Roth 10e NCLEX Chapter 20

MULTIPLE CHOICE 1. A client has recently been diagnosed with dyspepsia, and after discussion about the

underlying reasons, the nurse found that the client has been stressed at work and at home. Based on this information, the nurse would suggest that the cause of the dyspepsia is ______ in nature, and perhaps the best way to resolve the dyspepsia would be to _____________.
a. physiological; allow the client c. psychological; find relief from the

sufficient time to relax b. physiological; teach the client ideal eating habits
ANS: C

underlying stress d. psychological; treat other physical ailments the client may have

Psychological stress can affect stomach secretions and trigger dyspepsia. Treatment should include counseling to help the client find relief from the underlying stress, allow sufficient time to relax and enjoy meals, and learn to improve eating habits.
PTS: 1 REF: Dyspepsia

2. A client has recently been diagnosed with celiac disease, so they have a high sensitivity to

gluten. The client learns that the treatment is consumption of a gluten-free diet, but is not exactly sure what kinds of foods are gluten-free. The client asks the nurse to provide an example of a gluten-free dinner. Which of the following responses is appropriate?

a. Fish seasoned with salt and pepper,

c. Fish sticks, broccoli in a cheese sauce,

broccoli in a cheese sauce, and brown rice with a glass of light beer
b. Fish seasoned with salt and pepper,

and pretzels with a glass of light beer

d. Fish sticks, fresh mixed vegetables,

fresh mixed vegetables, and wild rice with a glass of soda

ANS: B

and pretzels with a glass of water

A gluten-free diet is used in the treatment of celiac disease. Gluten is a protein found in barley, oats, rye, and wheat. All products containing these grains are disallowed. Rice and corn may be used. A reduction in the fiber content of the diet is also frequently recommended. The cheese sauce in answers A and C likely contain gluten as do the pretzels in answers C and D. Answer B includes all foods that do not contain gluten. Review table 20-2.
PTS: 1 REF: Celiac Disease; Table 20-2

3. A client has recently undergone intestinal surgery, and will be on a low-residue diet during

recovery. The client asks the nurse to provide an example of a breakfast that would fit in a low residue diet. Which of the following meals would the nurse say is most appropriate for this client?

a. One fried egg and cheese on whole

c. Scrambled eggs seasoned with salt, a

fresh fruit cocktail, and multigrain toast with margarine and a cup of coffee b. Scrambled eggs seasoned with salt, a d. Scrambled eggs seasoned with salt, a fresh fruit cocktail, and a glazed donut ripe banana, and white toast with with a cup of coffee margarine with a cup of coffee with sugar
ANS: D

wheat toast, with hash browns, a fresh fruit cocktail, and a glass of milk

The low residue diet contains 5-10 grams of dietary fiber a day and is intended to reduce the work of the intestines by restricting the amount of dietary fiber and reducing food residue. Some foods that do not actually leave residue in the colon are considered low-residue foods because they increase stool volume or provide a laxative effect. Thus, high fiber foods such as whole wheat toast, and most fruits and vegetables would be excluded from the diet. Review table 20-5 for specific foods to include/exclude from a low residue diet.
PTS: 1 REF: The Low-Residue Diet; Table 20-5

4. A client with a gastrointestinal problem has recently been given a new diet and is quite

uncomfortable with it. If the client refuses to eat for the most part, what would be the most appropriate thing for the nurse to do in order to make the client more likely to eat?
a. Allow the client to temporarily stray c. Leave the client alone and hope they

from the diet because they are more likely to eat if they can eat what they want to eat. b. Continually remind the client to eat because it is important for health.
ANS: D

will eventually come around and begin to eat.

d. Show the client respect and

understanding while helping the client learn what they should eat and why.

Health care professionals who show respect and understanding for their clients will have the most success in helping them learn what they should and should not eat and why.
PTS: 1 REF: Considerations for the Health Care Professional

5. A client who has been diagnosed with pancreatitis is now ready for oral feedings, but must

follow a low-fiber diet. The client asks the nurse to provide an example of a low-fiber dinner. Which of the following examples would be the most appropriate for the nurse to give this client?
a. A ground beef patty with skinless c. Chicken broth, a ground beef patty, a

mashed potatoes, canned pears and a glass of diet soda. b. Baked fish with cooked, mashed cauliflower, chicken broth with noodles, and a glass of wine.

boiled potato with no skin, baked squash, and a glass of beer. d. Whole wheat pasta with alfredo sauce and Italian sausage, fresh pears, and a glass of beer.

ANS: A

Choice A contains all low fiber/low residue foods. Answers B and C each include an alcoholic beverage, which is inappropriate for a client with pancreatitis. Answer D contains fresh pears and whole wheat pasta which are not appropriate for a low-residue diet because they are high in fiber. Review Table 20-5.
PTS: 1 MULTIPLE RESPONSE 1. A client has been diagnosed with Crohns disease, and after being on a low-residue diet for REF: The Low-Residue Diet/Pancreatitis

awhile, the client is now ready to try a regular diet. The client is not sure what to expect in this new diet after becoming used to liquid and low-residue diets, so the client asks the nurse what the diet will consist of each day. Which of the following responses would be appropriate? Select all that apply.
a. Consume additional calories. b. Consume additional fats. c. Consume additional fiber. ANS: A, D, E d. Consume additional minerals. e. Consume additional vitamins. f. Consume up to 50 grams of protein.

When tolerated, the diet should include about 100 grams of protein, additional calories, vitamins, and minerals.
PTS: 1 REF: Inflammatory Bowel Disease

2. A hospitalized client has been diagnosed with a hiatal hernia. At discharge, the nurse teaching the client about what foods may exacerbate he condition. Which of the following foods would the nurse say are irritants to the esophagus? a. alcohol b. butter c. regular cola d. citrus fruits e. chocolate f. coffee

ANS: C, D, F Those who have a hiatal hernia should avoid foods that irritate the esophagus. These include carbonated beverages, citrus fruits and juices, tomato products, spicy foods, coffee, pepper, and some herbs. Alcohol, butter, and chocolate should also be avoided by those with a hiatal hernia, not because they are esophageal irritants, but because they cause the lower esophageal sphincter to relax. PTS: 1 NUMERIC RESPONSE 1. A 72 kg client with a peptic ulcer asks the nurse what changes should be made in their diet in REF: Esophagitis; Hiatal Hernia

order to alleviate the problem. The nurse notes that there is no bleeding associated with the peptic ulcer. Knowing that the client needs sufficient protein, but not an excess of protein, the nurse calculates the clients daily protein need. How much protein will the nurse say the client needs to consume each day?
ANS:

57.6 grams Rationale: Sufficient low-fat protein should be provided, but not in excess because of its ability to stimulate gastric acid secretion. It is recommended that clients receive no less than 0.8 gram of protein per kilogram of body weight. However, if there has been blood loss, protein may be increased to 1 or 1.5 grams per kilogram of body weight.
PTS: 1 REF: Peptic Ulcers

2. The nurse is educating a client who has advanced cirrhosis of the liver about the appropriate

diet for this condition. The client weighs 70 kg. What will the nurse say is the minimum number of daily calories that should come from carbohydrates?
ANS:

875 Rationale: The dietary treatment of cirrhosis provides at least 25 to 35 calories or more per kilogram of weight each day, depending on the clients condition. Supplements of vitamins and minerals are usually needed. In advanced cirrhosis, 50% to 60% of the calories should be from carbohydrates. Using the minimum requirements, multiply the 70 kg weight by 25 calories/kilogram, then take 50% of the result to determine how many calories each day should be from carbohydrates.
PTS: 1 REF: Cirrhosis

3. A client who has atherosclerosis is told they need to begin a high-fiber diet. The client asks

the nurse how many more grams of dietary fiber must be consumed each day in order to satisfy the minimum requirements of a high fiber diet. Assuming the client consumes an average U.S. diet, how much more fiber per day would the nurse tell the client should be eaten in order to satisfy the minimum requirements of a high-fiber diet?
ANS: 14 grams

Rationale: It is currently estimated that the normal diet in the Unites States contains about 11 grams of dietary fiber each day. A high-fiber diet is often 25 to 35 grams and should not exceed 50 grams a day. Using the minimum requirement of 25 grams, and assuming the client consumes the average amount of fiber (11 g), the client would have to consume 14 more grams per day.
PTS: 1 REF: The High-Fiber Diet