners to promote daily bowel movements.

d.

avoid foods that cause gas and increase pressure in the colon.

ANS: A

Diverticula are caused by high pressure in the colon, often in association with straining to have a bowel movement; they can be prevented by intake of high-fiber foods, such as fruits, vegetables, and whole grains. There is no evidence that nuts, seeds, or other foods with hulls increase risk of diverticula. Using stool softeners to promote daily bowel movements may help prevent diverticula, but eating a high-fiber diet is preferable because of other nutritional benefits. Foods that cause gas are not associated with formation of diverticula.

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24. Someone who may benefit from avoiding sugar-free chewing gum is a patient with

a.

peptic ulcer disease.

b.

gastroesophageal reflux disease.

c.

irritable bowel syndrome.

d.

celiac disease.

ANS: C

Sugar-free chewing gum is usually sweetened with sorbitol or mannitol, which may exacerbate irritable bowel syndrome. PUD, GERD, and celiac disease are not generally affected by chewing gum or intake of sugar alcohols.

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25. In consuming a high-fiber diet, it is important to also consume adequate amounts of

a.

fluid.

b.

calcium and iron.

c.

fat-soluble vitamins.

d.

complex carbohydrates.

ANS: A

It is important to consume adequate fluid along with a high-fiber diet to prevent fecal impaction. High-fiber diets generally have high levels of complex carbohydrates. Slightly more calcium and iron may be needed because fiber may decrease the bioavailability of these nutrients. However, diets high in fiber tend to have higher amounts of nutrients in general. Requirements for fat-soluble vitamins are not generally affected by fiber intake.

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26. If a client complains of excessive gas, a good question to ask is whether he or she

a.

drinks coffee and tea.

b.

has problems with constipation.

c.

chews gum.

d.

is under a lot of stress.

ANS: C

Excessive gas may be caused by swallowing air while chewing gum. Drinking coffee and tea, stress, and constipation do not usually cause excess gas formation.

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27. An example of a daily change that may help decrease constipation is

a.

drinking tomato juice instead of carbonated beverages with lunch.

b.

eating oatmeal and raisins instead of a bagel for breakfast.

c.

snacking on pretzels instead of potato chips.

d.

eating mashed potatoes instead of pasta with dinner.

ANS: B

Increasing intake of dietary fiber helps prevent constipation; oatmeal and raisins have significantly higher levels of fiber than does a bagel. In fruit and vegetable juices, most of the fiber is removed during the juicing process; drinking vegetable juice would add nutrients but not fiber. Pretzels have less fat than potato chips, but both have low amounts of fiber. Mashed potatoes contain only slightly more fiber than does pasta.

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28. An example of a high-fiber food item to include with lunch is

a.

pasta with tomato sauce and Parmesan cheese.

b.

beef tacos with lettuce and tomatoes.

c.

an omelet with mushrooms and onions.

d.

black bean soup.

ANS: D

Beans such as black beans have especially high amounts of fiber. Tomatoes, lettuce, mushrooms, onions, and white pasta have lower amounts of dietary fiber. Cheese, beef, and eggs contain no dietary fiber.

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29. A possible cause of acute diarrhea is

a.

short bowel syndrome.

b.

lactose intolerance.

c.

emotional stress.

d.

celiac disease.

ANS: C

Acute diarrhea may be caused by enteritis, medications, dietary changes, or emotional stress. Short bowel syndrome, lactose intolerance, and celiac disease may cause chronic diarrhea by causing various types of malabsorption.

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30. Treatment of diarrhea generally begins with

a.

a high-fiber, low-fat diet.

b.

removal of the cause of diarrhea.

c.

adequate fluids to hydrate the patient.

d.

a low-fat, low-fiber, or low-lactose diet.

ANS: C

The primary concern in treatment of diarrhea is provision of adequate fluids to hydrate the patient. After taking fluids, affected patients may progress to a low-fat, low-fiber, or low-lactose diet and then to a regular diet as tolerated. If possible, the cause of diarrhea may be removed, but this is not always possible and is not the first priority. A high-fiber, low-fat diet may be beneficial once the diarrhea has resolved.

DIF:Cognitive Level: AnalyzingREFage 297

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MSC:Client Needs: Physiological integrity

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