MSN Exam for Celiac Disease

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1) People with celiac disease often have which other disease?

1. Autoimmune thyroid disease
2. Type 1 diabetes
3. Rheumatoid arthritis
4. All of the above

2) After the nurse provides dietary restrictions to the parents of a child with celiac disease, which statement by the parents indicates effective teaching?

1. “Well follow these instructions until our child’s symptoms disappear.”
2. “Our child must maintain these dietary restrictions until adulthood.”
3. “Our child must maintain these dietary restrictions lifelong.”
4. “We’ll follow these instructions until our child has completely grown and developed.”

3) Discharge teaching for a child with celiac disease would include instructions about avoiding which of the following?

1. Rice
2. Milk
3. Wheat
4. Chicken

4) Which of the following would the nurse expect to assess in a child with celiac disease having a celiac crisis secondary to an upper respiratory infection?

1. Respiratory distress
2. Lethargy
3. Watery diarrhea
4. Weight gain

5) A newborn’s failure to pass meconium within the first 24 hours after birth may indicate which of the following?

1. Hirschsprung disease
2. Celiac disease
3. Intussusception
4. Abdominal wall defect

6) Which of the following meal selections is appropriate for the client with celiac disease?

1. Toast, jam, and apple juice
2. Peanut butter cookies and milk
3. Rice Krispies bar and milk

7) When assessing the client with celiac disease, the nurse can expect to find which of the following?

1. steatorrhea
2. jaundiced sclerae
3. clay-colored stools
4. widened pulse pressure

8) The nurse is providing dietary instructions to the mother of an 8-year-old child diagnosed with celiac disease. Which of the following foods, if selected by the mother, would indicate her understanding of the dietary instructions?

1. Ham sandwich on whole-wheat toast
2. Spaghetti and meatballs
3. Hamburger with ketchup
4. Cheese omelet

9) Nurse Christine provides health teaching for the parents of a child diagnosed with celiac disease. Nurse Christine teaches the parents to include which of the following food items in the child’s diet:

1. Rye toast
2. Oatmeal
3. White bread
4. Rice

10) People with celiac disease cannot eat which kind of food?

1. Fruits, especially strawberries
2. Dairy products, especially milk
3. Peanuts and nuts
4. Grains, especially wheat, rye, and barley
5. B and C

11) What circumstance may trigger celiac disease?

1. Surgery
2. Pregnancy
3. Viral infection
4. Emotional stress
5. All of the above

12) Which of these is a symptom of celiac disease?

1. Weight loss
2. Excessive gas
3. Joint pain
4. Diarrhea
5. All of the above

13) How is celiac disease diagnosed? A. B. C. D. E.

1. A blood test that measures antibodies
2. A bone scan
3. A biopsy of the small intestine
4. An MRI
5. A and C

14) How is celiac disease treated?

1. Antibiotics
2. Surgery
3. A change in diet
4. Radiation therapy

15) Which of these can be a complication of celiac disease?

1. Lymphoma
2. Osteoporosis
3. Miscarriage
4. Seizures
5. All of the above

Answers and Rationales

1. D. All of the above. All of the diseases listed are autoimmune diseases, as is celiac disease. Other autoimmune diseases that may occur along with celiac disease include dermatitis herpetiformis, collagen vascular disease, and Sjogren’s syndrome. Researchers suspect that the link between celiac disease and these other autoimmune diseases is genetic.
2. C. “Our child must maintain these dietary restrictions lifelong.”  A patient with celiac disease must maintain dietary restrictions lifelong to avoid recurrence of clinical manifestations of the disease. The other options are incorrect because signs and symptoms will reappear if the patient eats prohibited foods.
3. C. Wheat . Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. Rice, milk, and chicken do not contain gluten and need not be avoided.
4. C. Watery diarrhea . Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergic drugs. Celiac crisis is typically characterized by severe watery diarrhea. Respiratory distress is unlikely in a routine upper respiratory infection. Irritability, rather than lethargy, is more likely. Because of the fluid loss associated with the severe watery diarrhea, the child’s weight is more likely to be decreased.
5. A. Hirschsprung disease . Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. Failure to pass meconium is not associated with celiac disease, intussusception, or abdominal wall defect.
6. C. Rice Krispies bar and milk . Foods containing rice or millet are permitted on the diet of the client with celiac disease.
7. A. steatorrhea . Because celiac disease destroys the absorbing surface of the intestine, fat isn’t absorbed but is passed in the stool. Steatorrhea is bulky, fatty stools that have a foul odor. Jaundiced sclerae result from elevated bilirubin levels. Clay-colored stools are seen with biliary disease when bile flow is blocked. Celiac disease doesn’t cause a widened pulse pressure.
8. D. Cheese omelet . The child with celiac disease should be on a gluten-free diet.
9. D. Rice 
10. D. Grains, especially wheat, rye, and barley . When a person with celiac disease eats any of these grains, a protein called gluten found in them causes a reaction in his or her immune system. The immune system damages the tiny, fingerlike projections, called villi, that line the small intestine. Villi are important because nutrients pass through them into the bloodstream. When villi are destroyed, the person becomes malnourished, no matter how much food he or she eats. The person has difficulty absorbing carbohydrates, fat, protein, fat-soluble vitamins, calcium, magnesium, iron, folate, and zinc.
11. E. All of the above . Celiac is likely caused by both genetic factors (meaning it runs in families) and a trigger, which is gluten. The disease can develop in children and in adults, although it’s unclear who will develop it when. Some research suggests that the risk for celiac disease may be reduced if an infant is introduced to gluten while being breast-fed.
12. E. All of the above . Symptoms of celiac disease include weight loss, diarrhea, excessive gas, behavior changes, delayed growth (in children), failure to thrive (in infants), bone or joint pain, seizures, tingling numbness in the legs, tooth discoloration, and infertility. Symptoms differ from person to person; some have only abdominal symptoms, others have no symptoms. People without symptoms still have undamaged parts of their small intestine that are able to absorb enough nutrients. These people are still at risk for complications.
13. E. A and C . A person with celiac disease has higher than normal levels of certain antibodies. These antibodies can be measured with a blood test. If symptoms and the blood test suggest celiac disease, the doctor may then order a biopsy of the small intestine. The biopsy checks for damage to the villi. Without these tests, celiac disease is difficult to diagnose because its symptoms are similar to those of irritable bowel syndrome, Crohn’s disease, ulcerative colitis, diverticulosis, chronic fatigue syndrome, and depression.
14. C. A change in diet . A person with celiac disease must avoid any foods that contain gluten. For most people, a gluten-free diet will stop symptoms, heal intestinal damage, and prevent further damage. The healing process can take from six months (children) to two years (adults). This special diet must be followed for the rest of the person’s life, because eating any amount of gluten can damage the small intestine. Some people with celiac disease have a small intestine so damaged by the disease that it cannot heal even with a change in diet.
15. E. All of the above. Lymphoma, which is cancer of the lymph system, can develop in the small intestine of a person with celiac disease. Because it may be difficult for a person with celiac disease to absorb enough calcium, osteoporosis may develop. Because of poor absorption of nutrients, a woman with celiac disease who is pregnant may be at risk for miscarriage, as well as neural tube defects and other congenital defects. Seizures may be caused by poor absorption of folate. Poor absorption of folate and iron may cause anemia.