Pathophysiology: Chapter 23: Obesity and Disorders of Nutrition

Question 1

1. If a patient with multiple sclerosis starts coughing frequently during meals and starts to
   eat significantly less food than normal, the patient may have
   a. pneumonia.
   b. gastroesophageal reflux disease.
   c. peptic ulcer.
   d. dysphagia.

Answer 1

ANS: D
Patients with multiple sclerosis may develop dysphagia; coughing during meals and eating
less than usual are common symptoms. Dysphagia may cause pneumonia if food enters the
lungs and causes infection. Gastroesophageal reflux disease causes burning and pain but
typically not coughing. Peptic ulcer causes intestinal pain but not coughing.

Question 2

For a patient with dysphagia, the food that would be most difficult to swallow is

a. applesauce.
b. mashed potatoes.
c. chocolate pudding.
d. chicken noodle soup.

Answer 2

ANS: D
Patients with dysphagia often have difficulty swallowing thin liquids, such as chicken
noodle soup. Thicker, pureed foods such as applesauce, mashed potatoes, and chocolate
pudding are usually easier to swallow.

Question 3

If a patient has difficulty swallowing, the best position for eating is

a. propped up in bed with a caregiver by the bedside.
b. sitting upright opposite a caregiver.
c. sitting at a dining table with social dining companions.
d. lying on the left side, with a caregiver by the side.

Answer 3

ANS: B
The safest eating position for someone who has trouble swallowing is sitting upright; the
caregiver should sit opposite to help provide cues and reminders while the patient is eating.
It is usually best for patients with dysphagia not to interact socially during mealtimes
because talking may make swallowing more difficult. Sitting propped up in bed and leaning
back would make it easier for food to enter the airway. Lying on ones side while eating
is very likely to cause aspiration.

Question 4

The most acute risk for patients with dysphagia is:

a. constipation.
b. dehydration.
c. dry mouth.
d. panic attacks.

Answer 4

ANS: B
An acute daily concern for patients with dysphagia is dehydration. Patients are not usually
allowed to drink fluids without supervision, and so fluid intake must be monitored
throughout the day. Constipation and dry mouth may occur with poor fluid and food intake
but are less acute. Patients with dysphagia may experience feelings of panic, but this is not
the most acute concern.

Question 5

The most helpful recommendation for a client who often experiences heartburn at night
would be to
a. avoid eating within 4 hours of going to bed.
b. increase the fiber content of the diet.
c. decrease the fiber content of the diet.
d. take antacid medications before going to bed.

Answer 5

ANS: A
Gastroesophageal reflux disease (GERD) usually occurs 1 to 4 hours after eating; therefore,
waiting at least 4 hours after eating before going to bed would help prevent heartburn
at night. Antacid medications may be helpful but should not be used on a regular basis before
other strategies have been tried. Fiber content of the diet does not affect heartburn.

Question 6

An example of a meal that is likely to relax the lower esophageal sphincter and allow
gastroesophageal reflux is
a. pasta with marinara sauce and sourdough bread.
b. ham with rice pilaf.
c. fried chicken and pasta salad.
d. chicken and spinach tortilla wrap and salsa.

Answer 6

ANS: C
High-fat foods and beverages relax the lower esophageal sphincter (allowing stomach
contents to back up). Both fried chicken and pasta salad are high in fat and would exacerbate
gastroesophageal reflux. The other meals are relatively low in fat and would be much
less likely to cause reflux.

Question 7

Peptic ulcer disease (PUD) would be most like to occur in someone who uses medication
to treat
a. gastroesophageal reflux disease.
b. constipation.
c. celiac disease.
d. joint pain or arthritis.

Answer 7

ANS: D
Risk of PUD increases with chronic use of nonsteroidal anti-inflammatory drugs
(NSAIDs), often used to treat joint pain or arthritis. Use of antacids to treat GERD would
decrease risk of PUD. Laxatives and stool softeners used to treat constipation do not affect
risk of PUD. Celiac disease is treated by avoiding dietary sources of gluten, not with medications.

Question 8

Nutrition therapy for peptic ulcers should be individualized, depending on

a. type of drug treatment.
b. location of the ulcer.
c. patient tolerance.
d. the cause of the ulcer.

Answer 8

ANS: C
There are no specific dietary recommendations for treatment of peptic ulcer, and so foods
eaten depend on the patients symptoms and tolerance. The type of drug treatment and location
of the ulcer do not significantly affect food tolerance. Factors that contribute to
formation of peptic ulcers are mostly nonnutritional (stress, skipping meals, chronic use of
use of NSAIDs), and so dietary intake is not a significant factor in treatment.

Question 9

If a patient who has undergone gastric bypass surgery for treatment of extreme obesity
experiences sudden sweating, nausea, and stomach cramps after meals, the patient may
have
a. gastroesophageal reflux.
b. pancreatitis.
c. peptic ulcer disease.
d. dumping syndrome.

Answer 9

ANS: D
Patients who have undergone gastric bypass may experience dumping syndrome as a large
volume of hyperosmolar food is dumped into the small intestine because the stomach reservoir
is missing or too small. GERD and peptic ulcers are not necessarily more common
after gastrectomy. Pancreatitis causes extreme pain and vomiting but is not related to gastric
bypass.

Question 10

An appropriate meal for someone with dumping syndrome would be

a. a small vanilla milkshake.
b. cream of mushroom soup.
c. half a turkey sandwich.
d. popcorn and sugar-free soda.

Answer 10

ANS: C
Individual tolerances vary, but the turkey half-sandwich would probably be tolerated best.
Half a sandwich is probably small enough not to cause symptoms. A milkshake is high in
sugar and probably too cold. Cream of mushroom soup is probably too hot, and liquids
should be taken between rather than with meals. The carbonation in the soda may increase
gastrointestinal distention because of gas.

Question 11

If a patient has esophagitis and also has worn tooth enamel, he or she may have

a. a hiatal hernia.
b. fluoride deficiency.
c. an eating disorder.
d. gastroesophageal reflux disease.

Answer 11

ANS: C
The eating disorder bulimia nervosa causes esophagitis and eroded tooth enamel because
of the effects of stomach acid being vomited back into the esophagus and mouth. A hiatal
hernia and GERD may cause esophagitis, but stomach contents would enter only the
esophagus, not the mouth, and so the teeth would not be worn. Fluoride deficiency may
cause loss of tooth enamel but would not cause esophagitis.

Question 12

An example of a meal that may contain gluten is

a. baked chicken breast with herbed rice.
b. pork chop with sweet potatoes and butter.
c. grilled steak with baked potato and sour cream.
d. roast beef with mashed potatoes and gravy.

Answer 12

ANS: D
Gravy is often made with wheat flour, which contains gluten. Rice, potatoes, and sweet
potatoes do not contain gluten. Baked chicken, pork chops, and grilled steak do not contain
gluten unless they are breaded or coated with wheat flour before being cooked.

Question 13

A patient with lactose intolerance would be most likely to experience symptoms if he
or she ate a
a. cup of pudding.
b. turkey sandwich with Swiss cheese.
c. biscuit with butter and honey.
d. cup of sherbet.

Answer 13

ANS: A
A cup of pudding would contain a cup of milk; most individuals with lactose intolerance
can only tolerate to cup milk at one time. Sherbet, Swiss cheese, biscuits, and butter all
have low levels of lactose.

Question 14

Milk may be made suitable for patients with lactose intolerance by treating it with tablets
that contain
a. yogurt.
b. lactase enzyme.
c. vitamin D and calcium.
d. Lactobacillus acidophilus.

Answer 14

ANS: B
Lactase enzyme tables may be added to milk 24 hours before it is drunk to digest the lactose;
this makes the milk suitable for patients with lactose intolerance. Lactobacillus acidophilus
and yogurt are not necessarily better tolerated than regular milk. Vitamin D and
calcium do not affect lactose intolerance, although patients with lactose intolerance may
benefit from supplements of these nutrients if their intake is low because they avoid milk.

Question 15

For patients with inflammatory bowel disease, nutrition therapy is

a. the primary mode of treatment.
b. rarely necessary.
c. an important adjunct to drugs and surgery.
d. highly specialized.

Answer 15

ANS: C
Nutrition therapy is important to help maintain nutritional status of patients with inflammatory
bowel disease, but is used in conjunction with drug and surgical treatments; it is
not the primary mode of treatment. Nutrition therapy is often needed to maintain weight
and micronutrient status. Awareness of deficiencies that occur in these patients is important,
but the RD does not need specialized knowledge to work with patients with IBD.

Question 16

Because patients with active Crohns disease have intestinal inflammation, they benefit
from high intake of
a. fat.
b. dietary fiber.
c. simple sugars.
d. protein.

Answer 16

ANS: D
Patients with inflammatory bowel disease benefit from a diet high in protein to compensate
for malabsorption. Fat intake should be moderate to provide adequate kilocalories
within a healthful diet; high fat intake may cause steatorrhea. Dietary fiber may irritate the inflamed gut. Simple sugars provide a readily digested and absorbed source of energy but
no other nutrients.

Question 17

Patients with inflammatory bowel disease may benefit from a high-fiber diet during

a. acute episodes.
b. times of remission.
c. recovery from surgery.
d. preparation for surgery.

Answer 17

ANS: B
A high-fiber diet may help stimulate peristalsis during times of remission in patients with
inflammatory bowel disease. During acute episodes, the diet should be low in fiber and
should promote bowel rest. In general, the diet should be high calorie, high protein, and
nutrient dense to compensate for malabsorption.

Question 18

Fluid loss is most likely to be a problem for a patient with

a. a colostomy.
b. a hiatal hernia.
c. an ileostomy.
d. Crohns disease.

Answer 18

ANS: C
Fluid loss is most likely to be a problem for a patient with an ileostomy because food exits
the intestines before water is absorbed in the colon. A colostomy may cause some fluid
loss, depending on where the colostomy is located and how much of the colon the intestinal
contents pass through for fluid absorption. A hiatal hernia does not cause fluid loss.
Crohns disease may cause some fluid loss during acute periods of inflammation because of
malabsorption.

Question 19

The most significant nutritional concern for a patient with an ileostomy is

a. fat malabsorption and steatorrhea.
b. dumping syndrome.
c. loss of fluid and electrolytes.
d. malabsorption of protein and carbohydrates.

Answer 19

ANS: C
For a patient with an ileostomy, digestive output exits the body instead of passing through
the colon, the major site of absorption of water and electrolytes. Digestion and absorption
of protein, carbohydrate, and fat are not usually affected. Dumping syndrome is caused by
a partial or total gastrectomy.

Question 20

For patients with ostomies, a lower amount of output occurs

a. if the ostomy is closer to the rectum.
b. if the ostomy is closer to the rectum.
c. with high fiber intake.
d. with high fat intake.

Answer 20

ANS: A
As effluent progresses through the colon, water is absorbed, and the effluent becomes
more solid; therefore, an ostomy closer to the rectum would have a smaller volume. Fiber
intake may increase output slightly, but less so than the site of the ostomy; fat intake does
not significantly affect the amount of output.

Question 21

If a patient has had a large portion of their small intestine removed because of cancer
and is unable to maintain a stable weight, a feeding regimen that would be most appropriate
is
a. enteral feedings into the stomach.
b. enteral feedings into the jejunum.
c. parenteral nutrition only.
d. supplemental parenteral nutrition.

Answer 21

ANS: D
Patients who have undergone removal of large portions of the small intestine and are unable
to maintain their weight should receive supplemental parenteral nutrition. Enteral
feedings would not be more effective than oral feedings because these patients have a limited
amount of gut to absorb the nutrients. Parenteral nutrition should not be used alone
because some oral feeding helps stimulate recovery of gut function and maintain gut integrity.

Question 22

If a patient receiving chemotherapy is struggling with nausea and vomiting, helpful
suggestions may include
a. drinking acidic fruit juices to stimulate gastric juices.
b. being active before and after meals to improve appetite.
c. eating frequent small meals throughout the day.
d. eating foods with plenty of flavor and aroma.

Answer 22

ANS: C
Patients receiving chemotherapy who have nausea and vomiting are most likely to maintain
adequate nutritional intake if they eat several small meals throughout the day. Rest
before and after meals is more likely than activity to help control nausea. Acidic fruit juices
may increase feelings of nausea. Bland foods are likely to be better tolerated than flavorful
and aromatic foods.

Question 23

The best way to prevent formation of diverticula in the colon is to:

a. eat plenty of fruits, vegetables, and whole grains.
b. avoid foods with rough hulls, such as nuts and seeds.
c. use stool softeners to promote daily bowel movements.
d. avoid foods that cause gas and increase pressure in the colon.

Answer 23

ANS: A
Diverticula are caused by high pressure in the colon, often in association with straining to
have a bowel movement; they can be prevented by intake of high-fiber foods, such as
fruits, vegetables, and whole grains. There is no evidence that nuts, seeds, or other foods
with hulls increase risk of diverticula. Using stool softeners to promote daily bowel
movements may help prevent diverticula, but eating a high-fiber diet is preferable because
of other nutritional benefits. Foods that cause gas are not associated with formation of diverticula.

Question 24

Someone who may benefit from avoiding sugar-free chewing gum is a patient with

a. peptic ulcer disease.
b. gastroesophageal reflux disease.
c. irritable bowel syndrome.
d. celiac disease.

Answer 24

ANS: C
Sugar-free chewing gum is usually sweetened with sorbitol or mannitol, which may exacerbate
irritable bowel syndrome. PUD, GERD, and celiac disease are not generally affected
by chewing gum or intake of sugar alcohols.

Question 25

In consuming a high-fiber diet, it is important to also consume adequate amounts of

a. fluid.
b. calcium and iron.
c. fat-soluble vitamins.
d. complex carbohydrates.

Answer 25

ANS: A
It is important to consume adequate fluid along with a high-fiber diet to prevent fecal impaction.
High-fiber diets generally have high levels of complex carbohydrates. Slightly
more calcium and iron may be needed because fiber may decrease the bioavailability of
these nutrients. However, diets high in fiber tend to have higher amounts of nutrients in
general. Requirements for fat-soluble vitamins are not generally affected by fiber intake.

Question 26

If a client complains of excessive gas, a good question to ask is whether he or she

a. drinks coffee and tea.
b. has problems with constipation.
c. chews gum.
d. is under a lot of stress.

Answer 26

ANS: C
Excessive gas may be caused by swallowing air while chewing gum. Drinking coffee and
tea, stress, and constipation do not usually cause excess gas formation.

Question 27

An example of a daily change that may help decrease constipation is

a. drinking tomato juice instead of carbonated beverages with lunch.
b. eating oatmeal and raisins instead of a bagel for breakfast.
c. snacking on pretzels instead of potato chips.
d. eating mashed potatoes instead of pasta with dinner.

Answer 27

ANS: B
Increasing intake of dietary fiber helps prevent constipation; oatmeal and raisins have significantly
higher levels of fiber than does a bagel. In fruit and vegetable juices, most of the
fiber is removed during the juicing process; drinking vegetable juice would add nutrients
but not fiber. Pretzels have less fat than potato chips, but both have low amounts of fiber.
Mashed potatoes contain only slightly more fiber than does pasta.

Question 28

An example of a high-fiber food item to include with lunch is

a. pasta with tomato sauce and Parmesan cheese.
b. beef tacos with lettuce and tomatoes.
c. an omelet with mushrooms and onions.
d. black bean soup.

Answer 28

ANS: D
Beans such as black beans have especially high amounts of fiber. Tomatoes, lettuce,
mushrooms, onions, and white pasta have lower amounts of dietary fiber. Cheese, beef,
and eggs contain no dietary fiber.

Question 29

A possible cause of acute diarrhea is

a. short bowel syndrome.
b. lactose intolerance.
c. emotional stress.
d. celiac disease.

Answer 29

ANS: C
Acute diarrhea may be caused by enteritis, medications, dietary changes, or emotional
stress. Short bowel syndrome, lactose intolerance, and celiac disease may cause chronic
diarrhea by causing various types of malabsorption.

Question 30

Treatment of diarrhea generally begins with:

a. a high-fiber, low-fat diet.
b. removal of the cause of diarrhea.
c. adequate fluids to hydrate the patient.
d. a low-fat, low-fiber, or low-lactose diet.

Answer 30

ANS: C
The primary concern in treatment of diarrhea is provision of adequate fluids to hydrate the
patient. After taking fluids, affected patients may progress to a low-fat, low-fiber, or
low-lactose diet and then to a regular diet as tolerated. If possible, the cause of diarrhea
may be removed, but this is not always possible and is not the first priority. A high-fiber,
low-fat diet may be beneficial once the diarrhea has resolved.