Gastrointestinal

Question 1

What is true regarding overweight states in older adults?

Answer 1

Mortality in the elderly related to overweight states declines over time.

Overweight and obese states are not as important in predicting mortality in the elderly as they are in their younger counterparts. After age 65 years (some studies demonstrate after age 70), weight is less significant in decreasing risk for mortality than in younger adults. There are some benefits to weight loss in the obese elderly. One of them is better balance and decreased risk for falls. Others include less sleep apnea, decreased risk of diabetes, decreased rates of shortness of breath with respiratory and cardiac diseases.

Question 2

The early signs and symptoms of appendicitis:

Answer 2

are subtle.

Explanation:
The most consistent findings in adults with early presentation of acute appendicitis are very subtle and difficult to identify. Symptoms may be as vague as indigestion, flatulence, a feeling of ill-being. Initially, pain can be in the general abdomen, then become periumbilical, and finally localize to the lower right quadrant. Early symptoms are difficult to identify, especially in older adults.

Question 3

What is the most common nutrition syndrome in elderly patients?

Answer 3

Undernutrition

Explanation:
Some elderly patients have great challenges associated with eating and maintaining weight. They may be edentulous or have anorexia. Weight loss is associated with greater mortality in older adults than in patients who have not had recent weight loss. Clinically significant weight loss is usually considered to be about 4-5% of total body weight within 6-12 months. In older patients who do lose weight, they are less likely to gain it back than younger adults. This also increases risk of mortality.

Question 4

A patient with bulimia nervosa probably has concurrent:

Answer 4

anxiety.

Explanation:
It is very common that other co-morbidities are present with eating disorders. Anorexia is commonly accompanied by anxiety, especially at mealtimes. Neurotransmitters are thought to play some role in the pathogenesis of anorexia nervosa. This is common in the United States in women especially between the ages of 15 and 30 years. It is relatively uncommon in males.

Question 5

A 46 year-old female with low grade fever and nausea has pain at McBurney’s point. The most appropriate action by the NP is to:

Answer 5

refer to ER.

Explanation:
Patients with appendicitis usually have pain at McBurney’s point, the painful area in the lower right quadrant of the abdomen. This patient should be referred to the ER. It is likely that he will receive a CT of the abdomen or an abdominal ultrasound. The CT has very high sensitivity and specificity for appendicitis (95 and 94 percent respectively).

Question 6

A patient with a suspected hernia should be examined:

Answer 6

standing.

Explanation:
The patient should be examined while he is standing. He should be asked to bear down, cough, or strain during the exam. Though hernias are far more common in males, they can be found in females too. In males, the patient should be asked to stand. The examiner should put his 2nd or 3rd finger through the scrotum and into the external ring. When the patient is asked to cough, a silky feel will butt up against the examiner’s finger and it can be easily felt.

Question 7

What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms?

Answer 7

Calcium carbonate

Explanation:
Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This provides relief that can be noticed immediately. The increase in pH lasts for about 30 minutes. Ranitidine is an H2 blocker. It provides relief in 1-2 hours. This usually lasts for about 6-12 hours. Amantadine is an antiviral not used to treat GERD. Pantoprazole is a proton pump inhibitor. This provides relief after several hours or days of daily consumption.

Question 8

A 30 year-old female presents with lower abdominal pain. The Adult NP immediately considers an ectopic pregnancy as the cause. Which factor listed below does NOT increase her risk of an ectopic pregnancy?

Answer 8

Age

These do ingrease the risk
Prior history of ectopic pregnancy
IUD use
History of PID

Explanation:
In an ectopic pregnancy, the developing embryo becomes implanted outside the uterus. A common site is the fallopian tube. Young age is a low risk factor for ectopic pregnancy. The other choices all confer high risk of ectopic pregnancy. Other high risk factors are previous tubal surgery or pathology, tubal ligation and in utero DES exposure.

Question 9

Which beverage below does not increase the risk of gout in a male who is prone to this condition?

Answer 9

Wine

Explanation:
Alcohol is known to be a contributing factor in development of gouty arthritis. Particularly in males, who are more prone to gout than females, alcohol consumption increases the likelihood of gout development. Of all alcohols, wine does not contribute to the development of gout and so would be recommended for men who are prone to gout. Consumption of meat and fish increase the concentration of uric acid and thus, the risk of developing gout.

Question 10

A patient has suspected peptic ulcer disease. Her symptoms occur a few hours after eating. She likely has a:

Answer 10

duodenal ulcer.

Explanation:
Symptoms have a poor correlation with disease found during endoscopy. However, duodenal symptoms tend to occur within 2-5 hours of eating. These patients derive relief from eating or taking antacids. This is in contrast to a patient with a gastric ulcer who has symptoms within minutes of eating. He tends to derive less relief from antacids.

Question 11

A 40 year-old patient has the following laboratory values. How should they be interpreted? HBsAg (-), HBsAb (+), HBcAb (-)

Answer 11

The patient has been immunized.

Explanation:
Since this patient has a negative hepatitis B surface antigen (HBsAg), he does not have hepatitis B. Since the patient has a negative hepatitis B core antibody (HBcAb), he has never had hepatitis B. Since the patient has a positive hepatitis B surface antibody (HBsAb), he is considered immune from immunization because his hepatitis B core antibody is negative. If the core antibody had been positive, he would be considered immune from the disease.

Question 12

As an adult ages, what pharmacokinetic factor is influenced by decrease in liver mass?

Answer 12

Metabolism

Explanation:
As the liver decreases in mass and potentially has a decrease in blood flow, drug metabolism is decreased. Consequently, lower doses of medications in older adults may be as efficacious as higher doses in their younger counterparts.

Question 13

Which imaging study of the abdomen would be LEAST helpful in diagnosing an acute appendicitis?

Answer 13

X-ray
Explanation:
X-rays are usually not helpful in diagnosing appendicitis; however, some findings on radiograph can be associated with appendicitis: ileus, free air, right lower quadrant appendicolith or soft tissue density or a deformity of the cecal outline. A CT scan is considered more accurate than an ultrasound, but an ultrasound and CT are the most commonly used tests. The sensitivity and specificity with CT scan are 94 and 95 percent respectively. With an ultrasound, the sensitivity and specificity are 86 and 81% respectively. MRI is generally not used because it is more expensive, takes more time to complete and is not as readily available.

Question 14

A patient has been prescribed metronidazole for treatment of C. difficile. What should be avoided in this patient?

Answer 14

Alcohol

Explanation:
Patients should always be cautioned against alcohol ingestion (in any form) if they take metronidazole. Alcohol can (and usually does) produce a disulfiram reaction. This is characterized by abdominal cramps, nausea, vomiting, headache and elevated body temperature. Precautions should remain until 72 hours after the last dose of metronidazole.

Question 15

Which of the following symptoms is typical of GERD?

Answer 15

Pyrosis

Explanation:
Typical symptoms of GERD include pyrosis (heartburn). The other symptoms listed are considered atypical symptoms of GERD. Patients who present with atypical symptoms of GERD, especially if older than 50 years, should be considered for endoscopy.

Question 16

A patient who is 76 years-old should not have aspirin initiated for primary prevention of myocardial infarction if she has what other risk factor?

Answer 16

Chronic steroid use

Explanation:
Aspirin does increase the risk of gastrointestinal bleeding. Most learned authorities and ACOVE (Assessing Care of Vulnerable Elders) agree that when 2 or more risk factors are present, aspirin should not be added without some form of protection for the GI tract (misoprostol or a PPI). In considering all the risks for GI bleed, the most significant ones are age > 75 years, history of GI bleeding, warfarin use, and chronic steroid use. So, her age and use of steroids increase her risk of GI bleed sufficiently enough to offset the benefit that could be derived from taking an aspirin.

Question 17

A common cause of fecal incontinence in elderly patients is:

Answer 17

constipation.

Explanation:
Underlying constipation is a common cause of fecal incontinence in older adults. However, typically it is multifactorial. Risk factors include: age > 80 years, impaired mobility, and neurologic disorders including dementia. Inactivity and poor fluid consumption may contribute to constipation but are not causes of fecal incontinence.

Question 18

An inguinal hernia is palpated on a male patient by an examiner. Which word below best describes what the hernia feels like when touched by the examiner?

Answer 18

Silky

Explanation:
Patients should be in the standing position when examined for a hernia. They are asked to strain, cough or bear down after the examiner has inserted his fingertip within the external ring. The word used to describe the impulse of the hernia bumping into the finger is “silky”. Nodular might be the word used to describe a prostate gland. Bumpy implies an irregular surface on some object. This is not the case with a hernia.

Question 19

A 50 year-old with a history of 3-4 alcoholic drinks daily and weekend binges has elevated liver enzymes. Which set of enzymes is most representative of this patient?

Answer 19

AST = 200, ALT = 75

Explanation:
The normal AST/ALT ratio in healthy subjects is 0.8. In patients with alcoholic hepatitis, the usual ratio (AST:ALT) is 2:1. When the ALT is very elevated, infectious hepatitis must be considered. Normally, both AST and ALT are less than 40 IU/L. The level of elevation does not correlate with the degree of damage in the liver and has no prognostic value in patients with liver disease.

Question 20

The most common cause of diarrhea in adults is:

Answer 20

viral gastroenteritis.

Explanation:
Most cases of acute gastroenteritis are viral in origin. Severe diarrhea is usually caused by bacteria. This typically lasts longer than 3 days.

Question 21

A patient has been prescribed metronidazole for treatment of C. difficile. What should be avoided in this patient?

Answer 21

Alcohol

Explanation:
Patients should always be cautioned against alcohol ingestion (in any form) if they take metronidazole. Alcohol can (and usually does) produce a disulfiram reaction. This is characterized by abdominal cramps, nausea, vomiting, headache, and elevated body temperature. Precautions should remain until 72 hours after the last dose of metronidazole.

Question 22

A patient has hepatitis B. He probably has a predominance of:

Answer 22

lymphocytes.

Explanation:
Lymphocytes tend to be the predominant white cell present during viral infections. Hepatitis B is a viral infection. The total white count will likely be decreased. This happens very often in the presence of viral infections. A bacterial infection is frequently evidenced by an elevated leukocyte count, a increased neutrophil count, and a decreased lymphocyte count.

Question 23

A patient with hepatitis C should:

Answer 23

receive immunization for hepatitis A and B.

Explanation:
A patient with hepatitis C has a compromised liver due to his infection. He should be immunized against hepatitis A and B because infection with either of these (along with his hepatitis C infection) will further compromise his liver’s health.

Question 24

Which medication listed below can exacerbate the symptoms of GERD?

Answer 24

Verapamil

Explanation:
Verapamil is a calcium channel blocker. Calcium is needed for muscle contraction. Since the lower esophageal sphincter is opened and closed by muscles, the contraction of these muscles will be less forceful. GERD can be exacerbated in this case. Calcium channel blockers should be avoided in patients with severe GERD or in patients in whom calcium channel blockers exacerbate GERD symptoms.

Question 25

A 63 year-old male has been your patient for several years. He is a former smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure and lipids are well controlled. He presents to your clinic with complaints of fatigue and “just not feeling well” for the last few days. His vital signs and exam are normal. What is the most likely reason for this?

Answer 25

Daily grapefruit consumption for the past 10 days

Explanation:
Grapefruit is a potent inhibitor of the cytochrome P450 enzyme system. Statins and calcium channel blockers are two infamous drug interactions that occur with grapefruit and grapefruit juice. Because they inhibit metabolism of the statin, the patient continues to have statin in circulation because he cannot significantly metabolize the medication. When the next day’s dose is taken, its effect is coupled with the effect of the previous day’s dose. The effect is cumulative. Hepatoxicity can quickly develop. The simvastatin must be stopped immediately! The liver enzymes must be followed until they return to normal; which could take weeks, months or even longer.

Question 26

Which of the following is NOT part of the prescription for management of weight loss in older adults?

Answer 26

Increase carbohydrate intake

Explanation:
When treating patients with weight loss, the goal is to increase the number of calories at each meal. Fats are more heavily laden with calories than carbohydrates. Carbohydrates (and proteins) provide only 4 calories per gram; fats provide 9 calories per gram. The addition of fats will increase calories much more quickly than increasing carbohydrate intake. All of the suggestions listed above will increase caloric intake. Daytime snacks should be offered too. Consider a Vitamin B supplement because this can stimulate appetite.

Question 27

A 35 year-old patient has the following laboratory values. How should they be interpreted? HBsAg (-), HBsAb (-), HBcAb (-)

Answer 27

The patient should consider immunization.

Explanation:
This patient has a negative hepatitis B surface antigen (HBsAg). Therefore, he does not have hepatitis B. The patient has a negative hepatitis B core antibody (HBcAb). Therefore, he has never had hepatitis B. The patient has a negative hepatitis B surface antibody (HBsAb). Therefore, he is not considered immune, and immunization should be considered. There is a remote possibility that this patient has been immunized but did not produce hepatitis B surface antibodies. If this were the case, he should consider immunization once again. The correct answer is choice C.

Question 28

A patient with gall bladder disease has classic symptoms. Which symptom below is NOT classic of gallbladder disease?

Answer 28

Pain that occurs with fasting

Explanation:
The pain associated with cholecystitis is usually constant and may or may not occur in relation to meals, but it rarely occurs with fasting. Initial pain is usual after a fatty meal. The pain is usually in the upper right quadrant but is nearly as common in the mid abdomen. The pain can mimic a myocardial infarct and so it must be treated as cardiac pain until proven otherwise. The pain is usually caused by contraction of the gallbladder after a meal. The contraction may be to force a stone or sludge against the gallbladder outlet. Discomfort can last for several hours.

Question 29

Older adults frequently complain of constipation. Which medication listed below does NOT increase the incidence of constipation in an older adult?

Answer 29

Warfarin

Explanation:
Constipation is a common complaint in older adults because of mediations they routinely consume and many diseases that they often have. Some other examples of medications that can cause constipation are opiate analgesics, NSAIDs, and antacids. Some diseases and conditions that can produce constipation are hypothyroidism, colon cancer, electrolyte abnormalities, immobility, inability to chew food with subsequent change in diet.

Question 30

A patient has been diagnosed with Hepatitis A. The most common reported risk factor is:

Answer 30

traveling internationally.

Explanation:
Traveling internationally is the most common risk factor. Hepatitis A (HAV) is spread via the fecal-oral route (and is highly contagious), though, most people are not able to report eating or drinking contaminated food/drink source.Mexico, Central, and South America are countries with the highest reported rates of HAV. Other risk factors are contact with infected family or close contacts and homosexual activity among men.

Question 31

A 40 year-old patient has the following laboratory values. How should they be interpreted? HBsAg (-), HBsAb (+), HBcAb (+)

Answer 31

The patient had hepatitis.

Explanation:
This patient has a negative hepatitis B surface antigen (HBsAg). Therefore, he does not have hepatitis B. the patient has a positive hepatitis B surface antibody (HBsAb), therefore he is considered immune. The patient also has a positive hepatitis B core antibody (HBcAb), therefore, he is immune because he has had hepatitis B.

Question 32

A patient with diarrhea has a positive enzyme immunoassay for C. difficile. He is on clindamycin for a tooth abscess. How should he be managed?

Answer 32

Stop the clincamycin if possible, give

Explanation:
The most important step in treating infection with C. difficile is stopping ingestion of the offending antibiotic. In this case, stopping the clindamycin, if possible, is the most important part of treatment. Metronidazole is recommended initially for non-severe infection. If the antibiotic cannot be stopped, treatment for C. difficile should be continued as long as the patient must take the offending antibiotic.

Question 33

Which medication listed below can exacerbate the symptoms of GERD?

Answer 33

Verapamil

Explanation:
Verapamil is a calcium channel blocker. Calcium is needed for muscle contraction. Since the lower esophageal sphincter is opened and closed by muscles, the contraction of these muscles will be less forceful. GERD can be exacerbated in this case. Calcium channel blockers should be avoided in patients with severe GERD or in patients in whom calcium channel blockers exacerbate GERD symptoms.

Question 34

Which of the following symptoms is typical of GERD?

Answer 34

Pyrosis

Explanation:
Typical symptoms of GERD include pyrosis (heartburn). The other symptoms listed are considered atypical symptoms of GERD. Patients who present with atypical symptoms of GERD, especially if older than 50 years, should be considered for endoscopy.

Question 35

A single stool specimen obtained during a rectal examination is:

Answer 35

inadequate to screen colon cancer.

Explanation:
This is not adequate to screen for colorectal cancer. Fecal occult blood test have a much higher sensitivity if three consecutive stool specimens are used (applying 2 samples per card for each specimen). Since polyps do not usually bleed, the fecal occult blood test is not a good screen for polyps.

Question 36

An older adult was screened for colorectal cancer and had a positive screen. She went on to have a colonoscopy that was normal. She does not have colorectal cancer. The screen was a:

Answer 36

false positive.

Explanation:
The screen was a false positive. Unfortunately, one of the hazards of screening tests is the cost associated with false positives and false negatives. All screening tests have inherent costs associated with them.

Question 37

The two tests which can indicate with certainty that a patient has hepatitis B at present are:

Answer 37

hepatitis B surface antibody and core antibody.

Explanation:
The earliest serologic marker that indicates acute hepatitis B infection is the hepatitis B surface antibody. It becomes positive about 2-6 weeks after infection, but before symptom onset. The core antibody indicates that the hepatitis B virus is in the body now, or in the alternative, was in the body at an earlier time. The finding of a positive hepatitis B core antibody identifies with certainty hepatitis B infection (either at present or in the past). It does not indicate recovery.

Question 38

A patient has been diagnosed with Hepatitis B. The most common reported risk factor is:

Answer 38

sexual exposure.

Explanation:
Hepatitis B is transmitted by blood and body fluids. The most common risk factors are sexual exposure and IV drug use. Drinking contaminated water, eating contaminated food and traveling internationally increase the risk of Hepatitis A, which is transmitted via fecal oral routes.

Question 39

The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter and:

Answer 39

Shigella.

Explanation:
Shigella will be shed continuously in the stool and should be easily identified on stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. Generally, these three pathogens are easily identified if they are present.

Question 40

Which characteristic of hemorrhoids is unusual?

Answer 40

They are common in 20-30 year-olds.

Explanation:
Hemorrhoids are vascular structures in the anal canal. The classic symptoms of hemorrhoidal disease are bleeding, itching, burning. They are of equal prevalence in men and women, but development prior to age 20 years is unusual. The most common age for prevalence is 45-65 year-olds.

Question 41

Which patient has NO indications for further evaluation of his diarrhea? One with:

Answer 41

watery diarrhea and fever.

Explanation:
Diarrhea is extremely common. Evaluation of diarrhea should take place when specific criteria suggest severe illness. In addition to those listed, some conditions which indicate further work-up are: profuse watery diarrhea with signs of hypovolemia, passage of >6 unformed stools per 24 hours or a duration of illness > 48 hours, recent antibiotic use or recent hospitalization, and diarrhea in a patient > 70 years old.

Question 42

Which disease listed below does NOT impact an elder’s ability to eat?

Answer 42

Hypertension

Explanation:
Many, many diseases impact an elder patient’s ability to eat. About 50% of patients who have had stroke have impaired ability to eat. This can include difficulty feeding self as well as difficulty swallowing. Parkinson’s disease and many other neurological diseases have great impact on eating since coordinated muscle movement is needed for swallowing and feeding. Hypertension has no significant impact on a patient’s ability to eat.

Question 43

In a patient with end of life physical discomforts, constipation commonly occurs. What is the usual cause of this?

Answer 43

Opioid use

Explanation:
Opioids can cause severe constipation. At end of life this can be a significant cause of discomfort for the patient. Measures for relief of constipation should be instituted.

Question 44

A female patient presents with tenderness at McBurney’s point. Appendicitis is considered. What laboratory test would be LEAST helpful to exclude appendicitis?

Answer 44

CBC with elevated white count

Explanation:
CBC with an elevated white count simply indicates that an infection is likely. It is not specific for the location of the infection. Urinalysis should be performed to rule out a UTI. Symptoms can mimic an appendicitis. Serum pregnancy test must be performed since this patient could have an ectopic pregnancy. Positive pelvic cultures could indicate pelvic inflammatory disease as the cause of the pain.

Question 45

A 29 year-old male has recently returned from a camping trip with friends. He has a history of Type I diabetes mellitus and migraines. He reports a two-day history of nausea and vomiting. Which of the following is least likely a possible cause?

Answer 45

Giardia infection

Explanation:
Giardia causes diarrhea. Nausea and vomiting are usually caused by iatrogenic, toxic, infectious causes; GI diseases, CNS diseases (vertigo or tumor), or psychiatric causes. A 3-step approach to initial evaluation of nausea and vomiting is first to recognize and correct consequences of symptoms, secondly, identify underlying cause and treat, and then use empiric treatment to manage symptoms.

Question 46

An 84 year-old presents with a stated involuntary weight loss. He states that he’s lost about 6 pounds in the last 6 or 8 weeks. What statement below is NOT part of the assessment?

Answer 46

Evaluate his upper and lower extremity muscle mass.

Explanation:
Involuntary weight loss in older adults is often due to malignancy or disease. The initial assessment of an older adult who reports involuntary weight loss is to document the weight loss. If prior measurements are part of the patient’s chart, this would be helpful. Laboratory assessment should also be performed. Consideration should be given to performing a CBC, TSH, metabolic panel. Also consider chest and abdominal x-rays. If all are normal, he should be monitored and re-weighed on the same scale for comparison. A dietary consult should be in order. However, even with negative initial findings, a significant number of patients are later found to have disease or malignancy.

Question 47

Which description is more typical of a patient with acute cholecystitis?

Answer 47

Most are asymptomatic until a stone blocks the bile duct.

Explanation:
A patient with acute cholecystitis usually complains of abdominal pain in the upper right quadrant or epigastric area. Many patients complain of nausea. The patient lies very still on the exam table because cholecystitis is associated with peritoneal inflammation that is worse with movement. Elderly patients are more likely to NOT exhibit Murphy’s sign and thus, are more likely to suffer from complications of acute cholecystitis. Patients who are asymptomatic have cholelithiasis, not acute cholecystitis.

Question 48

A patient with diarrhea has a positive enzyme immunoassay for C. difficile. He is on clindamycin for a tooth abscess. How should he be managed?

Answer 48

Stop the clindamycin if possible, give metronidazole

Explanation:
The most important step in treating infection with C. difficile is stopping ingestion of the offending antibiotic. In this case, stopping the clindamycin, if possible, is the most important part of treatment. Metronidazole is recommended initially for non-severe infection. If the antibiotic cannot be stopped, treatment for C. difficile should be continued as long as the patient must take the offending antibiotic.

Question 49

A patient with diarrhea has a stool specimen positive for WBCs. What does this indicate?

Answer 49

A bacterial infection

Explanation:
When WBCs are found in stool specimens, it is indicative of infection or inflammation. In the case of a patient with symptoms suggestive of an infectious etiology, bacterial or viral infections should be considered. When considering a differential diagnosis and no infectious etiology is likely, Crohn’s disease or ulcerative colitis could be considered.

Question 50

An elderly adult with an appendicitis is unlikely to exhibit:

Answer 50

initial WBC elevation.

Explanation:
Very young children and elderly adults are not likely to have initial WBC elevations. Consequently, appendicitis can be easily missed in these populations. Generalized abdominal pain is typical initially. UTI symptoms in older adults can manifest as lower abdominal pain and are a common presentation in this age group. Low grade fever is common too.

Question 51

A 40 year-old patient has the following laboratory values. How should they be interpreted? HBsAg (-), HBsAb (+), HBcAb (-)

Answer 51

The patient has been immunized.

Explanation:
This patient has a negative hepatitis B surface antigen (HBsAg). Therefore, he does not have hepatitis B. The patient has a negative hepatitis B core antibody (HBcAb). Therefore, he has never had hepatitis B. The patient has a positive hepatitis B surface antibody (HBsAb). Therefore, he is considered immune. The patient is immune from immunization because his hepatitis B core antibody is negative. If the core antibody had been positive, he would be considered immune from the disease. The correct answer is choice D.

Question 52

A patient is in the clinic with a 36 hour history of diarrhea and moderate dehydration. Interventions should include:

Answer 52

oral rehydration with an electrolyte replenishment solution.

Explanation:
The goal in managing a patient who presents with dehydration is rehydration. This is typically done with a commercially prepared electrolyte solution. Infamously, these are poor tasting. Patients usually prefer to rehydrate with fluids like tea, cola or a sports drink. However, these usually contain too much carbohydrate, too little potassium, and too much sodium for ideal fluid replenishment. Consequently, these are avoided when rehydration is needed. These are preferred by patients because of their good taste. The oral tract is always preferred for rehydration when it can be used. Resumption of the usual fluid and solid food intake should occur AFTER rehydration has occurred.