Deck 19: Nutrition and Liver Diseases

Question 1

Fatty liver can develop from all of the following except:

A)alcoholic liver disease.
B)celiac disease.
C)protein-energy malnutrition.
D)obesity.

Answer 1

B

Question 2

A patient with cirrhosis may present with no symptoms.

Answer 2

True

Question 3

The most common cause of infection with acute hepatitis A virus is:

A)exposure to infected blood.
B)jaundice.
C)fecal-oral contamination.
D)sexual contact.

Answer 3

C

Question 4

High-fat foods may be restricted in patients with cirrhosis who are experiencing steatorrhea.

Question 5

Hepatomegaly refers to a surgical puncture of a body cavity with an aspirator to draw out excess fluid.

Question 6

Laboratory findings associated with fatty liver include all of the following except:

A)elevated HDL.
B)elevated ALT and AST.
C)elevated glucose.
D)elevated triglycerides.

Question 7

Hepatic encephalopathy may be caused by an increased ratio of aromatic amino acids to branched-chain amino acids in brain tissue.

Question 8

People with malnutrition may experience fatty liver.

Question 9

Eating well and taking supplements of protein, vitamins, and minerals protect the body from harmful effects of alcohol.

Question 10

An energy-dense, moderate-protein, low-electrolyte nutrient formula is recommended for tube-fed patients with ascites and fluid restrictions.

Question 11

When triglycerides accumulate in the liver, the liver:

A)becomes smaller.
B)turns into scar tissue.
C)ceases to function.
D)enlarges.

Question 12

Many patients with cirrhosis require medication or insulin to control hyperglycemia.

Question 13

Nutrients are carried from the digestive tract to the liver via small blood vessels called collaterals.

Question 14

A strict sodium restriction is part of the treatment for ascites.

Question 15

Which of the following results when bilirubin accumulates in the bloodstream?

A)jaundice
B)ascites
C)hepatic coma
D)mental disturbances

Question 16

The most common cause of chronic liver disease in the U.S.is:

A)vitamin B₁₂ deficiency.
B)alcoholism.
C)vitamin C toxicity.
D)protein deficiency.
E)hepatitis C infection.

Question 17

Fat should be restricted in the diet of all clients with cirrhosis.

Question 18

Which of the following is true regarding fatty liver?

A)It is a clinical finding common to many conditions.
B)It usually results in liver failure.
C)It cannot be reversed.
D)It does not result in elevated liver enzymes.

Question 19

Rapid weight loss aids in the recovery from liver disease.

Question 20

Diuretics are often prescribed to control ascites.

Question 21

Albumin is not always a good indicator of nutrition status in patients with liver disease because:

A)it is often low due to the disease.
B)it is affected by elevated liver enzymes.
C)liver disease causes elevated levels of albumin.
D)ammonia levels affect albumin levels.

Question 22

Ascites is exacerbated by:

A)low plasma albumin levels.
B)abdominal pressure.
C)hyperglycemia.
D)amino acid imbalances.

Question 23

Furosemide is a drug often used to treat the symptoms of cirrhosis.It is a(n):

A)appetite stimulant.
B)diuretic.
C)laxative.
D)antiviral.

Question 24

All of the following laboratory test results are elevated in liver disease except:

A)bilirubin.
B)albumin.
C)ammonia.
D)AST.

Question 25

Consequences of cirrhosis include all of the following except:

A)esophageal varices.
B)portal hypertension.
C)ascites.
D)intestinal lesions.

Question 26

Hepatitis patients should avoid:

A)fried foods.
B)high-protein foods.
C)excessive intakes of sodium.
D)alcohol.

Question 27

A client with cirrhosis who develops changes in personality and motor function may be exhibiting early symptoms of:

A)fatigue.
B)hepatic regression.
C)hepatitis.
D)malnutrition.
E)hepatic encephalopathy.

Question 28

Collaterals are:

A)small blood vessels in the intestines.
B)blood vessels that enlarge in order to allow an alternate path for blood flow.
C)induced by fatty liver disease.
D)hemorrhages in the esophagus.

Question 29

Most people in hepatic coma experience all of the following except:

A)elevated blood ammonia levels.
B)increased levels of branched-chain amino acids.
C)an accumulation of potentially toxic compounds in the brain.
D)elevated aromatic amino acid concentrations.

Question 30

The most appropriate diet for a malnourished person with hepatitis is:

A)a regular well-balanced diet.
B)a high-protein diet.
C)a tube feeding.
D)TPN.

Question 31

Prothrombin time in liver disease patients will be:

A)irrelevant.
B)decreased.
C)prolonged.
D)normal.

Question 32

In liver disease, blood ammonia levels rise because the liver cannot convert the ammonia to:

A)nitrogen.
B)amino acids.
C)urea.
D)sodium.
E)ammonia.

Question 33

Ascites is:

A)yellowing of the sclera of the eyes, skin, and mucous membranes.
B)fluid accumulation in the abdomen.
C)inflammation of the liver.
D)elevated blood ammonia levels.

Question 34

Blood flow is impeded in a cirrhotic liver, causing:

A)portal hypertension.
B)elevated cholesterol levels.
C)jaundice.
D)fatty liver.

Question 35

Drug therapy for the treatment of cirrhosis includes all of the following except:

A)antibiotics.
B)appetite stimulants.
C)immunosuppressants.
D)diuretics.

Question 36

To help reduce ammonia production in the colon, patients with cirrhosis may be given a(n):

A)antibiotic.
B)appetite stimulant.
C)enema.
D)diuretic.

Question 37

Factors involved in ascites include all of the following except:

A)portal hypertension.
B)reduced albumin synthesis.
C)fluid accumulation in the peritoneal cavity.
D)obesity.

Question 38

Among patients with liver disease, _____ may be a factor if malnutrition develops.

A)low-sodium diets
B)jaundice
C)lactulose
D)impaired memory

Question 39

A patient in the late stage of hepatic encephalopathy may exhibit all of the following symptoms except:

A)confusion.
B)prolonged attention span.
C)involuntary eye movements.
D)muscular rigidity.

Question 40

Which of the following is false?

A)High levels of blood ammonia may play an important role in the cause of hepatic coma.
B)The degree of elevation of blood ammonia levels correlates with the severity of hepatic encephalopathy.
C)Hepatic coma is a dangerous complication of liver disease.
D)A combination of metabolic abnormalities contribute to hepatic encephalopathy.

Question 41

Due to the risk of foodborne illness, Mr.Jamison should avoid all of the following foods except:

A)rare steak.
B)sushi.
C)unpasteurized milk.
D)canned vegetables.
Use the following case study to answer questions 48-54.
Brian is a 21-year-old Caucasian student who is in his last year of college.Though he is a good student, it has been Brian's practice since freshman year to binge drink on weekends, typically consuming more than a six-pack of beer on Friday and Saturday nights.Brian is 5'11" tall; has weighed about the same, 195 lbs., for the past few years; and is fairly muscular and athletic in his build.He eats most meals in the cafeteria, but despite access to homemade foods, he eats few vegetables, fruits, and whole grains, and his diet is high in fat and salt.The only snacks he consumes are from the vending machine, and he usually washes down a bag of corn chips with a soda, or grabs a burger, fries, and beer when out on weekends.He doesn't take any medications and has no significant medical history.A recent physical examination in preparation for basketball season revealed no remarkable physical findings except muscle aches since restarting weight lifting and new-onset stomach pain, which the doctor assesses to be gastritis.A lipid profile found his triglycerides and VLDL cholesterol to be elevated.His blood pressure is slightly elevated.He has a family history of hypertension, stroke, and alcohol abuse.

Question 42

When calculating energy needs for patients with ascites, include the patient's _____ in the equation.

A)appetite
B)activity level
C)dry weight
D)current weight

Question 43

Estimate the energy needs for a woman with cirrhosis who normally weighs 138 lb.

A)1568-1882 kcal/day
B)1882-2195 kcal/day
C)2195-2509 kcal/day
D)2509-2822 kcal/day

Question 44

To improve Mr.Jamison's appetite, his physician may prescribe:

A)megestrol acetate.
B)spironolactone.
C)rifaximin.
D)propranolol.

Question 45

Cirrhosis patients frequently develop insulin resistance and consequently must follow a diet that is:

A)consistent in carbohydrate content.
B)low in fiber.
C)consistent in vitamin K intake.
D)low in sodium.

Question 46

Of the following laboratory tests performed on Mr.Jamison, which one would you expect to see elevated?

A)albumin
B)transferrin
C)ammonia
D)HDL

Question 47

Protein needs for the client with cirrhosis who does not show signs of wasting are calculated based on:

A)0.5-1.0 grams/kg.
B)0.8-1.2 grams/kg.
C)1.5-2.0 grams/kg.
D)2.0-2.5 grams/kg.

Question 48

For a cirrhosis patient who is experiencing wasting and steatorrhea, you would suggest:

A)eating fruit canned in heavy syrup instead of juice.
B)adding mayonnaise to salads.
C)adding cheese to vegetables.
D)eating peanut butter instead of beans.

Question 49

Patients with cirrhosis require _____ in order to prevent wasting.

A)adequate fluid
B)adequate kcalories
C)high-fat diets
D)six large meals per day

Question 50

Performing a nutrition assessment on a patient who is a candidate for liver transplant is complicated by all of the following except:

A)liver dysfunction and malnutrition have similar metabolic effects.
B)fluid retention can mask weight loss.
C)fluid retention can alter lab values.
D)supplements may mask underlying nutrient deficiencies.

Question 51

All of the following are important factors in medical nutrition therapy following liver transplant except:

A)meeting increased energy needs.
B)protein restriction.
C)food safety education.
D)vitamin and mineral supplements.
Use the following case study to answer questions 42-47.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse.Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss.A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis.He is 5'10" tall and currently weighs 145 pounds.

Question 52

An important consideration in tube feeding a patient with esophageal varices is:

A)the location of the feeding tube.
B)the size of the feeding tube.
C)the possibility of aspiration.
D)the rate of the tube feeding.

Question 53

Persons using potassium-sparing diuretics should be cautioned about consuming:

A)salt substitutes.
B)herbs and spices.
C)soft drinks.
D)dairy foods.

Question 54

Patients with ascites generally must restrict their intake of:

A)fat.
B)carbohydrates.
C)sodium.
D)iron.

Question 55

For clients on sodium-restricted diets, you should suggest:

A)adding lemon juice to fish for flavoring.
B)using garlic salt or onion salt for seasoning.
C)eating saltines as a snack.
D)increasing fluid intake.

Question 56

Mr.Jamison begins experiencing hyperglycemia as his disease progresses.The appropriate diet for him is:

A)low in protein.
B)consistent in carbohydrate.
C)low in sodium.
D)consistent in fat.

Question 57

The dietitian assesses Mr.Jamison's protein needs based on an appropriate weight for his height and estimates that he requires _____ grams of protein per day.

A)25-51
B)52-62
C)56-83
D)98-118

Question 58

If a patient with ascites experiences a sodium level below 128 milliequivalents per liter, a fluid restriction of _____ per day may be necessary.

A)1000-1200 mL
B)1200-1500 mL
C)1500-1800 mL
D)1800-2000 mL

Question 59

Complications of cirrhosis that Mr.Jamison may be facing in the future include all of the following except:

A)ascites.
B)portal hypertension.
C)gastroesophageal varices.
D)kidney cancer.

Question 60

The diet of a client with cirrhosis who has severe steatorrhea may need to be supplemented with all of the following except:

A)B vitamins.
B)calcium.
C)magnesium.
D)zinc.

Question 61

The beneficial effects of moderate alcohol intake are mainly seen in:

A)women who have type 2 diabetes.
B)people with risk factors for liver disease.
C)older people with risk factors for heart disease.
D)men who work in the petrochemical industry.
Nursing Exam Review Multiple Choice

Question 62

Many nutrients are adversely affected by heavy drinking.The doctor cautions Brian to take a multivitamin-mineral supplement and to be aware that heavy drinking can reduce:

A)thiamin absorption.
B)vitamin A degradation.
C)folate degradation.
D)all of the above

Question 63

The nurse understands that _____ may not be a good indicator of nutritional status in patients with ascites.

A)height
B)weight
C)blood cholesterol
D)appetite

Question 64

The doctor asked Brian to return for regular blood pressure checks, and in the mean time, to cut back on alcohol to a reasonable amount, which at maximum is:

A)12 ounces of beer per day.
B)24 ounces of beer per day.
C)36 ounces of beer per day.
D)48 ounces of beer per day.

Question 65

The most common complication of alcohol abuse is:

A)chronic pancreatitis.
B)liver disease.
C)chronic renal failure.
D)heart arrhythmias.

Question 66

Kelly is a 27-year-old well-nourished female who has been diagnosed with hepatitis A.Which of the following nutrition interventions is needed?

A)high-kcalorie, high-protein diet
B)high-protein, low-fat diet
C)low-sodium, fluid-restricted diet
D)no dietary change is needed

Question 67

Which of Brian's blood lipids could be affected by drinking alcohol?

A)triglycerides
B)VLDL cholesterol
C)LDL cholesterol
D)both a and b
E)both b and c

Question 68

One drink is equivalent to _____ ounces of beer.

A)4
B)6
C)10
D)12

Question 69

Examples of common nutrient deficiencies seen as a result of alcohol abuse include all of the following except:

A)folate.
B)thiamin.
C)vitamin A.
D)sodium.

Question 70

The doctor states that when Brian returns in six months, he will order a panel of blood work called liver enzymes, explaining that he expects them to be normal if Brian complies with the instruction to drink alcohol only in moderation.He explains:

A)liver enzymes levels decline if a person has fatty liver.
B)ALT is a liver enzyme involved in alcohol metabolism.
C)AST is a liver enzyme released in response to stress.
D)elevated ALT and AST levels would be undesirable.

Question 71

A patient is admitted to the hospital with decreased albumin, elevated alkaline phosphatase, and elevated bilirubin.The nurse recognizes these clinical findings as evidence of:

A)portal hypertension.
B)liver disease.
C)esophageal varices.
D)hepatic coma.

Question 72

The nurse is working with a hepatitis patient who is malnourished.Which of the following would be the most appropriate type of nutrition support for this client?

A)a regular, balanced diet
B)frequent, small meals
C)enteral formula supplements
D)high-kcalorie, high-protein diet

Question 73

The risk of diet-drug interactions is high in patients with liver disease.The nurse understands that this is due to the fact that:

A)most drugs are metabolized in the liver.
B)most drugs are absorbed in the liver.
C)most people with liver disease do not eat well.
D)most nutrients are absorbed in the liver.

Question 74

The doctor addresses alcohol consumption when obtaining Brian's dietary history, noting that binge drinking could be a cause of:

A)gastritis.
B)hypertension.
C)muscle pain.
D)both a and b
E)both b and c

Question 75

Organs affected by alcohol abuse include all of the following except the:

A)lungs.
B)liver.
C)GI tract.
D)heart.

Question 76

Brian asks if he can take acetaminophen to relieve his muscle aches.The doctor replies:

A)"Yes, but you should double the dose if you drink alcohol that day."
B)"No; you should take a sedative."
C)"Yes; that drug doesn't interact with alcohol."
D)"Yes, if you abstain from drinking alcohol that day."

Question 77

The nurse notices abnormal electrolyte levels in a patient with cirrhosis and understands that it is likely a side effect of:

A)poor nutrition.
B)nitroglycerin.
C)lactulose.
D)appetite stimulants.

Question 78

The nurse recognizes the fact that patients with cirrhosis are likely to develop PEM.The nurse should plan to monitor the _____ of a patient with cirrhosis.

A)weight
B)meal intake
C)diet-drug interactions
D)lab values

Question 79

Diabetics who abuse alcohol are at risk of developing:

A)hypoglycemia.
B)hyperglycemia.
C)hyponatremia.
D)hyperatremia.

Question 80

Alcohol provides 7 kcal/g and can promote weight gain.Brian has not experienced a change in his weight.His BMI indicates that he is:

A)underweight.
B)at a healthy weight.
C)overweight.
D)obese.