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