Chapter 22: Surgery and Nutrition Support

Question 1

The most common nutrition deficiency related to surgery is

a. vitamin C.
b. iron.
c. protein.
d. essential fatty acids.

Answer 1

c. protein.

Protein deficiencies among surgical patients are the most common. Protein is needed to replace losses during surgery and to supply increased demands of the healing process.

Question 2

Before general surgery, nothing is given by mouth for at least _____ hours.

a. 4
b. 8
c. 12
d. 24

Answer 2

b. 8

Nothing is given by mouth for at least 8 hours before surgery to avoid serious complications such as aspiration of stomach contents into the lungs.

Question 3

Protein is especially needed in the postoperative recovery period for

a. energy.
b. control of edema.
c. control of hypertension.
d. optimal kidney function.

Answer 3

b. control of edema.

In addition to the protein losses from the body during surgery, other losses of protein from the body occur, including plasma protein loss from hemorrhage, wound bleeding, and various other body fluid losses or exudates. Protein assists in the maintenance of osmotic pressure, which is necessary to maintain normal movement of fluid between the capillaries and surrounding tissue. Without maintenance of osmotic pressure, edema develops.

Question 4

For a patient who can take an oral diet, an example of a primary source of energy during the postoperative period should be

a. meat.
b. cereals and other grains.
c. lemonade and sodas.
d. fried potatoes.

Answer 4

b. cereals and other grains.

the primary source of energy for the body should be carbohydrates.

Question 5

An important function of carbohydrates in the postoperative period is to

a. provide substrates for tissue repair.
b. provide a source of vitamins.
c. spare protein for tissue synthesis.
d. protect the adipose reserves.

Answer 5

c. spare protein for tissue synthesis.

Carbohydrates provide the necessary energy for the body to meet increased energy needs while also sparing protein for tissue synthesis.

Question 6

Two minerals that are lost during tissue catabolism are

a. sodium and chloride.
b. calcium and magnesium.
c. iron and sodium
d. potassium and phosphorus

Answer 6

d. potassium and phosphorus.

Potassium and phosphorus are lost during tissue catabolism. When tissue is broken down, cell potassium and phosphorus are lost. Potassium functions in metabolic reactions by playing a role in the storage of nitrogen in muscle protein. Phosphorus also contributes to energy and protein metabolism and to cell function as an essential component of cell enzymes, which control cell reproduction.

Question 7

Blood losses may result in a deficiency of

a. calcium.
b. glucose.
c. iron.
d. vitamin C.

Answer 7

c. iron.

Iron-deficiency anemia may result from blood loss or faulty iron absorption.

Question 8

Fluid loss is accompanied by loss of the electrolytes

a. sodium and chloride.
b. calcium and magnesium.
c. iron and zinc.
d. potassium and phosphorus.

Answer 8

a. sodium and chloride.

During the postoperative period, large water losses may occur as a result of vomiting, hemorrhage, fever, or excessive urination. Because sodium is the major guardian of extracellular fluid, losses will occur with losses of water. Chloride losses also occur because it is also widely distributed within the extracellular compartment. Intravenous fluid can help replenish fluid, sodium, and chloride.

Question 9

The vitamin needed to cement new tissues during the healing process is vitamin

a. A.
b. C.
c. B12.
d. K.

Answer 9

b. C.

Vitamin C is necessary to build and maintain strong tissues, especially connective tissues. The major protein involved in fibrous connective tissue is collagen. For the body to synthesis collagen, the amino acid proline must undergo a hydroxylation reaction yielding hydroxyproline. This hydroxylation reaction depends on ascorbic acid. Vitamin C is also necessary for the conversion of other amino acids needed for tissue healing

Question 10

Commercial enteral feeding formulas are preferred to blenderized food because they

a. have a thinner consistency.
b. carry less risk of bacterial growth and infection.
c. are better tolerated.
d. are less expensive.

Answer 10

b. carry less risk of bacterial growth and infection.

Commercially prepared enteral feeding formulas provide a sterile, homogenized solution available for the more comfortable, modern, small-bore feeding tubes and ensure a fixed profile of nutrients in intact or predigested form.

Question 11

The majority of postsurgical patients are encouraged to return to a regular oral diet as soon as possible because

a. they may become dehydrated.
b. regular food helps stimulate the gastrointestinal tract.
c. parenteral feedings are not very nutritious.
d. the kidneys may be overtaxed by parenteral feedings.

Answer 11

b. regular food helps stimulate the gastrointestinal tract.

Oral, regular feedings allow more needed nutrients to be added and help stimulate the normal action of the gastrointestinal tract.

Question 12

After surgery, oral feedings can begin as soon as

a. bowel sounds return.
b. the patient is conscious.
c. the patient’s appetite returns.
d. the patient is adequately hydrated.

Answer 12

a. bowel sounds return.

Oral feedings can be resumed after surgery once the gastrointestinal tract is functioning, usually indicated by the presence of bowel sounds.

Question 13

Patients who have had surgery of the head, neck, or throat may require

a. a clear liquid diet.
b. a full liquid diet.
c. tube feedings.
d. a low-residue diet.

Answer 13

c. tube feedings.

When regular oral feedings are not tolerated or the patient is severely debilitated or has undergone radical neck or face surgery, feedings by tube may be necessary.

Question 14

The parts of the gastrointestinal tract that are joined in a total gastrectomy are the

a. stomach and large intestine.
b. esophagus and stomach.
c. esophagus and small intestine.
d. duodenum and colon.

Answer 14

c. esophagus and small intestine.

A total gastrectomy involves joining the esophagus to small intestine. This type of surgical intervention can result in serious nutrition deficits immediately after surgery.

Question 15

For several days after a gastrectomy, meals should be

a. withheld.
b. liquid and at room temperature.
c. small, frequent, and easily digested.
d. low in fiber.

Answer 15

c. small, frequent, and easily digested.

After a gastrectomy, meals should be small, frequent, and easily digested. Frequent small feedings are generally resumed according to a patient’s tolerance. A typical pattern of simply dietary progression may cover a 2-week period.

Question 16

Patients who have had gastric surgery usually experience “dumping syndrome”

a. in the first 2 weeks.
b. as soon as any solid food is ingested.
c. when they drink liquids.
d. after recovery and when they are beginning to eat normally.

Answer 16

d. after recovery and when they are beginning to eat normally.

Dumping syndrome is a frequently encountered complication after extensive gastric resection. After the initial recovery from surgery, when the patient begins to feel better and eats a regular diet in greater volume and variety, discomfort may occur 30 to 60 minutes after meals. A cramping, full feeling develops, the pulse becomes rapid, and a wave of weakness, cold sweating, and dizziness may follow

Question 17

The food item most likely to lead to dumping syndrome is

a. lean meat.
b. butter.
c. chocolate cookies.

Answer 17

c. chocolate cookies.

The complex of symptoms in dumping syndrome constitutes a shock syndrome that results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or “dumps” into the small intestine.

Question 18

Physiologic symptoms of dumping syndrome result from

a. the intestinal contents being absorbed too quickly.
b. the ingested food remaining in the stomach too long.
c. the stomach emptying too quickly into the intestine.
d. water being drawn from the blood into the intestine and decreasing the blood volume.

Answer 18

d. water being drawn from the blood into the intestine and decreasing the blood volume.

Dumping syndrome results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or “dumps,” into the small intestine. This rapidly entering food mass is a concentrated solution in relation to the surrounding circulation of blood. To achieve an osmotic balance, water is drawn from the blood into the intestine. This water shift rapidly shrinks the vascular fluid volume. As a result, blood pressure drops and signs of rapid heart action to rebuild the blood volume appear.

Question 19

If a patient requires parenteral nutrition for a prolonged period, the route that should be used is

a. nasogastric.
b. percutaneous endoscopic gastrostomy.
c. total parenteral nutrition.
d. peripheral parenteral nutrition.

Answer 19

c. total parenteral nutrition.

Parenteral nutrition is indicated if the gastrointestinal tract cannot be used for a long period. Total parenteral nutrition, which supplies all the macronutrients and micronutrients along with fluid to meet daily requirements, is necessary for patients who need intravenous nutrition for an extended period.

Question 20

After a cholecystectomy, the diet usually is low to moderate in

a. protein.
b. fats.
c. fibrous foods.
d. simple carbohydrates.

Answer 20

b. fats.

Depending on individual tolerance and response, a relatively low-fat diet may be needed. The gallbladder stores bile produced by the liver, which is secreted when fat enters the small intestine. After surgery, control of fat in the diet facilitates wound healing and comfort because the hormonal stimulus for bile secretion still functions in the surgical area, causing pain with intake of fatty foods. The body also needs a period to readjust to the more dilute supply of liver bile available to assist in fat digestion and absorption.

Question 21

The surgery in which the colon is attached to an opening in the abdominal wall is known as a(n)

a. cholecystectomy.
b. ileostomy.
c. colostomy.
d. jejunostomy.

Answer 21

c. colostomy.

Intestinal surgery may require making of an opening in the abdominal wall to the outside from the intestine. If the opening is farther along the colon in the last part of the large intestine, it is called a colostomy.

Question 22

If the intestinal drainage from an ostomy site is still liquid, the patient has a(n)

a. gastrectomy.
b. ileostomy.
c. colostomy.
d. intestinal bypass.

Answer 22

b. ileostomy.

An ileostomy is an opening in the abdominal wall to the outside of the intestine. If the opening is in the area of the ileum, the first section of the large intestine, it is called an ileostomy.

Question 23

Foods that are allowed in a nonresidue diet include

a. strained fruit juices and eggs.
b. whole-grain bread.
c. vegetables.
d. milk and milk products.

Answer 23

a. strained fruit juices and eggs.

A nonresidue diet includes food items free from fiber, seeds, and skins and with minimal amounts of residue. Fruits and vegetables are omitted except for strained fruit juices. Milk is omitted. If the patient must remain on this diet for a prolonged period, supplementary vitamins and minerals should be administered. Eggs preferably should be hard cooked.

Question 24

A burn that causes cell damage in both the top layer of skin and some of the dermis is a _____ burn.

a. superficial
b. superficial partial-thickness
c. deep partial-thickness
d. full-thickness

Answer 24

b. superficial partial-thickness

Superficial partial-thickness burns involve cell damage in both the top layer of the skin (epidermis) and some of the second layer of the skin (dermis). A superficial burn involves cell damage in the top layer of skin, a deep partial-thickness burn results in destruction of the epidermis and dermis, and a full-thickness burn results loss of the epidermis, dermis, and frequently the underlying fat layer.

Question 25

During the initial stage of treatment of a severe burn

a. a dextrose intravenous feeding is started.
b. total parenteral nutrition is initiated.
c. the patient is encouraged to take water orally.
d. an intravenous electrolyte solution is given.

Answer 25

d. an intravenous electrolyte solution is given.

During the initial stage of treatment for a severe burn, referred to as the immediate shock period, massive flooding edema occurs at the burn site. Loss of protective skin leads to immediate losses of water, electrolytes, and protein. Cell dehydration follows. Immediate intravenous fluid therapy with a salt solution replaces water and electrolytes to help prevent shock.

Question 26

An appropriate tube feeding route for a patient at high risk for aspiration is

a. nasogastric.
b. nasojejunal.
c. gastrostomy.
d. esophagostomy.

Answer 26

b. nasojejunal.

If a patient is at high risk for aspiration, then a feeding tube is placed in the intestine rather than the stomach to lessen the chance of aspiration of food into the lungs.

Question 27

The intravenous solution that is immediately given to a burn patient to prevent hypovolemia is

a. lactated Ringer’s solution.
b. 5% dextrose.
c. normal saline.
d. total parenteral nutrition.

Answer 27

a. lactated Ringer’s solution.

Immediate intravenous fluid therapy with a salt solution replaces water and electrolytes to help prevent shock. Lactated Ringer’s solution is the intravenous fluid given to prevent hypovolemia. This is a salt solution, 6% hetastarch in solution.

Question 28

Total parenteral nutrition formulas provide protein in the form of

a. peptides.
b. protein isolates.
c. amino acids.
d. dextrose.

Answer 28

c. amino acids.

Parenteral nutrition therapy infuses nutrients directly into the bloodstream. Nutrients must be in their most absorbable form. Proteins are supplied in the simplest form, amino acids, for direct absorption into the bloodstream.

Question 29

A good snack for a patient with dumping syndrome is

a. cheese and whole grain crackers.
b. applesauce and graham crackers.
c. nonfat milk and pretzels.
d. fig bars and juice.

Answer 29

a. cheese and whole grain crackers.

The complex of symptoms in dumping syndrome constitutes a shock syndrome
that results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or “dumps,” into the small intestine. A proper food choice would include complex carbohydrate and protein—in this case, cheese and whole grain crackers.

Question 30

A food item that is a good source of potassium is

a. oranges.
b. graham crackers.
c. pretzels and honey dip.
d. lemonade.

Answer 30

a. oranges.

Rich sources of potassium include unprocessed foods including fruits such as oranges and bananas, vegetables such as broccoli and leafy greens, fresh meats, whole grains, and milk products.