domain 2 part2 Flashcards
When conducting a physical assessment of a patient, which method is used to estimate fat stores?
a. inspection
b. palpation
c. pallor
d. auscultation
a. inspection
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
d. all health team members can participate in the process
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
a. 250
bread= 80 cal x 2= 160
2 ounces of turkey= 45 cal/oz x 2= 90
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
b. it is related to demographic factors
Two liters of 5% dextrose solution provide how many calories?
a. 170
b. 340
c. 212
d. 195
b. 340
1L= 1000 ml
2000 ml x .05= 100
100 x 3.4 cal/ml= 340 calories
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
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
Catecholamines have what physiological effect?
a. induce diuresis
b. cause hypoglycemia
c. cause sodium retention
d. cause potassium retention
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.
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
b. sunken eyes, decreased renal function, increased tachycardia
prolonged dehydration is associated with low blood pressure, rapid heart (tachycardia) and breathing rates.
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
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
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
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.
The BMI for a woman who is 5’7” tall and weighs 148 lbs. indicates:
a. underweight
b. normal weight
c. overweight
d. obese
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)
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
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
Which survey is repated every few years
a. NHANES
b. WHO
c. Ten State
d. FAO
a. NHANES
ongoing survey to obtain info on health of American people. Evaluates clinical, chemical (Hgb, Hct, cholesterol), anthropometric nutritional data
The Healthy People 2020 Goals are an outgrowth of a report by:
a. ADA
b. the Surgeon General, under HHS
c. WHO
d. FAO
b. the Surgeon General, under HHS
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
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
When a starved patient begins to eat, they might expect:
a. constipation
b. an increased workload on the heart
c. lethargy
d. diarrhea
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.
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
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”
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
b. increased glucose release into the bloodstream
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
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)
which program provides food to needy individuals and families?
a. food banks
b. SNAP
c. CACFP
d. WIC
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
Which formual is high in protein, low in potassium and phosphorus?
a. Nepro
b. Osmolite
c. Sustacal
d. Jevity
a. Nepro
for kidney patients
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
a. prevention of chronic disease
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
b. explain that insulin therapy is related to intake
The treatment for IDDM is daily insulin, administered either by an injection, pump or inhaler.
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
b. the USDA Thrifty Food Program
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
b. Food stamps
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
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.
Which is permitted on a diet which excludes gluten?
a. rye
b. corn
c. barley
d. wheat bread
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
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
c. normal intake based on age
Where can a pregnant teen learn to cook?
a. EFNEP
b. Child Nutrition Services
c. UNICEF
d. WIC
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)
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
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.
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
c. give each participant recipes using the food items
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
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)
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
b. examine other anthropmetric measurements
could be he just has more muscle. need full assessment before making any recommendations or conclusions
Which of the following affects bioelectrical impedance analysis?
a. adipose stores
b. muscle mass
c. water
d. protein stores
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.
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
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
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
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
Which coorelates best with energy intake?
a. lean body mass
b. triceps skinfold
c. body mass index
d. body weight
d. body weight
Which of the following most affects osmolarity?
a. protein
b. sugar
c. electrolytes
d. fat
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.
Which fiber is insoluble in water?
a. pectin
b. gums
c. hemicellulose
d. polysaccharides
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.
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
d. only give water in the bottle
milk=carbohydrates=dental caries
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
a. 1 oz cheese and 1/2 cup orange juice
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
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
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
b. SNAP
Which drink would a Mormon choose?
a. cola
b. 7-up
c. tea
d. coffee
b. 7-up
Mormons: caffeine free soda drinks ok
no caffeine, alcohol
What section of the intestine is most likely to be involved in Crohns disease?
a. ileum
b. jejunum
c. duodenum
d. appendix
a. ileum
Crohns (IBD); affects the terminal ileum
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
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
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
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
