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

Appeared in: DHS 2018 shift 1st

Explanation

Celiac disease necessitates a strict lifelong avoidance of gluten, a protein found in wheat, barley, and rye.
The meal selection based on rice is the most appropriate choice because rice is a naturally gluten-free grain.
Options containing toast, cookies, and pizza are incorrect as their primary ingredient is wheat, a major source of gluten.
A critical teaching point is that while rice is safe, commercial products like Rice Krispies may contain malt flavoring from barley (a source of gluten), so choosing certified gluten-free products is essential for safety.

Option A: Toast is made from wheat bread. Wheat contains high levels of gluten, which damages the small intestine in individuals with celiac disease.
Option B: Peanut butter cookies are typically made with wheat flour, which contains gluten and is harmful to clients with celiac disease.
Option D: The crust of a standard cheese pizza is made from wheat dough, which is a primary source of gluten.

Clinical Relevance

Nursing practice connection: Use the key finding related to Dietary management for a client with celiac disease to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary role is patient education on adhering to a strict gluten-free diet to prevent symptoms and long-term complications like malnutrition, osteoporosis, and intestinal lymphoma.
Nurses must emphasize the importance of reading food labels for hidden gluten in additives, preservatives, and flavorings (e.g., malt).
What if the client chose 'oatmeal cookies'? The nurse should advise that while pure oats are gluten-free, they are frequently cross-contaminated with wheat during processing. Only oats specifically labeled 'certified gluten-free' are safe for consumption.

How to Approach the Question

First, identify the key condition in the question: 'celiac disease'.
Recall the primary dietary restriction for celiac disease, which is the complete avoidance of gluten.
Identify the main sources of gluten: Wheat, Barley, Rye, and Malt (often remembered by the acronym BROW - Barley, Rye, Oats, Wheat; oats are often included due to cross-contamination).
Systematically evaluate each meal option for the presence of these gluten-containing grains.
Eliminate 'Toast', 'Peanut butter cookies', and 'Cheese pizza' as they are all typically made with wheat flour.
Identify 'Rice krispies bar' as the most plausible correct answer because its main ingredient, rice, is naturally gluten-free, making it the only suitable option among the choices.

Concept Tested & Keywords

QRrz0JHXGQw6MV0M6sBzUw

E6 Nutrition Kumud Khanna 2e pp. 258-260, 257-259

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 111-113

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.