Chapter 23: Nutrition Support in Cancer and AIDS

Question 1

Ordinarily the cell operates in an orderly fashion under the influence of the

a. genetic code.
b. nucleus.
c. endoplasmic reticulum.
d. nutrients taken into the cell.

Answer 1

a. genetic code.

Human life results from the process of individual cell growth and reproduction, which are guided by a cell’s genes and genetic code.

Question 2

Cancers that originate from epithelial tissue are called

a. neoplasms.
b. sarcomas.
c. carcinomas.
d. lymphomas.

Answer 2

c. carcinomas.

Cancers that originate from epithelial tissue are called carcinomas. There are basal cell carcinomas, squamous cell carcinomas, and melanomas.

Question 3

Factors associated with the development of cancer include

a. processed foods.
b. radiation exposure.
c. food-borne disease.
d. diabetes mellitus.

Answer 3

b. radiation exposure.

Causes of cancer include mutations or changes in a cell’s genes; chemical carcinogens such as cigarette smoke; radiation from x-rays, radioactive materials, sunlight, or atomic wastes; viruses; epidemiologic factors; stress factors; and some dietary factors linking deficiencies of specific nutrients with and increased risk of DNA damage and cancer.

Question 4

Emotional stress may play a role in the development of cancer through the

a. increased metabolism of water-soluble vitamins.
b. increased metabolism caused by emotional stress.
c. damage to the immune system and the thymus gland.
d. increased hormonal levels associated with stress.

Answer 4

c. damage to the immune system and the thymus gland.

Studies of people under stress have shown increased incidence of cancer and a measured reduction of immune response to disease, especially in the response of the natural killer cells of the immune system.

Question 5

The cellular component of the immune system that is derived from the thymus is the

a. T cell.
b. B cell.
c. phagocyte.
d. lymphocyte.

Answer 5

a. T cell.

Two major cell populations provide the immune system’s primary “search and destroy” defense for detecting and killing alien, nonself substances that carry potential disease. These two populations of lymphocytes, a special type of white blood cell, develop early in life from a common stem cell in the bone marrow. These two types of cells are called T cells, which are derived from the thymus cells, and cells, which are derived from the bursal intestinal cells.

Question 6

The cells responsible for synthesis and secretion of antibodies are the

a. immunoglobulins.
b. T cells.
c. cells.
d. lymphocytes.

Answer 6

c. cells.

The cells are derived from the bursal intestinal cells. A major function of the cells is to produce proteins as antibodies, which also kill antigens.

Question 7

The nutrient primarily responsible for maintaining tissue integrity and immunocompetence is

a. carbohydrate.
b. protein.
c. vitamins.
d. minerals.

Answer 7

b. protein.

The core of the immune system, antibodies, are proteins in structure. A direct and simple example of the important role of nutrition in immunity is the link between protein energy malnutrition and suppressed immune function.

Question 8

Cancer therapy that uses radioactive isotopes is

a. surgery.
b. radiation.
c. chemotherapy.
d. x-rays.

Answer 8

b. radiation.

Radiation therapy involves treatment with high-energy radiography targeted on the cancer site to kill or shrink cancerous cells. Radiation may be administered to the body by an external machine or by implanted radioactive materials at the cancer site.

Question 9

Which of the following describes a disadvantage of abdominal radiation?

a. The structure and function of the bowel may be adversely affected.
b. The radiation can be dispersed to all the abdominal organs once it passes into the cavity.
c. It is hard to pinpoint the precise area to target the radiation.
d. There are no disadvantages.

Answer 9

a. The structure and function of the bowel may be adversely affected.

Radiation to the bowel affects the intestinal mucosa, causing loss of villi and absorbing surface; therefore malabsorption problems may follow. Ulcers or inflammation and obstruction or fistulas also may develop from tissue breakdown.

Question 10

Patients who receive chemotherapeutic drugs often develop

a. tremors.
b. anemia.
c. hypertension.
d. abnormal heart rhythms.

Answer 10

b. anemia.

Patients who receive chemotherapeutic drugs have effects on their bone marrow. Interferences with the production of specific blood factors cause related problems: reduced red blood cells, causing anemia; reduced white blood cells, causing lowered resistance to infections; and reduced blood platelets, causing bleeding.

Question 11

A major systemic effect of cancer is

a. edema.
b. hypoglycemia.
c. dehydration.
d. negative nitrogen balance.

Answer 11

d. negative nitrogen balance.

Negative nitrogen balance is a major systemic effect of cancer. Protein is necessary for tissue healing. Efficient protein use depends on an optimal protein/energy ratio to promote tissue building and prevent tissue catabolism.

Question 12

Food aversions result from long-term treatment by

a. surgery.
b. radiation.
c. chemotherapy.
d. medication.

Answer 12

c. chemotherapy.

Food aversions result from chemotherapy, which causes nausea and vomiting, loss of normal taste sensations, lack of appetite, diarrhea, ulcers, malabsorption, and stomatitis.

Question 13

Patients who receive chemotherapy drugs often develop anemia because the drugs

a. damage the bone marrow.
b. prevent iron absorption.
c. interfere with folate metabolism.
d. destroy hemoglobin.

Answer 13

a. damage the bone marrow.

Chemotherapy affects the bone marrow. Reduced red blood cells cause anemia.

Question 14

The primary goal in nutrition care of patients with cancer is to

a. prevent further growth of the tumor.
b. reduce nutrients that the tumor feeds on.
c. prevent malnutrition.
d. promote weight gain.

Answer 14

c. prevent malnutrition.

The primary goal of nutrition care in cancer is to prevent malnutrition. Negative nitrogen balance is a major systemic effect of cancer. Protein is necessary for tissue healing. Efficient protein use depends on an optimal protein/energy ratio to promote tissue building and prevent tissue catabolism. Adequate calories are necessary to spare protein for tissue building.

Question 15

To counteract the hypermetabolic state of cancer, it is important to increase the intake of

a. protein.
b. kilocalories.
c. vitamins.
d. fats.

Answer 15

b. kilocalories.

It is important to increase the intake of kilocalories to supply adequate energy and spare protein to be used for tissue healing. The hypermetabolic nature of the disease and its healing requirements place great energy demands on a cancer patient.

Question 16

For patients with cancer, additional dietary protein is necessary for

a. supplying energy needs.
b. tissue synthesis for healing.
c. supplying essential fatty acids.
d. weight gain.

Answer 16

b. tissue synthesis for healing.

Adequate dietary protein is necessary for tissue synthesis for healing. Essential amino acids and nitrogen are necessary to promote tissue healing and offset tissue breakdown by the disease.

Question 17

Given a choice and a functional gastrointestinal tract, the preferred method of feeding a patient with cancer is

a. normal oral intake.
b. liquid formula diet.
c. tube feeding.
d. total parenteral feeding.

Answer 17

a. normal oral intake.

With a functional gastrointestinal tract, the preferred method of feeding is a normal oral diet supplied with adequate kilocalories and protein sources along with adequate fat, vitamins, and minerals. Fluid intake is important to ensure replacement of gastrointestinal losses from fever, infection, vomiting, and diarrhea and to help the kidneys dispose of metabolic breakdown products.

Question 18

If salivary secretions are reduced or absent, it may be most helpful to

a. serve a clear liquid diet.
b. use tube feeding.
c. serve food in semiliquid form.
d. serve water with the meal.

Answer 18

c. serve food in semiliquid form.

Decreased saliva and a sore mouth often result from radiation to the head and neck area or from chemotherapy. Spraying the mouth with artificial saliva is helpful. Frequent small snacks, soft and bland and cool or cold, served in a semiliquid form may be better accepted.

Question 19

An oncogene is a

a. tumor composed of melanin.
b. gene that, when activated, causes neoplastic growth.
c. tumor derived from connective tissue.
d. malignant new growth composed of epithelial cells.

Answer 19

b. gene that, when activated, causes neoplastic growth.

An oncogene is a gene that, when activated, causes neoplastic growth. Oncogenic, or tumor-inducing, viruses that interfere with the function of regulatory genes have been identified and are the focus of much ongoing research.

Question 20

A sarcoma is a

a. tumor composed of melanin.
b. gene that, when activated, causes neoplastic growth.
c. tumor derived from connective tissue.
d. malignant new growth composed of epithelial cells.

Answer 20

c. tumor derived from connective tissue.

Cancer tumors are identified by their primary site of origin and stage of growth. A sarcoma is a tumor derived from connective tissue.

Question 21

The cells that activate the phagocytes are the

a. T cells.
b. B cells.
c. lymphocytes.
d. antigens.

Answer 21

a. T cells.

T cells are derived from thymus cells and activate the phagocytes, special cells that destroy invaders, as well as act as killer cells that attack and kill disease-carrying antigens.

Question 22

Mucositis is an inflammation of the

a. stomach mucosa.
b. intestinal mucosa.
c. oral mucosa.
d. pancreas.

Answer 22

c. oral mucosa.

Mucositis is an inflammation of the tissues around the mouth or other orifices of the body.

Question 23

Symptoms that may occur during the primary HIV infection stage include

a. persistent fatigue, night sweats, thrush, and diarrhea.
b. a short bout of mild mononucleosis or flulike syndrome.
c. pneumonia, lymphoma, Kaposi’s sarcoma, and tuberculosis.
d. hyperglycemia, heart arrhythmias, and loss of appetite.

Answer 23

b. a short bout of mild mononucleosis or flulike syndrome.

Approximately 2 to 4 weeks after initial exposure and infection, a mild flulike episode lasting about 1 week may occur. This brief, mild response reflects the initial development of antibodies to the viral infection.

Question 24

Tuberculosis or Kaposi’s sarcoma commonly occurs when T-helper lymphocyte counts are

a. less than 200/mm3.
b. 200 to 500/mm3.
c. 500 to 800/mm3.
d. 800 to 1000/mm3.

Answer 24

b. 200 to 500/mm3.

When falling T-helper lymphocyte counts are roughly between 200 and 500 mm3 , various diseases such as tuberculosis or Kaposi’s sarcoma generally occur. Persons infected with HIV usually lose 40 to 80 mm3 of T-helper lymphocytes every year.

Question 25

The normal blood level of T-helper lymphocytes in healthy adults is approximately

a. 800/mcL.
b. 500/mcL.
c. 100/mcL.
d. 230/mcL.

Answer 25

a. 800/mcL.

The normal blood level of T-helper lymphocytes in a healthy diet is approximately 800/mcL. Persons infected with HIV usually lose 40 to 80 mm3 of T-helper lymphocytes every year.

Question 26

Nutrition support is a vital care component throughout the progression of HIV infection because of its role in

a. controlling involuntary weight loss and tissue wasting.
b. maintaining cardiac function.
c. preventing the spread of the HIV virus.
d. preventing anemia and constipation.

Answer 26

a. controlling involuntary weight loss and tissue wasting.

The role of nutrition support is a vital component of care for the patient with HIV infection to control involuntary weight loss and tissue wasting. Patients with HIV typically have a decreased appetite and insufficient energy intake coupled with elevated resting energy expenditure. Major weight loss follows and eventually leads to extreme cachexia, similar to that seen in cancer patients.

Question 27

A fundamental effect of HIV infection is

a. nausea.
b. vomiting.
c. major weight loss.
d. cirrhosis.

Answer 27

c. major weight loss.

Patients with HIV typically have a decreased appetite and insufficient energy intake coupled with elevated resting energy expenditure. Major weight loss follows and eventually leads to extreme cachexia, similar to that seen in cancer patients.

Question 28

An HIV-positive patient should be referred to the clinical dietitian on the AIDS team

a. at the first contact with a health professional.
b. at stage 2 (AIDS-related complex).
c. at stage 3 (final stage of AIDS).
d. when the patient has nutrition-related problems.

Answer 28

a. at the first contact with a health professional.

An HIV-positive patient should be referred to the clinical dietitian at the first contact with a health professional. The initial evaluation is critical in providing guidelines for ongoing care. Patients with HIV typically have a decreased appetite and insufficient energy intake coupled with elevated resting energy expenditure. Major weight loss follows and eventually leads to extreme cachexia, similar to that seen in cancer patients.

Question 29

The nutrition care plan for AIDS patients is

a. the same as for all patients.
b. unchanged throughout the course of the disease.
c. based only on clinical observations and anthropometry.
d. individualized and continually adjusted throughout the course of the disease.

Answer 29

d. individualized and continually adjusted throughout the course of the disease.

The nutrition care plan for patient with AIDS, as any other medical nutrition therapy, is individualized and adjusted throughout the course of the disease.

Question 30

A therapy that assists in the prevention of lean tissue loss is

a. massage.
b. human growth hormone.
c. peripheral parenteral nutrition.
d. cigarette smoking.

Answer 30

c. peripheral parenteral nutrition.

The use of human growth hormone, cytokine inhibitors, and resistance training appears to be more effective in preventing the loss of lean tissue.

Question 31

Guidelines for counseling a person with HIV infection include

a. being well informed about available therapies.
b. expecting significant changes in lifestyle behaviors.
c. promoting optimal nutrition while making the fewest food changes.
d. acting as a catalyst for selecting appropriate lifestyle changes.

Answer 31

c. promoting optimal nutrition while making the fewest food changes.

Guidelines for counseling a person with HIV infection include promoting optimal nutrition while making the fewest food changes. Changing behavior in any area requires the motivation, desire, and ability to achieve one’s goals and AIDS is no exception. All information or actions should proceed in manageable steps, as small as necessary.