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.
A nutrition surveillance program is designed primarily to:
a. confirm results of annual nutritional surveys
b. identify the nutritional needs of the population
c. indicate the number of people at increased risk for medical conditions
d. indicate the causes underlying the nutrition problems identified
b. identify the nutritional needs of the population
Nutrition surveillance-continuous collection of data. identifies problems, sets a baseline, sets priorities, detects changes in trends. Data is used to identify needs and kind of intervention needed
A standing height should first be obtained when an infant is how many months old?
24 months
Which nutrient would most effectively reduce starvation ketosis?
a. corn oil
b. MCT oil
c. glucose
d. essential amino acids
c. glucose
starvation Ketosis is a metabolic state in which the body breaks down fat and produces acids called ketones.
ketosis is a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy.
An albumin of 5.0 mg/dl in a patient who has consumed very few calories and limited fluids for several weeks is likely due to:
a. increased liver production of albumin in response to poor intake
b. an increase in albumin due to dehydration
c. decreased intake of protein
d. retention of albumin due to the low calorie intake
b. an increase in albumin due to dehydration
normal albumin is 3.5-5
levels that are above normal range are likely due to dehydration
albumin has long half life, so not reflection of current protein intake
calorie and protein intake not generally associated with albumin
Macrocytic, pernicious anemia resembles the anemia due to a deficiency of:
a. folic acid
b. iron
c. megaloblastic cells
d. pyridoxine
a. folic acid
can be due to B12 or folate deficiency. (folate NEEDS B12 for transport inside the cell. poor folate. also iron is cofactor in folate metabolism)
Macrocytic anemia- unusually large red blood cells.
Pernicious anemia is a type of macrocytic anemia. It’s sometimes called megaloblastic anemia because of the abnormally large size of the red blood cells produced.
Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12.
Who has the greatest water, protein, and calorie needs per unit of body weight?
a. 6 month old
b. 50 year old female
c. 16 year old male
d. 25 year old male
a. 6 month old
the absolute need in grams per day (adults need more) – the relative need in grams per kg of BODY WEIGHT per day (children need more). As children get older (7-10 YO) their relative needs decline
The theory that a person must perceive the severity of a condition, and that making a change may help him prevent the condition from occurring is the:
a. stages of change model
b. diffusion of innovation model
c. theory of planned behavior
d. health belief model
d. health belief model
Health belief model-ramework for motivating people to take positive health actions that uses the desire to avoid a negative health consequence as the prime motivation. For example, HIV is a negative health consequence, and the desire to avoid HIV can be used to motivate sexually active people into practicing safe sex.
stages of change model- The 6 Stages of Change Model describes the series of stages we go through to change our lifestyle habits. The critical assumption that behavioral changes do not happen in one step, but through a series of distinct, predicable stages. (precontemplative, contemplative, preparation, action, mainteneance, relapse)
diffusion of innovation model- explain how, over time, an idea or product gains momentum and diffuses (or spreads) through a specific population or social system. The end result of this diffusion is that people, as part of a social system, adopt a new idea, behavior, or product. The key to adoption is that the person must perceive the idea, behavior, or product as new or innovative.
theory of planned behavior- The theory states that attitude toward behavior, subjective norms, and perceived behavioral control, together shape an individual’s behavioral intentions and behaviors.
A patient with a redundant ileum may develop a deficiency of:
a. fat-soluble vitamins
b. folic acid
c. vitamin B12
d. vitamin K
c. vitamin B12
Ileum-absorption of B12 and bile salts occurs
A redundant colon is longer than normal due to additional loops.
Surgical resection or disease of the distal ileum - because B12 is absorbed at the lower end of the small intestine, any surgical removal (e.g. weight loss surgery) or an inflammatory condition (e.g. Crohn’s and Celiac disease) that impairs the distal ileum will also impair absorption of Vitamin B12.
An example of an educational objective for a low fat cooking class given at a seniors center would be to:
a. appreciate the importance of lowering fat intake
b. understand the relationship between fat intake and heart disease
c. name two ways to decrease fat intake and heart disease
d. consider ways to decrease their risk of heart disease
c. name two ways to decrease fat intake and heart disease
Educational objectives= specific, measurable, achievable, relevant, time frame. action verbs are measureable: exercise, select, list, identify, count, produce
UNDERSSTAND, APPRECIATE ARE NOT ACTION VERBS
What would a vegan not eat?
a. coleslaw made with oil and vinegar
b. congealed fruit salad
c. salad with tofu dressing
d. peanut butter
b. congealed fruit salad
Vegans= no meat, or dairy. anything coming from animals
Gelatin used to make the fruit salad is derived from collagen taken from animal body parts.
Which contains more total dietary fiber:
a. 1/2 cup raw spinach
b. 1 oz raisin bran cereal
c. 1 slice whole wheat bread
d. 2 tbsp peanut butter
b. 1 oz raisin bran cereal
1 oz raisin bran = 3.3 g of fiber
1/2 cup spinach= less than 1 gram (more if cooked!)
1 slice bread= 2 g fiber
2 tbsp peanut butter= 2 g fiber
What change should be made in the following menu if it is to be served to Seventh Day Adventists? tomato juice, cottage cheese fruit plat or egg salad sandwich, milk, coffee, tea
a. offer fortified soy milk
b. offer decaffeinated beverages
c. offer tofu as an alternative to cottage cheese
d offer a meat analog as an alternative to egg salad
b. offer decaffeinated beverages
Seventh Day Adventist- pork prohibited and meat and fish avoided. most are vegetarians. alcohol, coffee and tea prohibited.
rationale- diet satisifies practice to “honor and glorify God”
The best way to counsel a patient with anorexia nervosa is to:
a. recommend that the patient increase food intake and attend weekly counseling sessions
b. emphasize the health benefits associated with increased intake
c. maintain a constan regimen to decrease inappropriate choices
d. remain flexible to help the patient set realistic goals
b. emphasize the health benefits associated with increased intake
plan with patient regular mealtimes, varied and moderate intake, gradually reintroduced feared foods. FOCUS ON HEALTH BENEFITS and life-sustaining aspects of food
Programs that focus on providing fresh fruits and vegetables are:
a. TANF and ASP
b. FFVP and SFMNP
c. TEFAP and NETP
d. DHHS and SBP
b. FFVP and SFMNP
FFVP=fresh fruit and vegetable program
SFMNP=seniors farmers market nutrition program
TEFAP= emergency food assisance program
NETP=nutrition education and training program
ASP=afterschool snack program
TANF= temporary assistance for needy families
DHHS= department of health and human services
Which of the following would likely have a very low albumin a few days after admission to an acute care hospital?
a. patient with anorexia nervosa
b. patient with a 30% full thickness burn
c. patient with newly diagnosed colon cancer
d. patient with COPD
b. patient with a 30% full thickness burn
Burn patients- reduction in albumin level due to a higher vascular permeability in the burn wounds that produces exudation with an important protein loss through the burn wound and an acute phase response of plasma protein synthesis in liver that occur with even a very small percentage of burn skin (0.8%) and that produces a decrease to about 80% of normal albumin and prealbumin levels.
When measuring a childs somatic protein mass, use the BMI and:
a. upper arm muscle area
b. triceps skinfold
c. mid-arm muscle circumference
d. knee to height ratio
a. upper arm muscle area
arm muscle are measures skeletal muscle mass (somatic protein)
Somatic protein status is a measure of the protein in skeletal muscle while visceral protein status is a measure of all other proteins (organs, viscera, serum, blood cells, white blood cells). Evaluation of somatic protein status can generally be performed using muscle circumference or mid-arm muscle area.
Somatic Protein Assessment= anthropometric measures such as midarm muscle area, midarm circumference, and overall body weight and subjective global assessment, biochemical tests such as creatinine height index and nitrogen balance can be used to more specifically analyze somatic protein status.
AN AIDS patient should select the following fresh fruit:
a. grapes, orange
b. orange, banana, pineapple
c. apple, grapes, peach
d. grapes, pear
b. orange, banana, pineapple
Asian, Hispanic and Native Americans have the following in common:
a. they consume few green vegetables
b. they consume significant amounts of dairy products
c. they consume little milk
d. they consume few root vegetables
c. they consume little milk
Your patient is on Coumadin. Which foods would make sure to consistently include in their diet?
a. oranges, peaches
b. sweet potatoes
c. beef, lamb
d. spinach, collard greens
d. spinach, collard greens
????
The first step in the implementation of a community-based program is:
a. obtain support from staff members
b. prepare a realistic budget based on goals and objectives
c. obtain administrative support
d. reach out to the target population
c. obtain administrative support
Funding for public health programs comes primarily from:
a. foundation grants
b. general revenue
c. charitable organizations
d. public/private partnerships
b. general revenue
In acute hepatitis, you would likely see:
a. decreases in SGOT, increase in SGPT
b. increase in both SGOT and SGPT
c. decreased in both SGOT and SGPT
d. increase in SGOT and decrease in SGPT
b. increase in both SGOT and SGPT
The SGOT (AST) test is a blood test. It helps to determine how well the liver is functioning by measuring levels of aspartate aminotransferase in the blood.
The normal range of SGPT (ALT) is from 7 to 56 units per liter of serum. SGPT is a sensitive indicator of liver damage or injury due to different types of disease.
In severe cirrhosis with ascites, diet therapy should be:
a. restrict sodium
b. restrict CHO and fat
c. restrict protein and sodium
d. restrict fat
a. restrict sodium
An AIDS patients temperature has risen to 102 degrees. His BMR has increased:
a. 24%
b. 36%
c. 12%
d. 5%
a. 24%
BMR increases 7% for every degree over normal body temperature (98.6)
How much additional water would a 65 kg patient need when receiving 2400 ml of a standard formula, 85% free water was given daily?
a. 125 ml
b. 235 ml
c. 155 ml
d. 270 ml
b. 235 ml
35ml x 65 kg=2275 ml
Formula= 2400ml x .85=2040 ml receiving.
2400-2275= 235 ml of additional water needed for patient
Fluid needs are important to consider for TF patients. Specific water needs for an individual can be calculated as 1 ml/kcal or 35 ml/kg usual body weight (UBW). Patients who have large water losses through perspiration or oozing wounds may require more fluids.
An athlete needs 4000 calories. The cornflakes nutrient label says that one serving provides 25% of the RDA for CHO. How many servings of cornflakes does he need to get his 25%?
a. one
b. two
c. three
d. four
b. two
Remember nutrient labels are based on 2000 kcal diet. The athlete needs 4000 calories. So amount needed is times 2
4000 kcal x .25= 1000 (based on 2000 kcal)
The steps in planning community-based nutrition programs are:
a. goals, develop mission statement, objectives
b. develop measurable goals, develop mission statement
c. develop mission statement, goals and measurable objectives
d. goals, objectives, develop mission statement
c. develop mission statement, goals and measurable objectives
What elements of the diet vary the most in hepatic disease?
a. fat, carbs, potassium
b. sodium, fluid, protein
c. sodium, potassium, protein
d. fat, sodium, potassium
b. sodium, fluid, protein
What is the most effective tool for providing nutrition education to the community?
a. the RDIs
b. the Healthy People 2020 report
c. the MyPlate food guidance system
d. the Healthy Eating Index
c. the MyPlate food guidance system
What should a Jewish patient include in his diet to increase intake of zinc?
a. fresh green vegetables
b. pork
c. turkey
d. wheat bread
c. turkey
Which surveillance system monitors changes in health risk behaviors over time and can be used to target those most at risk? a. BFRSS b. NHANES C. TANF D. Health and Diet Survey
a. BFRSS
BFRSS= behavioral risk factor surveillance system TANF= temporary assistance for needy families
A new patient with a BMI of 32 and hypertension comes to you for counseling. What is your first recommendation?
a. achieve DBW
b. maintain weight and exercise
c. reduce sodium intake
d. reduce sodium, reduce fluid, reduce caloric intake
c. reduce sodium intake
first goal is to decrease intake of sodium. That could help manage HTN and help with weight. Dont want to set too many goals
A female has a 36” waist and 40” hip measurement. She is at risk for:
a. nothing
b. cancer
c. heart disease
d. malnutrition
c. heart disease
If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men.
A vegan with macrocytic anemia needs which of the following?
a. iron-rich foods
b. fortified soy milk
c. eggs, wheat bread
d. meat, green vegetables
b. fortified soy milk
Macrocytic anemia is usually caused by a deficiency of folate or vitamin B-12, which is abundant in animal products.
A patient with a GFR of 20 ml/min should receive how many grams of protein/kg?
a. 1.1
b. 0.8
c. 0.6
d. 0.2
c. 0.6
Stage 4: GFR 15-29 (0.6-0.8 g pro/kg)
A patient is recovering from an ileocecal resection, where 100 cm was removed. What are your recommendations?
a. oral vitamin B12, increase fluids
b. parenteral vitamin B12, increase fluids, increase protein
c. decrease fluids, increase protein, parenteral B12
d. decrease protein, decrease fluids, oral B12
b. parenteral vitamin B12, increase fluids, increase protein
Ileocaecal resection removes the terminal ileum (the last part of the small intestine) and the caecum (the first part of the colon which connects the small and large intestines together). The healthy ends of the small intestine and the large intestine are then directly joined together. This surgery is often needed when these sections become severely damaged by Crohn’s disease. This can often result in strictures (a narrowing) of the bowel or blockages.
You can also be at risk of a vitamin B12 deficiency as the ileum is responsible for absorbing B12 from the food you eat
Having your ileum removed can put you at risk of bile acid malabsorption. This can cause chronic diarrhea
A patient on lithium carbonate decreases his sodium intake to 2 gm/day. The effect will be:
a. decreased activity of the drug
b. enhanced activity of the drug
c. no change in drug activity
d. reduced response to the drug
b. enhanced activity of the drug
Lithium is an oral medication used to treat the manic episodes of bipolar depression. Lithium affects the way that sodium chloride (salt) moves in and out of the body’s cells.
In the dietary guidelines, what represents the fat included?
a. 20-35% calories, <10% saturated fat
b. 30% calories, <6% saturated fat
c. 35% calories, <15% saturated fat
d. 35% calories, <10% saturated fat
a. 20-35% calories, <10% saturated fat
Which of the following would likely be a cause of marasmus?
a. leaving a patient for two weeks on D5W
b. chemotherapy
c. following a 20 gm protein diet for two months
d. antibiotic therapy
b. chemotherapy
Following resection of the small intestine, patients initially receive:
a. parenteral nutrition
b. elemental formula through an enteral feeding
c. predigested nutrients through a gastroostomy tube
d. lactose-free, low osmolar, jejunal feeding
a. parenteral nutrition
A tube feeding ran from 7 pm until 6 am, providing 1800 calories at 1.6 cal/cc. How many cc/hour were given?
a. 100
b. 125
c. 210
d. 65
a. 100
1800/1.6/11= 103
A patient on parenteral support develops sepsis. What is the likely cause?
a. lack of immune-enhancing nutrients
b. poor care of the entry site
c. related to the condition that created the need for parenteral support
d. bacterial translocation
d. bacterial translocation
A sedated patient receives 25cc of Propofol per hour. How many calories will he receive from the medication daily?
a. 500
b. 660
c. 720
d. 785
b. 660
25cc x 24 hours= 600 cc/hr x 1.1 kcal= 660 cal
Propofol is a lipid solution containing 1.1 kcal /mL.
A patient receives an enteral feeding providing 1 cal/ml from 8 pm until 9 am. What rate is needed to provide 1200 calories in 24 hours?
a. 75 ml/hr
b. 79 ml/hr
c. 87 ml/hr
d. 92 ml/hr
d. 92 ml/hr
1200/1cal/ml/13 hr= 92
A critically ill patient will likely need hospitalization for many days. When should the discharge plan begin?
a. as soon as it is known when the patient will be discharged
b. once the patient is stable
c. on the first day of admission
d. at least 2 days prior to discharge
c. on the first day of admission
What is not a likely cause of failure to thrive in a child?
a. vegetarian diet
b. chronic illness
c. parental food restrictions due to them being overly concerned with obesity
d. lack of fiber in the diet
a. vegetarian diet
A child with PKU can eat:
a. spaghetti with tomato sauce
b. vanilla ice cream
c. carrots and celery sticks
d. aspartame-sweeetened gelatin
c. carrots and celery sticks
Children with a high risk for food allergies should initially avoid:
a. peanut butter and milk
b. eggs and strawberries
c. oats and fish
d. citrus fruits and chocolate
a. peanut butter and milk
Eggs, milk, and peanuts are the most common causes of food allergies in children,
Which of the following would be classified as NI in the NCP?
a. not ready for diet change
b. altered GI function
c. involuntary weight loss
d. increased energy expenditure
d. increased energy expenditure
Which of the following would be appropriate for a hemodialysis patient on a 60 gm protein diet, with 75% from HBV protein?
a. 2 eggs, 2 ounces chicken, 3 ounces beef, 1/2 cup milk
b. 1 egg, 2 ounces chicken, 3 slices bread, 3 ounces beef
c. 2 eggs, 3 ounces chicken, 3 ounces beef, 1 cup milk
d. 1 egg, 3 ounces chicken, 2 cups milk, 5 slices bread
d. 1 egg, 3 ounces chicken, 2 cups milk, 5 slices bread (59gm pro)
75% HBV= 45 gm from animal sources
( egg, 3 oz chick, 2 c milk=44 mg)
Egg= 7 gm pro chicken/beef= 7 gm pro Milk= 8 gm pro Bread= 3 gm pro
Who resolves differences in bills from the House and the Senate?
a. House committee
b. Senate committee
c. Committee on resolutions
d. Joint conference committee of the House and Senate
d. Joint conference committee of the House and Senate
Which bill requests government funding?
a. budget bill
b. markup bill
c. appropriations bill
d. spending grant bill
c. appropriations bill
Infuse a peripheral solution at a maximum rate of how many mOsm/L?
a. 300
b. 800
c. 1400
d. 2000
b. 800
Which would be an expected outcome of WIC?
a. fewer women breast feed
b. fewer babies, better birth control
c. low income women have better knowledge concerning nutrition
d. less anemia, increased HG and HT levels in women
d. less anemia, increased HG and HT levels in women
The main reason why commodity foods obained from a USDA program may not be brought to a Kosher facility?
a. because meat cannot be served with dairy products at the same meal
b. kosher foods are not allowed to be mixed with non-kosher foods
c. Jewish dietary practices are lacto-ovo-vegetarian
d. Jewish dietary practices are lactovegetarian
b. kosher foods are not allowed to be mixed with non-kosher foods
What is the administration rate of enteral feeding if the patient is receiving 1800 ml of a 1 cal/ml solution daily?
a. 65 ml/hr
b. 75 ml/hr
c. 87 ml/hr
d. 92 ml/hr
b. 75 ml/hr
1800 ml/1 cal/24 hr= 75 ml/hr
The immune system reacts tofoods that are normally harmless. This is:
a. food intoxication
b. an inflammatory response
c. an immunoglobulin E (IgE) mediated reaction
d. food intolerance
c. an immunoglobulin E (IgE) mediated reaction
Which level of HgA1C suggests good compliance with dietary recommendations in a diabetic?
a. 6.8 mg/dl
b. 3.0 mg/dl
c. 8.8 mg/dl
d. 9.2 mg/dl
a. 6.8 mg/dl
What do these values represent…2.5 mg/dl serum phosphorus level and 1.3 mEq/L serum magnesium level?
a. hypophosphatemia, hypomagnesemia
b. hyperphosphatemia, hypomagnesemia
c. hyperphosphatemia, hyponatremia
d. hyperkalemia, hypermagnesemia
a. hypophosphatemia, hypomagnesemia
A concern with parenteral feeding is;
a. hypokalemia
b. hypercalcemia
c. hyponatremia
d. hypernatremia
a.hypokalemia
An infant requires 340 cal/24 hr. How many ounces of formula should be given every 6 hours?
a. 2
b. 3
c. 3.5
d. 4.25
d. 4.25
Which assessment tool might be given to clients prior to screening at a congregate meal site?
a. PEACH survey
b. DETERMINE checklist
c. NSI Level 1 screen
d. NSI level II screen
b. DETERMINE checklist
A Crohns patient who was previously well-nourished has a fever and ileus 7 days PO. Which feeding method should you recommend?
a. central venous hyperalimentation
b. full liquids
c. peripheral IV infusion
d. half-strength tube feeding
c. peripheral IV infusion
How many total calories are provided in 500 ml of a 20% dextrose solution with 500 ml of a 4% protein solution and 250 ml of a 20% lipid emulsion?
a. 870
b. 920
c. 1020
d. 1125
b. 920
500 ml x .20dex= 100 x 3.4 cal=340
500 ml x .04pro= 20 x 4= 80
250 ml x .20 lipid= 50 x 10= 500
Total= 920
500 ml x .20dex= 100 x 3.4 cal=340
500 ml x .04pro= 20 x 4= 80
250 ml x .20 lipid= 50 x 10= 500
Total= 920
What is the calorie: nitrogen ratio in the above solution?
a. 920;3.2
b. 287:1
c. 1020:6.25
d. 318: 1
b. 287:1
Calorie to nitrogen ratio= Kcals per day/gram nitrogen per day
grams protein= 20
20/6.25= 3.2
920/3.2= 287.5
287:1
Which religious group can consume alcohol?
a. Mormons
b. Muslims
c. Hindus
d. Buddhists
d. Buddhists
An example of a positive nutrition care outcome is:
a. increased intake of foods high in iron and vitamin C
b. increase in the number of participants in a weight management class
c. increase in physician referrals to the outpatient department
d. decrease in the number of complaints regarding low sodium meals
a. increased intake of foods high in iron and vitamin C
A patient weighing 104 kg is placed on a 1.5 cal/ml formula with 75% free water, 54 grams protein/L. He needs 3000 calories per day. How much formula should he receive daily to meet his needs?
a. 2000 ml
b. 3000 ml
c. 2275 ml
d. 2575 ml
a. 2000 ml
3000cal/1.5 cal/ml= 2000 ml
A patient weighing 104 kg is placed on a 1.5 cal/ml formula with 75% free water, 54 grams protein/L. He needs 3000 calories per day. How much protein will he receive?
a. 64 g
b. 108 g
c. 146 g
d. 150 g
b. 108 g
3000cal/1.5 cal/ml= 2000 ml
1000 ml= 1L
2000 ml= 2L
2L x 54 gm= 108 gm
A patient weighing 104 kg is placed on a 1.5 cal/ml formula with 75% free water, 54 grams protein/L. He needs 3000 calories per day. How much additional water should be provided per hour?
a. 52 ml
b. 89 ml
c. 78.5 ml
d. 62.5 ml
d. 62.5 ml
3000cal/1.5 cal/ml= 2000 ml
2000 x .75= 1500
3000-1500= 1500/24 hr= 62.5 ml
