CBC Nutritional Counseling Strategies 2 — Questions and Answers
Question 1: A patient 3 weeks post-sleeve gastrectomy reports difficulty meeting protein goals. Which counseling strategy is most appropriate first?
- Assess current intake patterns and identify tolerated protein sources (Correct answer)
- Immediately prescribe protein supplements at 120 g/day
- Advance the diet to solid meats to increase protein density
- Recommend delaying protein goals until 6 months post-op
Correct answer: Assess current intake patterns and identify tolerated protein sources
Assessment of current intake and tolerance must precede any intervention so recommendations are individualized and realistic.
Question 2: Which daily protein intake is generally recommended for adults after bariatric surgery to preserve lean body mass?
- 60-80 grams (Correct answer)
- 20-30 grams
- 150-200 grams
- 10-15 grams
Correct answer: 60-80 grams
Guidelines typically recommend a minimum of 60 grams per day, often 60-80 g or 1.1-1.5 g/kg ideal body weight, after bariatric surgery.
Question 3: A counselor uses open-ended questions, affirmations, reflective listening, and summaries with a bariatric patient. Which approach is being applied?
- Motivational interviewing (OARS) (Correct answer)
- Aversion therapy
- Directive confrontation
- Psychoanalytic free association
Correct answer: Motivational interviewing (OARS)
OARS (open questions, affirmations, reflections, summaries) is the core skill set of motivational interviewing.
Question 4: Why are patients counseled to separate liquids from solid meals by about 30 minutes after bariatric surgery?
- Drinking with meals can flush food through the pouch, reducing satiety and increasing intake (Correct answer)
- Liquids taken with food block vitamin B12 absorption
- Combining them causes immediate strictures
- It prevents all forms of acid reflux permanently
Correct answer: Drinking with meals can flush food through the pouch, reducing satiety and increasing intake
Fluids consumed with meals accelerate pouch emptying, decreasing satiety and potentially allowing greater calorie intake or discomfort.
Question 5: A gastric bypass patient experiences sweating, dizziness, and cramping 20 minutes after eating ice cream. What dietary counseling point addresses this?
- Limit simple sugars to prevent early dumping syndrome (Correct answer)
- Increase fluid intake during meals
- Add more high-fat foods to slow digestion
- Eat larger portions less frequently
Correct answer: Limit simple sugars to prevent early dumping syndrome
Early dumping syndrome is triggered by concentrated simple sugars rapidly entering the small intestine, so sugar restriction is the primary dietary strategy.
Question 6: When a patient says, "I know I should stop drinking soda, but it's my only treat," the counselor's best motivational interviewing response is to:
- Reflect the ambivalence and explore what the patient values about change (Correct answer)
- Warn the patient that soda will make the surgery fail
- Assign a strict no-soda contract immediately
- Change the subject to exercise goals
Correct answer: Reflect the ambivalence and explore what the patient values about change
Reflecting ambivalence and eliciting the patient's own reasons for change resolves resistance better than confrontation or directives.
Question 7: Which behavioral strategy best helps a post-bariatric patient who eats quickly and experiences frequent regurgitation?
- Mindful eating with small bites and 20-30 minutes per meal (Correct answer)
- Drinking water with each bite to wash food down
- Switching entirely to liquid meals long-term
- Eating only once per day to reduce episodes
Correct answer: Mindful eating with small bites and 20-30 minutes per meal
Slowing the eating pace with small, well-chewed bites reduces regurgitation and supports satiety recognition in the small pouch.
