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

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
a.

diarrhea.

b.

fatty liver.

c.

cholecystitis.

d.

viral hepatitis.

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
a.

losing weight.

b.

reducing fat intake.

c.

increasing protein intake.

d.

removing the underlying cause.

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
a.

A.

b.

B.

c.

C.

d.

D.

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).
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 391
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and
maintenance
4. A symptom that is common to all types of hepatitis is


a.

jaundice.

b.

headache.

c.

dehydration.

d.

muscle aches.

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
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
5. The recommended diet for patients with hepatitis is a well-balanced diet with
a.

low protein content.

b.

supplemental electrolytes.

c.

no alcoholic beverages.

d.

limited amounts of alcohol.

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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 390
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity
6. An individual may be at risk for hepatitis E if they travel to India and eat


a.

curried shrimp.

b.

fresh fruit salad.

c.

Tandoori chicken.

d.

cooked foods from street vendors.

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
a.

malabsorption.

b.

fat intolerance.

c.

loss of appetite.

d.

increased metabolic rate.

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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 394
TOP:Nursing Process: Assessment, Implementation

MSC:Client Needs: Physiological integrity
8. In cirrhosis of the liver, liver cells
a.

decrease in number and increase in size.

b.

are displaced by growth of tumors.

c.

become disconnected because of breakdown of
connective tissue.

d.

are replaced by accumulations of fibrous connective
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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 394
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
9. A low-fiber, soft diet is recommended for patients with

a.

hepatitis A.

b.

cholelithiasis.

c.

esophageal varices.

d.

hepatic encephalopathy.
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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 394
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity
10. Patients with ascites should restrict their intake of
a.

protein.

b.

sodium.

c.

dietary fiber.

d.

saturated fat.

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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 394
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity
11. If a patient with cirrhosis of the liver becomes confused and apathetic, he or she
may be developing
a.

fatty liver.


b.

hepatitis D.

c.

secondary depression.

d.

hepatic encephalopathy.

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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 394
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
12. Drugs that are used to treat hepatic encephalopathy include
a.

antidepressants.

b.

diuretics and steroids.

c.

neomycin and lactulose.

d.

laxatives and stool softeners.

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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 395


TOP:Nursing Process: Assessment, Implementation
MSC:Client Needs: Physiological integrity
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)
a.

alcoholic.

b.

light drinker.

c.

moderate drinker.

d.

heavy drinker.

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
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and
maintenance
14. Moderate daily alcohol intake may help reduce risk of
a.

cancer.

b.

stroke.

c.

hypertension.

d.

heart disease.

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.


PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 395
TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and
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.
a.

essential fatty

b.

essential amino

c.

aromatic amino

d.

branched-chain amino

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
a.

muscle catabolism.

b.

development of ascites.

c.

essential fatty acid deficiency.

d.

loss of appetite and taste acuity.

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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 395-396
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
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
a.

dehydration.

b.

fat redistribution.

c.

ascites and edema.

d.

electrolyte imbalances.

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

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


a.

weight loss, anorexia, and nausea.

b.

ascites, edema, and electrolyte imbalances.

c.

cirrhosis, hepatic encephalopathy, and hepatic coma.

d.

excessive weight gain, hypertension, and
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)
a.

underweight woman who runs 3 miles four times a week.

b.

man who smokes and eats eggs for breakfast every
day.

c.

overweight man who has recently begun an exercise
program.


d.

mother with four children who has lost 25 pounds in
the past 3 months.

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
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 20.
Cholecystitis is caused by
a.

blockage of the bile duct by gallstones, bacterial
infection, or ischemia.

b.

concentration of bile in the gallbladder that favors
formation of gallstones.

c.

failure of the gallbladder to contract and release bile
into the small intestine.

d.

intake of excessive amounts of cholesterol and fat
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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 397-398
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

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

a low-fat diet.

b.

gradual weight loss.

c.

increased fluid intake.

d.

a low-cholesterol 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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 398
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity
22. After surgical removal of the gallbladder (cholecystectomy), long-term dietary
recommendations are
a.

a low-fat, low-cholesterol diet.

b.

high protein and fluid intakes.

c.

a well-balanced diet with no other restrictions.

d.

small, frequent meals to ensure adequate intake.

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.


PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 398
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity 23.
Pancreatitis results in
a.

excessive production of digestive enzymes and
bicarbonate, causing duodenal ulcers.

b.

decreased production of digestive enzymes and
bicarbonate, causing malabsorption of fats and
proteins.

c.

increased production of pancreatic hormones, causing
a decrease in blood glucose levels.

d.

decreased production of pancreatic hormones, causing
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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 398-399
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity
24. During acute episodes of pancreatitis, patients often require
a.

a clear liquid diet.


b.

a high-protein diet.

c.

a high-fat, high-kcal diet.

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
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity
25. When patients with pancreatitis are able to tolerate enteral feedings, the
recommended formula is usually a _____ formula infused into the _____.
a.

low-fat elemental; jejunum.

b.

low-fat elemental; duodenum.

c.

high-kcal, high-protein; jejunum.

d.

high-kcal, high-protein; duodenum.

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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 399
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity


26. Cystic fibrosis is caused by
a.

a genetic defect.

b.

cigarette smoking.

c.

bacterial infection.

d.

inadequate folate intake.

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
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 27.
Most patients with cystic fibrosis require a
a.

low-fat, low-energy diet and hormone replacement
therapy.

b.

high-fiber diet, supplements of water-soluble vitamins,
and diuretics.

c.

high-protein diet, sodium restriction, and supplements
of fat-soluble vitamins.

d.

high-kcal diet, multivitamin supplements, and enzyme
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.
Patients have impaired secretion of enzymes, hormone production is normal. A
high-fiber diet does not have any specific benefit for this population. Diuretics are
not needed and could be dangerous because of excessive electrolyte losses. Sodium
intake should be liberal, rather than restricted. Protein intakes may exceed the DRI,
but needs are met by increased food intake.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 399-400
TOP:Nursing Process: Planning, Implementation
MSC:Client Needs: Physiological integrity
28. One of the most important tools for coping with the reality of a serious chronic
disease such as cystic fibrosis is
a.

having a sense of humor.

b.

avoiding talking about it.

c.

making friends only with others who have the same
disease.

d.

making friends only with others who do not have the
same disease.

ANS: A
A sense of humor is a helpful coping mechanism for patients with chronic diseases
such as cystic fibrosis. Avoiding talking about it simply magnifies fears and causes
isolation. It is probably helpful for patients to have friends who have the disease
who can identify with its struggles and friends who do not have the disease who can
provide a sense of normalcy.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 400
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity
29. Infants with cystic fibrosis


a.

should be fed specially designed infant formulas.

b.

should receive vitamin and mineral supplements.

c.

may be breastfed with use of enzyme replacement
therapy.

d.

should delay introduction of weaning foods if they are
underweight.

ANS: C
Infants with cystic fibrosis may be breastfed or fed infant formula along with
enzyme replacement therapy. They may need supplemental fat and carbohydrate to
add kcals, but do not need specially designed infant formulas or vitamin and mineral
supplements. Guidelines for adding weaning foods are the same as for healthy
infants.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 399
TOP:Nursing Process: Assessment, Implementation
MSC:Client Needs: Physiological integrity
30. A bottle of beer that contains 13 g of carbohydrates and 16 g of alcohol provides
_____ kcals.
a.

116

b.

155

c.

164

d.

203

ANS: C


Carbohydrate provides 4 kcal/g; alcohol provides 7 kcal/g. Therefore, this bottle of
beer would provide (13 × 4) + (16 × 7) = 52 + 112 = 164 kcals. PTS: 1 DIF:
Cognitive Level: Application REF: pp. 401-403

TOP:Nursing Process: Assessment, Planning
MSC: Client Needs: Health promotion and maintenance