Domain 2 part 4 Flashcards
1
Q
An animal adult shows that you have successfully met the indicator “95% of high risk patients are assessed within 24 hours of admission”. The next step is to:
a. establish a new indicator
b. report the successful completion of intervention
c. evaluate the need to continue monitoring the indicator
d. evaluate the need to revise the standard of care
A
c. evaluate the need to continue monitoring the indicator
2
Q
A nephrotic syndrome patient with edema has a declining serum albumin level. A contributing factor would be:
a. diversion of protein to intracellular spaces
b. decreased synthesis by the liver due to catabolic state
c. a decreased appetite and less food consumption
c. a loss of protein in the urine
A
c. a loss of protein in the urine
3
Q
Which best determines whether or not to intervene with a new patient?
a. the patients current medical diagnosis
b. the patients nutritional status history
c. a request by the patients family
d. nutrition screening results
A
d. nutrition screening results
4
Q
Which outcome would justify continuing a WIC program?
a. number of participants enrolled increased
b. infant morbidity rate decreased
c. maternal weight gains during pregnancy increased
d. number of diverse cultures participating decreased
A
b. infant morbidity rate decreased
5
Q
A patient with severe acute pancreatitis experiences nausea and vomiting and requires 2500 calories/day. Which of the following would you recommend?
a. 3000 cc of 1 cal/cc tube feeding through the jejunum
b. 1500 cc of a 2 cal/cc nasogastric tube feeding
c. 1000 cc of D50W, 1000 cc of 7% amino acids, 650 cc of 20% lipids
d. 1000 cc of D50W, 1000cc of 7% amino acids, 500 cc of 10% lipids
A
d. 10000 cc of D50W, 1000cc of 7% amino acids, 500 cc of 10% lipids
6
Q
Roman Catholic dietary laws state that fish is:
a. to be served every Friday all year
b. to be served on Ash Wednesday and Good Friday
c. served on Ash Wednesday and Fridays during Lent
d. no longer required on Fridays
A
c. served on Ash Wednesday and Fridays during Lent
7
Q
Tube-fed patients should have gastric residuals checked:
a. once a day until volume goals have been met
b. 2 hours after feeding begins
c. every 4 hours during the first 48 hours of feeding
d. only if the abdomen becomes distended
A
c. every 4 hours during the first 48 hours of feeding
8
Q
Which condition benefits from the use of indirect calorimetry?
a. post-gastrectomy
b. patient receiving chemotherapy
c. patient with third degree burns
d. post-surgical patient
A
c. patient with third degree burns
9
Q
A Rabbi is admitted to the hospital. What question might he ask the Dietitian?
a. What time are meals served?
b. Who cooks the food?
c. What is the mixture of foods in combination of dishes?
d. Where will I eat?
A
c. What is the mixture of foods in combination of dishes?
10
Q
In most patients, a normal gastric residual volume would be
a. less than 100 ml
b. less than 200 ml
c. more than 200 ml
d. less than 250 ml
A
d. less than 250 ml
11
Q
A patient on parenteral nutrition is to be transitioned to enteral feeding. He should receive:
a. half-strength enteral feeding initially
b. half-strength, then 3/4 strength enteral feeding
c. half-strength enteral feeding with a low osmolality
d. full-strength enteral feeding at a low rate
A
d. full-strength enteral feeding at a low rate
12
Q
A patient with low hemoglobin, low hematocrit, high MCV has:
a. microcytic anemia from lack of folate or B12
b. macrocytic anemia from lack of folate or B12
c. microcytic anemia from lack of iron
d. macrocytic anemia from lack of iron
A
b. macrocytic anemia from lack of folate or B12
13
Q
What is the best practical way to measure energy balance?
a. evaluate weight gain and weight loss
b. utilize food intake records
c. use activity factors
d. calculate the number of calories consumed
A
a. evaluate weight gain and weight loss
food intake records could lack accuracy. Scale is more accurate and concrete measure of energy balance
14
Q
Which supplements are recommended with peritoneal dialysis
a. same as those for hemodialysis
b. only the water-soluble vitamins
c. same as those for hemodidalysis plus thiamin
d. only iron and folate
A
c. same as those for hemodidalysis plus thiamin
15
Q
Patients with cardiac cachexia on a loop diuretic should be evaluated for:
a. riboflavin status
b. acidosis
c. thaimin status
d. alkalosis
A
c. thaimin status
16
Q
An appropriate menu for a Kosher meal is:
a. macaroni and cheese, green beans
b. roast beef, potato, vegetable, cream soup
c. veal parmesan, noodles, green beans
d. crabmeat salad, lettuce, milk
A
a. macaroni and cheese, green beans
kosher= no pork or shellfish, meat and dairy in same meal not allowed, leavened food is restricted during Passover
veal no= animals without cloven hooves and no not chew their cud are forbidden
17
Q
A Hispanic women needs more calcium in her diet. What do you recommend?
a. milk
b. plantains
c. avocados
d. pinto beans
A
d. pinto beans
top sources of calcium besides dairy include seeds, beans, dark leafy greens, sardines, canned salmon, tofu
18
Q
Which of the following would lacto-ovo-vegetarian not eat?
a. eggs
b. halibut
c. cheese
d. beans
A
b. halibut
19
Q
Which provides the most vitamin A for a Mexican?
a. tortillas and refried beans
b. cantaloupe and squash
c. cheese
d. tortillas and milk
A
b. cantaloupe and squash
Vitamin A= yellow and orange fruits and vegetables, dark leafy greens, cantaloupe, fish, liver, fortified skim milk
20
Q
Which snack would you not give to an infant?
a. yogurt
b. cheese sticks
c. graham crackers
d. grapes
A
d. grapes
21
Q
Following an ileal resection, which supplements are recommended?
a. calcium, magnesium, zinc, fat-soluble vitamins
b. water-soluble vitamins, calcium and phosphorus
c. zinc, thiamin, iron
d. fat-soluble vitamins
A
a. calcium, magnesium, zinc, fat-soluble vitamins
ileum (bile salts and vitamin B12)
need to limit fat (malabsorption), use MCT (doesnt require bile salts), supplement with fat-soluble vitamins, Ca, Mg, Zn and parenteral B12
There is malabsorption of calcium, mg, and Zn with ileal resections.
An ileal resection can also lead to formation of renal oxylate stones
22
Q
Which supplements are recommended with cirrhosis?
a. B complex, calcium, zinc, magnesium
b. fat-soluble vitamins and zinc
c. water-soluble vitamins and magnesium
d. chromium, zinc, riboflavin, thiamin
A
a. B complex, calcium, zinc, magnesium
Cirrhosis=
high protein, high calorie, moderate to low fat. low fiber if varices are present, low sodium if edema or ascites. Supplement with B complex, Vitamin C, K, Zn, Mg. monitor need for A and D
23
Q
The nutrition prescription for an infant with phenylketonuria includes:
a. high phenylalanine, low tyrosine
b. low phenylalanine, high tyrosine
c. low phenylalanine, high isoleucine
d. low phenylalanine, high valine
A
b. low phenylalanine, high tyrosine
PKU= missing enzyme that converts phenylalanine into tyrosine.
tyrosine becomes a CONDITIONAL AMINO ACID
24
Q
An infant with acute diarrhea should receive;
a. glucose and electrolytes only for the first 24 hours
b. half-strength formula until diarrhea stops
c. rehydration within 4-6 hours
d. formula that is low in fiber
A
c. rehydration within 4-6 hours
25
A patient requires 1800 calories per day and is restricted to 1500 ml fluid. The enteral formula selected has 1.5 cal/cc, 55 gm protein per liter, and 77% water. How much formula does she need daily?
a. 1500 ml
b. 1400 ml
c. 1300 ml
d. 1200 ml
d. 1200 ml
1800 cal/ 1.5 cal/cc= 1200 ml (cc)
26
What would you first advise a constipated patient to do?
a. take a mild laxative
b. eat less fat
c. increase fluids and fiber intake
d. eat more protein
c. increase fluids and fiber intake
27
A patient with dysphagia waiting for a swallow test may receive:
a. thick liquids
b. thin liquids
c. peripheral parenteral nutrition
d. parenteral nutrition
a. thick liquids
Modifying oral liquid intake using thickened liquids has been the cornerstone of clinical practice in treating adults with dysphagia
28
What diest is typically recommended for a patient who has undergone a gastrectomy?
a. low fiber foods and two glasses of milk each day
b. high fiber foods and restriction of fluids with meals
c. carbohydrated, protein and fat at each meal, and no dairy products
d. carbohydrate, protein and fat at each meal, and restriction of fluids with meals
d. carbohydrate, protein, and fat at each meal, and restriction of fluids with meals
gastrectomy= removal of part or all of the stomach.
29
A parenteral solution includes 65 grams of protein, 200 gm dextrose and 20% fat emulsion at 7 ml per hour. How many total calories will this provide in a 24 hour period?
a. 1155
b. 1276
c. 1307
d. 1385
b. 1276
65 gm pro x 4= 260 cal
200 gm Dex x 3.4= 680 cal
7ml x 24= 168 ml x 2= 336
total= 1276 cal
30
When a patient is receiving an isotonic, polymeric enteral feeding and the medication propofol, your concern is;
a. not providing adequate protein
b. providing too many calories
c. delivery of excessive sodium
d. development of diarrhea
b. providing too many calories
The medication propofol also contains calories that you need to consider.
Propofol is a lipid solution containing 1.1 kcal /mL.
When provided at an infusion rate exceeding 20 mL hr, the caloric value of the propofol in combination with feeds can lead to significant OVERFEEDING.
Overfeeding is associated with hyperglycemia, fatty liver, hypertryglyceridemia, and excess CO2 production.
31
Which of the following items is appropriate for a Muslim diet?
a. sweet and sour pork
b. salad with imitation bacon bits
c. pork fried rice
d. chicken in wine sauce
b. salad with imitation bacon bits
Muslim-no pork, alcohol, coffee, tea
32
The medication megestrol acetate may be used to;
a. correct a vitamin A deficiency
b. increase appetite
c. initiate weight loss
d. promote sleep
b. increase appetite
Megestrol acetate (MGA), sold under the brand name Megace among others, is used mainly as an appetite stimulant to treat wasting syndromes such as cachexia. It is also used to treat breast cancer and endometrial cancer,
33
What may be lacking in the traditional diet for Asians living in America?
a. iron
b. calcium
c. folic acid
d. thiamin
b. calcium
Asians dont consume milk
34
Maple syrup urine disese and homocytinuria:
a. have non-dietary treatments
b. have protein as the nutrient of concern
c. require a fluid restriction
d. have carbohydrate as the nutrient of concern
b. have protein as the nutrient of concern
Maple syrup urine disease: have to restrict BCAA. Avoid eggs, meat, nuts, other dairy products
Homocytnuria: amino acid metabolism disorder. High methionine and homocysteine levels
35
A patient comes to you with a diet that you know is not good to follow. What should you do?
a. tell him its not good
b. explain why it is not good
c. tell him to only follow what you have provided
d. let him do as he wishes
b. explain why it is not good
36
Following a Roux-en-Y procedure, assess the need to supplement:
a. folate, vitamin B12, potassium, magnesium
b. no supplementation is needed
c. fat-soluble vitamins
d. potassium and magnesium
a. folate, vitamin B12, potassium, magnesium
Roux-en-Y= small gastric pouch connected directly to the jejunum. food bypasses the rest of the stomach and goes directly into the small intestine.
37
```
Retrovir (NRTI) can lead to low levels of:
a. vitamin B12, copper, zinc
b water-soluble vitamins
c. calcium and phosphorus
d. folate, pyridoxine, vitamin C
```
a. vitamin B12, copper, zinc
Retrovir= antiretroviral medicine. It is used with other medicines to treat HIV.
Drug can lead to anemia, loss of appetite, low Vitamin B12, copper, zinc and carnitine
38
Which guideline is used in planning meals for healthy people?
a. EAR
b. UL
c. AI
d. DRI
a. EAR
EAR= estimated average requirement
This is a measurement of the nutrient intake value estimated to meet the requirement for half the healthy individuals in a group.
DRI— Dietary reference intake: the general levels of nutrients needed for dietary consumption.
DRI includes recommended dietary allowance (RDA), adequate intake (AI), and tolerable upper intake level (UL).
39
Which of the following is true about SGOT:
a. it is increased with hepatitis and diabetes
b. it is increased with hepatitis, decreased with diabetes
c. it is decreased in both hepatitis and diabetes
d. it is decreased with hepatitis and increased with diabetes
b. it is increased with hepatitis, decreased with diabetes
The SGOT (serum glutamic-oxaloacetic transminase) test, also known as an AST test, measures the amount of a protein enzyme called glutamic-oxaloacetic transaminase occurring in your blood. This enzyme is normally found in the liver, heart muscles, muscles and red blood cells.
Type 2 diabetes and liver disease seem to have a connection; the liver is one of the targets of some common diabetic medications. The body needs the liver to help maintain normal glucose levels. But when the cells in the body become resistant to insulin, the liver produces more and more glucose and tends to get overworked, eventually no longer working properly. Insulin resistance that leads to liver dysfunction usually results in type 2 diabetes.
elevated levels of ALT and GGT and the lowest levels of AST/ALT are associated with a higher prevalence for type 2 diabetes and prediabetes.
40
What is the best way to increase attendance at a nutrition seminar for dentists?
a. hold it in a location convenient to large numbers of dentists
b. have it held in a medical facility
c. hold in on weekends when their offices are likely closed
d. have it sponsored by a dental organization
d. have it sponsored by a dental organization
41
After one year, which of the following would justify continuing a monthly hear-healthy eating class?
a. all of the participants attended at least 90% of the classes
b. other community members have inquired about joining thr program
c. physicians have begun referring their patients to the class
d. participants report decreased cholesterol levels
d. participants report decreased cholesterol levels
42
The dietitians analytical skills are needed most in which component of the NSI?
a. DETERMINE checklist
b. Level I
c. Level II
d. Level III
c. Level II
NSI= nutrition screening initiative (elderly)
Central to the initiative is a questionnaire designed to determine your nutritional risk, which is based on common warning signs of poor nutrition. The checklist, called DETERMINE= disease, eating poorly, tooth problems, economic issues, reduced social contact, multiple medicines, involuntary weight loss or gain, needs assistance and elderly above age 80.
Level II: Measures of height and weight, weight change and dietary habits plus additional lab values and anthropometric measures, Severity of Illness: albumin, cholesterol, Functional status, living environment, provision for more detailed physical examination and evaluation of depression and mental status.
43
What would you suggest to decrease fat intake for a Hispanic patient?
a. change from whole milk to 2% milk
b. change beans from refried to boiled
c. change to low fat yogurt
d. serve low fat cheese
b. change beans from refried to boiled
beans is staple. larger portion of diet that is high in fat
44
A patient receives 1800 ml of a 1 cal/cc formula with 44 grams protein per liter. How much protein will he receive?
a. 44
b. 79
c. 65
d. 88
b. 79
1800 ml x 44 gm pro/ 1000= 79.2 gm pro
45
Which tests measure somatic protein:
a. prealbumin, albumin
b. creatinine clearance, serum creatinine
c. serum transferrin
d. prealbumin, albumin, transferrin
b. creatinine clearance, serum creatinine
tests that measure somatic protein= AMA, serum creatinine, creatinine clearance, creatinine height index
tests that measure visceral protein=albumin, transferrin
46
Expected creatinine clearance is estimated from the clients:
a. weight and height
b. TSF, AMC
c. height
d. waist circumference
a. weight and height
urinary creatinine clearance
- measures GFR
- estimate includes body surface area (HEIGHT AND WEIGHT)
47
How much water does an athlete need if they have lost 2 pounds during a marathon?
a. 8 ounces
b. 16 ounces
c. 24 ounces
d. 32 ounces
d. 32 ounces
for each pound lost, drink 16 ounces of water
16 x 2= 32 ounces
48
Which vitamin will interfere with Levodopa?
a. pyridoxine
b. cyanocobalamin
c. thaimin
d. riboflavin
a. pyridoxine
Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Used to treat patients with Parkinsons disease.
49
Levodopa is used in the treatment of:
a. rheumatoid arthritis
b. Parkinsons disease
c. diabetic ketoacidosis
d. nephrotic syndrome
b. Parkinsons disease
Levodopa= helps in replacing the dopamine levels lost during the Parkinson’s disease among patients. Dopamine forms a chemical messenger formed in the human brain. Parkinson’s symptoms take place whenever there is reduction in the levels of dopamine.
50
Quickly stopping a 25% dextrose solution leads to:
a. hyperglycemia
b. hypoglycemia
c. hypophosphatemia
d. hyperkalemia
b. hypoglycemia
51
Infants born to mothers with diabetes may be:
a. larger than normal, and be hypoglycemia shortly after birth
b. smaller than normal and be hyperglycemic shortly after birth
c. larger than normal and be hyperglycemic shortly after birth
d. smaller than normal and be hypoglycemic shortly after birth
a. larger than normal, and be hypoglycemia shortly after birth
After birth, when maternal glucose disappears and the infant is on his own for making glucose, levels drop. The infant becomes hypoglycemic. Babies born to diabetic mothers may temporarily need extra glucose to keep their blood sugar levels high enough to supply energy to their brains.
52
What is the most important advice to give a patient with a peptic ulcer?
a. drink milk every 1-2 hours
b. consume small portions
c. eat everything in balance
d. abstain from spicy food
d. abstain from spicy food
53
A tube fed patient develops diarrhea. What needs to be done first?
a. review their nutritional needs
b. increase the rate of the feeding
c. review the osmolality of the feeding
d. discontinue the feeding until the diarrhea stops
c. review the osmolality of the feeding
Diarrhea in the tube fed patient has many causes. Typically, it is not the tube-feeding formula itself, as most are lactose-free and have lower osmolality. Diarrhea may be related to the infusion rate of the feeding (given too quickly for absorption). More common causes of tube feeding related diarrhea are related to medications.
54
Which nutrients would be most helpful when treating a patient with a progressive infection?
a. phosphorus and zinc
b. sodium and potassium
c. sodium and chromium
d. potassium and magnesium
a. phosphorus and zinc
Progressive infection= gets worse
Phosphorus is needed to properly synthesize, absorb and use vitamins and minerals from food – including B vitamins like riboflavin and niacin. Phosphorus is also very important for synthesizing amino acids, the building blocks of proteins, in order to help with cellular function, energy production, reproduction and growth.
Zinc helps fight infection and inflammation by boosting the body's immune response.
55
An outpatient would like to take vitamin C supplements. You should:
a. ignore the request and adivse her to drink more juices
b. ignore her request and talk about incorporating better balanced foods into her diet
c. explain the dangers of taking too much vitamin C
d. ask her to keep a food diary to see where she is lacking
d. ask her to keep a food diary to see where she is lacking
56
Why would you add bicarbonate to a solution for a person with hyperkalemia?
a. it forces magnesium out of the cell to attract potassium
b. it forces chloride out of the cell to attract potassium
c. it exchanges phosphorus for potassium
d. it exchanges hydrogen for potassium
d. it exchanges hydrogen for potassium
57
A patient on Levodopa should:
a. increase protein intake at breakfast
b. consume no more than 40 gm protein per day
c. evely divide protein intake througout the day
d. minimize protein at breakfast and lunch, and add it to dinner
d. minimize protein at breakfast and lunch, and add it to dinner
When food is taken with levodopa (L-dopa), protein in the food can interfere with absorption of this medicine into your bloodstream. Additionally, high blood levels of protein can interfere with transport of this medicine from your blood into your brain, where the medicine actually works.
58
?
a. essential fatty acid supplements
b. polyunsaturated fats
c. LCT
d. MCT
d. MCT
MCTs do not require pancreatic lipase
59
four patients are admitted to your service. Who would you address first?
a. patient who had a recent MI
b. patient with gastric distress
c. patient with cancer
d. patient admitted for an appendectomy
b. patient with gastric distress
60
Which of the following is an example of a secondary prevention program?
a. offer health risk appraisals with referrals as needed for follow up
b. bring fruits instead of sweet rolls to all weekly staff meetings
c. offer heart-healthy eating cooking classes at civic centers
d. set up walking programs during lunch breaks
a. offer health risk appraisals with referrals as needed for follow up
secondary prevention= recruiting those with elevated risk factors into treatment program (risk reduction)
61
When counseling a hypertensive patient with limited education, which would be the most appropriate question to ask in assessing her comprehension level?
a. do you enjoy salty foods
b. name a food that is high in sodium
c. do have difficulty swallowing or chewing
d. how many meals and snacks do you consume each day
b. name a food that is high in sodium
62
Based on the DRGs, Medicare reimbursement depends on:
I. length of patient stay
II. age of patient
III primary diagnosis
a. I
b. II, III
c. I, II
d. I, II, III
b. II, III
II. age of patient
III primary diagnosis
Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).
Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance).
63
A patient is diagnosed with iatrogenic malnutrition. Nutritional therapy should be:
a. high-calorie
b. high protein
c. high calorie, high protein
d. low calorie, high protein
c. high calorie, high protein
Iatrogenic malnutrition is a protein-calorie malnutrition brought on by treatments, medications and hospitalization.
64
Within 2-3 hours of continuous exercise at 60-80% of maximum:
a. muscle glycogen is depleted
b. muscle glycogen is the main energy source
c. amino acids begin to contribute a source of energy
d. fatty acids are the flavored substrates
a. muscle glycogen is depleted
If glycogen stores are not being replenished with carbohydrates from food or drinks, glycogen stores can run out. Once this occurs, the body will find alternative ways to create more glucose. This process is called GLUCONEOGENESIS, or the formation of glucose from new sources. The liver will begin to break down fat and protein to form glucose, which can then be used for energy.
After glycogen stores have been depleted and before gluconeogenesis kicks in, an athlete may experience symptoms of hypoglycemia, which occurs when blood glucose levels are low. During hypoglycemia, a person may feel extreme fatigue and a near complete loss of energy, often referred to as "bonking". When this occurs, it is not uncommon to see athletes collapse from the extreme fatigue. Dizziness and hallucinations may also occur under these conditions.
65
To maintain hydration during continuous endurance physical activity of 4 hours, consume:
a. fluids
b. fluids and sodium
c. fluids, sodium, carbohydrates
d. non-CHO electrolyte solutions
c. fluids, sodium, carbohydrates
66
To restore hydration after continuous endurance activity of 2 hours, consume:
a. fluid, carbohydrate, sodium
b. non-CHO electrolyte solutions
c. fluids
d. fluids and sodium
a. fluid, carbohydrate, sodium
67
The test that measures toxic levels of lead in the blood is the:
a. prothrombin test
b. free erythrocyte protoporphyrin test
c. hemoglobin value test
d. MCV
b. free erythrocyte protoporphyrin test
68
Nutrition intervention with Alzheimer's disease should include:
a. eating with TV on to provide stimulation
b. offer one food at a time, avoid distractions
c. encourage eating meals with others
d. several small meals and snacks throughout the day
b. offer one food at a time, avoid distractions
69
Anasarca is extreme generalized edema and swelling of the skin associated with:
a. uncontrolled diabetes
b. heart, liver or renal failure
c. short bowel syndrome
d. pancreatitis
b. heart, liver or renal failure
Anasarca is a medical condition in which the whole body swells up. This is due to accumulation of fluid in the extracellular space
Anasarca Causes
There are very many conditions that can lead to the above described pathophysiology and thus resulting in anasarca. The most common and important ones are given below.
Liver failure
Liver is an organ that produces many plasma proteins which helps in maintaining the oncotic pressure in blood vessels. When it fails, the proteins produced are less in amount and thus resulting in a decreased oncotic pressure.
Kidney failure
Kidney failure can lead to sodium and water retention and thus anasarca. Certain kidney diseases such as nephrotic syndrome can cause protein loss through the urine resulting in a decreased capillary oncotic pressure.
Congestive cardiac failure
The function of the heart is to pump blood. When it fails to pump effectively, the flow of blood slows down, resulting in the blood being held up in the veins before the right side of the heart. This means there is more blood in the veins of the limbs, abdomen and elsewhere. An increased hydrostatic pressure in the capillaries ensues.
Severe malnutrition
Protein-energy malnutrition results in low protein in the circulation and thus a decreased capillary oncotic pressure.
70
Glucophage (Metformin) functions by:
a. stimulating insulin secretion
b. inhibiting digestive enzyme action
c. decreasing peripheral resistance
d. enhancing insulin action
d. enhancing insulin action
Metformin suppresses hepatic glucose production, increase insulin uptake in muscles
71
Constipation in an infant would most likely be due to:
a. GI distress
b. lack of fruits
c. inadequate fluid intake
d. excessive formula
c. inadequate fluid intake
72
Which is not included in a subjective global assessment?
a. dietary intake information from a 24 hour recall
b. information from patient regarding weight changes
c. serum albumin levels
d. physical appearance
c. serum albumin levels
SGA=includes five components weight loss, food consumption, gastrointestinal symptoms, functional status, and physical examination information
73
the MNA and NSI screening tools are designed for use with:
a. individuals over 65 years
b. children ages 2-12
c. all adults
d. infants and children up to age 10
a. individuals over 65 years
```
NSI= Nutrition screening initiative (DETERMINE checklist)
MNA= mini nutritional assessment.screening and assessment tool validated for use in older adults age 65 and above who are malnourished or at risk of malnutrition . It’s able to classify older people as well nourished, at risk of malnutrition or malnourished.
```
74
The Health Risk Appraisal (HRA) calculates:
a. a population's general health status
b. the health status of individuals
c. the health status of an individual over the age of 65 living independently
d. the health status of an outpaitnet with chronic disease
a. a population's general health status
75
What We Eat In America (WWEIA):
a. conducts telephone interviews asking about eating behaviors
b. is the dietary intake component of NHANES
c. evaluates seven nutrients consumed by adults and households
d. identifies nutritional needs and the kind of intervention that is needed
b. is the dietary intake component of NHANES
WWEIA is aka National Food and Nutrition Survey (NFNS)
- 2 days of 24-hour dietary recall data with times of eating occassions and sources of foods eaten away from home
- USDA conducts over-sampling of adults >= 60, African Americans, Hispanics
76
Which of the following is an achieveable outcome for a weight loss program?
a. promote desirable body weight among young adults
b. increase by 25% the number of physicians who refer , patients for weight-managment counseling
c. screen and refer for treatment within two years those whose body weight is 10% above desireable
d. reduce by 10% the number of obese adults, ages 25-49, within two years of starting the program.
d. reduce by 10% the number of obese adults, ages 25-49, within two years of starting the program.
```
GOAL= gives a general statement of your program’s purpose
OBJECTIVES= are more concrete and specific in how the goal will be achieved.
OUTCOMES= should reflect what is the expected resulted at the end of your proposal’s project period.
```
For example, a community cancer wellness program targets cancer patients at risk for not receiving prescribed medical care due to lack of insurance or being underinsured.
Goal: The Cancer Wellness Foundation will assist 1,000 individuals in receiving prescribed medical treatment for their cancer diagnosis that otherwise lack access to care.
Objective: 300 cancer patients that cannot afford round-trip transportation to prescribed chemotherapy and radiation appointments will be issued gasoline vouchers.
Outcome: 95% of cancer patients participating in the transportation program will report receiving in all chemotherapy and radiation treatments as prescribed by their medical doctor.
77
If a child with cystic fibrosis has daily large, foul-smelling sttols you shoud first check their:
a. fecal fat
b. total fat intake
c. compliance with PERT
d. calorie intake
c. compliance with PERT
Cystic fibrosis patients need to take pancreatic enzyme replacement therapy (PERT) in order to prevent the symptoms of fat malabsorption. These symptoms include frequent pale, oily and offensive stools, abdominal pain, poor growth and deficiencies of fat soluble vitamins and essential fatty acids.
78
A patient with diabetes has not eaten for more than three days. You should:
a. liberalize the diet
b. provide multivitamin/mineral supplements
c. provide increased fluids
d. stay with her plan and encourage small frequent feedings
a. liberalize the diet
need CHO to regulate insulin.
79
Nursing can participate in which step of the Nutrition Care Process?
a. Assessment
b. Diagnosis
c. Intervention
d. Monitor and evaluation
a. Assessment
80
An increased intake of which of the following might be the cause of diarrhea without malabsorption in children?
a. sorbitol
b. fat
c. protein
d. fruit
a. sorbitol
Research suggests that beverages sweetened with sorbitol can cause diarrhea, more-so in children than in adults.
Sorbitol causes diarrhea for the same reason that it helps constipation: sorbitol is an osmotic laxative, which means that it draws water into the intestine and keeps the stool from drying out. A stool with more water is softer and easier to pass. For a constipated person, that’s a good thing.
81
A strict Muslim would not consume:
a. fruited gelatin,ham
b. dairy products
c. non-carbonated beverages
d. eggs, cheese
a. fruited gelatin,ham
no pork
82
With a CHO; insulin ratio of 16:1, how much insulin is needed with this meal?
2 ounces beef, 2/3 cup steamed brown rice, 1/2 cup cooked beets, 1 slice bread, 1 tsp butter, 1/2 cup vanilla ice cream
a. 7 units
b. 6 units
c. 5 units
d. 4 units
d. 4 units
```
2 ounces beef= 0 carbs
2/3 cup brown rice= 2 servings= 30 CHO
1/2 cup beets= 5 CHO
1 slice bread= 15 CHO
butter= 0 carbs
1/2 c vanilla ice cream= 1 starch, 1 fat= 15 CHO
```
65 CHO
65/ 16= 4
83
A diabetic needs 1800 calories, 50% from carbohydrates. How many CHO choices can he have at each meal if he has 2 snacks with 2 CHO choices each?
a. 2
b. 3
c. 4
d. 5
c. 4
1800 x .50= 900 cal/ 4= 225 gram
2 snacks with 2 CHO choices each= 30 gm x2= 60 gram
225- 60= 165/ 3 meals= 55 gram/15 gm=3.6 = 4 CHO choices at each of the 3 meals
84
A patient with inflammatory bowel disease has steatorrhea. In addition to limiting the fat intake, which minerals should be assessed?
a. iron and phosphorus
b. calcium and phosphorus
c. iron and zinc
d. calcium, magnesium and zinc
d. calcium, magnesium and zinc
energy needs according to current BMI, limit fat only if steatorrhea, water soluble and fat soluble vitamins; iron, folate. assess Ca, Mg, Zn, MCT oil
85
A patient presents with following lab values:
ALP 100 U/L, AST 30 U/L, ALT 35 U/L. This indicates:
a. hepatic encephalopathy
b. hepatitis
c. cirrhosis
d. normal liver function
d. normal liver function
All values are within normal limits
ALP=The normal range for serum ALP level is 20 to 140
ALP blood test measures blood alkaline phosphatase to detect liver and bone problems.
AST= The normal range of values for AST (SGOT) is about 5 to 40 units per liter
ALT=The normal range of values for ALT (SGPT) is about 7 to 56 units per liter of serum.
Elevated ALT and AST levels may indicate hepatitis A, B or C, heart failure or nonalcoholic fatty liver disease,
86
A patient on warfarin should avoid:
a. black cohosh, ginseng
b. thiamin supplements
c. simple carbohydrates
d. B vitamin supplements
a. black cohosh, ginseng
87
The best way for you to follow-up on a patients application of diet instruction provided is to:
a. ask him how he is doing with changes
b. evaluate his actual intake over time
c. ask him questions about different meal options
d. look for non-verbal cues to determine his progress
b. evaluate his actual intake over time
88
A family enrolled in the SNAP program is unsure of the best way to plan meals and budget. Refer them to:
a. congregate meal site
b. TANF
c. WIC
d. EFNEP
d. EFNEP
EFNEP=Expanded food and nutrtion education program
teaches skills needed to obtain a healthy diet (budget, meal planning, shop, cook)
89
When estimating the desirable body weight of a patient who has a below the knee amputation of his right leg, decrease the estimate by:
a. 6%
b. 8%
c. 12%
d. 16%
a. 6%
```
Amputations:
entire leg=16%
lower leg with foot= 6%
entire arm= 5%
forearm with hand= 2.3%
Equation:
100- %amputation)/ 100 x IBW
```
90
The oral-glucose lowering medication Glucotrol:
a. enhances insulin action
b. inhibits enzymes that digest carbohydrate
c. promotes insulin secretion
d. decreases glucagon production
c. promotes insulin secretion
Glucotrol= oral diabetes medicine that helps control blood sugar levels by helping your pancreas produce insulin. Glucotrol is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.
91
The immunosuppressant drug cyclosporine may cause:
a. hypokalemia and hypoglycemia
b. hyperlipidemia and hyperkalemia
c. hypermagnesemia
d. hyponatremia
b. hyperlipidemia and hyperkalemia
cyclosporine can effect the renin-angiotensin-aldosterone system and potassium excretion in renal transplant recipients. cyclosporine causes suppression of plasma renin activity and a tubular insensitivity to aldosterone, both of which may impair potassium excretion.
cyclosporine affects bile acid synthesis and worsens glucose tolerance, both factors that may promote hyperlipidemia.
The first therapeutic approach to hyperlipidemia in the transplant recipient is dietary calorie-fat restriction and supplementation with soluble fiber.
92
A patient with heart failure on a loop diuretic needs to have the status of which vitamin evaluated
a. pantothenic acid
b. niacin
c. riboflavin
d. thiamin
d. thiamin
Loop diuretics= used in the treatment of heart failure. In this condition, fluid accumulates in your body, due to the heart not pumping blood around the body as well as it normally would. So, you may become breathless (as fluid accumulates in the lungs) and your ankles and legs may swell with extra fluid in the tissues (oedema).
patients using diuretics have an increased urinary excretion of thiamine and thus are at a higher risk for developing thiamine deficiency.
93
In the TM model, which stage of change is represented by this comment: "Although I do not like and therefore do not eat many vegetables, I saw an interesting vegetable side dish at a friends cookout"
a. pre-contemplation
b. preparation
c. action
d. contemplation
d. contemplation
1. Pre-contemplation- UNAWARE or NOT INTERESTED in making a change
2. Contemplation- THINKING about making a change
3. Preparation- decides to change and PLANS the change
4. Action- TRIES to make the CHANGE
5. Maintenance- SUSTAINS THE CHANGE for 6 months or longer
94
Which stage of change is represented by this comment: " I asked for the recipe for the vegetable dish"
a. preparation
b. action
c. contemplation
d. pre-contemplation
a. preparation
preparation- decides to change and plans the change
95
Which stage of change is represented by this comment; " I served the vegetable dish to my family and surprisingly we all enjoyed it"
a. action
b. preparation
c. maintenance
d. contemplation
a. action
Action- TRIES to make the CHANGE
96
Which stage of change is represented by this comment: " Each week I prepare a vegetable dish found on a great website recommended by my friend"
a. preparation
b. contemplation
c. action
d. maintenance
d. maintenance
Maintenance- SUSTAINS THE CHANGE for 6 months or longer
97
Which may help to relieve the symptoms of hepatic encephalopathy?
a. increase AAA and decrease BCAA
b. decrease ammonia production
c. decrease AAA and increase BCAA
d. decrease AAA
c. decrease AAA and increase BCAA
```
AAA= aromatic amino acids (phenylalanine, tyrosine, tryptophan)
BCAA= branched chain amino acids (leucine, isoleucine, and valine
```
Altered neurotransmitter theory: BCAA decreases (used by muscles for energy); AAA increases because damaged liver is unable to clear them
Liver failure is associated with hepatic encephalopathy (HE). An imbalance in plasma levels of aromatic amino acids (AAA) phenylalanine, tyrosine, and tryptophan and branched-chain amino acids
98
You are planning a health promotion program for employees. To assess employees needs, use information from:
a. health-risk appraisals
b. nutrition assessments
c. medical records
d. interviews
a. health-risk appraisals
Health risk appraisal is a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease (Centers for Medicare and Medicaid)
99
A post-surgical patient experiences a drop in serum albumin. The reason is likely:
a. the patient has not consumed adequate nutrition for three days
b. decreased serum albumin levels are normal after catabolic stress
c. the laboratory may have read the results incorrectly
d. the patient has iatrogenic malnutrition
b. decreased serum albumin levels are normal after catabolic stress
albumin: 3.5-5.0 g/dl
hypoalbuminemia associated with edema, SURGERY
Infections, surgery, trauma or burns can lead to an increase in cytokine release and reduced albumin production. Decreased albumin synthesis, increased albumin breakdown, a redistribution of albumin in body fluids and greater losses of albumin can all contribute to lower serum levels with the stress response.
HIGH LEVELS ASSOCIATED WITH DEHYDRATION
100
Which of the following guidelines should be used when you are estimating the prevalence of inadequate intake levels of vitamin A within a group of adults?
a. recommended dietary allowance (RDA)
b. estimated average requirement (EAR)
c. tolerable upper intake level (UL)
d. adequate intake (AI)
b. estimated average requirement (EAR)
EAR= estimated average requirement
This is a measurement of the nutrient intake value estimated to meet the requirement for half the healthy individuals in a group.
101
To complete a subjective global assessment evaluate:
a. his lab values over the past 6 months
b. current body weight compared to ideal body weight
c. usual dietary intake using a food frequency questionannaire
d. the presence of edema and wasting or dehydration
d. the presence of edema and wasting or dehydration
SGA= history, intake, GI symptoms, functional capacity, physical appearance, edema, weight change
The subjective global assessment is a clinical method for nutritional assessment that considers not only body composition alterations but also changes in physiological function.
102
The primary focus of nutrition care for a man with hypertension and a BMI of 32 should be to:
a. decrease sodium intake
b. increase potassium intake
c. increase calcium intake
d. decrease body weight
d. decrease body weight
103
When screening pregnant women for gestational diabetes, the amount of oral glucose used is:
a. 25 grams
b. 40 grams
c. 50 grams
d. 100 grams
c. 50 grams
at 24-28 weeks of gestation, screen with 50 gm oral glucose load; glucose >= 140 mg/dl indicates need for further testing
104
An 80 year old female receives Meals on Wheels. What other nutrition assistance program would she qualify for?
a. CACFP
b. TEFAP
c. SFMNP
d. TANF
c. SFMNP
SFMNP= senior farmers market nutrtion program (>=60 yo)
EFNEP= expanded food and nutrition education program (teach skills)
TANF= temporary assistance for needy families
CACFP=Child and adult care food program (family and adult daycare centers-free or reduced price meals)
105
The absorption of calcium and iron is likely to be affected by the:
a. Billroth II procedure
b. ileostomy
c. cholecystectomy
d. Billroth I procedure
a. Billroth II procedure
Billroth II (gastrojejunostomy). when food bypasses the duodenum, then the secretion of SECRETIN and PANCREOZYMIN by the duodenum is REDUCED. These hormones are responsible for stimulating the pancreas, so now there lis lttle pancreatic section. As a result, calcium (absorption in duodenum) and iron absorption (requires acid) are adversely affected
106
Bitots spots indicate a deficiency of:
a. vitamin A
b. vitamin E
c. thiamin
d. niacin
a. vitamin A
fat-soluble vitamin (skin, vision)
yellow and orange F&Vs, dark leafy, fish, liver
M: 900 ug
F: 700 ug
107
To calculate the estimated caloric needs of a patient who is significantly underweight the dietitian should use:
a. that patients actual body weight
b. the patients adjusted body weight
c. the patients desirable body weight
d. 90% of the patients desireable body weight
a. that patients actual body weight
108
Skinfold thickness measurements are best for assessing:
a. an 18th month old with growth failure
b. a 36 year old athlete
c. a 54 year old woman with significant weight loss
d. an 82 year old man with Diabetes
b. a 36 year old athlete
Skinfold measurements are a more common method for assessing body composition in the fitness setting.
109
Which of the following lab values would likely indicate that dialysis is necessary?
serum creatinine BUN
a. 2.0 80
b. 3.0 90
c. 4.0 100
d. 6.0 70
serum creatinine BUN
d. 6.0 70
serum creatinine: 0.6-1.4
may indicate renal disease
Creatinine level more than 5, needs immediate dialysis treatment, as it signs towards the damage of other internal organs.
BUN: 10-20
indicator of renal disease
BUN: creatinine ratio normal: 10-15:1
110
Following a Roux-en-Y bypass, which should be be recommended first?
a. potassium, magnesium
b. folate, vitamin B12, iron
c. multi-vitamin with iron
d. calcium and multi-vitamin with iron
d. calcium and multi-vitamin with iron
pouch connecting directly to jejujnum
calcium iron, M/V. May require Vitamin B12
111
Which of the following medications is an appetite suppressant?
a. prednisone
b. dextroamphetamine
c. erythromycin
d. dronabinol
b. dextroamphetamine
dextroamphetamin (adderall)- appetite suppressant, anorexia, nausea, weight loss
Dextroamphetamine is a psychostimulant drug that is often prescribed to treat ADHD and narcolepsy but can be habit-forming and may cause addiction.
112
The drug methlyphenidate may have the adverse effect of:
a. increased excretion of folate requiring supplementation
b. type 2 diabetes
c. anorexia affecting growth
d. involuntary weight gain
c. anorexia affecting growth
methlyphenidate (Ritalin)- anorexia, wieght loss, nausea
Prescribed for treating attention deficit hyperactivity disorder (ADHD) and narcolepsy. However, it is not approved for use in children younger than six years old, and it is not approved for treating adult ADHD .
113
Hemodialysis requires supplementation of:
a. pyridoxine, folic acid, 1-25-dihydroxyvitamin D3
b. pyridoxine, folic and vitamin A
c. vitamin C, calcium, 25-hydroxyvitamin D3
d. vitamin C, calcium and vitamin A
a. pyridoxine (B6), folic acid, 1-25-dihydroxyvitamin D3 (B12)
supplements- vitamin C, B6, folate, B12
114
Which of the following directly assists the greatest number of people?
a. Supplemental Nutrition Assistance Program
b. National School Lunch Program
c. Child and Adult Care Program
d. Supplemental Nutrition Program for Women, Infants and Children
a. Supplemental Nutrition Assistance Program
115
Which program helps provide nutritious meals to an adolescent residential facility?
a. Supplemental Nutrition Assistance Program
b. National School Breakfast Program
c. Expanded Food and Nutrition Education Program
d. The Emergency Food Assistance Program
b. National School Breakfast Program
entitlement program
The School Breakfast Program (SBP) provides reimbursement to states to operate nonprofit breakfast programs in schools and RESIDENTIAL childcare institutions.
116
A primary use of the Dietary Reference Intakes is to:
a. calculate parenteral nutrition requirements
b. assess nutrient intakes of at-risk populations
c. plan menus for healthy people
d. educate an individual with hyperlipidemia
c. plan menus for healthy people
DRI— Dietary reference intake: the general levels of nutrients needed for dietary consumption.
DRI includes recommended dietary allowance (RDA), adequate intake (AI), and tolerable upper intake level (UL).
117
The full function of the gastrointestinal tract is utilized with which type of nutrition support?
a. an isotonic, polymeric formula delivered by a nasogastric tube
b. a BCAA formual delivered by a nasogastric tube
c. peripheral parenteral nutrition
d. parenteral nutrition
a. an isotonic, polymeric formula delivered by a nasogastric tube
118
A client who takes orlistat may need to:
a. use MCT as a supplement
b. take a multivitamin supplement
c. take an omega-3 fatty acid supplement
d. avoid caffeinated and carbonated beverages
b. take a multivitamin supplement
Orlistat= decreased fat absorrption by binding lipase; vitamin/ mineral supplement
Orlistat is a lipase inhibitor and works by preventing fats in food from being absorbed in the gut. Since many vitamins are fat soluble, they need to have fat to be absorbed. Examples are vitamins A, D, E, K and beta-carotene. So taking a daily multivitamin will help you get these essential nutrients.
119
Which program supports public and non-profit food service programs for homeless shelters?
a. CACFP
b. SFSP
c. SNAP
d. CSFP
a. CACFP
```
CACFP= child and adult care food program
CSFP= Commodity Supplemental Food Program provides supplementary USDA food packages to the low-income elderly of at least 60 years of age.
SFSP= summer food service program
```
120
A patient with diabetic gastroparesis should avoid foods that are:
a. high in simple sugars
b. high in fat
c. low in fiber
d. low in protein
b. high in fat
Diabetic gastroparesis is diagnosed by the presence of upper GI symptoms suggestive of delayed gastric emptying in patients with diabetes, exclusion of mechanical obstruction that could cause upper GI symptoms, and demonstration of delayed
gastric emptying.
strictly avoid meat with gristle, dried fruits and beans, caffeine, spicy dishes, popcorn, nuts, seeds, chocolate, oatmeal, oranges and broccoli, all of which are either high in fat or fiber, and difficult to digest.
121
Which would be the least expensive enteral nutrition formula?
a. elemental
b. chemically-defined
c. isotonic, intact protein, polymeric
d. modular
c. isotonic, intact protein, polymeric
122
Which is an example of an entitlement program run by the government?
a. EFNEP
b. SFMNP
c. SNAP
d. FNCS
c. SNAP
```
Entitlement programs:
NSLP
NSBP
SFSP
SNAP (largest)
```
123
How much protein is needed for a patient with a stage 3 burn?
a. 10-20% of total calories
b. 20-25% of total calories
c. 25-30% of total calories
d. 25-40% of total calories
b. 20-25% of total calories
Adults with a burn greater than 20% of TBSA likely to have significant hypermetabolism. They are unlikely to be able to meet their nutrition requirements orally.
High protein delivery of 1.5-3.0 g/kg ideal body weight/day or 20-25% of total energy is required for burn patients. Non-protein calorie to nitrogen ratio should be maintained between 150:1 and 100:1
124
A swallowing test has been ordered for a patient who holds food in his mouth for along time and is coughing. Which food can he have for dessert?
a. ice cream
b. smooth pudding
c. gelatin
d. bread pudding
b. smooth pudding
