Nutrition B 2016 Rationales

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Nutrition B 2016 Rationales:
1. A Nurse is planning dietary interventions for a client who is prescribed external
radiation for laryngeal cancer. The client reports manifestations of stomatitis. Which
of the following interventions should the nurse include?
 Provide meals at room temperature.
o The nurse should plan to offer the clients foods at room temperature
or colder. Foods at these temperatures are less irritating to the
mucosa.
o The nurse should tell the client to avoid spices and salty foods because
they can irritate the oral mucosa.
o The nurse should instruct the client to avoid citrus and other acidic
foods because they irritate the oral mucosa. Citrus fruits are an
appropriate food recommendation for a client who has dry mouth.
o Encourage the client to drink high calorie, high protein drinks as meal
substitutes. The intervention provides adequate nutrient intake with
minimal irritation to the oral mucosa. The client should avoid tomato
juice because it is acidic and salty.
2. A nurse is caring for a client who has diabetes mellitus and reports feeling dizzy,
weak and skaky. Which of the following is the priority action by the nurse?
 Check the clients glucose levels.
o The 1st action should the nurse take is using the nursing process to
assess the client. Therefore, checking the clients blood glucose level is
priority.
3.A home health nurse is reviewing the medical record of a client who has an open
reduction internal fixation on the tibia. Which of the following findings should the
nurse identify as a risk factor for impaired wound healing?
 The client consumes 1,00 k/cal daily.
o Adults who have surery require at least 1,500 k/cal daily to meet
energy needs and build protein for tissue healing. The nurse should
recognize that a 1,000 k;cal day intake is below the clients needs.
o A hemoglobin level below the expected reference range is a risk factor
for impaired wound healing.
o Pulses +3 strength are an expected finding. The nurse should identify
tissue perfusion as risk factor for impaired wound healing.
o The body uses zinc to build proteins and aid the immune response.
The nurse should identify this finding as a factor that will promote
wound healing.
4. A nurse is assessing the meal pattern of a client who has diverticular disease and
a prescription for a high-fiber diet. Which of the following food choices by the client
contains the most fiber?
 ½ cup bran cereal.
o Contained 8.8 g per serving.
o One medium apple with skin contains 3.3 g of fiber.
o ½ cup of cooked oatmeal contains 2g of fiber.
o One medium banana contains 3 g of fiber.
5. A nurse is reviewing the laboratory data of four clients. The nurse should identify
that which of the following clients is experiencing fluid overload?
 A client who has a sodium level of 130.
o Reference range of sodium is 136 to 145. A decreased sodium level is
an indication of a lack of sodium intake or hemodilution from fluid
overload.
o Hct of 55% indicated fluid volume deficit. (Reference range 37 to 47%
for woman and 42 to 52% for men.)
o Specific gravity of 1.035 is greater than the expected reference range
of 1.005 to 1.030. An elevated urine specific gravity indicates fluid
volume deficit.
o Albumin of 5.5 is greater than expected reference range of 3.5 to 5g.
Indicating dehydration, fluid volume deficit.
6. A nurse is teaching a client who has chronic kidney disease about limiting her
calcium intake. Which of the following food choices should the nurse inform the
client contains the highest amount of calcium and should be limited in her diet?
 1 cup low-fat yogurt.
o Contains 314 mg of calcium per cup.
o 1 oz of cheddar cheese contains 214 mg of calcium per ounce.
o 1 egg contains 25 mg of calcium.
o 1.2 cup spinach contains 122 mg of calcium per half cup.
7. A nurse is providing teaching to a client who is lactating about increasing her
protein intake. Which of the following foods should the nurse recommend as the
best source of protein?
 Cottage cheese.
o It’s a complete protein. Contains all nine essential amino acids and
provide the best support for human growth and nourishment.
8. A nurse is teaching about nutritional requirements for a client who is starting a
vegetarian diet. Which of the following information should the nurse include in the
teaching?
 Include two servings per day of nuts when on a vegetarian diet.
o The nurse should instruct the client to eat two servings of nuts or
flaxseed per day to receive the daily requirement of omega-3 fatty
acids.
o Require decreased intake of dietary fat rather than fewer calories.
o Instruct the client to take vitamin b12 supplements or consume foods
fortified with b12 to compensate for a potential deficiency.
o Low fat cheese as a protein substitute.
9. A nurse is performing a comprehensive nutritional assessment for a client. After
reviewing the clients lab results, which of the following findings should the nurse
report to the provider?
 Prealbumin 8 mEq/L.
o Critical value that indicates severe malnurtion and requires reporting
to the provider.
10. A nurse is providing discharge teaching to a client who has Parkinson’s disease
and prescription for levodopa- carbidopa. Which of the following foods should the
nurse instruct the client to consume with the medication?
 1 slice of wheat toast.
o Absoption decreases with protein. Wheat toast consumes 3g.
o 6 peanut butter crackers contain 6g.
o Cheddar chesse contains 7g.
o 6 oz greek yogurt contains 17g.
11. Which of the following foods items should the nurse include as containing the
highest amount of folate?
 3.5 oz chicken liver.
o Contains highest amount of folate. 770 mcg.
o Chick peas contains 141 mcg.
o 1 medium oange contains 47 mcg.
o 1 slice white bread contains 38 mcg.
12. A nurse is teaching an adolescent who has a new diagnosis of celiac disease.
Which of the following statements by the client indicates an understanding of the
teaching?
 I need to eliminate rye from my diet.
o Eating sources of gluten such as barley or rye, increases the
manifestations of celiac disease.
o Oil content of food night need to be decreased in a client who is on a
low fat diet.
o Acidic foods do not affect the manifestations of celiac disease.
o Client who can not tolerate lactose should avoid milk products.
13. A nurse I providing teaching to a client who has diabetes mellitus and hba1c of
8.7%. Which of the following statements by the client indicates an understanding of
his laboratory value?
 This shows that I have not been following my diet.
o 8.7% is not within expected reference range. The goal for a client who
has diabetes is between 6.5% and 7%.
o Exercise does not effect hbac1 level.
14. A nurse is teaching a client who is preparing for bowel surgery about a
low0residue diet. Which of the following food choices by the client indicates an
understanding of the teaching?
 Two poached eggs and a banana.
o Low residue diet limits the amount of stool traveling through the
intestinal tract. The nurse should teach the client to avoid foods high
in fiber.
o Avoid whole grains, fruits with seeds.
15. A nurse is caring for a client who is receiving continuous enteral feedings via an
NG tube. The nurse notices that the tube feeding has stopped infusing. Which of the
following actions is the nurse priority?
 Flush the tube with warm water.
o The 1st action the nurse should take when a tube feeding stops
infusing is to flush the tube with 30 to 50 ML of water to re-establish
flow. Other interventions might be required if flushing does not
remove the clog.
16. A nurse is teaching an older adult about nutritional recommendations. Which of
the following statements should the nurse make?
 You should increase your daily protein intake.
o To increase his daily intake of protein to increase strength and
enhance immune function and wound healing. Protein intake of 20%
to 25% of the clients daily calorie intake.
o Add a calcium supplement to his diet to maintain healthy bones and
prevent osteoporosis.
o Add vitamin D supplement to his diet to promote calcium absorption.
17. A nurse is providing dietary instructions for a client who has a prescription for
warfarin. Which of the following foods should the nurse recommend the client to eat
in moderation while taking this medication?
 Green leafy vegetables.
o Maintain consistent intake of green leafy vegetables, which contain a
natural form of vitamin K that can negate the anticoagulation effect of
warfarin.
18. A nurse is teaching an older adult client about measures to reduce the risk of
osteomalacia. Which of the following instructions should the nurse include in the
teaching?
 Consume 20 mcg of vitamin D daily,
o Recommended for clients age 65 and older to decrease bone loss and
maintain bone mineralization.
o Eat foods rich in antioxidants. Protects cells from being destroyed by
free radicals.
o Client who has gout to decrease intake of foods that contain purine,
such as organ meats and certain types of seafood. These foods
increase uric acid levels, which exacerbate the possibility of an acute
attack.
o Recommended dose of vitamin E is 15 mg per day. It decreases
platelet aggregation, which can interfere with blood clotting in an
older adult client.
19. A nurse is caring for a client who is receiving total parenteral nutrition (TPN).
The current bag of tpn is empty and a new bag is not available on the unit. Which of
the following solutions should the nurse infuse until a new bag of TPN is available?
 Dextrose 10% in water.
o Prevents hypoglycemia.
o 0.45% sodium chloride, dextrose 5% in lactated ringers, and 0.9%
sodium chloride will not prevent adverse effects.
20. A nurse is providing dietary teaching for a client who is postoperative following
gastric bypass. Which of the following instructions should the nurse include?
 Start each meal with a protein.
o The client should consume 60 to 120 g of protein each day.
o Instruct the client to eat three meals and two snacks of a limited
portion size each day.
o Eat slowly, and to stop eating when he begins to feel full.
o Chew food well, plan for meals to last between 30 to 60 mins.
21. A nurse is initiating an enternal feeding for a client who has chronic bronchitis.
Which of the following types of formula should the nurse anticipate administering to
the client?
 High calorie.
o Pulmonary disease requires a formula that is high in calories and
protein to maintain energy demands.
o Prevents malnutrition and maintain muscle and lung strength.
22. A community health nurse is planning to teach a class about weight management
for cardiovascular health. Which of the following statements should the nurse plan
to make to the participants?
 Plan to lose weight gradually at ½ to 1 pound per week.
o Vitamin supplements are not necessary. Multivitamin supplements do
no decrease or prevent cardiovascular disease.
o Adequate protein is important for maintaining muscle mass.
o Client should limit their sodium intake to 1,500 mg/day.
23. A nurse is caring for a client who receiving continuous enternal tube feedings.
Which of the following actions should the nurse take to prevent aspiration?
 Monitor gastric residuals every 4 hr.
o Delayed gastric emptying places the client at risk for aspiration.
o The head of the clients bed should be elevated to between 30 degrees
and 45 degrees during the feeding and for at least 1 hr. afterward.
o Flushing the tube with 30 to 50ml of water before and after
medication administer helps maintain tube patency but does not
prevent aspiration.
24. A nurse is providing teaching of a client who is at 24 weeks of gestation and
reports constipation. Which of the following instructions should the nurse include in
the teaching? (Select all that apply.)
 Drink eight 240 ml (8oz ) glasses is water daily is correct.
 Increase daily fiber intake.
 Perform exercises regularly using large muscle groups.
o Eating small amounts of food is give to a client who has nausea and
vomiting.
o Glycerin should not be used cause it can cause the client to become
dependent on stimulation to have a bowel movement.
25. A nurse I caring for an older adult who has a pressure ulcer. The client practices
orthodox Judaism and strictly follows kosher dietary laws. Which of the following
foods should the nurse provide for this client?
 Macaroni and cheese.
o Compliance with kosher dietary laws. Contains protein which
contributes to wound healing.
o Only seafood that can be consumed is fish with fins and scales.
o Dairy and meat cannot be eating together.
o Pork and pork products can not be eaten.
26. A nurse is caring for a client who develops diarrhea while receiving a continuous
enteral tube feeding. Which of the following actions should the nurse take?
 Warm the formula to room temp.
o Client can develop diarrhea if the formula being infused is too cold.
o Elevating the head of the clients bed to 30 prevents aspiration rather
than diarrhea.
o Provide a low fat formula for a client who has diarrhea.
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o The nurse should identify that lower extremity edema is manifestation of
malnutrition and inactive of a protein deficiency in the client.
o Decreased reflexes and weak hand grasps are manifestations of
malnutrition.
o Dry conjunctiva and corneal vascularization are manifestations of
malnutrition.
o Dry skin is a manifestation of malnutrition.
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o The nurse should explain to the client that her restrictions and privileges
would be dependent on treatment compliance and direct weight gain. This
approach involves the client in development of the plan of care and gives her
control in achieving desires privileges.
o The nurse is in charge of making meal times. Allowing the client to schedule
her own mealtimes does no ensure that will consume enough calories for
increased weight gain.
o The nurse should remain with the client during meals and for at least 1 hr
after meals.
o The nurse should weight the client at the same time each day.
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o The nurse should instruct the client that consuming skin on fruits and
vegetables adds fiber to the diet.
o Instruct the client to add a small amount of bran to her daily diet. Working up
to 3 tablespoons daily, which is less than 1.4 cup. Adding fiber gradually
should prevent abdominal distention and excessive flatus.
o Replave meat entreets with a main dish that features dried peas or beans to
add fiber to her diet.
o Increase fluid intake as fiber intake increases to prevent constipation.
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o Lip emulsions are isotonic and are composed of soybean or safflower plus
soybean oil, with egg phospholipid used as an emulsifier. Clients who are
allergic to eggs can have a reaction to the emulsifier. Therefore, the nurse
should report this finding to this provider.
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o Whole grains are a healthy choice of carbohydrate as they contain
ingredients that lower the risk of cardiovascular disease, including the
improvement of blood pressure.
o Moderate daily intake of alcohol for hypertension is one for women and 2 for
men.
o Increased potassium levels decrease blood pressure levels.
o The client should limit intake of food high in sodium, including dairy
products. To lower blood pressure, the nurse should instruct the client to
choose low fat dairy products.
o Potassium level is 3.5 to 5.0
o Calcium is 9.0 to 10.5
o Sodium is 136-145.
o A client who eats more than half of most meals, occasionally refuses a meal,
and has four servings of protein each days scores a 3 (adequate) in the
nutrition category of the braden scale.
o A client who scares a 2 ( probably inadequate) in the nutrition category of
the braden scale only eats about half of meals or snacks and only occasionally
takes dietary supplements.
o A client who scores a 1 ( very poor) in the nutrition category of the braden
scale never finishes a complete meal, drinks little fluid and does not drink
any dietary supplements.
o A client who scores a 4 ( excellent) in the nutrition category of the braden
scale eats most of every meal, eats plenty of protein, and occasionally eats
between meals.
o To decrease fluid retention, a client who has cirrhosis should limit his daily
sodium intake to 2,000 mg.
o To decrease fluid retention, a client who has cirrhosis should limit fluid
intake to 1.5 L per day.
o To prevent malnutrition, a client who has cirrhosis should consume 0.8 to 1.2
g/kg of protein daily.
o Client who has cirrhosis should consume foods that contain vitamin K.
o A feature of the DASH diet is a reduction in total cholesterol. This lab finding
is within the expected reference range and indicates that the client has
achieved one of the goals of the dash diet.
o Fasting glucose 130 is expected reference range and indicates that the client
has not reached a goal of dash diet.
o Chloride 106 is within the expected reference range but is not an indication
that the client has not reached a goal of dash diet.
o Sodium 150 is an above the expected reference range and indicates that the
client has not reached a goal of dash diet.
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o The nurse should recognize that cantaloupe is a food source high in
potassium. The client should avoid cantaloupe as well as other foods that are
high in potassium for the medication captopril.
o Watermelon does not create a potential food and medication interaction for
the client because it is not high in potassium.
o Lettuce does not create a potential food and medication interaction for the
client because it is not high in potassium.
o Carrots are high in beta-carotene and do not create a potential food and
medication because it is not high in potassium.
o A client who had mucositis should increase fluid intake to promote hydration
and peristalsis.
o A client who has mucositis should be provided with room temp or cooled
liquids to reduce irritation.
o Avoid glycerin-based swabs because they cause dryness and irritation.
o Avoid acidic foods to prevent further irritation.
o Pinto beans are the best food source to recommend because the contain the
highest amount of zinc per serving.
o Math.
o 0.8 ( 2.2/116).
o lowering solid fat intake to an adolescent who is overweight.
o Instruct the client to limit her meat intake to 5oz per day.
o Limit egg yolk consumption to three per week.
o Select cheeses that contain no more than 3g of fat per serving.
o Choose margarine that contains no more than 2g of saturated fat per
tablespoon.
o The nurse should instruct the client that completely thawed breast milk can
be stored in the refrigerator, but must be used within 24 hrs. Breast milk that
has been previously frozen should not be refrozen once it has thawed
completely. Thawing creates possibility for bacterial growth and causes a
decrease in antibacterial activity, which destroys antibodies in the milk.
o Any milk left in a bottle from a feeding should be immediately discarded.
o Recommended duration of time for safely storing expressed breasts milk is 6
months.
o Place the container of breast milk under warm, running water. Should not be
thawed in microwave.
o Manifestations for sodium deficit: confusion, headaches, nausea, dizziness,
and abdominal cramps. Sodium toxicity include confusion, thirst, weakness.
o Phosphorous toxicity manifestations: numbness tingling around the mouth
and extremities and tetany.
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o Manifestations of potassium deficiency are an irregular heart rate, muscle
weakness, leg cramps, and anorexia. Toxicity are vomiting, diarrhea, cardiac
dysrhythmias, and muscle weakness.
o Manifestations of chloride deficiency are lack of emotion, anorexia, and
muscle cramps.
o The nurse should recommend yogurt as a snack for a 2 year old toddler.
Yogurt prevents no choking hazard and increased activity level, toddlers
require 13 to 16 g of protein each day to meet the demands of muscle
growth. At 8g/cup, yogurt is a high quality source of protein.
o A hot dog is too large for a 2 year old to chew and swallow. Be cause their
chewing skills are not yet mature, children are at high risk for choking until
they reach 4 years of age.
o A peanut butter is thick and bread if hard to swallow. Be cause their chewing
skills are not yet mature, children are at high risk for choking until they reach
4 years of age.
o Fruit gel bites vary in size and sugar content. Makes it hard for the 2 year old
to swallow and chew.
o Infant has cleft lip and palate. Which position should the nurse place?
o Upright position with the caregiver supporting the infants head. The
nipple should be directed to the side of the infants mouth to prevent
the formula from entering the nasal passage.
o Supine, football hold, and lateral can enter the nasal passage through
the cleft in the palate.
o Citrus fruits stimulate the production of more saliva, which helps diminish
the metallic taste.
o Pickles as a snack stimulate the production of more salivas, helps diminish
the metallic taste.
o Gargling with mouthwash stimulates the production of more saliva, which
helps diminish the metallic taste.
o The nurse should provide small, frequent meals for a client who is
experiencing altered tase.
o Plastic utensils should be used to avoid increasing the metallic taste in foods.
o To prevent diarrhea, the nurse should decrease the rate of the tube feeding,
which allows for better absorption of the enteral formula.
o Check the clients gastric residual routinely to reduce the risk for aspiration
and monitor the absorption of the feeding, but this action will not reduce the
clients diarrhea.
o Promethazine is administered for the treatment and prevention of nausea
and vomiting, rather than diarrhea.
o The nurse should flush the clients feeding tube before and after giving
medications or if the tube is clogged.
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o Lutein, a carotenoid found in vitamin A, slows the progression of AMD and is
found in kale, spinach, collards and mustard greens.
o Foods with low glycemic index can aid clients who have diabetes mellitus in
managing postprandial hyperglycemia, but foods that have a high glycemic
index have no effect on AMD.
o Niacin aids in lowering LDL and triglycerides, but it has no effect on AMD.
o Soy products do not contain antioxidants, lutein, or vitamins E and b12, all of
which can slow age –related vision loss. Soy products are used as meat
substitutes in veg diets.
o Client with difficulty swallowing after stroke.
o Tilting the head forward promotes swallowing by pushing the clients
epiglottis downward and opening the esophagus.
o The client should avoid consuming thin liquids because this can increase the
risk of aspiration and choking.
o The client should place food on the unaffected side of the mouth to prevent
aspiration and choking.
o Taking moderate bites when eating increase the client’s risk of choking. The
client should take small bites when he is eating.
o Limit disruptions during mealtimes allow the client to take his time eating
which reduces the risk for choking. The nurse should allow the client at least
30 min for each meal.
o Avoid taking atorvastatin with grapefruit juice because it can increase serum
levels of the medication.
o Orange juice, coffee, and milk is safe to take with atorvastatin.
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The nurse should ask if the client fasting is exempt during illness.
Ask if fasting means refraining from drinking liquids.
Ask if there are certain hours of the day fasting occurs.
Ask if fasting means eating only a certain type of food.
o A mechanical soft diet is a diet of foods with altered texture. It includes
cooked fruits and vegetables, foods that are softened with liquids, and foods
that are thickened for consistency.
o Cooked fruits and vegetables.
o Thickener added to thin liquids like skim milk
o Prevention of cancer.
o Instruct the clients to consume four to five servings or about 2.5 cups
of fruits and vegetables daily.
o Limit their daily intake of alcohol to one drink for women or two
drinks for men.
o Instruct the clients to choose whole grain foods over refined foods to
prevent gastro cancer and to help maintain a healthy weight.
o Limit their consumption of processed meats they contain increased
amounts of sodium and are high in saturated trans fats.
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o Hydrolyzed formula provides protein and other nutrients in their simplest
form, requiring little or no digestion and decreasing stimulation of the bowel.
This type of formula is beneficial for clients who have impaired digestion due
to conditions such as inflammatory bowel disease.
o Polymeric formula contains complex nutrient molecules and is not indicated
for clients who have impaired digestion.
o Milk based supplemental formulas contain lactose and are poorly tolerated
by clients who have inflammatory bowel disease.
o Modular formulas are intended to increase the intake of a specific nutrient
without increasing volume; they are not intended for clients who have
impaired digestion.
o Vitamin A enables the eyes to adapt to dim lighting more rapidly at night,
which improves night vision.
o Calcium facilities never transmission and cell membrane permeability, but its
not a micronutrient that improves night vision.
o Vitamin b6 assists in the formation of heme in hemoglobin and the synthase
of neurotransmitters, but it is not a micronutrient that improves night vision.
o Phosphorus assists in the formation of bones and teeth, and the regulation of
hormone activity but it is not a micronutrient that improves night vision.
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Adding vitamin D to calcium supplements increases calcium absorption.
The client should take calcium with milk to promote absorption.
Calcium is best absorbed when 500 mg or less is taken at a time.
Vitamin B12 does not affect the absorption of calcium.
o A client who is experiencing dehydration should receive a continues infusion
to prevent receiving a high carb load with each feeding.
o A child formula has nothing to do with dehydration. It can cause abdominal
distention and cramping. The nurse should warm the formula to room temp
prior to administration.
o A client who is experiencing dehydration should receive additional water,
but diluting the formula will also reduce the amount of nutrients the client
receives.
o A client experiencing dehydration should receive low protein formula.
o A client who is experiencing distention and bloating should receive a low fat
formula.
o A client who has ESKD has impaired kidney function and is unable to
eliminate potassium. As urine output declines, hyperkalemia develops, which
can cause cardiac dysrhythmias.
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o The clients risk for dysthymias’ does not increase due to a diet low in fat. A
diet that is high in fat can lead to CAD, which can increase risk for
dysrhythmias.
o The clients risk for dysrhythmias does not increase du to a diet rich in
protein. However, as uremia occurs from the build up waste products from
the breakdown of protein, a client who hs ESKD should not consume a diet
rich in protein.
o A diet deficient in iron can lead to anemia, but the clients risk for
dysrhythmias does not increase due to low intake of iron.
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The nurse should recognize confusion as a manifestation of hypoglycemia.
Polydipsia is manifestation of hyperglycemia.
Vomiting is hyperglycemia.
Ketonuria is hyperglycemia.
o The nurse should recommend the client consume the supplement with
beverages containing vitamin c, such as tomato juice, orange juice, because it
will enhance the absorption of iron supplement.
o Green tea contains caffeine, which impairs iron absorption when the items
are consumed together.
o Milk contains calcium, which impairs absorption.
o Protein shake contains calcium which impairs iron absorption.
o A client who has celiac disease can consume tapioca because this grain does
not contain gluten.
o A client who has celiac disease should avoid processed foods, including
canned coups, they contain gluten.
o Whole wheat bread avoid= gluten.
o Celiac disease dietary restriction should be followed through lifetime.
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