Chapter 22

Question 0

​2.​Dietary factors that may help protect against carcinogenesis include

a. electrolytes.
b. amino acids.
c. antioxidants.
d. monounsaturated fatty acids.

Answer 0

ANS:​C
Dietary antioxidants, found in fruits and vegetables as well as 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.

Question 1

​1.​The stage of carcinogenesis in which the deoxyribonucleic acid (DNA) of the cell undergoes mutation is called

a. initiation.
b. metastasis.
c. promotion.
d. progression.

Answer 1

ANS:​A
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.

Question 2

​3.​Fruits and vegetables contain some specific chemicals that help prevent cancer, known as

a. phytosterols.
b. vitamins.
c. antineoplastics.
d. phytochemicals.

Answer 2

ANS:​D
Fruits and vegetables contain phytochemicals that help prevent cancer. They 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.

Question 3

​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.

Answer 3

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.

Question 4

​5.​The syndrome of loss of lean body mass and body fat stores that occurs in many patients with cancer is called

a. cachexia.
b. anorexia.
c. neoplasia.
d. catabolism.

Answer 4

ANS:​A
The syndrome of loss of lean body mass and body fat stores that occurs in many patients with cancer is called cachexia. Anorexia refers to loss of appetite or restriction of food intake without the metabolic effects that cause excessive wasting; anorexia may contribute to cachexia in patients with cancer. Neoplasia refers to the abnormal proliferation of cells seen in cancer. Catabolism refers to the breakdown of lean tissue and fat leads to wasting.

Question 5

​6.​Benefits of adequate dietary intake in patients with cancer include

a. decreased risk of hypertension.
b. increased tolerance of therapy.
c. prevention of metastasis of the disease.
d. prevention of hair loss during chemotherapy.

Answer 5

ANS:​B
The benefits of adequate dietary intake in patients with cancer include increased ability to tolerate the effects of therapy. Hypertension is not usually related to cancer. Adequate dietary intake does not necessarily prevent metastasis of the disease or hair loss.

Question 6

​7.​A common problem in patients with head and neck cancer, even before they undergo surgery, is

a. dehydration.
b. nausea and vomiting.
c. protein-energy malnutrition.
d. weight gain due to inactivity.

Answer 6

ANS:​C
Many patients with head and neck cancer enter surgery with protein-energy malnutrition. Dehydration, nausea, and vomiting are not common. Rather than gaining weight, most patients lose weight due to the cancer process and poor intake.

Question 7

​8.​If a patient has dumping syndrome after surgery to remove a tumor, they have probably had a

a. vagotomy.
b. gastrectomy.
c. pancreatectomy.
d. small bowel resection.

Answer 7

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.

Question 8

​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.

Answer 8

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 they exposed to higher doses of the drugs. The impact of chemotherapy drugs on these cells is not related to absorption and excretion.

Question 9

​10.​Effects of chemotherapy on bone marrow result in

a. allergic reactions.
b. immunosuppression.
c. nausea and vomiting.
d. loss of lean body mass.

Answer 9

ANS:​B
The effects of chemotherapy on bone marrow cause immunosuppression because bone marrow produces many immune factors. Chemotherapy does not generally increase allergic reactions. Certain types of chemotherapy may cause nausea and vomiting or loss of lean body mass, but these side effects are not caused by the drugs’ effects on bone marrow.

Question 10

​11.​Side effects of radiation therapy are caused by damage to _____ cells _____ the treatment range.

a. healthy; within
b. healthy; outside
c. cancer; within
d. cancer; outside

Answer 10

ANS:​A
Side effects of radiation therapy are caused by damage to healthy cells within the treatment range. Radiation does not affect healthy cells or cancer cells outside the treatment range. The intended effect of radiation therapy is damage to cancer cells in the treatment range.

Question 11

​12.​An allogeneic bone marrow transplant uses bone marrow

a. obtained from an identical twin.
b. collected from a matched healthy donor.
c. collected using hypoallergenic techniques.
d. harvested from the patient before treatment.

Answer 11

ANS:​B
An allogeneic bone marrow transplant uses bone marrow collected from a matched healthy donor. If the bone marrow is obtained from an identical twin, it is called syngenic. If the bone marrow is harvested from the patient before treatment, it is called autologous. Bone marrow is not collected using hypoallergenic techniques.

Question 12

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

a. achieve adequate nutrient intakes.
b. provide nutrients that cannot be infused.
c. maintain the integrity of the small intestine.
d. maintain a sense of normalcy for the patient.

Answer 12

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 intakes using parenteral nutrition; all nutrients can be infused if parenteral nutrition is carefully planned. Oral intake does help maintain some normalcy for the patient, but this is not the main reason for using it.

Question 13

​14.​A meal that a patient with immunosuppression who needs to follow a low-bacterial diet 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.

Answer 13

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.

Question 14

​15.​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 detection 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.

Answer 14

ANS:​C
The Patient-Generated Subjective Global Assessment tool allows for early detection 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 are vital in recognizing early signs of malnutrition and initiating early intervention. The form does not evaluate psychosocial status.

Question 15

​16.​Patients who are experiencing nausea or vomiting may find it easiest to tolerate foods like

a. chicken noodle soup.
b. a turkey sandwich.
c. chicken curry with rice.
d. taco salad with jalapenos.

Answer 15

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

Question 16

​17.​Acquired immunodeficiency syndrome (AIDS) is caused by a

a. fungus.
b. parasite.
c. rotavirus.
d. retrovirus.

Answer 16

ANS:​D
AIDS is caused by a retrovirus. Fungal infections usually only occur on the skin or nails. Parasitic infections are most common in the intestines, although they may travel to other parts of the body. Rotavirus is a virus that causes diarrhea.

Question 17

​18.​Infections that cause the morbidity associated with AIDS are called _____ infections.

a. invasive
b. neoplastic
c. metastatic
d. opportunistic

Answer 17

ANS:​D
Infections that cause the morbidity associated with AIDS are called opportunistic infections. Neoplastic and metastatic are terms associated with cancer. Invasive infections occur when bacteria invade blood, muscle, and fat tissue, rather than infecting epithelia.

Question 18

​19.​Nutritional problems associated with the use of highly active antiretroviral therapy (HAART) include

a. hypertension and stroke.
b. nausea and food aversions.
c. loss of lean body mass and body fat.
d. hyperlipidemia and diabetes mellitus.

Answer 18

ANS:​D
Nutritional problems associated with the use of HAART include hyperlipidemia and diabetes mellitus. Loss of lean body mass and body fat occur if HAART is not used. Nausea and food aversions are more common side effects of cancer treatment. Hypertension and stroke are not associated with use of HAART.

Question 19

​20.​The Centers for Disease Control and Prevention (CDC) have defined AIDS-related wasting syndrome as _____ loss of >10% of body weight in 1 month _____ chronic diarrhea, weakness, or fever.

a. involuntary; without
b. voluntary; without
c. involuntary; with
d. voluntary; with

Answer 19

ANS:​C
CDC has defined wasting syndrome as involuntary loss of >10% of body weight in 1 month with chronic diarrhea, weakness, or fever. Voluntary weight loss is caused by dieting, not wasting syndrome.

Question 20

​21.​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.

Answer 20

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 will tend to fill the stomach so that the patient will actually consume less food and nutrients. Not eating unless really hungry will also decrease food intake, especially if the patient’s appetite is poor. Taking a daily multivitamin and mineral supplement will not help increase food intake and will not increase energy and protein intake.

Question 21

​22.​One of the reasons that nutrition therapy is so important for patients with HIV/AIDS is that it is an area where
a.
clients 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.

Answer 21

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, so 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.

Question 22

​23.​Factors that contribute to malnutrition in patients with HIV/AIDS include

a. opportunistic infections.
b. fear of weight gain.
c. use of antiretroviral therapy.
d. increase in physical activity.

Answer 22

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 and/or decreased nutrient intake. 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.

Question 23

​24.​Hypogonadism may contribute to malnutrition and wasting because of
a.
increased metabolic rate.
b.
dry mouth and stomatitis.
c.
fatigue and inability to prepare food.
d.
altered taste acuity and food aversions.

Answer 23

ANS:​C
Patients with hypogonadism experience fatigue that makes it difficult to prepare and consume food; this may contribute to malnutrition and wasting. Hypogonadism is not associated with increased metabolic rate, dry mouth, stomatitis, altered taste acuity, or food aversions.

Question 24

​25.​Some types of antiretroviral therapy are associated with changes in body composition that are referred to as
a.
lipodystrophy.
b.
hypogonadism.
c.
hyperlipidemia.
d.
wasting syndrome.

Answer 24

ANS:​A
Antiretroviral therapy can cause a fat redistribution syndrome known as lipodystrophy. Hypogonadism is a different endocrine-related problem that can occur in patients with AIDS. Hyperlipidemia is also associated with antiretroviral therapy, but this is not associated with changes in body composition. Wasting syndrome is generally prevented by use of antiretroviral therapy.

Question 25

​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.

Answer 25

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, should 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 eating undercooked meat, poultry, fish, or eggs will help decrease the risk of experiencing other food borne illnesses. Eating canned fruits and vegetables is generally safe for patients with HIV/AIDS.

Question 26

​27.​Patients with cancer who undergo radiation of their lower abdomen are likely to experience
a.
nausea.
b.
vomiting.
c.
diarrhea.
d.
constipation.

Answer 26

ANS:​C
Patients with cancer who undergo radiation of their lower abdomen are likely to experience damage to the gastrointestinal tract in the radiated area, causing malabsorption and diarrhea. Patients who receive radiation in the upper abdomen may experience nausea and vomiting due to damage to the stomach. Patients receiving radiation do not usually experience constipation.

Question 27

​28.​Foods that may help stimulate food intake in patients with taste abnormalities include those that are

a. tart.
b. salty.
c. sweet.
d. bland.

Answer 27

ANS:​A
Foods that may help stimulate food intake in patients with taste abnormalities include those that are tart or spicy. Salty, sweet, and bland foods do not help overcome taste abnormalities.

Question 28

​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 their usual eating habits.

Answer 28

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 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.

Question 29

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

a. fat.
b. fluids.
c. protein.
d. dietary fiber.

Answer 29

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