Chapter 22: Surgery and Nutrition Support Nursing School Test Banks

Chapter 22: Surgery and Nutrition Support
Test Bank

MULTIPLE CHOICE

1. The most common nutrition deficiency among surgical patients is a deficiency of
a. vitamin C.
b. iron.
c. protein.
d. essential fatty acids.
ANS: C
Protein deficiencies among surgical patients are the most common.

DIF: Cognitive Level: Knowledge REF: 449 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

2. Before general surgery, nothing is given by mouth for at least _____ hours.
a. 4
b. 8
c. 12
d. 24
ANS: B
Nothing is given by mouth for at least 8 hours before surgery to avoid serious complications such as aspiration of stomach contents into the lungs.

DIF: Cognitive Level: Knowledge REF: 449 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

3. Protein is especially needed in the postoperative recovery period for
a. energy.
b. control of edema.
c. control of hypertension.
d. optimal kidney function.
ANS: B
Protein assists in the maintenance of osmotic pressure, which is necessary to maintain normal movement of fluid between the capillaries and surrounding tissue. Without maintenance of osmotic pressure, edema develops.

DIF: Cognitive Level: Knowledge REF: 450 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

4. For a patient who can take an oral diet, a food that would be a good source of energy during the postoperative period could be
a. meat.
b. cereals and other grains.
c. carrots.
d. fried potatoes.
ANS: B
During the postoperative period, the primary source of energy for the body should be carbohydrates supplied by cereals and other grains.

DIF: Cognitive Level: Application REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

5. A food choice that provides a good source of energy during the postoperative period is
a. hamburger.
b. potato chips.
c. oatmeal.
d. shrimp.
h
ANS: C
Oatmeal is a good source of carbohydrates that provides the necessary energy for the body to meet increased energy needs while also sparing protein for tissue synthesis.

DIF: Cognitive Level: Application REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

6. Blood losses may result in a deficiency of
a. calcium.
b. glucose.
c. iron.
d. vitamin C.
ANS: C
Iron-deficiency anemia may result from blood loss or faulty iron absorption.

DIF: Cognitive Level: Knowledge REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

7. Two minerals that are lost during tissue catabolism are
a. sodium and chloride.
b. calcium and magnesium.
c. iron and zinc.
d. potassium and phosphorus.
ANS: D
Potassium and phosphorus are lost during tissue catabolism. When tissue is broken down, cell potassium and phosphorus are lost from inside the cells.

DIF: Cognitive Level: Knowledge REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

8. Fluid loss is accompanied by loss of the electrolytes
a. sodium and chloride.
b. calcium and magnesium.
c. iron and zinc.
d. potassium and phosphorus.
ANS: A
During the postoperative period, large water losses may occur as a result of vomiting, hemorrhage, fever, or excessive urination. Because sodium is the major electrolyte in extracellular fluid, losses will occur with losses of water. Chloride losses also occur because it is also widely distributed within the extracellular compartment.

DIF: Cognitive Level: Comprehension REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

9. A good source of vitamin C, important during the healing process, is
a. whole wheat crackers.
b. broccoli.
c. vanilla pudding.
d. pretzels.
ANS: B
Broccoli is a good source of vitamin C necessary to build and maintain strong tissues, especially connective tissues.

DIF: Cognitive Level: Application REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

10. Commercial enteral feeding formulas are preferred to blenderized food because they
a. have a thinner consistency.
b. carry less risk of bacterial growth and infection.
c. are better tolerated.
d. are less expensive.
ANS: B
Commercially prepared enteral feeding formulas provide a sterile, homogenized solution and are less likely to become contaminated with bacteria than blenderized food.

DIF: Cognitive Level: Knowledge REF: 456-457 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

11. An example of a food item that is usually NOT part of a regular oral diet is
a. steamed broccoli.
b. braised chicken.
c. baked potato.
d. pureed carrots.
ANS: D
Pureed carrots are not part of a regular oral diet since the texture has been modified.

DIF: Cognitive Level: Application REF: 452-453 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

12. Advancing the carbohydrate load in total parenteral nutrition too quickly may result in
a. hyperglycemia.
b. hypoglycemia.
c. fluid overload.
d. anemia.
ANS: A
Advancing the carbohydrate load too quickly when administering total parenteral nutrition can result in hyperglycemia.

DIF: Cognitive Level: Application REF: 452 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

13. Patients who have had radical surgery of the head, neck, or throat may require
a. a clear liquid diet.
b. a full liquid diet.
c. tube feedings.
d. a low-residue diet.
ANS: C
When regular oral feedings are not tolerated or the patient is severely debilitated or has undergone radical neck or face surgery, feedings by tube may be necessary.

DIF: Cognitive Level: Application REF: 462 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. Immediately following a gastrectomy, postoperative nutrition feedings are met by
a. small frequent oral feedings.
b. jejunostomy feedings.
c. total parenteral nutrition.
d. an oral full liquid diet.
ANS: B
Postopertive feedings immediately following a gastrectomy usually are provided though a jejunostomy tube providing elemental feedings.

DIF: Cognitive Level: Knowledge REF: 462 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. Once placed on an oral diet following a gastrectomy, an appropriate feeding would consist of
a. water and ice chips only.
b. chocolate pudding and ginger ale.
c. scrambled eggs and toast.
d. steak strips and potato wedges.
ANS: C
After a gastrectomy, meals should be small, frequent, and easily digested such as scrambled eggs and toast.

DIF: Cognitive Level: Application REF: 462 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

16. Ms. Jones has recently had gastric surgery and 45 minutes after eating her regular diet she feels cramping and full with waves of weakness and dizziness. Ms. Jones is most likely experiencing
a. a heart attack.
b. a gallbladder attack.
c. a pulmonary embolus.
d. dumping syndrome.
ANS: D
Dumping syndrome is a frequently encountered complication after extensive gastric resection. After the initial recovery from surgery, when the patient begins to feel better and eats a regular diet in greater volume and variety, discomfort may occur 30 to 60 minutes after meals. A cramping and full feeling develops, the pulse becomes rapid, and a wave of weakness, cold sweating, and dizziness may follow.

DIF: Cognitive Level: Application REF: 462
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. Of the following, the food item most likely to lead to dumping syndrome is
a. lean meat.
b. butter.
c. chocolate cookies.
d. whole wheat toast.
ANS: C
The complex of symptoms in dumping syndrome constitutes a shock syndrome that results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or dumps into the small intestine.

DIF: Cognitive Level: Application REF: 462 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

18. Physiologic symptoms of dumping syndrome result from
a. the intestinal contents being absorbed too quickly.
b. the ingested food remaining in the stomach too long.
c. the stomach emptying too quickly into the intestine.
d. water being drawn from the blood into the intestine and decreasing the blood volume.
ANS: D
Dumping syndrome results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or dumps, into the small intestine. This rapidly entering food mass is a concentrated solution in relation to the surrounding circulation of blood. To achieve an osmotic balance, water is drawn from the blood into the intestine. This water shift rapidly shrinks the vascular fluid volume. As a result, blood pressure drops and signs of rapid heart action to rebuild the blood volume appear.

DIF: Cognitive Level: Knowledge REF: 462-463 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. If a patient requires parenteral nutrition for a prolonged period, the most appropriate type of feeding is
a. elemental enteral formula.
b. intact enteral formula.
c. total parenteral nutrition.
d. peripheral parenteral nutrition.
ANS: C
Total parenteral nutrition is indicated if the gastrointestinal tract cannot be used for a long period. Total parenteral nutrition, which supplies all the macronutrients and micronutrients along with fluid to meet daily requirements, is necessary for patients who need intravenous nutrition for an extended period.

DIF: Cognitive Level: Application REF: 458 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. After a cholecystectomy, an example of a food item that may need to be decreased is
a. fried chicken.
b. applesauce.
c. whole grain bread.
d. sherbet.
ANS: A
Depending on individual tolerance and response, a relatively low-fat diet may be needed. The gallbladder stores bile produced by the liver, which is secreted when fat enters the small intestine. After surgery, control of fat in the diet facilitates wound healing and comfort because the hormonal stimulus for bile secretion still functions in the surgical area, causing pain with intake of fatty foods. The body also needs a period to readjust to the more dilute supply of liver bile available to assist in fat digestion and absorption.

DIF: Cognitive Level: Application REF: 463-464 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

21. The surgery in which the colon is attached to an opening in the abdominal wall is known as a(n)
a. cholecystectomy.
b. ileostomy.
c. colostomy.
d. jejunostomy.
ANS: C
Intestinal surgery may require the making of an opening in the abdominal wall to the outside from the intestine. If the opening is farther along the colon in the last part of the large intestine, it is called a colostomy.

DIF: Cognitive Level: Knowledge REF: 464-465 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. If the intestinal drainage from an ostomy site is still liquid, the patient has a(n)
a. gastrectomy.
b. ileostomy.
c. colostomy.
d. intestinal bypass.
ANS: B
An ileostomy is an opening in the abdominal wall to the ileum. The drainage from an ileostomy is liquid because the food mass is still liquid at this point.

DIF: Cognitive Level: Application REF: 465-466 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

23. Of the following, a food item found on a full liquid diet is
a. pureed chicken.
b. mashed potatoes.
c. chocolate ice cream.
d. scrambled eggs.
ANS: C DIF: Cognitive Level: Application REF: 455
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

24. A burn that causes cell damage in both the top layer of skin and some of the dermis is a _____ burn.
a. superficial
b. superficial partial-thickness
c. deep partial-thickness
d. full-thickness
ANS: B
Superficial partial-thickness burns involve cell damage in both the top layer of the skin (epidermis) and some of the second layer of the skin (dermis). A superficial burn involves cell damage in the top layer of skin, a deep partial-thickness burn results in destruction of the epidermis and dermis, and a full-thickness burn results in loss of the epidermis, dermis, and frequently the underlying fat layer.

DIF: Cognitive Level: Knowledge REF: 466 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

25. During the initial stage of treatment of a severe burn
a. a dextrose intravenous feeding is started.
b. total parenteral nutrition is initiated.
c. the patient is encouraged to take water orally.
d. an intravenous electrolyte solution is given.
ANS: D
During the initial stage of treatment for a severe burn, referred to as the immediate shock period, massive flooding edema occurs at the burn site. Loss of protective skin leads to immediate losses of water, electrolytes, and protein. Cell dehydration follows. Immediate intravenous fluid therapy with a salt solution replaces water and electrolytes to help prevent shock.

DIF: Cognitive Level: Knowledge REF: 466-467
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. An intravenous solution that is immediately given to a burn patient to prevent hypovolemia is
a. lactated Ringers solution.
b. 5% dextrose.
c. normal saline.
d. total parenteral nutrition.
ANS: A
Immediate intravenous fluid therapy with a salt solution replaces water and electrolytes to help prevent shock. Lactated Ringers solution is the intravenous fluid given to prevent hypovolemia. This is a salt solution, 6% hetastarch in solution.

DIF: Cognitive Level: Knowledge REF: 467
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. An appropriate tube feeding route for a patient at high risk for aspiration is
a. nasogastric.
b. nasojejunal.
c. gastrostomy.
d. esophagostomy.
ANS: B
If a patient is at high risk for aspiration, then a feeding tube is placed in the small intestine rather than the stomach to lessen the chance of aspiration of food into the lungs.

DIF: Cognitive Level: Comprehension REF: 455-456
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. Total parenteral nutrition formulas provide protein in the form of
a. peptides.
b. protein isolates.
c. amino acids.
d. dextrose.
ANS: C
Parenteral nutrition therapy infuses nutrients directly into the bloodstream. Proteins are supplied in the simplest form, amino acids, for direct absorption into the bloodstream.

DIF: Cognitive Level: Knowledge REF: 458-459 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. A good snack for a patient with dumping syndrome is
a. cheese and whole grain crackers.
b. applesauce and graham crackers.
c. nonfat milk and pretzels.
d. fig bars and juice.
ANS: A
The complex of symptoms in dumping syndrome constitutes a shock syndrome
that results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or dumps, into the small intestine. An appropriate food choice for someone with dumping syndrome would include complex carbohydrate and protein as well as fatin this case, cheese and whole grain crackers. Nonfat milk and pretzels would not provide any fat, plus liquids should be given between rather than with meals, and milk contains some simple carbohydrates, which may not be tolerated.

DIF: Cognitive Level: Application REF: 462-463
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. Patients who are treated with antibiotics may have decreased synthesis of
a. vitamin K.
b. vitamin C.
c. zinc.
d. iron.
ANS: A
Patients who are treated with antibiotic may have decreased gut flora and vitamin K synthesis.

DIF: Cognitive Level: Application REF: 451 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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