Domain 2 part 4 Flashcards
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
c. evaluate the need to continue monitoring the indicator
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
c. a loss of protein in the urine
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
d. nutrition screening results
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
b. infant morbidity rate decreased
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
d. 10000 cc of D50W, 1000cc of 7% amino acids, 500 cc of 10% lipids
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
c. served on Ash Wednesday and Fridays during Lent
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
c. every 4 hours during the first 48 hours of feeding
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
c. patient with third degree burns
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?
c. What is the mixture of foods in combination of dishes?
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
d. less than 250 ml
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
d. full-strength enteral feeding at a low rate
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
b. macrocytic anemia from lack of folate or B12
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. evaluate weight gain and weight loss
food intake records could lack accuracy. Scale is more accurate and concrete measure of energy balance
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
c. same as those for hemodidalysis plus thiamin
Patients with cardiac cachexia on a loop diuretic should be evaluated for:
a. riboflavin status
b. acidosis
c. thaimin status
d. alkalosis
c. thaimin status
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. 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
A Hispanic women needs more calcium in her diet. What do you recommend?
a. milk
b. plantains
c. avocados
d. pinto beans
d. pinto beans
top sources of calcium besides dairy include seeds, beans, dark leafy greens, sardines, canned salmon, tofu
Which of the following would lacto-ovo-vegetarian not eat?
a. eggs
b. halibut
c. cheese
d. beans
b. halibut
Which provides the most vitamin A for a Mexican?
a. tortillas and refried beans
b. cantaloupe and squash
c. cheese
d. tortillas and milk
b. cantaloupe and squash
Vitamin A= yellow and orange fruits and vegetables, dark leafy greens, cantaloupe, fish, liver, fortified skim milk
Which snack would you not give to an infant?
a. yogurt
b. cheese sticks
c. graham crackers
d. grapes
d. grapes
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. 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
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. 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
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
b. low phenylalanine, high tyrosine
PKU= missing enzyme that converts phenylalanine into tyrosine.
tyrosine becomes a CONDITIONAL AMINO ACID
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
c. rehydration within 4-6 hours
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)
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
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
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.
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
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.
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
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,
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
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
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
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.
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
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).
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.
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
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
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.
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
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
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
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)
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
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.
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.
