Chapter 20: Nutrition in Cancer and HIV/AIDS My Nursing Test Banks

Chapter 20: Nutrition in Cancer and HIV/AIDS

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

MULTIPLE CHOICE

1. When someone smokes cigarettes and drinks three alcoholic beverages a day, he or she is contributing to his or her cancer risk via

a.

initiation.

b.

metastasis.

c.

promotion.

d.

progression.

ANS: C

Cigarettes and alcohol contribute to cancer risk by promoting abnormal cell growth in cells that are already mutated. Initiation is the stage in which the DNA in a normal cell is mutated. Progression is the stage in which the abnormal cells spread outside their original location. Metastasis is the spread of cancer to secondary sites. The DNA of the cell undergoes mutation in the initiation stage of carcinogenesis. Promotion is the second stage, in which abnormal cell growth occurs. Progression is the third stage, in which cancer cells spread beyond their original location. Metastasis is formation of cancer in secondary sites.

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2. Someone who uses sunscreen and wears UV protective clothing and hats to prevent development of skin cancer may need to

a.

use light therapy to prevent seasonal affective disorder.

b.

consume extra vitamins C and E and other dietary antioxidants.

c.

ensure adequate intake of vitamin D from fortified foods and supplements.

d.

consume additional fluids to replace sweat losses caused by additional clothing.

ANS: C

Dietary antioxidants, found in fruits and vegetables, as well as in some other foods, may help protect against carcinogenesis. Electrolytes, amino acids, and monounsaturated fatty acids are all important in maintaining good nutritional status but do not help protect against carcinogenesis.

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3. Fruits and vegetables help prevent cancer because they have high amounts of

a.

phytosterols.

b.

vitamins.

c.

antineoplastics.

d.

antioxidants.

ANS: D

Fruits and vegetables have high amounts of antioxidants that help prevent DNA mutation that leads to cancer. Antioxidants have antineoplastic qualities, but this is not what they are called. Fruits and vegetables contain vitamins, but not all vitamins help prevent cancer. Phytosterols are found in plant oils and help lower blood cholesterol level.

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4. A dietary change that would help prevent cancer, according to the National Cancer Institute recommendations, is

a.

eating vegetarian meals two or more times a week.

b.

choosing organic, pesticide-free fruits and vegetables.

c.

eating five or more daily servings of fruits and vegetables.

d.

consuming three or more daily servings of low-fat dairy products.

ANS: C

Eating five of more daily servings of fruits and vegetables would help prevent cancer. Eating vegetarian meals two or more times a week may help prevent cardiovascular disease. Choosing organic, pesticide-free fruits and vegetables would help protect the environment. Consuming three or more daily servings of low-fat dairy products would help prevent osteoporosis and hypertension.

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5. Factors that contribute to loss of lean body mass in many patients with cancer that are outside the patients control include

a.

hypermetabolism.

b.

inadequate protein intake.

c.

inadequate energy intake.

d.

drug noncompliance.

ANS: A

Hypermetabolism may be caused by release of cytokines as part of the cancer process; this is outside the patients control. It may be difficult to maintain adequate intakes of protein and energy and to comply with drug regimens, but these factors are within the patients control.

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6. A patient in whom cancer has been newly diagnosed is about to begin intense chemotherapy. She tells you that the only good thing about this diagnosis is that she will now be able to lose weight without even trying. The most appropriate nursing response would be to

a.

encourage the patient to celebrate the positive aspects of the disease.

b.

encourage adequate nutrient intake to maximize tolerance of chemotherapy.

c.

reinforce the need to achieve and maintain ideal body weight.

d.

emphasize eating the right types of foods rather than an amount of food.

ANS: B

Patients tolerate chemotherapy better when they are able to maintain good nutritional status. Even though weight loss may seem like a positive side effect, it could have a negative effect if nutrient stores are depleted. Minimizing loss of lean body mass and maximizing nutrient stores are more important than attaining ideal body weight in patients with cancer. Making good food choices is important, but eating enough food to maintain lean body mass stores is more important.

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7. If a patient is going to have surgery to remove cancer of the esophagus, it is important to

a.

prevent poor food intake as a result of depression by warning the patient that the surgery may be disfiguring.

b.

emphasize complete abstinence from cigarette smoking and use of alcoholic beverages.

c.

provide nutrition support to reverse malnutrition caused by difficulty eating during the disease progression.

d.

encourage the patient to enjoy favorite foods to maximize intake.

ANS: C

Many patients with head and neck cancer enter surgery with protein-energy malnutrition because the disease may have prevented adequate intake; nutrition support to reverse malnutrition can greatly improve outcomes. Warning a patient about being disfigured may not prevent depression. Abstinence from cigarette smoking and alcoholic beverages is wise, but is not necessarily the first priority. Enjoying favorite foods may be helpful to attain adequate intakes of energy, but good sources of protein and micronutrients should also be emphasized.

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8. If a patient has dumping syndrome after surgery to remove a tumor, he or she has probably had a

a.

vagotomy.

b.

gastrectomy.

c.

pancreatectomy.

d.

small bowel resection.

ANS: B

Dumping syndrome often occurs after a full or partial gastrectomy. Vagotomy may cause gastric stasis, diarrhea, and fat malabsorption. Pancreatectomy may cause type 1 diabetes and malabsorption of many nutrients. Small bowel resection may cause malabsorption of multiple nutrients, depending on the site and extent of resection.

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9. Bone marrow cells and cells lining the gastrointestinal tract are more susceptible than other cells to damage caused by chemotherapy because they

a.

are target cells for drugs.

b.

have a rapid turnover rate.

c.

are exposed to higher doses of the drugs.

d.

absorb more of the drugs than they excrete.

ANS: B

Bone marrow cells and cells lining the gastrointestinal tract have a rapid turnover rate, which makes them highly susceptible to damage caused by chemotherapy. The drugs do not target these cells specifically, nor are the cells exposed to higher doses of the drugs. The effect of chemotherapy drugs on these cells is not related to absorption and excretion.

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10. If a patient with cancer is receiving a combination of chemotherapeutic agents that is known to interfere with bone marrow, they should give special attention to prevention of

a.

dehydration.

b.

foodborne illness.

c.

nausea and vomiting.

d.

loss of bone mass.

ANS: B

The effects of chemotherapy on bone marrow cause immunosuppression because bone marrow produces many immune factors; therefore, it would be especially important to avoid risk of foodborne illness. Certain types of chemotherapy may cause nausea, vomiting, or diarrhea (which may cause dehydration) or may interfere with calcium metabolism, causing loss of bone mass, but these side effects are not caused by the drugs effects on bone marrow.

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11. If a patient has cancer and is being treated with chemotherapy, the greatest food safety concern is

a.

avoiding pesticide residues.

b.

potential food-drug interactions.

c.

choosing natural food products.

d.

preventing foodborne illness.

ANS: D

Individuals undergoing chemotherapy have weakened immune systems and therefore need to be especially careful to prevent foodborne illness. Concerns about pesticide residues are no greater for patients with cancer than for the rest of the population. Food-drug interactions may be a concern for specific individuals but are not related to food safety. Choosing natural food products is not necessarily beneficial and is not a particular concern for patients receiving chemotherapy.

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MSC: Client Needs: Safe and effective care environment

12. If a patient is receiving radiation therapy to the head and neck, he or she may need

a.

moist and semiliquid foods because of loss of saliva.

b.

dry foods because of taste changes.

c.

extra fluids and electrolytes because of diarrhea.

d.

extra dietary fiber and fluids to prevent constipation.

ANS: A

Radiation of the head and neck may damage salivary glands; therefore, moist and semiliquid foods may be needed. The patient may experience taste changes, but dry foods do not help with this problem. Diarrhea and constipation are more common with radiation to the abdomen and pelvis.

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13. Patients who have just received bone marrow transplants should not eat

a.

canned tuna.

b.

soft cheeses.

c.

mayonnaise.

d.

steamed vegetables.

ANS: B

Patients who have just received a bone marrow transplant have immunosuppression as a result of the transplantation and drug therapies; thus they should avoid potential sources of foodborne illness, such as soft cheeses made from unpasteurized milk. Canned tuna, commercial mayonnaise, and steamed vegetables carry a lower risk for causing foodborne illness.

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14. Patients who receive bone marrow transplants often require parenteral nutrition. Some oral intake is important to help

a.

achieve adequate nutrient intake.

b.

provide nutrients that cannot be infused.

c.

maintain the integrity of the small intestine.

d.

maintain a sense of normality for the patient.

ANS: C

Some oral or enteral intake is important for patients receiving bone marrow transplants and parenteral nutrition to help maintain the integrity of the small intestine. It is possible to achieve adequate intake through parenteral nutrition; all nutrients can be infused if parenteral nutrition is carefully planned. Oral intake does help maintain some normality for the patient, but this is not the main reason for using it.

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15. If a patient with immunosuppression needs to follow a low-bacterial diet, a meal that he or she should avoid is

a.

Caesar salad dressing with alfalfa sprouts.

b.

breakfast cereal with milk.

c.

homemade bread with butter.

d.

chicken breast sandwich with mayonnaise.

ANS: A

Patients with immunosuppression who need to follow a low-bacterial diet should avoid Caesar salad dressing made with raw eggs and alfalfa sprouts. Commercial dressings are safe, and the other salad ingredients would be safe as long as they are washed. Breakfast cereal, pasteurized milk, homemade or store-bought bread, butter, cooked chicken, and mayonnaise may all be included as part of a low-bacterial diet.

DIF:Cognitive Level: ApplyingREFages 418-420

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MSC: Client Needs: Health promotion and maintenance | Client Needs: Safe and effective care environment

16. The Patient-Generated Subjective Global Assessment tool

a.

should not be used as a basis for interventions because the data are subjective.

b.

provides a method for assessing the psychosocial effects of cancer on the patient.

c.

allows for early identification of patients who have potential or actual nutritional deficits.

d.

allows patients to evaluate their own nutritional status without the input of a registered dietitian.

ANS: C

The Patient-Generated Subjective Global Assessment tool allows for early identification of patients who have potential or actual nutritional deficits. Some parts of the form are completed by the patient, but others are completed by the registered dietitian, and the results are scored and evaluated by a registered dietitian. The data are subjective but vital for recognizing early signs of malnutrition and initiating early intervention. The form does not evaluate psychosocial status.

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17. Patients who are experiencing nausea or vomiting may find it easiest to tolerate foods such as

a.

chicken noodle soup.

b.

a turkey sandwich.

c.

chicken curry with rice.

d.

taco salad with jalapenos.

ANS: B

Patients experiencing nausea and vomiting usually find it easiest to tolerate bland, low-fat foods with minimal odor, served cold or at room temperature, with limited fluids at mealtimes; the turkey sandwich would probably be tolerated best. Chicken noodle soup is usually served hot and is mostly fluid. Chicken curry is served hot, is highly seasoned, and has a strong aroma. Taco salad with jalapenos would be very spicy.

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18. For patients infected with the human immunodeficiency virus (HIV), complex highly active antiretroviral therapy (HAART) regimens require

a.

avoidance of alcohol and nonprescription medications.

b.

self-monitoring of blood glucose levels.

c.

following a neutropenic diet protocol.

d.

careful timing around meals and snacks to promote absorption.

ANS: D

HAART drug regimens can be complex, and administration of each drug needs to be planned around timing and content of meals and snacks to maximize absorption. Use of alcohol and prescription medications should be checked with the pharmacist, but complete avoidance is not necessarily mandatory. A neutropenic diet may be helpful for prevention of foodborne illness but is not necessary to support drug therapy. HAART may have an adverse effect on blood glucose levels, but self-monitoring of blood glucose is not needed for everyone using HAART.

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19. If a patient develops HIV-associated lipodystrophy syndrome (HALS), the best dietary recommendation is to

a.

maintain adequate protein and energy intake so as to reduce muscle loss.

b.

use medium-chain triglycerides and avoid lactose.

c.

avoid raw, undercooked, or unpasteurized foods.

d.

follow a Mediterranean diet and take omega-3 fatty acid supplements

ANS: D

A Mediterranean-style diet and omega-3 fatty acids may help ameliorate HALS. Maintaining adequate protein and energy intake to reduce muscle loss is important for overall nutritional health; medium-chain triglycerides and avoiding lactose may help patients with diarrhea; and avoiding raw and undercooked foods will help prevent foodborne illness, but these are not related to HALS.

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20. If a patient with HIV/AIDs is experiencing diarrhea, a good way to increase energy and protein intakes would be to

a.

add skim milk powder to shakes and soups.

b.

add butter to hot cereals, vegetables, rice, and noodles.

c.

eat three main meals daily, each with a serving of meat or fish.

d.

use peanut butter on toast or as a dip for fruits and vegetables.

ANS: D

Adding peanut butter would add protein and energy. Adding skim milk powder would add protein and energy, but it also contains lactose, which may exacerbate diarrhea. Adding butter provides additional energy but not protein. Intake is usually better when eating is spread between several small meals and snacks rather than three main meals.

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21. If a patient with HIV/AIDS has been feeling very weak and whose weight has dropped from 180 lb to 160 lb in 4 weeks, he or she would be considered to have

a.

opportunistic infections.

b.

lipodystrophy or HALS.

c.

AIDS-related wasting syndrome.

d.

AIDS-related depression.

ANS: C

Involuntary loss of more than 10% of body weight in 1 month with chronic diarrhea, weakness, or fever is characteristic of AIDS-related wasting syndrome; loss of 20 lb from and original weight of 180 lb is greater than 10%. Lipodystrophy is characterized by body composition changes and metabolic alterations. Opportunistic infections and depression may or may not be associated with weight loss.

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22. Strategies that may help maximize food intake in patients with HIV/AIDS include

a.

eating several small meals and snacks daily.

b.

drinking 1 to 2 glasses of water with each meal.

c.

not eating unless really hungry, to avoid nausea.

d.

taking a daily multivitamin and mineral supplement.

ANS: A

Patients with HIV/AIDS can help maximize their food intake if they eat several small meals and snacks daily. Drinking water with meals tends to fill the stomach, so that the patient will actually consume less food and fewer nutrients. Not eating unless really hungry will also decrease food intake, especially if the patients appetite is poor. Taking a daily multivitamin and mineral supplement will not help increase food intake and will not increase energy and protein intake.

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23. One of the reasons that nutrition therapy is so important for patients with HIV/AIDS is that it is an area in which

a.

patients can have some control of their medical care.

b.

their needs are not affected by the disease process.

c.

interventions can have curative effects on the disease.

d.

they do not need the involvement of health care providers.

ANS: A

Nutrition therapy is very important for patients with HIV/AIDS because they can make their own choices and work to improve their nutritional status; thus they can have some control of their medical care. Patients nutrient needs are greatly affected by the HIV/AIDS disease process. Nutrition interventions cannot help cure HIV/AIDS. Patients with HIV/AIDS still need the involvement of health care providers to help them achieve optimal nutritional status.

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24. The factor that contributes most to malnutrition in patients with HIV/AIDS is

a.

opportunistic infections.

b.

fear of weight gain.

c.

use of antiretroviral therapy.

d.

increase in physical activity.

ANS: A

Opportunistic infections contribute to malnutrition in patients with HIV/AIDS because they often cause nutrition-related problems such as sore mouth, nausea, vomiting, diarrhea, fatigue, and fever, which lead to increased nutrient needs, decreased nutrient intake, or both. Patients using antiretroviral therapy may fear weight gain and lipodystrophy, but malnutrition is less common in patients who use these drugs. If patients with HIV/AIDS feel well enough to increase their physical activity level, they are unlikely to suffer from malnutrition.

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25. Patients infected with HIV who develop hypogonadism are most likely to experience

a.

loss of body fat.

b.

weight gain.

c.

loss of muscle mass.

d.

dehydration.

ANS: C

Patients with hypogonadism experience fatigue that makes it difficult to prepare and consume food; this may contribute to malnutrition and loss of muscle mass. Loss of body fat may occur but is less pronounced. Weight gain is less common. Dehydration as a result of diarrhea, vomiting, or fever is not directly related to hypogonadism.

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26. To minimize risk of infection with Cryptosporidium, patients with HIV/AIDS should

a.

eat yogurt that contains live cultures.

b.

avoid eating canned fruits and vegetables.

c.

avoid eating undercooked meat, poultry, fish, or eggs.

d.

drink only filtered water or water than has been boiled for 1 minute.

ANS: D

To minimize risk of infection with Cryptosporidium (a water-borne pathogen), the Centers for Disease Control and Prevention recommend that patients with weakened immune systems, including those with HIV/AIDS, drink only filtered water or water than has been boiled for 1 minute. Eating yogurt that contains live cultures may help prevent or minimize diarrhea. Avoiding undercooked meat, poultry, fish, or eggs helps decrease the risk of experiencing other foodborne illnesses. Eating canned fruits and vegetables is generally safe for patients with HIV/AIDS.

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27. Patients with cancer who undergo irradiation of the lower abdomen are likely to experience

a.

nausea.

b.

vomiting.

c.

diarrhea.

d.

constipation.

ANS: C

Patients with cancer who undergo irradiation of the lower abdomen are likely to experience damage to the gastrointestinal tract in the radiated area, which causes malabsorption and diarrhea. Patients who receive radiation in the upper abdomen may experience nausea and vomiting as a result of damage to the stomach. Patients receiving radiation do not usually experience constipation.

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28. A seasoning that may help stimulate food intake in patients with taste abnormalities is

a.

lemon juice.

b.

soy sauce.

c.

honey.

d.

garlic.

ANS: A

Foods that may help stimulate food intake in patients with taste abnormalities include those that are tart, such as lemon juice. Salty (soy sauce), sweet (honey), and bland (garlic) seasonings are less likely to help overcome taste abnormalities.

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29. An important nutritional goal for patients with cancer or HIV/AIDS is to

a.

eat several meals a day.

b.

avoid use of supplements.

c.

improve quality of life.

d.

maintain usual eating habits.

ANS: C

The overarching goal of nutrition interventions for patients with cancer or HIV/AIDS is to improve quality of life by enjoying eating and feeling strong enough to participate in normal daily activities. Eating several meals a day is a strategy to help achieve this goal, but it is not a goal. Patients should try to focus on eating food rather than using supplements, but it is not necessary to avoid supplements completely. Patients may need to modify their usual eating habits to achieve optimal nutritional status and improve their quality of life.

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30. Patients experiencing diarrhea should make sure they have a generous intake of

a.

fat.

b.

fluids.

c.

protein.

d.

dietary fiber.

ANS: B

It is important for patients with diarrhea to ensure adequate fluid intake. High intake of fat may exacerbate diarrhea. An adequate intake of protein helps maintain the integrity of gastrointestinal health, which minimizes diarrhea, but protein intake is not the first concern during acute diarrhea. Excessive amounts of dietary fiber may also exacerbate diarrhea.

DIF:Cognitive Level: UnderstandingREFages 426-427

TOP:Nursing Process: Planning| Nursing Process: Implementation

MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance

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