CBC Nutritional Counseling Strategies 3 — Questions and Answers
Question 1: Which micronutrient deficiency is most closely associated with rapid weight loss and persistent vomiting after bariatric surgery, requiring urgent counseling and supplementation?
- Thiamine (vitamin B1) (Correct answer)
- Vitamin K
- Biotin
- Molybdenum
Correct answer: Thiamine (vitamin B1)
Thiamine stores deplete within weeks, and deficiency during vomiting can cause Wernicke encephalopathy, making it a supplementation emergency.
Question 2: A patient 1 year after Roux-en-Y gastric bypass asks why she must take vitamin B12 even though she eats meat. The best explanation is that:
- Bypassing the stomach reduces intrinsic factor and acid needed for B12 absorption (Correct answer)
- Meat loses all B12 during cooking
- B12 is only absorbed in the colon, which is removed
- Her multivitamin cancels out dietary B12
Correct answer: Bypassing the stomach reduces intrinsic factor and acid needed for B12 absorption
Gastric bypass diminishes acid and intrinsic factor production, impairing B12 release and absorption regardless of dietary intake.
Question 3: During a counseling session, a patient reports grazing on crackers and chips throughout the day 18 months post-op with weight regain. The most effective strategy is to:
- Establish structured meal and snack times with protein-first planning (Correct answer)
- Prohibit all carbohydrates permanently
- Recommend immediate revision surgery
- Advise skipping breakfast to cut calories
Correct answer: Establish structured meal and snack times with protein-first planning
Grazing responds best to structured eating schedules that restore planned, protein-forward meals rather than bans or drastic measures.
Question 4: Which counseling recommendation addresses calcium supplementation after malabsorptive bariatric procedures?
- Use calcium citrate in divided doses of 500-600 mg, separated from iron (Correct answer)
- Take calcium carbonate once daily with iron for convenience
- Rely on dairy alone since supplements are unnecessary
- Take all calcium in a single 2,000 mg dose at bedtime
Correct answer: Use calcium citrate in divided doses of 500-600 mg, separated from iron
Calcium citrate absorbs without stomach acid and should be split into doses of 500-600 mg taken apart from iron to avoid competition.
Question 5: A patient asks whether she can drink alcohol socially after gastric bypass. The counselor should explain that:
- Altered anatomy speeds absorption, raising intoxication and addiction transfer risk (Correct answer)
- Alcohol is fully safe once the pouch heals at 6 weeks
- Only beer is dangerous after bypass
- Alcohol absorption is slower, so more can be consumed safely
Correct answer: Altered anatomy speeds absorption, raising intoxication and addiction transfer risk
Post-bypass patients absorb alcohol faster and peak higher, increasing both intoxication risk and susceptibility to alcohol use disorder.
Question 6: In the transtheoretical (stages of change) model, a preoperative patient who is gathering information about post-surgery diets but has not changed eating habits is most likely in which stage?
- Contemplation or preparation (Correct answer)
- Maintenance
- Termination
- Relapse
Correct answer: Contemplation or preparation
Actively considering and preparing for change without yet acting places the patient between contemplation and preparation.
Question 7: Which fluid counseling target is standard for post-bariatric patients to prevent dehydration?
- At least 48-64 ounces of low-calorie, non-carbonated fluid daily, sipped between meals (Correct answer)
- 8 ounces total per day to protect the pouch
- Unlimited carbonated beverages for variety
- All fluids consumed only during meals
Correct answer: At least 48-64 ounces of low-calorie, non-carbonated fluid daily, sipped between meals
Patients should sip at least 48-64 oz of non-carbonated, low-calorie fluids daily between meals since large gulps and carbonation are poorly tolerated.
CBC Nutritional Counseling Strategies 3
Which micronutrient deficiency is most closely associated with rapid weight loss and persistent vomiting after bariatric surgery, requiring urgent counseling and supplementation?