domain 2 part 3 Flashcards
A tube fed patient receiving bolus feedings develops a distended abdomen. What should you recommend?
a. change the tube feeding to isotonic; lactose free
b. decreased the osmolality of the feeding
c. decrease the amount of water flush
d. decrease the rate
d. decrease the rate
bolus feeding uses a pump or syringe to push the formula several times a day, similar to mealtimes.
Abdomens become distended because of air collecting in the bowel or intestines. Slow the rate.
Which food is highest in fiber?
a. cooked dried beans
b. a tomato
c. wheat bread
d. lettuce
a. cooked dried beans
beans and peas contain the highest amount of fiber: around 15 gm
bread only about 2-3 grams fiber
Which of the following is lowest in fat?
a. hamburger
b. salami
c. goat cheese
d. canadian bacon
d. canadian bacon
Lean protein= 7 grams of protein, 3 grams of fat, 55 calories and equals any one of the following items.
Medium fat protein= 7 grams of protein, 5 grams of fat, 75 calories and equals any one of the following items:
High fat protein= 7 grams of protein, 8 grams of fat, 100 calories and is equal to any one of the following items.
hamburger- med fat protein (5 gm)
salami- high fat protein (8 gm)
goat cheese-
canadian bacon- lean protein (3 gm)
Which is true with osteoporosis?
a. it is more common in men than in women
b. it is treated with 500 mg calcium per day
c. it is common in those 65 years of age and older
d. weight-bearing exercise exacerbates the problem
c. it is common in those 65 years of age and older
osteoporosis: loss of bone tissue
affect white and Asian women more
treatment: (HRT) hormone replacement therapy, WEIGHT-BEARING EXERCISE, vitamin D (400-800) and CALCIUM (>= 1200 mg, don’t exceed 500-600 mg at one time), supplements, adequate protein, moderate to low sodium, 5 servings F&V
The maximum hang time for open enteral systems
a. 2 hours
b. 4 hours
c. 6 hours
d. 8 hours
b. 4 hours
open enteral system- max 4 hours
closed: 24-48 hours
What is a guide for calculating water needs with tube feedings
a. 1 cc water/ 0.5 cal
b. 1 cc water/1.0 cal
c. 1 cc water/2.0 cal
d. 1 cc water/3.0 cal
b. 1 cc water/1.0 cal
give 1 cc water for every calorie
1 cal.cc formulas are 80-86% water
1.5 cal cc are 76-78% water
2 cal/ cc are 69-71% water
Following a colectomy, the absorption of which of the following would be of the most concern?
a. vitamins D and E
b. water and sodium
c. B vitamins
d. vitamin C
b. water and sodium
Colectomy - remove all or part of your colon. Your colon, also called your large intestine, is a long tubelike organ at the end of your digestive tract (rectum)
One of the major functions of the intact large intestine is to ABSORB water and electrolytes.
colon: water, Na, K, vitamin K formed by bacterial action
According to the diabetic exchange lists, which of the following is equivalent to one medium-fat protein?
a. 4 ounces tofu
b. 2 ounces pork
c. 2 eggs
d. 2 Tbsp peanut butter
a. 4 ounces tofu
** look at portion size too, not just what it is!!
4 ounces tofu= 1 medium fat protein
2 ounces pork= 1 oz is a serving size ( can be lean or medium fat depending on cut)
2 eggs= 2 servings of med fat protein
2 Tbsp PB= 1 serving of HIGH FAT protein
A long term care patient has normal intestinal function but cannot eat. What tube feeding should you provide?
a. high protein, high-calorie formula
b. isotonic, polymeric formula
c. elemental formula
d. low fiber, low-fat formula
b. isotonic, polymeric formula
For enteral nutrition the recommendation for someone with normal GI function is to give them a standard polymeric formula (intact protein [not pre-digested], and isotonic [osmolality is close to that of blood])
most provide 1- 1.5 cal/cc
Which food should someone on an MAOI not eat?
a. cottage cheese
b. herbal tea
c. pepperoni
d. butter
c. pepperoni
MAOI inhibitors interact releasing NE which elevated BP. Restrict aged, fermented, dried, pickled, smoked foods. avoid hard, aged cheeses, luncheon meats, sausages, tofu
The normal range for hemoglobin A1C is;
a. 1-2%
b. 4-6%
c. 10-12%
d. 35-40%
b. 4-6%
Hemoglobin A1C measures % of hemoglobin that has glucose attached. it is a measure of L/T glucose control (60-90 days)
Normal: < 5.7 %
Prediabetes: 5.7-6.4%
Diabetes: 6.5 %
If a diabetic patient reduces his calorie intake from 2300 to 1800 calories per day, how much will he lose in one month?
a. 4 pounds
b. 6 pounds
c. 2 pounds
d. 8 pounds
a. 4 pounds
2300-1800= 500 cal/d x 7day= 3500
3500 x 4 wk/mo=14000
14000/3500 (cal/lb)= 4 pounds
A spastic quadriplegic requires:
a. lower energy intake
b. fewer calories, increased fluid and fiber
c. increase fluid and fiber, acid ash diet
d. lower energy intake, acid ash diet
b. fewer calories, increased fluid and fiber
usually obese, limited activity. so recommend low calorie, high fluid, high fiber diet
prevent constipation with high fluid, high fiber to prevent high blood pressure
Adequate fluid intake to eliminate the risk of constipation or impaired renal clearance of medications. Fiber decreases intestinal transit time and improves bowel movement regularity
An athlete complains of weakness, rapid weight gain and muscle spasms. What may be the cause?
a. lack of adequate rest
b. too much exercise
c. carbohydrate loading
d. not enough iron
c. carbohydrate loading
Carbs are stored in your muscles and liver in the form of glycogen, which your body uses as fuel. Once this fuel runs out, fatigue sets in and your performance suffers.
carb loading can backfire too, causing you to put on extra pounds of water weight (as your body stores water with carbs).
Who is most at risk from protein-calorie malnutrition?
a. cancer patient on chemotherapy
b. patient with gastric ulcers
c. patient with Crohns disease
d. patient with megaloblastic anemia
a. cancer patient on chemotherapy
due to cancer and treatment side effects.
protein-calorie malnutrition, malabsorption, fluid and electrolyte imbalances
Patients with decubitus ulcers will likely demonstrate low:
a. serum sodium
b. serum albumin
c. serum potassium
d. serum glucose
b. serum albumin
The albumin value is directly related to the severity of the protein deficiency. The extent to which albumin is decreased can help predict the risk of pressure ulcer formation.
However, it is important to note that the albumin level is not a specific marker of nutritional status since serum albumin can be reduced in a variety of disease states and injury, independent of the patients nutritional status.
NHANES III increased the number of participants in which age group?
a. infants and children
b. elderly
c. adolescents
d. pregnant women and infants
b. elderly
NHANES III: oversampling of adults >= 65 with NO upper age limit
Which type of anemia is likely to be seen in a patient with arthritis?
a. microcytic, hypochromic
b. anemia secondary to chronic disease
c. macrocytic
d. megaloblastic
b. anemia secondary to chronic disease
Chronic inflammation can lower the production of red blood cells in your bone marrow. This can lead to the release of certain proteins that affect how the body uses iron.
Inflammation can also affect the way the body produces erythropoietin, a hormone that controls the production of red blood cells.
A TPN solution is to be delivered at 50ml per hour at 3/4 strength. What is the appropriate order?
a. 900 ml formula, 300 ml water
b. 600 ml formula, 600 ml water
c. 800 ml formula, 400 ml water
d. 300 ml formula, 900 ml water
a. 900 ml formula, 300 ml water
50 ml x 24 hours= 1200 ml
1200 x .75= 900 ml + 300 ml water= 1200 ml formula
Determine the calorie contribution of carbohydrates from the following parenteral formula. The amounts stated are given per liter.
300 ml 60% dextrose; 500 ml 10% amino acids; 200 ml 20% lipid.
The total nutrient mixture administered at 65 ml/hr for 24 hours.
a. 393 cal/d
b. 1550 cal/d
c. 955 cal/d
d. 1572 cal/d
c. 955 cal/d
1. calculate kcal from CHO per liter 300 ml x .60= 180 gm x 3.4 cal= 612 cal 2.Calculate volume of TPN per liter 65 ml.hr x 24 hr= 1560 ml/24 hours 3. Multiply steps 1 and step 2 and divide by 1000 (ml) 612 cal x 1560 ml/1000= 955 cal/d
Determine the calorie contribution of lipids from the following parenteral formula. The amounts stated are given per liter.
300 ml 60% dextrose; 500 ml 10% amino acids; 200 ml 20% lipid.
The total nutrient mixture administered at 65 ml/hr for 24 hours.
a. 519
b. 561
c. 577
d. 624
d. 624
- calculate kcal from lipids per liter
200 ml x .20= 40 gm x 10 cal= 400 cal - calculate volume of TPN per liter
65 ml/hr x 24 hr= 1560 ml/24 hr - Multiply steps 1 and step 2 and divide by 1000(ml)
400 cal x 1560 ml/24hr= 624000/1000= 624 cal/d
Determine the protein intake per day in grams from the following parenteral formula. The amounts stated are given per liter.
300 ml 60% dextrose; 500 ml 10% amino acids; 200 ml 20% lipid.
The total nutrient mixture administered at 65 ml/hr for 24 hours.
a. 78
b. 80
c. 84
d. 86
a. 78
- calculate kcal from protein per liter
500 ml x .10= 50 gm x 4 200 cal - calculate the volume of TPN per liter
65 ml/hr x 24 hr= 1560 ml/24hr - Multiply steps 1 and step 2 and divide by 1000 (ml)
200 cal x 1560ml/hr=312000/1000= 312 cal/d - divide cal/day by 4 cal/gm= 78 gm/pro/d
How much free water is in 1.5 liters of an enteral feeding that has 1.5 calories per cc?
a. 1155 cc
b. 1057 cc
c. 926 cc
d. 901 cc
a. 1155 cc
1 cal/cc formula has 80-86% water
1.5 cal/cc formula usually have 77% water.
2 cal/cc formula has 69-71% water
1.5L(1000)= 1500ml x .77= 1155 ml
ml=cc
A patient receives 4 ounces whole milk and 6 graham crackers as a snack. Which of the following substitutes would lower the glycemic index?
a. skim milk in place of whole milk
b. fruit juice in place of whole milk
c. 12 saltines in place of 6 graham crackers
d. 1 Tbsp peanut butter in place of 3 graham crackers
d. 1 Tbsp peanut butter in place of 3 graham crackers
The glycemic index (GI) is a measure that ranks foods according to their effect on your blood sugar levels.
Foods with a low-GI value are the preferred choice, as they are slowly digested and absorbed, causing a slower and smaller rise in blood sugar levels.
The rates at which different foods raise blood sugar levels are ranked in comparison with the absorption of 50 grams of pure glucose, which is used as a reference food and has a GI value of 100.
The following are the three GI ratings:
Low: 55 or less Medium: 56–69 High: 70 or more
Which will cause the most delay in gastric emptying?
a. lean baked meat
b. broiled cod
c. shrimp
d. corned beef
d. corned beef
Fats delay emptying of the stomach. corned beef his a high-fat meat. all the other choices are much lower in fat.
For patients with gastroparesis, fatty foods and oils should be restricted, because they delay stomach emptying.
If a patient’s GFR is < 50 ml/minute, what should their protein intake be (in g/kg)?
a. 1
b. .6-.8
c. .55-.6
d. .2-.4
b. .6-.8
chronic kidney disease
stage 1 GFR >= 90 & stage 2 GFR 60-89=0.8-1.4 pro/kg
GFR 30-59 & stage 4 GFR 15-29= 0.6-.8 gpro/kg
A 2-year-old child with iron-deficiency anemia has anorexia, vomiting, weight loss and restlessness. Look for:
a. excessive milk and fruit juice intake
b. excessive vitamin C and D intake
c. asthma and respiratory distress
d. pica and lead poisoning
d. pica and lead poisoning
Pica is an eating disorder that can result in serious health problems, such as lead poisoning and iron-deficiency anemia.
A high, toxic dose of lead poisoning may result in emergency symptoms. These include: severe abdominal pain and cramping ; vomiting; muscle weakness; stumbling when walking; seizures;
A program that links sources of unused, cooked and fresh foods with social service agencies that serve the hungry is the:
a. PPFP
b. USDA
c. CACFP
d. TEFAP
a. PPFP
PPFP=Prepared and perishable food programs= nonprofit program that links sources of unused, cooked and fresh foods with social service agencies that serve the hungry
TEFAP= The Emergency Food Assistance Program is a Federal program that helps supplement the diets of low-income Americans, including elderly people, by providing them with emergency food and nutrition assistance at no cost.
A man with HIV disease presents with the following data. What should be your primary concern as his Dietitian?
Height 5’10” Weight 115 lbs
Hct 35% MCV 102fl BUN 11 mg/dl
albumin 2.8 g/dl CD4 280 lymphocytes 1200/cubic mm
a. anemia
b. weight
c. renal failure
d. protein deficiency
b. weight
his weight is significantly lower than what it should be.
IBW= 106 + 60= 166
% IBW= current wt / IBW x100 (115/166 x 100=69%)
albumin= normal is 3.5-50 (2.8 is low)
BUN= normal is 10-20
Hct= men is 42-52% (low at 35%) possibly anemia
An example of a tertiary prevention program is:
a. at the workplace, coordinate walking groups at lunchtime
b. exercise classes in a cardiac rehabilitation program
c. cooking classes for heart-healthy eating
d. workplace screening for hypertension
b. exercise classes in a cardiac rehabilitation program
Community intervention
Primary prevention= early screening for risks (health promotion)
secondary prevention= those with risk factors into program (risk reduction)
TERTIARY prevention= intervention to reduce severity of disease (rehab efforts)
A side effect of the herb yohimbe is:
a. lowering of blood pressure
b. elevated blood pressure
c. hyperglycemia
d. hypoglycemia
b. elevated blood pressure
Yohimbe= herb for erectile dysfunction (elevates blood pressure)
Which program teaches good nutrition practices and provides foods with certain nutrients?
a. EFNEP
b. FFVP
c. WIC
d. CACFP
c. WIC
WIC= provides specific foods and nutrition education
EFNEP= expanded food and nutrition education program (educates but doesnt provide food)
FFVP=fresh fruit and vegetable program (introduces children to fresh F&V)
CACFP=child and adult care food program ( provides commodity foods and NE materials)
A PN patient is receiving 45 cal/kg. What may be the result?
a. hypocalcemia
b. hyperkalemia
c. hypokalemia
d. hyperphosphatemia
c. hypokalemia
WHY??????
Hypophosphatemia, hypokalemia, and hypomagnesemia are imbalances associated with refeeding syndrome. This syndrome is a potential problem when malnourished patients receive aggressive enteral feedings.
A tube fed patient develops diarrhea. What is the most likely cause?
a. medications
b. the osmolality is too low
c. the strength is too weak
d. it is being given at an improper rate
a. medications
Diarrhea is a common complication associated with drugs and antibiotics.
The most commonly reported complication of enteral tube feeding (EN) is diarrhea, which occurs in up to 30% of patients on general medical and surgical wards and up to 68% of patients on intensive care units.
Diarrhea may result from a variety of causes including bacterial or viral infection, use of hyper-osmolar formula, lactose intolerance, antibiotic treatment, magnesium containing antacids, drug side-effects (e.g. digoxin and propanolol) and so called inert fillers of drugs which can include magnesium stearate, docusate sodium and sorbitol. In patients with a short bowel and no colon, additional factors contribute to the development of diarrhea, including loss of the daily intestinal secretions produced in response to food, and rapid gastric emptying and small bowel transit. A lack of peptide YY, which is known to delay gastric emptying and small intestinal motility, and is found in the highest concentration in the colon, may be responsible for this.
A male patient has hypertension, high cholesterol, diabetes, and is 55 pounds above his desirable weight. What do you recommend?
a. low sodium
b. low carbs
c. low calories
d. low fat
c. low calories
a reduction in weight will help control/lower the severity of all the other health conditions (HTN, cholesterol, DM)
A patient with liver disease needs adjustments in the intake of:
a. protein, fat and sodium
b. protein, fluids, sodium
c. protein, calories, sodium
d. fluids, calories, fat
b. protein, fluids, sodium
Liver disease= A high protein diet is important for people with chronic liver disease as the protein is used to maintain muscles and body tissues (including the liver) and to keep the body working normally. Fluids and sodium need to be reduced
The most useful data in evaluating the nutritional status of children is:
a. sex and age
b. iron and vitamin intake
c. energy intake and health history
d. height and weight
c. energy intake and health history
a nutritional assessment helps to evaluate the nutritional status
The dietary intake component of NHANES is:
a. WWEIA
b. BRFSS
c. Ten state nutrition survey
d. PNSS
a. WWEIA
WWEIA= what we eat in america (dietary intake component of NHANES)
Memory loss may be associated with a deficiency of:
a. riboflavin
b. thiamin
c. protein
d. electrolytes
b. thiamin
The vitamin deficiency most commonly associated with memory loss is vitamin B-1, or thiamine (Beriberi). Thiamine is a crucial vitamin for increasing focus, energy, fighting chronic stress and possibly preventing memory loss.
Foods high in thiamin include PORK, fish, seeds, nuts, beans, green peas, tofu, brown rice, squash, asparagus, and seafood.
Wernicke–Korsakoff syndrome is the typical result of alcoholism induced Vitamin B-1 deficiency. Symptoms include memory loss, impairment of reflex and motor functions, confusion and hallucinations. Infusion therapy with thiamin can reduce symptoms, but memory loss tends to remain in people with Wernicke–Korsakoff syndrome.
Which of the following would lower serum cholesterol levels?
a. dried beans
b. green beans
c. yellow beans
d. summer squash
a. dried beans
Beans and Lentils for Lowering Cholesterol. Beans and lentils are source of soluble fiber which helps slow down the absorption of lipids and gradually reduce cholesterol levels. Its soluble dietary fiber can also improve the excretion of fecal bile acid which can lead to a reduction of fat absorption and cholesterol.
In a PN mixture, what volume of the amino acid solutions listed would come closest to providing 185 calories?
a. 1000 ml of 8.5% amino acids
b. 850 ml of 5.5% amino acids
c. 500 ml of 7.0% amino acids
d. 500 ml of 10% amino acids
b. 850 ml of 5.5% amino acids
850 ml x .055= 46.75 x 4= 187 cal
Enteral feeding products that contain protein in the form of small peptides and amino acids may be recommended for patients who have:
a. short bowel syndrome
b. undergone a gastrectomy
c. undergone a colectomy
d. undergone a cholecystectomy
a. short bowel syndrome
Short Bowel Syndrome- condition that causes malabsorption and nutrient deficiency because a large section of the SMALL INTESTINE is missing or has been surgically removed. Patients with SBS typically experience severe diarrhea, steatorrhea, electrolyte disturbances, dehydration, malnutrition, and weight loss.
elemental formulas (have pre-digested protein or amino acids, glucose or sucrose, small fat, vitamins, minerals, electrolytes). given to patients with malabsorption.
Chemical digestion starts in the mouth and continues in the stomach, but most of the process occurs in the SMALL INTESTINE.
Cholecystectomy-removal of the gallbladder.
colectomy- removal of colon (large intestine)
Gastrectomy is the removal of part or all of the stomach.
Which diet follows the AHA recommendations for healthy hearts?
a. 25-30% calories from fat, <10% saturated fats, < 200 mg cholesterol
b. <=35% cal from fat, < 2 gm sodium, <200 mg cholesterol
c. 25-30% cal from fat, <10% sat fats, <200 mg cholesterol, 5-10% MUFA, 20% PUFA
d. <=35% cal from fat, <7% sat fats, 5-10% PUFA, up to 20% MUFA, < 200 mg cholesterol
d. <=35% cal from fat, <7% sat fats, 5-10% PUFA, up to 20% MUFA, < 200 mg cholesterol
A renal patient has come for dialysis on Monday morning with a serum sodium of 130mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on Friday morning. His laboratory indicators were in acceptable ranges on Friday afternoon. What would you expect happened over the weekend?
a. consumed too little sodium, too much water, too little protein
b. consumed too little sodium, not enough water, too much protein
c. consumed too much sodium, too much water, too much protein
d. consume too much sodium, too little water, too little protein
c. consumed too much sodium, too much water, too much protein
A low sodium level in your blood may be caused by too much water or fluid in the body. This “watering down” effect makes the amount of sodium seem low. Low blood sodium can also be due to losing sodium from the body or losing both sodium and fluid from the body. Kidney failure - the kidneys CANNOT get rid of extra fluid from the body
When serum sodium is low (usually because total body water is high), antidiuretic hormone (ADH) is suppressed and a dilute urine is excreted. In addition, the kidney produces renin, which stimulates aldosterone production, which decreases the excretion of sodium in the urine, therefore increasing sodium levels in the body.
sodium-normal is 135-145. its a little low
BUN- way high. normal is 10-20. BUN is related to protein intake
creatinine- within range. normal is .6-1.4
A renal patient has come for dialysis on Monday morning with a serum sodium of 130mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on Friday morning. His laboratory indicators were in acceptable ranges on Friday afternoon. What else would you expect to see?
a. increased bicarbonate, increased potassium, decreased phosphorus
b. decreased bicarbonate, increased potassium, increased phosphorus
c. decreased bicarbonate, decreased potassium, increased phosphorus
d. increased bicarbonate, increased potassium, increased phosphorus
b. decreased bicarbonate, increased potassium, increased phosphorus
Body needs to maintain electrolyte balance.
Phosphorus- protein intake
kidneys regulate bicarbonate (HCO3-)
Low bicarbonate levels in the blood means that the body has an acid-base imbalance or an electrolyte imbalance.
Metabolic acidosis- kidneys are holding on to too much acid and your bicarbonate levels fall to compensate
Low bicarbonate levels may be due to metabolic acidosis, diabetic ketoacidosis, kidney disease, Addison’s disease, chronic diarrhea, methanol, or ethylene glycol or aspirin poisoning.
A renal patient has come for dialysis on Monday morning with a serum sodium of 130mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on Friday morning. His laboratory indicators were in acceptable ranges on Friday afternoon.
With this same patient, what would the lab values above have likely reflected if the patient had been nauseated and had averaged only 400 calories from primarily starchy foods over the weekend?
a. little or no rise in potassium, BUN/creatinine ratio <10
b. increased phosphorus, BUN/creatinine ratio >15
c. typical rise in potassium, BUN/creatinine ratio >15
d. metabolic alkalosis, BUN/creatinine ratio <10
a. little or no rise in potassium, BUN/creatinine ratio <10
potassium ????
lower BUN/creatinine ratio= low protein intake
Both BUN and creatinine are filtered in the kidneys and excreted through urination and they are a perfect parameter for identifying the overall functions of the kidneys.
The BUN and creatinine are both end products of metabolism. The BUN and creatinine are waste products that need to be filtered by the kidneys and excreted through urination.
