Question 1

The nurse prepares education for the family of a client with dysphagia. Which food should the nurse encourage the family and client to avoid?

Accepted Answer

A client with dysphagia should avoid foods that are hard, crunchy, or spicy to decrease the likelihood of aspiration or choking. Foods should be prepared to the client's taste before being processed to the recommended consistency, and spices in moderation should only be avoided if there is a reason, such as the need for a low-sodium diet. Thin liquids are usually postponed until a full evaluation is complete and recommendations are made for texture and consistency.

Question 2

A client is experiencing frequent nausea and vomiting. Which dietary suggestion should the nurse make to this client?

Accepted Answer

If a client is experiencing intermittent nausea and vomiting, a high-carbohydrate diet consisting of foods or liquids in small portions throughout the day will promote adequate nutrition and hydration. TPN is reserved for clients who are unable to tolerate any intake for several days. Clients should be advised to avoid or limit physical activity just before and after eating. High-fat foods should be avoided since they take longer to empty from the stomach and may promote nausea.

Question 3

The nurse is preparing teaching material for a client with gastroesophageal reflux disease (GERD). Which food item should the nurse urge the client to avoid?

Accepted Answer

Symptoms of GERD can be exacerbated by foods/drinks that contribute to increase gastric acid or decrease the competence of the lower gastric sphincter when consumed. Alcohol causes increased gastric acid production, decreased lower esophageal sphincter pressure, and also delays gastric emptying, all factors that contribute to symptoms. Ice cream, rice, and pasta are bland foods that should not cause irritation in the gastrointestinal tract.

Question 4

The nurse is concerned that a client with Crohn disease continues to lose weight. Which reason should the nurse identify as increasing this client's risk for malnutrition?

Accepted Answer

Poor nutritional intake can continue even when disease is not active due to ongoing avoidance of foods that can cause symptoms associated with a disease to flare up. During inactive disease, clients are at nutritional risk because of malabsorption resulting from inflammation of the bowel's absorptive surface. Dietary adjustments may be needed to promote healing of the mucosal surfaces and fistulas that develop during active disease states. Adequate nutrition is necessary to promote intestinal integrity and to prevent migration of intestinal bacteria to other parts of the body which can result in infection.

Question 5

A client has less than 100 cm of small intestine after surgery to remove a malignancy. For which reason should the nurse suspect that is client is at risk for malnutrition?

Accepted Answer

Short bowel syndrome results in malabsorption of nutrients, vitamins, and bile salts in the small intestine and is not affected by gastric emptying which precedes the delivery of gastric contents to the intestines. Without a terminal ileum, fats, fat soluble vitamins, and bile salt are delivered directly to the colon where they are poorly absorbed. Colon resection can result in problems with absorption of fluid and electrolytes. Gall and kidney stones are the result of poor absorption of bile salts in the absence of a terminal ileum but do not directly cause malnutrition.

Question 6

A client with abdominal pain, diarrhea, and weight loss is diagnosed with celiac sprue. For which reason should the nurse plan interventions to help prevent this client from developing malnutrition?

Accepted Answer

Celiac sprue is an autoimmune disease that causes atrophy rather than inflammation to intestinal villi. Large losses of intestinal fluid and loss of zinc result from inflammatory bowel disease. Steatorrhea, or fatty diarrhea, causes malabsorption of calcium.

Question 7

A client with diabetes is being treated for weight loss, nausea, vomiting, and loss of appetite caused by gastroparesis. What should be included when providing this client with a pureed diet?

Accepted Answer

Gastroparesis is a motility disorder of the stomach that causes low gastric emptying and results in nausea, vomiting, and loss of appetite which can lead to malnutrition. Liquid nutritional supplements may be used to ensure adequate caloric and nutritional intake. High-fiber foods are avoided to prevent obstructions. High-fat foods are avoided due to slower gastric emptying. The addition of spices has no effect on this condition.

Question 8

A child is diagnosed with lactose intolerance. For which reason should the nurse expect this client to be prescribed calcium and vitamin D supplements?

Accepted Answer

Adequate amounts of calcium and vitamin D are needed for growth and bone mineralization among children. An injection of vitamin K at birth supplies the needed stores to avoid bleeding until the infant is able to obtain a supply through breast milk or formula. Vitamin D and calcium do not contribute to fat stores or muscle development in the body.

Question 9

A client is diagnosed with inflammatory bowel disease. For which reason should the nurse expect this client to be prescribed additional calories in the diet?

Accepted Answer

A client with inflammatory bowel disease often develops inflammation in the bowel wall which promotes bleeding and fistula formation. Increased calories are needed to promote mucosal healing and fistula closure as well as provide nutritional support to meet the normal caloric and nutritional requirements for energy.

Question 10

A client with diverticular disease asks what can be done to prevent the development of diverticulosis. What should the nurse respond to this client?

Accepted Answer

The goal of nutritional therapy to prevent diverticulosis is the intake of adequate fiber to prevent symptoms. Fruits and vegetables are good sources of dietary fiber. A low-fat diet may contribute to control of diarrhea but does not impact the diverticula. Whole grains and legumes are an additional source of dietary fiber.

Question 11

The nurse is developing an eating plan for a client with constipation. What action should the nurse suggest for the client?

Accepted Answer

The goal of nutritional therapy for constipation is to maximize the intake of dietary fiber and fluids to promote normal intestinal transit. The addition of natural dietary fiber such as fruits, vegetables, whole grains, and legumes should be encouraged. Stool softeners and laxatives should be used sparingly and only as needed, since a balanced nutritional intake contains the necessary fiber to promote normal bowel movements. Highly processed foods such as white bread, white rice, and peeled potatoes should be avoided.

Question 12

An older client with gastroesophageal reflux disease (GERD) experiences heartburn at night and insomnia. What should the nurse recommend to this client?

Accepted Answer

Avoiding caffeinated beverages and sleeping with the head of the bed elevated are recommended to decrease symptoms of GERD. Carbonated beverages, which can cause gastric distention, should also be avoided including those that are noncaffeinated. Spicy seasonings such as garlic and red pepper may cause irritation to the lower portion of the esophagus. Sleeping in a position that elevates the feet will increase symptoms and should be avoided.

Question 13

An obese client with nonalcoholic fatty liver disease asks for suggestions to lose weight. What should the nurse recommend to this client?

Accepted Answer

In an overweight or obese client with fatty liver disease, slow weight loss should be recommended. Rapid weight loss through excessive dieting or bypass surgery should be avoided since it contributes to fatty liver disease. A high-fiber diet is recommended for weight loss and bowel health.

Question 14

A client with dumping syndrome experiences abdominal cramps, bloating, and diarrhea one hour after eating a large meal. Which suggestion should the nurse make to this client?

Accepted Answer

Eating small meals and snacks throughout the day promotes slower gastric emptying allowing foods to be more efficiently absorbed in the intestines. Rest and staying in a recumbent position has been shown to slow peristalsis. Fluid should be taken between rather than with meals. Foods high in simple sugars promote rather than delay rapid gastric emptying.

Question 15

The nurse prepares to assess a child with inflammatory bowel disease. Which comments by the parents should the nurse expect when discussing the child's health history? (Select all that apply.)

Accepted Answer

Children who have inflammatory bowel disease often experience growth failure in response to treatment with corticosteroids. They lose weight and are not as tall as their peers. Corticosteroids are prescribed to people with inflammatory bowel disease to decrease inflammation in their intestine and colon. Many people who have inflammatory bowel disease develop lactose intolerance. They develop an increased level of discomfort after ingesting products that contain lactose. People with celiac sprue should not ingest anything that contains wheat, barley, or rye. People with inflammatory bowel disease do not have to avoid wheat, barley, and rye. Chewing gum and eating foods that contain sorbitol, raffinose, and fructose should be avoided by people who have problems with intestinal gas.
Children who have inflammatory bowel disease often experience growth failure in response to treatment with corticosteroids. They lose weight and are not as tall as their peers. Corticosteroids are prescribed to people with inflammatory bowel disease to decrease inflammation in their intestine and colon. Many people who have inflammatory bowel disease develop lactose intolerance. They develop an increased level of discomfort after ingesting products that contain lactose. People with celiac sprue should not ingest anything that contains wheat, barley, or rye. People with inflammatory bowel disease do not have to avoid wheat, barley, and rye. Chewing gum and eating foods that contain sorbitol, raffinose, and fructose should be avoided by people who have problems with intestinal gas.
Children who have inflammatory bowel disease often experience growth failure in response to treatment with corticosteroids. They lose weight and are not as tall as their peers. Corticosteroids are prescribed to people with inflammatory bowel disease to decrease inflammation in their intestine and colon. Many people who have inflammatory bowel disease develop lactose intolerance. They develop an increased level of discomfort after ingesting products that contain lactose. People with celiac sprue should not ingest anything that contains wheat, barley, or rye. People with inflammatory bowel disease do not have to avoid wheat, barley, and rye. Chewing gum and eating foods that contain sorbitol, raffinose, and fructose should be avoided by people who have problems with intestinal gas.

Question 16

An older client with dumping syndrome is embarrassed by frequent diarrhea and bloating after meals and has stopped going out for lunch or dinner with friends because of it. What should the nurse recommend to this client?

Accepted Answer

Clients with dumping syndrome should be advised to eat several small meals portions throughout the day with snacks to avoid rapid gastric emptying. Avoiding food promotes a poor nutritional intake resulting in numerous problems including a fatty liver and malnutrition, but does not prevent rapid transit of food into the intestines following a large meal. Foods high in simple carbohydrates also promote rapid transit and poor absorption of food in the intestines. Avoiding going out to eat may adversely affect this client's socialization and should not be recommended.

Question 17

A client has been experiencing intermitted diarrhea with constipation. How should the nurse assess the amount of fiber that this client ingests?

Accepted Answer

The best way for the nurse to asses if there is sufficient fiber in a client's diet is to conduct a brief diet history of plant based foods. Recommendations of dietary alterations or substitutions are not beneficial in the assessment of dietary fiber since there is no reason to assume the client will follow those suggestions. Weight loss or gain is not an adequate indication of dietary fiber content.

Question 18

A client suspected of having celiac sprue is scheduled for a bowel biopsy. What should the nurse instruct this client to prepare for this procedure?

Accepted Answer

Clients preparing for a bowel biopsy to establish a diagnosis of celiac sprue should be instructed to continue their normal diet to avoid false negative results that could occur if gluten is removed from their diet. Products containing oats should be closely examined since some cross-contamination can occur during the processing of grains. Eating additional foods containing gluten should be avoided to prevent an exacerbation of gastrointestinal symptoms if celiac sprue if suspected. Excessive intake of foods containing wheat or wheat by-products should be avoided until after biopsy results are available.

Quiz 23: Disorders of the Gastrointestinal Tract, Liver, Pancreas, and Gallbladder