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Chapter 18: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas

1. A common disorder in patients who abuse alcohol is

a. diarrhea.
b. fatty liver.
c. cholecystitis.
d. viral hepatitis.

ANS: B
Fatty liver is the earliest form of alcoholic liver disease. Alcohol abuse does not cause diarrhea or cholecystitis. Viral hepatitis is caused by viral infection.

DIF: Cognitive Level: Knowledge REF: Pages 386, 389, 394
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

2. It is possible to reverse fatty infiltration of the liver by

a. losing weight.
b. reducing fat intake.
c. increasing protein intake.
d. removing the underlying cause.

ANS: D
Fatty infiltration of the liver can be reversed by removing the underlying cause. This may be alcohol abuse, excessive kcal intake, obesity, complications of drug therapy (e.g., corticosteroids, tetracyclines), total parenteral nutrition, pregnancy, diabetes mellitus, inadequate intake of protein (e.g., kwashiorkor), infection, or malignancy. Losing weight and reducing fat intake will only help if the underlying cause for that individual is related to weight and fat intake. Increasing protein intake will only help if the cause is kwashiorkor.

DIF: Cognitive Level: Comprehension REF: Page 386
TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

3. A type of hepatitis that is transmitted via the fecal-oral route is hepatitis

a. A.
b. B.
c. C.
d. D.

ANS: A
Hepatitis A is transmitted via the fecal-oral route. Hepatitis B and D are transmitted parenterally or sexually. Hepatitis C is transmitted via blood or serum (sharing of contaminated needles, razors, toothbrushes, nail files, barber’s scissors, tattooing equipment, body piercing, or acupuncture needles).

DIF: Cognitive Level: Knowledge REF: Page 388
TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance

4. A symptom that is common to all types of hepatitis is

a. jaundice.
b. headache.
c. dehydration.
d. muscle aches.

ANS: A
All types of hepatitis cause jaundice. Hepatitis E causes flu-like aches and pains, including headache. Dehydration may occur if patients have nausea and vomiting.

DIF: Cognitive Level: Knowledge REF: Page 388
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

5. The recommended diet for patients with hepatitis is a well-balanced diet with

a. low protein content.
b. supplemental electrolytes.
c. no alcoholic beverages.
d. limited amounts of alcohol.

ANS: C
Total abstinence from alcohol is imperative for patients with hepatitis. The diet should be high in protein and kcals; supplemental electrolytes are not generally needed.

DIF: Cognitive Level: Comprehension REF: Page 390
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

6. An individual may be at risk for hepatitis E if they travel to India and eat

a. curried shrimp.
b. fresh fruit salad.
c. Tandoori chicken.
d. cooked foods from street vendors.

ANS: B
Hepatitis E is transmitted via the fecal-oral route; food prepared by infected food handlers may transmit the disease. Raw fruits and vegetables (e.g., fruit salad) are common sources of infection. Foods that are cooked, such as curried shrimp and Tandoori chicken, and foods prepared by street vendors, are not common sources.
DIF: Cognitive Level: Application REF: Page 389
TOP: Nursing Process: Planning
MSC: Client Needs: Health promotion and maintenance

7. For patients with hepatitis, a significant barrier to maintaining an adequate intake of kcals is

a. malabsorption.
b. fat intolerance.
c. loss of appetite.
d. increased metabolic rate.

ANS: C
Patients with hepatitis often have very little appetite, which makes it hard for them to achieve adequate oral intake of nutrients. Patients with hepatitis do not usually have problems with malabsorption, fat intolerance, or increased metabolic rate.

DIF: Cognitive Level: Knowledge REF: Page 390
TOP: Nursing Process: Assessment, Implementation
MSC: Client Needs: Physiological integrity

8. In cirrhosis of the liver, liver cells

a. decrease in number and increase in size.
b. are displaced by growth of tumors.
c. become disconnected because of breakdown of connective tissue.
d. are replaced by accumulations of fibrous connective tissue and fat.

ANS: D
In cirrhosis of the liver, liver cells are replaced by accumulations of fibrous connective tissue and fat. The cells die, so they do decrease in number, but do not increase in size. Liver tumors are caused by cancer, not cirrhosis. Cirrhosis does not cause breakdown of connective tissue.

DIF: Cognitive Level: Knowledge REF: Page 390
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

9. A low-fiber, soft diet is recommended for patients with

a. hepatitis A.
b. cholelithiasis.
c. esophageal varices.
d. hepatic encephalopathy.

ANS: C
A low-fiber, soft diet is recommended for patients with esophageal varices because fibrous or abrasive foods could cause potentially life-threatening bleeding. Patients with hepatitis A should follow a high-protein, high-kcal diet; patients with cholelithiasis should follow a low-fat diet; patients with hepatic encephalopathy should restrict their protein intake.

DIF: Cognitive Level: Comprehension REF: Pages 390-392, 394
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

10. Patients with ascites should restrict their intake of

a. protein.
b. sodium.
c. dietary fiber.
d. saturated fat.

ANS: B
Patients with ascites should restrict their intake of sodium to limit fluid retention. Protein intake should not be restricted unless the patient has encephalopathy. Dietary fiber intake should only be limited if the patient has esophageal varices. Intake of saturated fat does not need to be limited.

DIF: Cognitive Level: Comprehension REF: Page 392
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

11. If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing

a. fatty liver.
b. hepatitis D.
c. secondary depression.
d. hepatic encephalopathy.

ANS: D
If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing hepatic encephalopathy, as the brain is influenced by compounds that have been absorbed from the intestine and have not been metabolized by the liver. Fatty liver develops first, before progression to cirrhosis. Any form of hepatitis can lead to cirrhosis, but cirrhosis does not cause hepatitis. Depression may cause apathy, but does not usually cause confusion.

DIF: Cognitive Level: Knowledge REF: Pages 386, 390
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

12. Drugs that are used to treat hepatic encephalopathy include

a. antidepressants.
b. diuretics and steroids.
c. neomycin and lactulose.
d. laxatives and stool softeners.

ANS: C
Neomycin is an antibiotic used to sterilize the bowel to decrease the amount of urea that can be converted to ammonia. Lactulose is used to lower stool pH which traps ammonia in the colon. Antidepressants are ineffective because the mental problems associated with encephalopathy are related to metabolism rather than depression. Diuretics are used to treat ascites associated with cirrhosis, but are not used for encephalopathy. Steroids are not effective. Lactulose is used to lower stool pH, not for its laxative and stool softening effects.

DIF: Cognitive Level: Comprehension REF: Page 391
TOP: Nursing Process: Assessment, Implementation
MSC: Client Needs: Physiological integrity

13. Someone who drinks one glass of wine every night with dinner plus an occasional beer when watching a football game would be considered to be a(n)

a. alcoholic.
b. light drinker.
c. moderate drinker.
d. heavy drinker.

ANS: C
Someone who drinks 1-2 drinks per day is considered a moderate drinker. A heavy drinker consumes 3 or more drinks daily. A light drinker is not defined. Alcoholism is a disabling addictive dependence on alcohol, usually characterized by intake of significantly more than 1-2 drinks daily.

DIF: Cognitive Level: Application REF: Page 391
TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance

14. Moderate daily alcohol intake may help reduce risk of

a. cancer.
b. stroke.
c. hypertension.
d. heart disease.

ANS: D
Moderate alcohol intake may help reduce risk of heart disease. Risk of many types of cancer increases with increasing alcohol intake. Risk of hypertension increases with alcohol intake. Risk of stroke is not linked to alcohol intake.

DIF: Cognitive Level: Knowledge REF: Page 391
TOP: Nursing Process: Assessment
MSC: Client Needs: Health promotion and maintenance

15. If a patient with cirrhosis of the liver seems to be vulnerable to development of hepatic encephalopathy, his or her diet may be supplemented with a formula that contains _____ acids.

a. essential fatty
b. essential amino
c. aromatic amino
d. branched-chain amino

ANS: D
Patients who are vulnerable to development of hepatic encephalopathy may be given a formula that contains branched-chain amino acids and restricted aromatic amino acids to ensure adequate protein intake with minimal ammonia production. Essential fatty acids and essential amino acids do not help prevent hepatic encephalopathy.

DIF: Cognitive Level: Knowledge REF: Page 392
TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity

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16. An adequate kcal intake is especially important for patients with cirrhosis of the liver to prevent

a. muscle catabolism.
b. development of ascites.
c. essential fatty acid deficiency.
d. loss of appetite and taste acuity.

ANS: A
Adequate intake of kcals helps prevent breakdown of muscle to provide energy in patients with cirrhosis of the liver. Adequate kcal intake does not prevent ascites, essential fatty acid deficiency, and loss of appetite and taste acuity.

DIF: Cognitive Level: Knowledge REF: Page 392
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

17. A patient with end-stage liver disease may lose fat stores and muscle mass, but this may not be evident from measurements of body weight because of

a. dehydration.
b. fat redistribution.
c. ascites and edema.
d. electrolyte imbalances.

ANS: C
Patients with end-stage liver disease often accumulate fluid due to ascites and edema. This increases body weight, which may mask fat and muscle losses. Patients with end-stage liver disease are not usually dehydrated and do not usually have electrolyte imbalances. Fat infiltrates the liver but is not otherwise redistributed in the body.

DIF: Cognitive Level: Application REF: Pages 390, 392
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

18. After liver transplantation, long-term nutrition management may need to be tailored to help prevent

a. weight loss, anorexia, and nausea.
b. ascites, edema, and electrolyte imbalances.
c. cirrhosis, hepatic encephalopathy, and hepatic coma.
d. excessive weight gain, hypertension, and hyperlipidemia.

ANS: D
Long-term nutrition management after a liver transplant needs to be tailored to help prevent excessive weight gain, hypertension, and hyperlipidemia. Weight loss, anorexia, and nausea do not usually occur. Ascites, edema, and electrolyte imbalances may occur immediately after the transplant, but do not usually persist long term. Cirrhosis, hepatic encephalopathy, and hepatic coma do not occur after a successful transplant.

DIF: Cognitive Level: Comprehension REF: Pages 392-393
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological integrity

19. An example of an individual who may be at high risk for gallstones is a(n)

a. underweight woman who runs 3 miles four times a week.
b. man who smokes and eats eggs for breakfast every day.
c. overweight man who has recently begun an exercise program.
d. mother with four children who has lost 25 pounds in the past 3 months.

ANS: D
Rapid weight loss increases risk for gallstones, so a mother who has lost 25 pounds in the past 3 months could easily develop gallstones. Underweight, regular exercise, smoking, and eating eggs do not increase risk for gallstones. Overweight increases risk for gallstones, but less than rapid weight loss.

DIF: Cognitive Level: Application REF: Page 394
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

20. Cholecystitis is caused by

a. blockage of the bile duct by gallstones, bacterial infection, or ischemia.
b. concentration of bile in the gallbladder that favors formation of gallstones.
c. failure of the gallbladder to contract and release bile into the small intestine.
d. intake of excessive amounts of cholesterol and fat combined with bacterial infection.

ANS: A
Cholecystitis occurs when gallstones block the cystic duct or as the result of stasis, bacterial infection, or ischemia of the gallbladder. Concentration of bile in the gallbladder causes cholelithiasis, or formation of gallstones. Failure of the gallbladder to contract and release bile may lead to gallstone formation; this may be caused by very low fat intake or dieting. Intake of excessive amounts of cholesterol and fat and bacterial infection are not associated with gallbladder disease.

DIF: Cognitive Level: Knowledge REF: Page 394
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

21. If a patient experiences chronic symptoms of cholelithiasis and cholecystitis, the recommended nutrition therapy is

a. a low-fat diet.
b. gradual weight loss.
c. increased fluid intake.
d. a low-cholesterol diet.

ANS: A
A low-fat diet is used to treat painful symptoms associated with cholelithiasis and cholecystitis. Gradual weight loss may be beneficial in the long term, but will not decrease painful symptoms. Increased fluid intake and a low-cholesterol diet do not alleviate symptoms.

DIF: Cognitive Level: Comprehension REF: Page 394
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

22. After surgical removal of the gallbladder (cholecystectomy), long-term dietary recommendations are

a. a low-fat, low-cholesterol diet.
b. high protein and fluid intakes.
c. a well-balanced diet with no other restrictions.
d. small, frequent meals to ensure adequate intake.

ANS: C
After cholecystectomy, long-term dietary restrictions are not needed. Some patients need to restrict fat intake for a few weeks during recovery, but not long term. High protein and fluid intakes and small, frequent meals are not needed.

DIF: Cognitive Level: Knowledge REF: Page 394
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

23. Pancreatitis results in

a. excessive production of digestive enzymes and bicarbonate, causing duodenal ulcers.
b. decreased production of digestive enzymes and bicarbonate, causing malabsorption of fats and proteins.
c. increased production of pancreatic hormones, causing a decrease in blood glucose levels.
d. decreased production of pancreatic hormones, causing an increase in blood glucose levels.

ANS: B
Pancreatitis causes decreased production of digestive enzymes and bicarbonate, causing malabsorption of fats and proteins. Duodenal ulcers do not occur. Pancreatitis affects mainly the exocrine pancreas, so blood glucose levels are unaffected.

DIF: Cognitive Level: Knowledge REF: Page 394
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

24. During acute episodes of pancreatitis, patients often require

a. a clear liquid diet.
b. a high-protein diet.
c. a high-fat, high-kcal diet.
d. enteral or parenteral nutrition.

ANS: D
During acute episodes of pancreatitis, patients often need enteral nutrition infused into the jejunum, further down the gut than would cause pancreatic stimulation. An oral feeding can cause pancreatic stimulation and acute pain.

DIF: Cognitive Level: Comprehension REF: Page 395
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

25. When patients with pancreatitis are able to tolerate enteral feedings, the recommended formula is usually a _____ formula infused into the _____.

a. low-fat elemental; jejunum.
b. low-fat elemental; duodenum.
c. high-kcal, high-protein; jejunum.
d. high-kcal, high-protein; duodenum.

ANS: A
Enteral feedings for patients with pancreatitis should be low-fat elemental formulas infused into the jejunum to decrease pancreatic stimulation. High-kcal, high-protein formulas and infusion into the duodenum would both increase pancreatic stimulation.

DIF: Cognitive Level: Comprehension REF: Page 395
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

26. Cystic fibrosis is caused by

a. a genetic defect.
b. cigarette smoking.
c. bacterial infection.
d. inadequate folate intake.

ANS: A
Cystic fibrosis is an autosomal recessive inherited disease (i.e., it is caused by a genetic defect). The lung problems seen in cystic fibrosis are not caused by smoking cigarettes. Frequent lung infections are a symptom, rather than a cause of the disease. Inadequate folate intake is linked to increased risk of neural tube defects.

DIF: Cognitive Level: Knowledge REF: Page 395
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity

27. Most patients with cystic fibrosis require a

a. low-fat, low-energy diet and hormone replacement therapy.
b. high-fiber diet, supplements of water-soluble vitamins, and diuretics.
c. high-protein diet, sodium restriction, and supplements of fat-soluble vitamins.
d. high-kcal diet, multivitamin supplements, and enzyme replacement therapy.

ANS: D
Patients with cystic fibrosis require a high-kcal diet to compensate for high metabolic rate and malabsorption, multivitamin supplements to compensate for malabsorption, and enzyme replacement therapy to increase digestion and absorption of nutrients. A low-fat, low-energy diet would result in malnutrition. Patients have impaired secretion of enzymes, hormone production is normal. A high-fiber diet does not have any specific benefit for this population. Diuretics are not needed and could be dangerous because of excessive electrolyte losses. Sodium intake should be liberal, rather than restricted. Protein intakes may exceed the DRI, but needs are met by increased food intake.

DIF: Cognitive Level: Comprehension REF: Page 395
TOP: Nursing Process: Planning, Implementation
MSC: Client Needs: Physiological integrity

28. One of the most important tools for coping with the reality of a serious chronic disease such as cystic fibrosis is

a. having a sense of humor.
b. avoiding talking about it.
c. making friends only with others who have the same disease.
d. making friends only with others who do not have the same disease.

ANS: A
A sense of humor is a helpful coping mechanism for patients with chronic diseases such as cystic fibrosis. Avoiding talking about it simply magnifies fears and causes isolation. It is probably helpful for patients to have friends who have the disease who can identify with its struggles and friends who do not have the disease who can provide a sense of normalcy.

DIF: Cognitive Level: Comprehension REF: Page 396
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial integrity

29. Infants with cystic fibrosis

a. should be fed specially designed infant formulas.
b. should receive vitamin and mineral supplements.
c. may be breastfed with use of enzyme replacement therapy.
d. should delay introduction of weaning foods if they are underweight.

ANS: C
Infants with cystic fibrosis may be breastfed or fed infant formula along with enzyme replacement therapy. They may need supplemental fat and carbohydrate to add kcals, but do not need specially designed infant formulas or vitamin and mineral supplements. Guidelines for adding weaning foods are the same as for healthy infants.

DIF: Cognitive Level: Knowledge REF: Page 395
TOP: Nursing Process: Assessment, Implementation
MSC: Client Needs: Physiological integrity

30. A bottle of beer that contains 13 g of carbohydrates and 16 g of alcohol provides _____ kcals.

a. 116
b. 155
c. 164
d. 203

ANS: C
Carbohydrate provides 4 kcal/g; alcohol provides 7 kcal/g. Therefore, this bottle of beer would provide (13 ´ 4) + (16 ´ 7) = 52 + 112 = 164 kcals.

DIF: Cognitive Level: Application REF: Page 398
TOP: Nursing Process: Assessment, Planning
MSC: Client Needs: Health promotion and maintenance

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