Test bank for nutritional foundations and clinical applications 5th edition by grodner

390 TOP:Nursing Process: Planning, Implementation MSC:Client Needs: Physiological integrity... 394 TOP:Nursing Process: Assessment, Implementation MSC:Client Needs: Physiological integri

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Test Bank for Nutritional Foundations and Clinical Applications 5th

Edition by Grodner

Sample

Chapter 18: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas Test Bank

MULTIPLE CHOICE

1 A common disorder in patients who abuse alcohol is

ANS: B

Fatty liver is the earliest form of alcoholic liver disease Alcohol abuse does not cause diarrhea or cholecystitis Viral hepatitis is caused by viral infection

PTS: 1 DIF: Cognitive Level: Knowledge REF: p 390

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

2 It is possible to reverse fatty infiltration of the liver by

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c increasing protein intake

ANS: D

Fatty infiltration of the liver can be reversed by removing the underlying cause This may be alcohol abuse, excessive kcal intake, obesity, complications of drug therapy (e.g., corticosteroids, tetracyclines), total parenteral nutrition, pregnancy, diabetes mellitus, inadequate intake of protein (e.g., kwashiorkor), infection, or malignancy Losing weight and reducing fat intake will only help if the underlying cause for that individual is related to weight and fat intake Increasing protein intake will only help

if the cause is kwashiorkor

PTS: 1 DIF: Cognitive Level: Comprehension REF: p 390

TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

3 A type of hepatitis that is transmitted via the fecal-oral route is hepatitis

ANS: A

Hepatitis A is transmitted via the fecal-oral route Hepatitis B and D are transmitted parenterally or sexually Hepatitis C is transmitted via blood or serum (sharing of contaminated needles, razors, toothbrushes, nail files, barber’s scissors, tattooing equipment, body piercing, or acupuncture needles)

TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and

maintenance

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4 A symptom that is common to all types of hepatitis is

ANS: A

All types of hepatitis cause jaundice Hepatitis E causes flu-like aches and pains, including headache Dehydration may occur if patients have nausea and vomiting PTS: 1 DIF: Cognitive Level: Knowledge REF: pp 392-393

5 The recommended diet for patients with hepatitis is a well-balanced diet with

ANS: C

Total abstinence from alcohol is imperative for patients with hepatitis The diet should be high in protein and kcals; supplemental electrolytes are not generally needed

TOP:Nursing Process: Planning, Implementation

MSC:Client Needs: Physiological integrity

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6 An individual may be at risk for hepatitis E if they travel to India and eat

ANS: B

Hepatitis E is transmitted via the fecal-oral route; food prepared by infected food handlers may transmit the disease Raw fruits and vegetables (e.g., fruit salad) are common sources of infection Foods that are cooked, such as curried shrimp and Tandoori chicken, and foods prepared by street vendors, are not common sources PTS: 1 DIF: Cognitive Level: Application REF: pp 393-394

TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and

maintenance

7 For patients with hepatitis, a significant barrier to maintaining an adequate intake

of kcals is

ANS: C

Patients with hepatitis often have very little appetite, which makes it hard for them

to achieve adequate oral intake of nutrients Patients with hepatitis do not usually have problems with malabsorption, fat intolerance, or increased metabolic rate

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TOP:Nursing Process: Assessment, Implementation

8 In cirrhosis of the liver, liver cells

connective tissue

tissue and fat

ANS: D

In cirrhosis of the liver, liver cells are replaced by accumulations of fibrous

connective tissue and fat The cells die, so they do decrease in number, but do not increase in size Liver tumors are caused by cancer, not cirrhosis Cirrhosis does not cause breakdown of connective tissue

9 A low-fiber, soft diet is recommended for patients with

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ANS: C

A low-fiber, soft diet is recommended for patients with esophageal varices because fibrous or abrasive foods could cause potentially life-threatening bleeding Patients with hepatitis A should follow a high-protein, high-kcal diet; patients with

cholelithiasis should follow a low-fat diet; patients with hepatic encephalopathy should restrict their protein intake

10 Patients with ascites should restrict their intake of

ANS: B

Patients with ascites should restrict their intake of sodium to limit fluid retention Protein intake should not be restricted unless the patient has encephalopathy Dietary fiber intake should only be limited if the patient has esophageal varices Intake of saturated fat does not need to be limited

11 If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing

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b hepatitis D

ANS: D

If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing hepatic encephalopathy, as the brain is influenced by compounds that have been absorbed from the intestine and have not been metabolized by the liver Fatty liver develops first, before progression to cirrhosis Any form of hepatitis can lead to cirrhosis, but cirrhosis does not cause hepatitis Depression may cause apathy, but does not usually cause confusion

12 Drugs that are used to treat hepatic encephalopathy include

ANS: C

Neomycin is an antibiotic used to sterilize the bowel to decrease the amount of urea that can be converted to ammonia Lactulose is used to lower stool pH which traps ammonia in the colon Antidepressants are ineffective because the mental problems associated with encephalopathy are related to metabolism rather than depression Diuretics are used to treat ascites associated with cirrhosis, but are not used for encephalopathy Steroids are not effective Lactulose is used to lower stool pH, not for its laxative and stool softening effects

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TOP:Nursing Process: Assessment, Implementation

13 Someone who drinks one glass of wine every night with dinner plus an

occasional beer when watching a football game would be considered to be a(n)

ANS: C

Someone who drinks 1-2 drinks per day is considered a moderate drinker A heavy drinker consumes 3 or more drinks daily A light drinker is not defined Alcoholism

is a disabling addictive dependence on alcohol, usually characterized by intake of significantly more than 1-2 drinks daily

PTS: 1 DIF: Cognitive Level: Application REF: p 395

maintenance

14 Moderate daily alcohol intake may help reduce risk of

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ANS: D

Moderate alcohol intake may help reduce risk of heart disease Risk of many types of cancer increases with increasing alcohol intake Risk of hypertension increases with alcohol intake Risk of stroke is not linked to alcohol intake

maintenance

15 If a patient with cirrhosis of the liver seems to be vulnerable to development of hepatic encephalopathy, his or her diet may be supplemented with a formula that contains _ acids

ANS: D

Patients who are vulnerable to development of hepatic encephalopathy may be given a formula that contains branched-chain amino acids and restricted aromatic amino acids to ensure adequate protein intake with minimal ammonia production Essential fatty acids and essential amino acids do not help prevent hepatic

encephalopathy

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp 395-396

TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

16 An adequate kcal intake is especially important for patients with cirrhosis of the liver to prevent

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b development of ascites

ANS: A

Adequate intake of kcals helps prevent breakdown of muscle to provide energy in patients with cirrhosis of the liver Adequate kcal intake does not prevent ascites, essential fatty acid deficiency, and loss of appetite and taste acuity

17 A patient with end-stage liver disease may lose fat stores and muscle mass, but this may not be evident from measurements of body weight because of

ANS: C

Patients with end-stage liver disease often accumulate fluid due to ascites and edema This increases body weight, which may mask fat and muscle losses Patients with end-stage liver disease are not usually dehydrated and do not usually have electrolyte imbalances Fat infiltrates the liver but is not otherwise redistributed in the body

PTS: 1 DIF: Cognitive Level: Application REF: p 396

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18 After liver transplantation, long-term nutrition management may need to be tailored to help prevent

hyperlipidemia

ANS: D

Long-term nutrition management after a liver transplant needs to be tailored to help prevent excessive weight gain, hypertension, and hyperlipidemia Weight loss, anorexia, and nausea do not usually occur Ascites, edema, and electrolyte

imbalances may occur immediately after the transplant, but do not usually persist long term Cirrhosis, hepatic encephalopathy, and hepatic coma do not occur after a successful transplant

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp 396-397

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity

19 An example of an individual who may be at high risk for gallstones is a(n)

week

day

program

the past 3 months

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ANS: D

Rapid weight loss increases risk for gallstones, so a mother who has lost 25 pounds

in the past 3 months could easily develop gallstones Underweight, regular exercise, smoking, and eating eggs do not increase risk for gallstones Overweight increases risk for gallstones, but less than rapid weight loss

PTS: 1 DIF: Cognitive Level: Application REF: pp 397-398

20 Cholecystitis is caused by

infection, or ischemia

formation of gallstones

into the small intestine

combined with bacterial infection

ANS: A

Cholecystitis occurs when gallstones block the cystic duct or as the result of stasis, bacterial infection, or ischemia of the gallbladder Concentration of bile in the

gallbladder causes cholelithiasis, or formation of gallstones Failure of the

gallbladder to contract and release bile may lead to gallstone formation; this may be caused by very low fat intake or dieting Intake of excessive amounts of cholesterol and fat and bacterial infection are not associated with gallbladder disease

21 If a patient experiences chronic symptoms of cholelithiasis and cholecystitis, the recommended nutrition therapy is

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a a low-fat diet

ANS: A

A low-fat diet is used to treat painful symptoms associated with cholelithiasis and cholecystitis Gradual weight loss may be beneficial in the long term, but will not decrease painful symptoms Increased fluid intake and a low-cholesterol diet do not alleviate symptoms

22 After surgical removal of the gallbladder (cholecystectomy), long-term dietary recommendations are

ANS: C

After cholecystectomy, long-term dietary restrictions are not needed Some patients need to restrict fat intake for a few weeks during recovery, but not long term High protein and fluid intakes and small, frequent meals are not needed

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23 Pancreatitis results in

bicarbonate, causing duodenal ulcers

bicarbonate, causing malabsorption of fats and

proteins

a decrease in blood glucose levels

an increase in blood glucose levels

ANS: B

Pancreatitis causes decreased production of digestive enzymes and bicarbonate, causing malabsorption of fats and proteins Duodenal ulcers do not occur

Pancreatitis affects mainly the exocrine pancreas, so blood glucose levels are unaffected

24 During acute episodes of pancreatitis, patients often require

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d enteral or parenteral nutrition

ANS: D

During acute episodes of pancreatitis, patients often need enteral nutrition infused into the jejunum, further down the gut than would cause pancreatic stimulation An oral feeding can cause pancreatic stimulation and acute pain

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp 398-399

25 When patients with pancreatitis are able to tolerate enteral feedings, the

recommended formula is usually a _ formula infused into the _

ANS: A

Enteral feedings for patients with pancreatitis should be low-fat elemental formulas infused into the jejunum to decrease pancreatic stimulation High-kcal, high-protein formulas and infusion into the duodenum would both increase pancreatic

stimulation

26 Cystic fibrosis is caused by

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a a genetic defect

ANS: A

Cystic fibrosis is an autosomal recessive inherited disease (i.e., it is caused by a genetic defect) The lung problems seen in cystic fibrosis are not caused by smoking cigarettes Frequent lung infections are a symptom, rather than a cause of the

disease Inadequate folate intake is linked to increased risk of neural tube defects PTS: 1 DIF: Cognitive Level: Knowledge REF: pp 399-400

27 Most patients with cystic fibrosis require a

therapy

and diuretics

of fat-soluble vitamins

replacement therapy

ANS: D

Patients with cystic fibrosis require a high-kcal diet to compensate for high

metabolic rate and malabsorption, multivitamin supplements to compensate for malabsorption, and enzyme replacement therapy to increase digestion and

absorption of nutrients A low-fat, low-energy diet would result in malnutrition

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