domain 2 part2

Question 1

When conducting a physical assessment of a patient, which method is used to estimate fat stores?

a. inspection
b. palpation
c. pallor
d. auscultation

Answer 1

a. inspection

Question 2

Which statement applies to nutritional screening?

a. only a physician makes the referral
b. only a dietician makes the referral
c. it is exclusively done by nursing
d. all health team members can participate in the process

Answer 2

d. all health team members can participate in the process

Question 3

A sandwich with two pieces of white bread and two ounces of turkey provides how many calories?

a. 250
b. 145
c. 198
d. 290

Answer 3

a. 250

bread= 80 cal x 2= 160
2 ounces of turkey= 45 cal/oz x 2= 90

Question 4

Current research on the relationship between cancer and diet includes all of the following except

a. cancer is associated with the intake of vitamin A
b. it is related to demographic factors
c. it is related to epidemiologic data
d. it is associated with ascorbic acid

Answer 4

b. it is related to demographic factors

Question 5

Two liters of 5% dextrose solution provide how many calories?

a. 170
b. 340
c. 212
d. 195

Answer 5

b. 340

1L= 1000 ml
2000 ml x .05= 100
100 x 3.4 cal/ml= 340 calories

Question 6

When instructing a patient on diet therapy needed during intake of a monoamine oxidase inhibitor, which would not be included?

a. milk, cottage cheese, yogurt
b. yogurt, ricotta cheese
c. swiss cheese, yogurt
d. cheddar cheese, swiss cheese

Answer 6

d. cheddar cheese, swiss cheese

Certain foods and drinks can cause dangerous reactions if they’re taken with an MAOI (anti-depressant drug). AOVID foods that contain high levels of TYRAMINE, DOPAMINE, and TRYPTOPHAN.

Some restricted foods may include: aged, fermented, dried, pickled, and smoked foods. Avoid hard aged cheese (CHEDDAR, SWISS), sauerkraut, sausages, luncheon meats, tofu, miso, chianti wine

OK foods- cottage cheese and cream cheese

Question 7

Catecholamines have what physiological effect?

a. induce diuresis
b. cause hypoglycemia
c. cause sodium retention
d. cause potassium retention

Answer 7

c. cause sodium retention

catecholamines (dopamine, epinephrine, and norepinephrine), play an important role in the body’s physiological response to stress (fight or flight response)- increase heart rate, blood pressure and blood glucose levels (activate sympathetic nervous system)

The immediate effects of catecholamines include: increasing your cardiac output, sending more blood flow to your skeletal muscles, RETAINING SODIUM, slowing down the intestines, constricting the blood vessels in the skin, increasing glucose in your bloodstream, opening up your lungs, and making you feel excited.

The renin–angiotensin system (RAS), or renin–angiotensin–aldosterone system (RAAS), is a hormone system that regulates blood pressure and fluid and electrolyte balance, as well as systemic vascular resistance.
Angiotensin II is a potent vasoconstrictive peptide that causes blood vessels to narrow, resulting in increased blood pressure.[5] Angiotensin II also stimulates the secretion of the hormone aldosterone[5] from the adrenal cortex. Aldosterone causes the renal tubules to increase the reabsorption of sodium and water into the blood, while at the same time causing the excretion of potassium (to maintain electrolyte balance). This increases the volume of extracellular fluid in the body, which also increases blood pressure.

Question 8

A patient with dehydration exhibits the symptoms of:

a. high blood pressure, dizziness
b. sunken eyes, decreased renal function, increased tachycardia
c. decreased BUN, decreased serum creatinine
d. low blood pressure, low serum sodium

Answer 8

b. sunken eyes, decreased renal function, increased tachycardia

prolonged dehydration is associated with low blood pressure, rapid heart (tachycardia) and breathing rates.

Question 9

Why would a man who eats very little protein have an albumin of 5.5 g/dl

a. carbohydrate keeps albumin levels elevated
b. he is dehydrated
c. serum albumin falls quickly with protein deprivation
d. it is a sign of protein malnutrition

Answer 9

b. he is dehydrated

Albumin: 3.5-5.0
Without enough protein, your albumin levels may drop, however, the man’s albumin level increased therefore associated with dehydration

hyperalbuminemia likely due to dehydration
hypoalbuminemia associated with edema, surgery

Question 10

The diet for stomatitis is

a. low fat, high carbohydrate, normal protein
b. avoid spices, very hot, very cold, sour, tart foods
c. high protein, high carbohydrate
d. liquids, mostly carbohydrates

Answer 10

b. avoid spices, very hot, very cold, sour, tart foods

Stomatitis, a general term for an inflamed and sore mouth, can disrupt a person’s ability to eat, talk, and sleep. Stomatitis can occur anywhere in the mouth, including the inside of the cheeks, gums, tongue, lips, and palate.

Question 11

The BMI for a woman who is 5’7” tall and weighs 148 lbs. indicates:

a. underweight
b. normal weight
c. overweight
d. obese

Answer 11

b. normal weight

BMI calculation: weight in lbs divided by height in inches squared x 703

BMI= 23(normal weight range is 18.5-24.99)

Question 12

Which of the following is not a guideline for Medicaid?
I. low income
II. over the age of 60 only
III. nutritional needs

a. I
b. II, III
c. II
d. III

Answer 12

b. II, III
II. over the age of 60 only
III. nutritional needs

Medicaid= DHHS. federal law. payment for medical care for all eligible needy: ALL ages, blind, disabled, dependent children

Question 13

Which survey is repated every few years

a. NHANES
b. WHO
c. Ten State
d. FAO

Answer 13

a. NHANES

ongoing survey to obtain info on health of American people. Evaluates clinical, chemical (Hgb, Hct, cholesterol), anthropometric nutritional data

Question 14

The Healthy People 2020 Goals are an outgrowth of a report by:

a. ADA
b. the Surgeon General, under HHS
c. WHO
d. FAO

Answer 14

b. the Surgeon General, under HHS

Question 15

An example of a “Healthy People 2020” goal is:

a. a decrease in saturated fat consumption
b. an increase in iron intake
c. promote healthy behaviors across every stage of life
d. an increase in the intake of complex carbohydrates

Answer 15

c. promote healthy behaviors across every stage of life

GOALS is different From OBJECTIVES
the overarching goals are to attain high quaility, longer lives free of preventable disease, disability, injury, premature death, achieve health equity etc

Question 16

When a starved patient begins to eat, they might expect:

a. constipation
b. an increased workload on the heart
c. lethargy
d. diarrhea

Answer 16

b. an increased workload on the heart (REFEEDING SYNDROME, MAIN SIGN IS HYPOPHOSPHATEMIA)

Refeeding syndrome describes a series of metabolic events that occur by reintroducing nutrition to patients who are underweight, starved or severely malnourished. When these types of patients begin to be fed again, primarily with carbohydrates, the result is electrolyte disturbances such as a rapid fall in phosphate, magnesium and potassium levels.

Another big concern is fluid retention and micronutrient deficiencies such as thiamine and folic acid. Thiamine is important for carbohydrate metabolism. It is a water sol-uble vitamin, and total body stores can quickly become depleted with weight loss and malnutrition. If refeeding syndrome is severe, it may result in pulmonary failure, cardiac failure, hypotension, arrhythmias, seizures, neu-romuscular dysfunction and neurologic complications

A main sign of refeeding syndrome is that patients develop hypophosphatemia. Phosphate is necessary for the accrual of lean tissue mass and a vital component of the metabolic pathway. When one starts to eat again, the reintroduction of carbohydrates causes a sudden shift from fat and protein back to carbohydrate metabolism, and secretion of insulin increases, causing circulating insulin levels to increase. This stimulates uptake of phosphate into the cells that results in hypophosphatemia.

Question 17

Which of the following would be classified as NB in the NCP?

a. hypermetabolism
b. inadequate enteral intake
c. impaired ability to prepare foods
d. excessive protein intake

Answer 17

c. impaired ability to prepare foods

NB- NCP code related to nutrition behavior problems

BEHAVIORAL- ENVIRONMENTAL NB Defined as “nutritional findings/problems identified as related to knowledge, attitudes/beliefs, physical environment, or food supply and safety”

Question 18

The immediate post-stress release of glucagon:

a. increased glucose uptake into cells
b. increased glucose release into the bloodstream
c. increases insulin release
d. increased fluid and sodium excretion

Answer 18

b. increased glucose release into the bloodstream

Question 19

Which of the following is the appropriate diet for peritoneal dialysis?

a. .8 grams protein, 35 cals/kg
b. 2.0 grams protein, 30 cals/kg
c. 1.3 grams protein, 35 cals/kg
d. 1.0 grams protein, 35 cals/kg

Answer 19

c. 1.3 grams protein, 35 cals/kg

PD:
1.2-1.3 gm pro/kg SBW or adjusted BW; >=50% HBV
< 60 years old; 35 cal/kg (including dialysate)
>= 60 years od; 30-35 cal/kg
2-3 gm sodium based on blood pressure and weight
potassium generally unrestricted (usually 2-4 gm)
<= 2000 mg total elemental calcium including diet and binders
800-1000 mg phosphorus or 10-15 mg phosphorus/gm protein
1-3 L fluid depending on output, cardiac status
CAPD- continuous ambulatory peritoneal dialysis 4-5x/day
VM as for hemodialysis except thiamin (may need extra due to loss)

Question 20

which program provides food to needy individuals and families?

a. food banks
b. SNAP
c. CACFP
d. WIC

Answer 20

a. food banks

all provide food to needy. others have qualifications that need to be met to receive
SNAP-low income
CACFP (child and adult care food program) low income family day care, neighboorhoods, homeless shelters, adult day care
WIC- mothers and infants and children up to 5

Question 21

Which formual is high in protein, low in potassium and phosphorus?

a. Nepro
b. Osmolite
c. Sustacal
d. Jevity

Answer 21

a. Nepro

for kidney patients

Question 22

What is the goal of the Dietary Guidelines?

a. prevention of chronic disease
b. provide standards for SNAP allocation
c. provide standards for WIC
d. provide standards for EFNEP

Answer 22

a. prevention of chronic disease

Question 23

If an IDDM tells you she eats meals on an irregular schedule, and often misses meals, you should:

a. obtain more information about her usual eating habits
b. explain that insulin therapy is related to intake
c. do nothing if blood sugar levels are okay
d. ask her to complet a detailed food record

Answer 23

b. explain that insulin therapy is related to intake

The treatment for IDDM is daily insulin, administered either by an injection, pump or inhaler.

Question 24

The allowance for SNAP is based on:

a. the average cost of food used by a family of the same size
b. the USDA Thrifty Food Program
c. data from the Congregate Meal Program
d. the cost of the MyPlate components

Answer 24

b. the USDA Thrifty Food Program

Question 25

A single man with two daughters, ages 10 and 11 is looking for aid. Which program might provide assistance? a. WIC b. Food stamps c. Child Care Food Program d. Headstart

Answer 25

b. Food stamps

Question 26

Why is an affluent couple (the man with diabetes, 67 years old, and the wife with a broken arm, 50 years of age) not eligible for Meals on Wheels? a. she is too young b. they are affluent c. this program does not cater to special diets d. they can leave the house

Answer 26

d. they can leave the house In order to qualify for the meals on wheels food delivery program, seniors must be at least 60 years of age, be home bound or have a disability that limits mobility outside the home. Meals on wheels offers funded and paid meal service. Low-income seniors living in urban or rural areas, and seniors facing the prospect of living in a senior care facility, can apply for government-funded meals through local assistance programs.

Question 27

Which is permitted on a diet which excludes gluten? a. rye b. corn c. barley d. wheat bread

Answer 27

b. corn celiac disease need to be on gluten-free diet. NO wheat, rye, oats (if harvested by wheat), barley, buckwheat, bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents OK FOODS; corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax

Question 28

Nutritional advice to a parent with a child with autism spectrum disorder should include: a. oral supplements between meals b. high sodium, high fiber foods c. normal intake based on age d. low fiber, high calories

Answer 28

c. normal intake based on age

Question 29

Where can a pregnant teen learn to cook? a. EFNEP b. Child Nutrition Services c. UNICEF d. WIC

Answer 29

a. EFNEP EFNEP=Expanded food and nutrition education program USDA provides grants to universities that assist in community development trains nutrition aids to educate the public improves food practices of low income homemakers with young children works with small groups; TEACHES SKILLS needed to obtain a healthy diet (HOW TO BUDGET, MEAL PLANNING, SHOP, COOK)

Question 30

``` Which of the following tube feeding ingredients might precipitate an allergic reaction in a child with a milk allergry? a. hydrolyzed maltodextrin b. modified starch c. casein d carrageenan ```

Answer 30

c. casein Lactose intolerance, which is an intolerance to the sugar found in milk, is one of the most common food intolerances, but an intolerance to casein can sometimes cause similar symptoms. CASEIN is one of the main proteins found in milk and some dairy products. there are two types of proteins in milk: casein and whey. Casein protein is slower-digesting than whey, and they both have all nine essential amino acids.

Question 31

How can you enhance useage of commodity foods from a food donation program? a. teach food donation staff how to use the items b. make a poster on usage c. give each participant recipes using the food items d. calculate the amounts of nutrients provided in the donated foods

Answer 31

c. give each participant recipes using the food items

Question 32

a poor, healthy 19 year old mother is unsure how to feed her 4 year old child. Which program may offer her the most help? a. EFNEP b. WIC c. HHS d. CACFP

Answer 32

a. EFNEP Expanded food and nutrition education program teaches, helps improve food practices of low income homemakeers with young children (budget, meal planning, shop, cook)

Question 33

An athlete weighs more than the average person of his height. What should you do first? a. put him on a slow weight reduction diet b. examine other anthropmetric measurements c. have him incrase his exercise d. suggest he drink more water

Answer 33

b. examine other anthropmetric measurements could be he just has more muscle. need full assessment before making any recommendations or conclusions

Question 34

Which of the following affects bioelectrical impedance analysis? a. adipose stores b. muscle mass c. water d. protein stores

Answer 34

BIA- used to evaluate fat free mass and total body water. must be well hydrated, no caffein,e alcohol or diuretics in the past 24 hours, no exercise in the past 4-6 hours. fever, electrolyte imbalance and extreme obesity may affect reliability.

Question 35

Which is the most appropriate bedtime snack for a diabetic on NPH insulin? a. apple juice and crackers b. graham crackers and diet soda c. fresh fruit and crackers d. cheese and crackers

Answer 35

d. cheese and crackers snack= 30 gm CHO (pro.cho, fat) NPH insulin, is an intermediate–acting insulin (Humulin N, Novolin N, ReliOn) given to help control blood sugar levels in people with diabetes. 1. onset= 2-4 hours, duration=10-16 hours, cloudy in appearance

Question 36

What can be done to lower the respiratory quotient of a tube fed pulmonary patient? a. add MCT oil to decrease energy required for growth b. change the type of fat to improve oxyen exchange c. add carbodhydrate to decrease the respiratory quotient d. add a fat emulsion to replace some of the carbohydrate

Answer 36

d. add a fat emulsion to replace some of the carbohydrate pulmonary patient has difficulty breathing. low oxygen levels and this leads to marked shortness of breath. Definition of Respiratory Quotient: It is the ratio of the volume of CO2 produced by the volume of O2 consumed (i.e., CO2/O2) during a given time. R.Q. acts as a guide as to the type of food burning or the nature of synthesis taking place in the whole body as well as in a particular organ. Respiratory quotient. A value of 0.7 indicates that lipids are being metabolized, 0.8 for proteins, and 1.0 for carbohydrates. The approximate respiratory quotient of a mixed diet is 0.8. Some of the other factors that may affect the respiratory quotient are energy balance, circulating insulin, and insulin sensitivity. Acidosis: RQ increases Alkalosis: RQ decreases Diabetes: RQ decreases. with insulin-RQ increases

Question 37

Which coorelates best with energy intake? a. lean body mass b. triceps skinfold c. body mass index d. body weight

Answer 37

d. body weight

Question 38

Which of the following most affects osmolarity? a. protein b. sugar c. electrolytes d. fat

Answer 38

c. electrolytes electrolytes play a principle role in water distribution and total water content Extreme variation in osmolarity causes cells to shrink or swell, damaging or destroying cellular structure and disrupting normal cellular function.

Question 39

Which fiber is insoluble in water? a. pectin b. gums c. hemicellulose d. polysaccharides

Answer 39

c. hemicellulose Insoluble fiber, found in wholegrains and green beans, helps prevent constipation. Insoluble fiber doesn’t dissolve in water. It includes PLANT CELLULOSE and HEMICELLULOSE. Most plants contain both soluble and insoluble fiber, but in different amounts. Insoluble fiber is found in foods such as wheat bran, vegetables, and whole grains. It adds bulk to the stool and appears to help food pass more quickly through the stomach and intestines. Soluble fiber dissolves in water and helps reduce cholesterol. It is found in apples and citrus fruits.

Question 40

An infant wants a bottle at bedtime. You should counsel the parents to: a. give the bottle only at bedtime b. give the bottle only if the baby insists c. only give milk in the bottle d. only give water in the bottle

Answer 40

d. only give water in the bottle milk=carbohydrates=dental caries

Question 41

A diabetic wants to exchange his bedtime snack of 8 ounces whole milk. What do you suggest? a. 1 oz cheese and 1/2 cup orange juice b. 2 graham crackers and 1/2 cup orange juice c. 1 ounce cheese d. 2 ounces cheese

Answer 41

a. 1 oz cheese and 1/2 cup orange juice

Question 42

Which of the following may result in hypoalbuminemia? a. amino acid supplementation prior to surgery b. a high protein diet with inadequate water c. providing only a 5% dextrose in water solution after stress d. giving a trauma patient enteral feeding only

Answer 42

c. providing only a 5% dextrose in water solution after stress In parental nutrition the energy requirements are 30-35 calories/kg; up to 70% dextrose solution. Only 5% solution would be underfeeding patient and could result in hypoalbuminemia. Dextrose 5% in water is used to treat low blood sugar (hypoglycemia), insulin shock, or dehydration (fluid loss). Dextrose 5% in water is also given for nutritional support to patients who are unable to eat because of illness, injury, or other medical condition. hypoalbuminemia= edema, surgery

Question 43

A mother with 2 daughters, ages 8 and 11, does not earn enough money to feed her family. Which program would you suggest? a. WIC b. SNAP c. Child and Adult Care Food Program d. Medicaid

Answer 43

b. SNAP

Question 44

Which drink would a Mormon choose? a. cola b. 7-up c. tea d. coffee

Answer 44

b. 7-up Mormons: caffeine free soda drinks ok no caffeine, alcohol

Question 45

What section of the intestine is most likely to be involved in Crohns disease? a. ileum b. jejunum c. duodenum d. appendix

Answer 45

a. ileum Crohns (IBD); affects the terminal ileum

Question 46

Which of the following would be classified as NC in the NCP? a. inadequate vitamin intake b. limited access to food c. swallowing difficulty d. inappropriate intake of food fats

Answer 46

c. swallowing difficulty (functional) CLINICAL NC Defined as “nutritional findings/problems identified as related to medical or physical conditions could be related to functional difficulties (swallowing, chewing), biochemical (utilization), weight

Question 47

An infants failure to thrive can be seen in: a. their behavior b. comparison with growth charts c. weight for height d. height for age

Answer 47

b. comparison with growth charts Symptoms of failure to thrive( FTT) include: Height, weight, and head circumference do not match standard growth charts Weight is lower than third percentile of standard growth charts or 20% below the ideal weight for their height . FTT may result from acute or chronic illness, restricted diet, poor appetite, lack of fiber leading to chronic constipation, diminished intake

Question 48

Which of the following can be offered to a patient when his diet prescription is moved from NDD level 3 to level 2? a. soft pancake b. bread pudding c. rice pudding d. saltine crackers

Answer 48

a. soft pancake NDD level 2 (mild to moderate) moist, soft-textured, easily formed into a bolus; moist, tender ground or diced meats soft cooked vegetables, soft or canned fruits. Soft pancake ok. NO bread, rice, cheese cubes.

Question 49

A pork chop is which type of protein exchange? a. high fat protein b. mediium fat protein c. medium fat protein plus one fat exchange d. lean protein

Answer 49

d. lean protein

Question 50

What should most be encouraged in a Headstart program? a. nutrition activities related to food b. participation for at least one year c. class instructions d. healthy snacks

Answer 50

a. nutrition activities related to food Headstart (USDHHS) helps low income children; ages 3 through 5 introduces new foods, teaches good food habits childs participation in food activities is important

Question 51

Medicaide benefits apply to: a. healthy adults b. a 60 year old female c. those at nutritional risk d. low income individuals

Answer 51

d. low income individuals all ages, blind, disabled, dependent children

Question 52

The symbol U on a food label indicates a. it is treated with ultraviolet light b. is treated with radiation c. vitamin retention has been retained during processing d. it is a Kosher designation

Answer 52

d. it is a Kosher designation

Question 53

Congregate meals and home delivered meals fall under: a. WIC b. EFNEP c. Older Americans Act Nutrition Program Title III d. Medicare

Answer 53

c. Older Americans Act Nutrition Program Title III OOA- 1 hot meal each day, 5 days/wk, provide 1/3 recommended intake eligibility: 60 and older plus spouse regardless of income Congregate meals- ambulatory; Meals on Wheels- must be homebound

Question 54

Which is most characteristic of marasmus? a. serum albumin of 2.5 g/dl b. edema c. severe fat and muscle wasting d. decreased lymphocytes

Answer 54

c. severe fat and muscle wasting a form of protein-calorie malnutrition occurring chiefly in the first year of life, with growth retardation and wasting of subcutaneous fat and muscle, but usually with retention of appetite and mental alertness.

Question 55

The stasis of pancreatic juice and bile could result in: I. autodigestion II fat malabsorption III obstructive jaundice a. I and II b. I and III c. II and III d. I, II, and III

Answer 55

d. I, II, and III

Question 56

A side effect of antidepressants is: a. chronic diarrhea b. muscle wasting c. excess weight gain d. nausea and vomiting

Answer 56

c. excess weight gain

Question 57

Which would you recommend to a Mexican American on a low fat diet? a. low fat cottage cheese b. skim milk c. beans and rice d. low fat yogurt

Answer 57

c. beans and rice

Question 58

Hypertension will decrease with a decrease in: a. fiber b. alcohol c. potassium d. calcium

Answer 58

b. alcohol

Question 59

What medication is affected by serum sodium levels? a. lithium carbonate b. Mellaril c. Valproate d. Tetracycline

Answer 59

a. lithium carbonate Lithium- used to treat the manic episodes of bipolar depression. Symptoms of mania include hyperactivity, aggression, anger and poor judgment, as well as a reduced need for sleep. Lithium affects the way that sodium chloride (salt) moves in and out of the body's cells. Since sodium also affects how water moves in the body, salt and fluid intake is important for people who take lithium. You must drink enough to prevent dehydration and consume the same amount of salt each day.

Question 60

A child has been measured several times before the age of two years. Results of the measurements were not accurate because the child was measured: a. first thing in the morning b. standing up c. after breakfast d. with light clothing

Answer 60

b. standing up measure standing up AT 2 years, not before

Question 61

Which of the following is not a governmental agency? a. Health and Human Services b. Food and Drug Administration c. Food and Nutrition Board d. American Heart Association

Answer 61

d. American Heart Association

Question 62

Low levels of folate, pyridoxine and cyanocobalamin are associated with; a. glycogen storage disease b. homocystinuria c. phenylketonuria d. galactosemia

Answer 62

b. homocystinuria Homocystinurias- inherited disorder of amino acid metabolism characterized by severe elevations of methionin and homycysteie in plasma, and excessive excretion of homocysteien in urine. associated with low levels of folate, B6 (pyridoxine), B12

Question 63

A patient with low hemoglobin and low MCV might have: a. microcytic anemia b. macrocytic anemia c. megaloblastic anemia d. normochromic anemia

Answer 63

a. microcytic anemia Microcytic anemia is a condition in which the body's tissues and organs do not get enough oxygen. This lack of oxygen can happen because the body does not have enough red blood cells, or because the red blood cells do not contain enough hemoglobin, which is a protein that transports oxygen in the blood. When there is a lack of hemoglobin in a red blood cell, the cell is smaller in size and can carry less oxygen.

Question 64

According to the Food Lists for Diabetes Exchanges, 2 Tbsp peanut butter is equivalent to; a. 2 high fat protein b. 1 high fat protein c. 2 fats d. 1 high fat protein plus 2 fats

Answer 64

a. 2 high fat protein 1 Tbsp peanut butter is a serving of high fat protein Equiv: 7 grams of protein, 8 grams fat, 100 calories

Question 65

Which of the following has the fewest calories? a. plain hamburger on a bun b. chefs salad with dressing c. green salad with thousand island dressing, and shredded cheese d. fried fish sandwich

Answer 65

a. plain hamburger on a bun 80 cal bun meat 75-100 calories for 1 ounce

Question 66

Which of the following indicated protein calorie malnutrition? a. creatinine height index of 93% b. height for weight ratio of 89% c. triceps skinfold and arm muscle circumference of 79% d. serum albumin of 4.5; transferrin of 410

Answer 66

c. triceps skinfold and arm muscle circumference of 79% triceps skinfold and arm muscle circumference measure fat reserves and skeletal muscle mass

Question 67

A child with AIDS needs a high calorie and ________ intake. a. megadose vitamins b. high protein c. low fat d. low residue

Answer 67

b. high protein high protein, high calorie with supplements needed for weight gain. energy needs: general guidelines plus appropriate stress factors

Question 68

An appropriate measurement for iron status in a local community is: a. serum iron b. transferrin c. TIBC d. hematocrit

Answer 68

d. hematocrit Hct: Men 42-52%; women 37-47%; pregnant 33%, newbord 44-64% Hematocrit is the percentage of red blood cells in the total blood volume. Red blood cells are vital to your health. Imagine them as the subway system of your blood. They transport oxygen and nutrients to various locations in your body. A low hematocrit with a low mean corpuscular volume (MCV) with a high RDW suggests a chronic iron-deficient anemia

Question 69

Which of the following may help decrease cavities? a. raisins b. carrots c. cheese d. yogurt

Answer 69

c. cheese Cheese may help reduce cavities forming in teeth because it neutralises plaque acid,

Question 70

Which test helps you determine if a diabetic has been following his diet? a. blood glucose b. urine ketones c. glycosylated hemoglobin d. urine sugar

Answer 70

c. glycosylated hemoglobin measures % of hemoglobin that has glucose attached. normal < 5.7%; over 65 years <7% in healhty, <=8% in frail elderly. It is a measure of long term blood glucose control (60-90 days) Goal for diabetecs is <7%

Question 71

You discover an incorrect diet order entered in the patients chart. a. chart the orders an incorrect b. file the order becaue it was written by a physician c. discuss the order with the physiciain and make suggestions d. change the order in the chart

Answer 71

c. discuss the order with the physiciain and make suggestions

Question 72

What is the best therapy for weight loss? a. reducing 500 calories per day and exercise b. support groups, excercise and diet control c. exercise, diet, behavior modification d. exercise and diet control

Answer 72

c. exercise, diet, behavior modification

Question 73

Which is most associated with incidence of Type 2 diabetes? a. sugar intake b. protein intake c. overweight d. salt intake

Answer 73

c. overweight

Question 74

According to the ADA exchange lists, what is the nutrient content of the following: 1 cup rasberries, 1/2 cup cereal, 1 cup 1% milk, 1 tsp margarine, black coffee, 1 slice toast, 1 egg calories protein CHO fat a. 397 12 61 6.5 b. 346 12 52 9 c. 365 21 57 14 d. 327 13 58 10

Answer 74

calories protein CHO fat c. 365 21 57 14 1 cup rasberries 15 gm CHO 60 calories 1/2 cup cereal 15 gm CHO 3 gm pro 80 cal 1 cup 1% milk 12 gm CHO 8 gm Pro 90 cal 1 tsp margarine 5 gm fat 45 cal black coffee free food 1 slice toast 15 gm CHO 3 gm Pro 80 calories 1 egg (med fat) 7 gm Pro 5 gm fat 75 calories

Question 75

St Johns Wort has which effect on Coumadin? a. decreases drug metabolism and decreases its effect b. increases drug metabolism and decreased its effect c. decreases drug metabolism and increases its effect d. increases drg metabolism and increases its effect

Answer 75

b. increases drug metabolism and decreased its effect Drug metabolism is the chemical alteration of a drug by the body. Some drugs are chemically altered by the body (metabolized).

Question 76

Which bacteria may cause gastric ulcers? a. salmonella b. streptococcus aureus c. helicobacter pylori d. clostridium perfringens

Answer 76

c. helicobacter pylori

Question 77

The appropriate diet therapy following a Billroth II is: a. high carbohydrate, low fat, high protein b. high fat, high protein, high carbohydrate c. decrease simple carbohydrates, high protein, moderate fat, B12 supplements d. low fat, low protein, high carbohydrate

Answer 77

c. decrease simple carbohydrates, high protein, moderate fat, B12 supplements Billroth II: (gastrojejunosotmy) When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. Affects calcium and iron absorption, B12 deficiency (lack of IF), folate deficiency (needs B12 for transport inside the cell)

Question 78

Which of the following diseases may lead to anemia? a. myocardial infarction b. galactosemia c. renal failure d. diabetes mellitus

Answer 78

c. renal failure anemia due to decreased production of erythropoietin upset in blood pressure decreased activation of vitamin D (kidney produces active form which promotes efficient absorption of calcium by the gut)

Question 79

To learn about prenatal problems in the community, go to: a. Center for Disease Control b. WIC c. NHANES d. FDA

Answer 79

b. WIC WIC- for pregnant, postpartum, breast-feeding women; infants and children up to 5

Question 80

Which best applies to nutritional screening? a. HIPPA standards must be followed b. It should include nutritional parameters c. It is done after nutritional problems are identified d. It is only done on at risk patients

Answer 80

b. It should include nutritional parameters For screening to be effective, the mechanism must be accurate based on: specificity ( can it ID patients without a condition), sensitivity ( can it ID thoses who have the condition) Joint Commision- nutrition risk identified in hospitalized patients within 24 hr of admission, does not mandate method of screening

Question 81

After a gastrectomy, the diet order should indicate a decrease in: a. disaccharides b. fats c. protein d. complex carbohydrates

Answer 81

a. disaccharides Disaccharides are a simple-sugar form of carbohydrate Disaccharides are non-essential nutrients, which means they are not necessary for health or life of human beings.

Question 82

? a. 60 minutes every day b. 30 minutes every day c. 60 minutes at least 3 days each week d. 90 minutes at least 3 days each week

Answer 82

a. 60 minutes every day

Question 83

Which of the following provides 45 gm of CHO? a. one cup pasta b. one cup black beans c. 1 - 1/2 cup blueberries d. 2 small tortillas

Answer 83

b. one cup black beans ``` All one servings = 15 gm CHO 1/2 cup pasta = 1 serving 1/3 cup beans= 1 serving 1 cup blueberries= 1 serving 1 6 inch tortilla = 1 serving ```

Question 84

The Prader Willi syndrome is associated with.. a. hyperactivity b. deficiency of glucose-6-phosphatase c. macrocytic anemia d. obesity

Answer 84

d. obesity Prader Willi Syndrome= congenital disorder. subnormal LBM, supra-normal body fat Ghrelin levels are elevated which stimulates growth hormone secretion, appetite, intake, and fat mass deposition. do not sense satiety, decreased energy requirements. Best treatment is to control food intake obesity at 2-3 years of age, hypogonadism, muscle hyptonia, FTT, short stature

Question 85

Which of the following is permitted on a diet restricting tyramine? a. hard cheese like cheddar or swiss b. uncured cheese like cottage and ricotta c. pickled or smoked foods d. tofu

Answer 85

b. uncured cheese like cottage and ricotta Certain foods and drinks can cause dangerous reactions if they're taken with an MAOI (anti-depressant drug). AOVID foods that contain high levels of TYRAMINE, DOPAMINE, and TRYPTOPHAN. Some restricted foods may include: aged, fermented, dried, pickled, and smoked foods. Avoid hard aged cheese (CHEDDAR, SWISS), sauerkraut, sausages, luncheon meats, tofu, miso, chianti wine OK foods- cottage cheese and cream cheese

Question 86

What does a fecal fat of 12 grams indicate? a. severe malabsorption b. normal fat absorption c. high normal fat absorption d. nothing

Answer 86

a. severe malabsorption Steatorrhea- consequence of malabsorption normal stool fat 2-5 gram; > 7 gm=malabosorption high protein, high complex CHO, fat as tolerated, vitamins (esp fat-soluble), minerals, MCT

Question 87

If a patient cannot metabolize urea properly, what will accumulate in his blood? a. uric acid b. ammonia c. protein d. glucose

Answer 87

b. ammonia Urea is the principal nitrogenous waste product of metabolism and is generated from protein breakdown. It is eliminated from the body almost exclusively by the kidneys in urine. The urea cycle operates only to eliminate excess nitrogen.

Question 88

A patient with cystic fibrosis, who is non-compliant with their nutritional prescription, may present with: a. hypernatremia b. hyponatremia c. hypokalemia d. hyperkalemia

Answer 88

b. hyponatremia high perspiration of electrolyte levels, malabsorption high protein, high calorie, unrestricted fat, liberal in salt additional 2-4 gm sal/day in hot weather, with heavy perspiration

Question 89

Who is the most appropriate candidate for parenteral nutrition? a. 12-year-old girl coming in for an appendectomy b. middle-aged woman who will begin chemotherapy c. elderly lady with emphysema d. young man going for gallbladder surgery

Answer 89

b. middle-aged woman who will begin chemotherapy PN: ex; malnourished cancer patient on therapy who are anticipated to be unable to ingest and absorb adequate nutrients for a period of 7-14 days

Question 90

An example of a primary prevention program for a local community would be; a. low sodium cooking classes for hypertensive patients b. have local farmers bring fresh fruits and vegetables into schools c. at health fairs, refer high risk individuals to appropriate programs d. education programs for those recently diagnosed with diabetes

Answer 90

b. have local farmers bring fresh fruits and vegetables into schools Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur.

Question 91

WIC encourages women with babies to; a. formula feed b. breastfeed c. feed solid foods early d. feed a mixture of formula and solid foods early

Answer 91

b. breastfeed

Question 92

In reviewing the patients medical record, you note a hemoglobin of 10 g/dl and an MCV of 110 cu mm. You should document: a. anemia due to intrinsic factor b. anemia without nutritional implications c. anemia with larger than normal erythrocytes d. that the iron content of the diet should be increased

Answer 92

c. anemia with larger than normal erythrocytes Hgb: M: 14-17 gm/dl; F: 12-15 gm/dl; preg >=11 MCV (mean corpuscular volume); 84 - 100 cu microm Elevations in MCV are typically observed in B12- or folate-deficient states, and can be observed in hypothyroid states or in liver disease. High MCV values are also commonly observed in anemias Hemoglobin is measured as part of a complete blood count (CBC), a routine test that is commonly ordered by doctors to help diagnose a range of conditions, such as infection, anemia and leukemia.

Question 93

For which disease would a low sodium diet be recommended? a. ascites b. esophageal varices c. pancreatitis d. appendicitis

Answer 93

a. ascites Ascites is most often seen in people with liver disease. This uncomfortable condition results from the accumulation of fluid in the peritoneal cavity, which is the space in your abdomen between your abdominal organs. A low-sodium diet is recommended for people with ascites. Depending on the degree of your ascites, you may need to limit your daily sodium intake from 1,500 to 2,000 milligrams a day. For perspective, 1 teaspoon of salt contains 2,400 milligrams of sodium.

Question 94

A patient needs a 2000 calorie, 2 gram sodium feeding. Which formula is best? calories/cc gNa/liter a. formula 1 1 2 b. formula 2 1.5 2 c. formula 3 2 1 d. formular 4 1 1

Answer 94

d. formular 4 1 cal/cc 1 gNa/L

Question 95

A 75-year old female with adequate income would benefit from: a. SNAP b. Congregate meals c. EFNEP d. WIC

Answer 95

b. Congregate meals no income requirement. 60 years or older plus spouse

Question 96

Which can be included in a meal for gluten-induced enteropathy? a. spaghetti and tomato sauce b. cheese and crackers c. potatoes and butter d. oatmeal with sugar

Answer 96

c. potatoes and butter Gluten-sensitive enteropathy or, as it is more commonly called, celiac disease, is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten.

Question 97

Phytochemicals, which may influence the development of tumors, are found in: a. fruits, vegetables, grains b. lean poultry and fish c. low fat dairy products d. polyunsaturated fats

Answer 97

a. fruits, vegetables, grains Phytochemicals are non-nutritive plant chemicals that have protective or disease preventive properties. ``` six important phytonutrients Carotenoids Ellagic acid Flavonoids Resveratrol Glucosinolates Phytoestrogens ```

Question 98

A patient with hyperphosphatemia, hyperkalemia and hypermagnesemia may have: a. renal disease b. re-feeding syndrome c. pancreatic disease d. liver disease

Answer 98

a. renal disease

Question 99

``` Which supplements are recommended with hemodialysis? a. vitamins C, B6, folate, B12 b vitamins A, D, E, K c. thiamin, riboflavin, vitamin C d. thiamin, folate, vitamins E and C ```

Answer 99

a. vitamins C, B6, folate, B12 Vitamin C: Helps absorb iron; manufacture collagen, form and repair RBCs, bones and other tissues; maintains healthy gums, heals wounds; keeps immune system healthy. Vitamin B6 (pyridoxine): Helps body make protein, which is then used to make cells; also helps make RBCs Folate: Helps make DNA for new cells; works with vitamin B12 to make RBCs. Vitamin B12: Helps make new cells; maintains nerve cells; works with folate to make RBCs.

Question 100

A person with the dumping syndrome cannot handle: a. complex carbs b. polysaccharides c. disaccharides d. amino acids

Answer 100

c. disaccharides Disaccharides, along with monosaccharides, are called simple carbohydrates. The three most common disaccharides in foods are sucrose, lactose and maltose. Dumping syndrome is common after gastric surgery. Eating smaller meals but more frequently. Restricting simple carbohydrates( e.g. glucose, disaccharides), eating more protein, and not drinking liquids during a meal can reduce the symptoms of dumping syndrome.

Question 101

What is the appropriate diet for heart failure? a. low potassium b. low calcium c. low sodium d. low fat

Answer 101

c. low sodium The reduced blood flow to the kidneys causes secretion of hormones that hold in SODIUM and FLUID leading to weight gain. Following a low-salt diet helps keep high blood pressure and swelling (also called edema) under control. It can also make breathing easier if you have heart failure. You should have no more than 2,300 milligrams of sodium each day if you’ve got heart failure. Less than 1,500 mg a day is ideal.

Question 102

How many calories are provided in 1.5 liters of D25W? a. 1275 b. 2275 c. 1500 d. 2000

Answer 102

a. 1275 1.5 L (convert to ml)= 1.5 x 1000= 1500 ml 1500 ml x .25= 375 375 x 3.4 cal= 1275 cal

Question 103

A homeless patient who is deficient in all nutrients is to be discharged. What organization may help? a. WIC b. EFNEP c. a local social services organization d. a shelter for the homeless

Answer 103

c. a local social services organization

Question 104

Why might a child with PKU have an increased incidence of dental caries? a. phenylalanine is not converted to tyrosine b. pyruvate is not converted to alanine c. the diet is high in carbohydrates and low in protein d. the diet is devoid of protein

Answer 104

c. the diet is high in carbohydrates and low in protein PKU: missing phenylalanine hydroxylase enzyme that converts phenylalanine into tyrosine So PHENYLALANINE ACCUMULATES. Diet= LOW IN PHENYLALANINE (MOSTLY FOUND IN PROTEIN FOODS) All types of meat, including pork, chicken, beef and fish, as well as milk, eggs, nuts, cheese and soybeans are very high in phenylalanine. PKU patients are to eat low-protein foods such as low-protein breads, pastas and cereals. Babies with PKU are often fed a special formula containing high protein and low phenylalanine.

Question 105

Trauma can place the patient in: a. anabolic state b. hypermetabolic state c. hypothermic state d. hypometabolic state

Answer 105

b. hypermetabolic state Response to injury: hypermetabolic, catabolic response following trauma (accelerated catabolism of LBM leading to negative nitrogen balance as protein is catabolized to release glucose for energy)

Question 106

A patient who had an ileal resection is placed on a tube feeding and begins to have diarrhea. This may be due to: a. use of a hypertonic formula b. use of an isotonic formula c. blockage of the GI tract d. lactose intolerance

Answer 106

a. use of a hypertonic formula Complications of Hypertonic Formulas. Monomeric formulas tend to be the most hypertonic. When hypertonic formulas draw water into the lumen of the GI tract, the following symptoms can occur: Cramping; Nausea; Vomiting; Diarrhea Diarrhea is one of the most common complications in patients who receive tube‐feeding formulas. Since the COLON is the final site of water and electrolyte absorption and ultimately determines fecal composition, diarrhea during tube feeding may result from altered colonic function.

Question 107

Which is restricted in a diet for hepatic encephalopathy? a. protein, sodium, fluid b. protein, fluid, calories c. calories, protein, fat d. sodium, fat, calories

Answer 107

a. protein, sodium, fluid Hepatic encephalopathy starts when your liver gets damaged from a disease you've had a long time, like chronic hepatitis, Reye's syndrome, or cirrhosis. It doesn't work right anymore, and toxins get into your bloodstream (AMMONIA) and travel to your brain. They build up there and cause the mental and physical symptoms of HE. In hepatic failure, the liver cant convert ammonia (waste product of protein) into urea so ammonia accumulates

Question 108

How many non-protein calories are provided by 2 liters of a 7% Aminosyn solution and 1 liter of 10% dextrose in water? a. 340 b. 390 c. 170 d. 255

Answer 108

a. 340 1L= 1000ml x 10%= 100 x 3.4 cal= 340 calories 7% Aminosyn solution is an amino acid solution with electrolytes nonprotein calories= dextrose and fatty acids

Question 109

When should you provide nutrition counseling to an AIDS patient? a. when nausea and vomiting become problems b. immediately upon diagnosis c. when diarrhea occurs d. no counseling is needed

Answer 109

b. immediately upon diagnosis

Question 110

Medicare is for: a. elderly b. financially needy c. those at nutrtional risk d. those wtih medical needs

Answer 110

a. elderly Medicare: health insurance program for people over 65; of ANY AGE with END-STAGE RENAL DISEASE; employers and employees pay

Question 111

What best measures excess calorie reserves? a. weight b. creatinine c. triceps skinfold d. arm circumference

Answer 111

c. triceps skinfold TSF; measures body fat and CALORIE reserves Male: 12.5 mm Females: 16.5 mm

Question 112

Why might a patient with ascites be dehydrated? a. fluid has moved to interstitial space b. fluid has moved to intravascular space c. fluid has moved to vascular spaces d. fluid has moved to the lung

Answer 112

a. fluid has moved to interstitial space ascites, a condition caused by severe liver disease. It causes excess fluid to build up in your abdomen, making your belly swell and protrude. ascites is often a result of portal hypertension and is made worse with salt intake. Therefore, sodium restriction – not fluid restriction – is the mainstay of ascites treatment. However, those with extreme hyponatremia (sodium levels in the blood that are too low) may be required to limit their water intake. The intracellular fluid (ICF) is the fluid within cells. The interstitial fluid (IF) is part of the extracellular fluid (ECF) between the cells. Blood plasma is the second part of the ECF. Materials travel between cells and the plasma in capillaries through the IF.

Question 113

Which of the following is equivalent to a lean protein exchange? a. 1/4 cup low fat cottage cheese b. 2 Tbsp grated parmesan cheese c. 1 ounce mozzarela cheese d. 1 ounce swiss cheese

Answer 113

a. 1/4 cup low fat cottage cheese One exchange has 7 grams of protein, 3 grams of fat, 55 calories

Question 114

Which is a common complication of AIDS? a. constipation b. diarrhea c. hypoglycemia d. hyperkalemia

Answer 114

b. diarrhea side effect of medications

Question 115

A post-surgical patient with prolonged ileus should be treated with; a. high fiber diet b. enteral nutrition with added fiber c. enteral nutrition d. parenteral nutrition

Answer 115

d. parenteral nutrition An ileus is a type of bowel obstruction in which intestinal peristalsis temporarily ceases. Nutritional care: start with parenteral nutrition initially to restore and maintain nutrient status

Question 116

A common result of treating an AIDS patient with zidovudine is? a. diarrhea b. constipation c. macrocytic anemia d. hypokalemia

Answer 116

c. macrocytic anemia treatment with zidovudine can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, and carnitine. macrocytic anemia caused by vitamin B-12 and folate deficiencies

Question 117

A 140 lb female on dialysis should have how many grams of protein? a. 38-55 b. 58-63 c. 70-89 d. 30-38

Answer 117

c. 70-89 For HD: 1.2 gm PRO For PD: 1.2-1.3 gm PRO At least 50% HBV protein 140 lb / 2.2= 64 kg x 1.2= 77

Question 118

An obese person with Type 2 diabetes should: a. time meals b. decrease the frequency of feedings c. achieve DBW (desirable body weight) d. increase the frequency of feedings

Answer 118

c. achieve DBW (desirable body weight) strategies for Type 2: healthy eating and PA. 1. achieve glucose, lipid and blood pressure goals 2. weight loss if necessary; improve food choices, SPACE MEALS, exercise