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
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
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.
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
d. lean protein
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
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
Medicaide benefits apply to:
a. healthy adults
b. a 60 year old female
c. those at nutritional risk
d. low income individuals
d. low income individuals
all ages, blind, disabled, dependent children
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
d. it is a Kosher designation
Congregate meals and home delivered meals fall under:
a. WIC
b. EFNEP
c. Older Americans Act Nutrition Program Title III
d. Medicare
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
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
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.
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
d. I, II, and III
A side effect of antidepressants is:
a. chronic diarrhea
b. muscle wasting
c. excess weight gain
d. nausea and vomiting
c. excess weight gain
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
c. beans and rice
Hypertension will decrease with a decrease in:
a. fiber
b. alcohol
c. potassium
d. calcium
b. alcohol
What medication is affected by serum sodium levels?
a. lithium carbonate
b. Mellaril
c. Valproate
d. Tetracycline
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.
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
b. standing up
measure standing up AT 2 years, not before
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
d. American Heart Association
Low levels of folate, pyridoxine and cyanocobalamin are associated with;
a. glycogen storage disease
b. homocystinuria
c. phenylketonuria
d. galactosemia
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
A patient with low hemoglobin and low MCV might have:
a. microcytic anemia
b. macrocytic anemia
c. megaloblastic anemia
d. normochromic anemia
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.
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
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
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
a. plain hamburger on a bun
80 cal bun
meat 75-100 calories for 1 ounce
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
c. triceps skinfold and arm muscle circumference of 79%
triceps skinfold and arm muscle circumference measure fat reserves and skeletal muscle mass
A child with AIDS needs a high calorie and ________ intake.
a. megadose vitamins
b. high protein
c. low fat
d. low residue
b. high protein
high protein, high calorie with supplements needed for weight gain. energy needs: general guidelines plus appropriate stress factors
An appropriate measurement for iron status in a local community is:
a. serum iron
b. transferrin
c. TIBC
d. hematocrit
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
Which of the following may help decrease cavities?
a. raisins
b. carrots
c. cheese
d. yogurt
c. cheese
Cheese may help reduce cavities forming in teeth because it neutralises plaque acid,
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
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%
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
c. discuss the order with the physiciain and make suggestions
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
c. exercise, diet, behavior modification
Which is most associated with incidence of Type 2 diabetes?
a. sugar intake
b. protein intake
c. overweight
d. salt intake
c. overweight
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
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
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
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).
Which bacteria may cause gastric ulcers?
a. salmonella
b. streptococcus aureus
c. helicobacter pylori
d. clostridium perfringens
c. helicobacter pylori
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
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)
Which of the following diseases may lead to anemia?
a. myocardial infarction
b. galactosemia
c. renal failure
d. diabetes mellitus
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)
To learn about prenatal problems in the community, go to:
a. Center for Disease Control
b. WIC
c. NHANES
d. FDA
b. WIC
WIC- for pregnant, postpartum, breast-feeding women; infants and children up to 5
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
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
After a gastrectomy, the diet order should indicate a decrease in:
a. disaccharides
b. fats
c. protein
d. complex carbohydrates
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.
?
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
a. 60 minutes every day
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
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
The Prader Willi syndrome is associated with..
a. hyperactivity
b. deficiency of glucose-6-phosphatase
c. macrocytic anemia
d. obesity
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
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
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
What does a fecal fat of 12 grams indicate?
a. severe malabsorption
b. normal fat absorption
c. high normal fat absorption
d. nothing
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
If a patient cannot metabolize urea properly, what will accumulate in his blood?
a. uric acid
b. ammonia
c. protein
d. glucose
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.
A patient with cystic fibrosis, who is non-compliant with their nutritional prescription, may present with:
a. hypernatremia
b. hyponatremia
c. hypokalemia
d. hyperkalemia
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
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
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
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
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.
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
b. breastfeed
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
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.
For which disease would a low sodium diet be recommended?
a. ascites
b. esophageal varices
c. pancreatitis
d. appendicitis
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.
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
d. formular 4 1 cal/cc 1 gNa/L
A 75-year old female with adequate income would benefit from:
a. SNAP
b. Congregate meals
c. EFNEP
d. WIC
b. Congregate meals
no income requirement. 60 years or older plus spouse
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
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.
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
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
A patient with hyperphosphatemia, hyperkalemia and hypermagnesemia may have:
a. renal disease
b. re-feeding syndrome
c. pancreatic disease
d. liver disease
a. renal disease
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
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.
A person with the dumping syndrome cannot handle:
a. complex carbs
b. polysaccharides
c. disaccharides
d. amino acids
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.
What is the appropriate diet for heart failure?
a. low potassium
b. low calcium
c. low sodium
d. low fat
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.
How many calories are provided in 1.5 liters of D25W?
a. 1275
b. 2275
c. 1500
d. 2000
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
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
c. a local social services organization
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
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.
Trauma can place the patient in:
a. anabolic state
b. hypermetabolic state
c. hypothermic state
d. hypometabolic state
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)
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
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.
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
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
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
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
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
b. immediately upon diagnosis
Medicare is for:
a. elderly
b. financially needy
c. those at nutrtional risk
d. those wtih medical needs
a. elderly
Medicare: health insurance program for people over 65; of ANY AGE with END-STAGE RENAL DISEASE; employers and employees pay
What best measures excess calorie reserves?
a. weight
b. creatinine
c. triceps skinfold
d. arm circumference
c. triceps skinfold
TSF; measures body fat and CALORIE reserves
Male: 12.5 mm
Females: 16.5 mm
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
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.
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
a. 1/4 cup low fat cottage cheese
One exchange has 7 grams of protein, 3 grams of fat, 55 calories
Which is a common complication of AIDS?
a. constipation
b. diarrhea
c. hypoglycemia
d. hyperkalemia
b. diarrhea
side effect of medications
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
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
A common result of treating an AIDS patient with zidovudine is?
a. diarrhea
b. constipation
c. macrocytic anemia
d. hypokalemia
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
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
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
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
c. achieve DBW (desirable body weight)
strategies for Type 2: healthy eating and PA.
- achieve glucose, lipid and blood pressure goals
- weight loss if necessary; improve food choices, SPACE MEALS, exercise
