Hark questions Flashcards by Olga Arnold

Body mass index (BMI) may overestimate an individual’s body fat in which of the following scenarios?

a. Underweight individuals
b. Normal weight individuals
c. Extremely muscular individuals
d. Obese individuals

c. Extremely muscular individuals

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Which of the following tissues manifest an iron deficiency and is likely to appear abnormal on physical examination?

a. Skin
b. Nails
c. Mouth
d. All of the above

d. All of the above

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Waist circumference (WC) is recommended to only be measured in patients with a BMI less than which of the following because it does not provide additional information about risk?

a. ≤25 kg/m2
b. ≤30 kg/m2
c. ≤35 kg/m2
d. ≤40 kg/m2

c. ≤35 kg/m2

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Which of the following BMI values indicates a patient is at risk of malnutrition and needs further nutritional assessment?

a. <18.5 kg/m2
b. <19.5 kg/m2
c. <20.5 kg/m2
d. <21.5 kg/m2

a. <18.5 kg/m2

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When interpreting serum albumin in hospitalized patients, levels may be falsely elevated irrespective of nutritional status in which of the following conditions?

a. Liver disease
b. Dehydration
c. Diabetes
d. Stroke

b. Dehydration

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DE is a 45-year-old man is seeing his primary care physician for an annual physical. His doctor suspects he has metabolic syndrome based on the following measurements and fasting laboratory data:
Blood pressure: 140/80 mm Hg Waist circumference: 38′′
Triglycerides: 230 mg/dL HDL-C: 35 mg/dL Glucose: 120 mg/dL
How many of the metabolic syndrome criteria does he meet based on these results?

a. 1
b. 2
c. 3
d. 4

d. 4

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CR is a 49 year-old man who has recently been diagnosed with colon cancer. He has lost 15 lb over the past 3 months, which is a clinically significant weight loss. His usual weight is 170 lb and his current weight is 155 lb. Which of the following percent weight changes accurately reflects the patients’ weight history?

a. 2.5% weight change
b. 5.5% weight change
c. 8.8% weight change
d. 10% weight change

c. 8.8% weight change

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BF is a 56-year-old obese woman who has successfully undergone bariatric surgery. She has been prescribed a multivitamin, B12, calcium, vitamin D, and numerous other supplements. How long after her surgery should be advised to continue to take these supplements?

a. 1 year
b. 2 years
c. 5 years
d. For the rest of her life

d. For the rest of her life

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PR is a 54-year-old man who recently underwent gastric bypass surgery. He presents to his surgeon 6 months post-operatively complaining of headaches, fatigue, and being cold all the time. Which of the following deficiencies is most likely associated with these symptoms in patients who have undergone gastric bypass surgery?

a. Vitamin C
b. Riboflavin
c. Zinc
d. Iron

d. Iron

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DD is a 3-year-old boy from Africa who is admitted to the hospital and diagnosed with kwashiorkor. Which of the following macronutrients is believed to be deficient in patients with kwashiorkor?

a. Protein
b. Carbohydrates
c. Fiber
d. Calories

a. Protein

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Side effects associated with Roux-en-Y bariatric surgery frequently include dumping syndrome. Which of the following dietary recommendations are appropriate to reduce dumping syndrome post-bariatric surgery?

a. Eat 3 meals everyday
b. Take vitamin and mineral supplements with meals
c. Avoid drinking fluids for at least 30 minutes after meals
d. Add more dietary fiber

c. Avoid drinking fluids for at least 30 minutes after meals

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SD is a 50-year-old woman with a BMI of 28 kg/m2. She has been referred for nutrition counseling by her primary care physician and asks how many calories she needs to reduce each day to lose 1 lb per week. Which of the following is the correct answer?

a. 250 kcal/day
b. 500 kcal/day
c. 750 kcal/day
d. 900 kcal/day

b. 500 kcal/day

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Nutrition issues can be integrated into all components of the clinical assessment, including the medical history, social history, review of systems, physical examination, laboratory data, and treatment plan. Which of the following sections is the most appropriate time to discuss the patient’s dietary intake, either using a 24-hour recall, food frequency questionnaire or usual intake method?

a. Medical history
b. Social history
c. Review of systems
d. Physical examination

b. Social history

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EF is a 56-year-old male who was treated for Crohn’s disease with a resection of his terminal ileum. He has not taken any vitamin supplements following this procedure. He presents to his primary care physician complaining of numbness and tingling in his hands and feet. Which of the following vitamin deficiency should be suspected?

a. Vitamin C
b. Vitamin D
c. Vitamin B12
d. Vitamin K

c. Vitamin B12

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CF is a 16-year-old teenager who comes to her pediatrician because she has been having headaches and blurred vision. She has started taking large doses of vitamins to help reduce her acne. Mega doses of which of the following vitamins could contribute to headaches and blurred vision (above the tolerable upper limit recommendation)?

a. Vitamin A
b. Vitamin B12
c. Vitamin E
d. Vitamin B6

a. Vitamin A

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NS is a 6-year-old boy who has been diagnosed with lead poisoning. According to the CDC,
children exposed to lead are at increased risk of which of the following conditions?

a. Brain damage
b. Otitis media
c. Alopecia
d. Strabismus

a. Brain damage

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GM is a 35-year-old homeless man who presents to the Emergency Department with a red, swollen tongue, soreness of the lips and mouth, dermatitis, and diarrhea. Which of the following vitamin deficiencies should be suspected in this patient?

a. Vitamin C deficiency
b. Iron deficiency
c. Niacin deficiency
d. Folate deficiency

c. Niacin deficiency

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Which of the following minerals functions as an antioxidant as a component of enzymes that protect cells from the damaging effects of free radicals?

a. Phosphorous
b. Selenium
c. Potassium
d. Chromium

b. Selenium

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When taken alone, in doses ranging from 300 to 900 mg/day, St. John’s Wort has been shown to be moderately effective in the treatment of which for the following conditions

a. Mild-to-moderate depressive symptoms
b. Type 2 diabetes
c. Hypertension
d. Osteoarthritis

a. Mild-to-moderate depressive symptoms

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LF is a 22-year-old female who complains of weakness, fatigue, and feeling cold. When asked about her diet, she admits that she switched to a vegan diet 6 months ago and has been avoiding meat, chicken, and fish. Based on this scenario, which of the following deficiency should be suspected in this patient?

a. Magnesium
b. Vitamin K
c. Iron
d. Selenium

c. Iron

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Which of the following supplements are appropriate to prescribe to a 35-year-old woman with chronic constipation and no other medical conditions?

a. Magnesium
b. Iron
c. B-complex
d. Vitamin D

a. Magnesium

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TL is a 74-year-old female with a medical history of osteoporosis and a hip fracture 2 years ago. She has been taking 1000 mg/day of calcium for at least 10 years and now requests information about vitamin D. She lives in an independent living facility in Boston. How much vitamin D3 would be appropriate to prescribed to TL based on the RDA?

a. 200 IU/day
b. 300 IU/day
c. 500 IU/day
d. 800 IU/day

d. 800 IU/day

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Which of the following laboratory measures is the best determinant of iron status in a normal 18-year-old female with regular menses and no chronic health problems?

a. Ferritin
b. Transferrin saturation
c. Prealbumin
d. Total iron-binding capacity

a. Ferritin

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VF is a 43-year-old female with a history of hypertension who is managed with a diuretic and beta-blocker. She presents to her primary care physician complaining of weakness. She is diagnosed with hypokalemia. Which of the following foods should she be advised to increase?

a. Whole grain cereal
b. Orange juice
c. Yogurt
d. Eggs

b. Orange juice

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HV is a 42-year-old male who recently broke his hip after falling off his bike during a race. He is currently taking warfarin to reduce his chance of blood clotting. The function of which of the following vitamins is inhibited by warfarin therapy? a. Vitamin E b. Vitamin A c. Vitamin D d. Vitamin K

d. Vitamin K

Nutritional requirements for certain macronutrients and micronutrients increase significantly during pregnancy. Which of the following nutrient requirements increases the most during pregnancy? a. Protein b. Fat c. Carbohydrates d. Fiber

a. Protein

EH is a 17-year-old teenager who comes to a prenatal clinic for the first time at 18 weeks gestation. She has gained only a few pounds since she became pregnant. Based on her pre- pregnancy BMI (21 kg/m2) what is the total amount of weight she should gain during pregnancy according to the Institute of Medicine’s recommendations? a. 10–15 pounds b. 15–25 pounds c. 25–35 pounds d. 35–40 pounds

c. 25–35 pounds

MW is a 32-year-old pregnant woman who comes to see her obstetrician for a routine prenatal visit. She is complaining of fatigue and her hemoglobin and hematocrit results indicate that she is anemic. Pregnant women are more likely to experience anemia in which of the following trimesters? a. 1st trimester b. 2nd trimester c. 3rd trimester d. There is no difference in the prevalence of anemia during pregnancy

c. 3rd trimester

RL is a 31-year-old obese woman who is 26 weeks in gestation. She is being screened for gestational diabetes by her obstetrician since she has a family history of type 2 diabetes. Which of the following results for a 1-hour, 50-g glucose load would be considered a positive diagnosis for gestational diabetes? a. 100–110 mg/dL b. 110–120 mg/dL c. 120–130 mg/dL d. 130–140 mg/dL

d. 130–140 mg/dL

Which of the following population groups in the United States has the highest prevalence of neural tube defects? a. Non-Hispanic white women b. Non-Hispanic black women c. Asian women d. Hispanic women

d. Hispanic women

Breast-fed infants may feed more often than formula-fed infants because breast milk empties from an infant’s stomach slightly more rapidly than formula-fed infants. On average, what is the approximate time for breast milk to empty from an infant’s stomach? a. 1 hour b. 1.5 hours c. 2 hours d. 3 hours

b. 1.5 hours

JG is a 22-year-old woman who recently delivered a healthy, full-term infant. She is breastfeeding her 3-month old and complains to her family doctor about sore nipples. Which of the following strategies could help JG prevent and treat sore nipples associated with breastfeeding? a. Make sure the infant is tummy to tummy and latching on properly b. Apply moisturizer to the breast after feeding c. Clean the breasts with a washcloth and soap after breastfeeding d. Apply heat to the nipple area after feeding

a. Make sure the infant is tummy to tummy and latching on properly

RT is a 25-year-old female who has recently found out that she is pregnant. She questions her obstetrician about which exercises are appropriate during pregnancy. Which of the following exercises would not be considered safe during pregnancy? a. Rebounding on a trampoline b. Walking c. Yoga d. Swimming

a. Rebounding on a trampoline

JN is a 33-year-old female who has been successfully breastfeeding her infant since she gave birth 4 weeks ago but now has been diagnosed with mastitis and prescribed an antibiotic. Which of the following is the most appropriate recommendation for breastfeeding women with mastitis? a. Avoid breastfeeding with the infected breast b. Discontinue breastfeeding c. Continue breastfeeding and nurse frequently d. Switch to infant formula until the mastitis is resolved

c. Continue breastfeeding and nurse frequently

According to the CDC, to reduce the risk of bearing a child with a neural tube defect, what is the minimum amount of folic acid a woman of childbearing age should consume on a daily basis prior to becoming pregnant? a. 400μg/day b. 600μg/day c. 800μg/day d. 1000μg/day

a. 400μg/day

GH is a 24-year-old woman who has been breastfeeding for the past 3 months. She questions her pediatrician about whether she is able to provide enough nutrition for her infant. What parameters should be used to determine if breastfeeding is providing adequate nutrition for an infant or child? a. Monitoring growth and development on the growth charts b. Measuring the amount of milk being produced by the mother c. Tracking the frequency that the infant feeds d. Assessing the number of bowel movements of the infant

a. Monitoring growth and development on the growth charts

LM asks how quickly after delivery she can return to her pre-pregnancy weight while she is breastfeeding. Which of the following would be considered a safe weight loss while breastfeeding? a. 1–2 pounds/week b. 1–2 pounds/month c. 6–8 pounds/month d. Women should not lose weight during breastfeeding

b. 1–2 pounds/month

JS is a 31-year-old woman who has just found out that she is pregnant and asks her obstetrician about drinking coffee during pregnancy. She is very concerned about recent reports describing the increased risk of miscarriage related to excess caffeine intake. Since she has had two previous miscarriages according to the March of Dimes, what is the current recommendation for limiting caffeine intake during pregnancy? a. Less than 200 mg/day b. Less than 300 mg/day c. Less than 400 mg/day d. Less than 500 mg/day

a. Less than 200 mg/day

When making dietary modifications in situations where calorie and protein intake are inadequate, it is appropriate to a. Present large portions of food and allow the patient to select what they want b. Remove traditional dietary restrictions related to specific disease processes c. Drink calorically dense beverages with meals d. All of the above

b. Remove traditional dietary restrictions related to specific disease processes

Activities of daily living (ADLs) reflect an individual’s most basic capacity for self-care, and may be limited in approximately 10% of older adults. Which of the following are considered ADLs? a. Preparing meals b. Housework c. Feeding d. Managing money

c. Feeding

A Dual Energy X-ray Absortionmetry (DEXA) scan is used to assess bone mineral density. Which of the following scores indicate osteoporosis? a. greater than -2.5 b. −1 to −2.5 c. less than -2.5 d. -2.0

c. less than -2.5

Malnutrition in older adults is associated with which of the following factors? a. Moderate alcohol intake b. Problems with chewing and swallowing c. Reduced gait d. Glaucoma

b. Problems with chewing and swallowing

What dietary supplement is appropriate to recommend for a person with intermediate to advanced age-related macular degeneration (AMD)? a. Multivitamin and mineral supplement b. Combination of vitamin A, D, E, and K c. Combination of magnesium, potassium, phosphorous, and calcium d. Combination of zinc, copper, vitamin E, and vitamin C

d. Combination of zinc, copper, vitamin E, and vitamin C

Dehydration in older adults has been linked to impaired cognition, kidney stones, and constipation. This population is less likely to experience signs and symptoms of dehydration because of which of the following physiological changes associated with aging? a. Increased total body water b. Decline in thirst perception c. Reduced tolerance to fluid d. Increased taste sensation

b. Decline in thirst perception

RF is an 83-year-old female who is living in an assisted living facility. Her recent blood tests results show a low serum vitamin B12 level even though her dietary intake of vitamin B12 is adequate. Which of the following mechanisms most likely explains the cause of RF’s low vitamin B12 levels? a. Decreased ability to absorb protein-bound vitamin B12 b. Increased conversion of vitamin B12 to the inactive form c. Increased HCL production d. Decreased vitamin C intake which is required for vitamin B12 absorption

a. Decreased ability to absorb protein-bound vitamin B12

Nutritional frailty is defined as which of the following in older adults? a. Albumin <3.5 mg/dL b. Oral health problems which change appetite c. Sarcopenia and rapid, unintentional weight loss d. Complaints of food tasting bland

c. Sarcopenia and rapid, unintentional weight loss

Body composition changes are a normal consequence of aging. Which of the following age-related physiological changes results in a reduced caloric need in older adults? a. Lean body mass declines, fat mass increases b. Bone mineral density increases c. Vitamin and mineral absorption declines d. Fat mass is reduced

a. Lean body mass declines, fat mass increases

BMI is used in older adults to assess nutritional status. Which of the following BMI cut-off points should be used as a red flag to signal the patient is underweight and further assessment is warranted? a. BMI <16 kg/m2 b. BMI <18.5 kg/m2 c. BMI <22 kg/m2 d. BMI <25 kg/m2

c. BMI <22 kg/m2

Cachexia is the term used to describe the clinical wasting syndrome that results from the nutritional and metabolic abnormalities seen in cancer patients. Which of the following mechanisms play a role in the cachexia, malnutrition, and associated weight loss seen in cancer patients? a. Decreased gluconeogenesis b. Decreased mobilization of free fatty acids c. Enhanced taste and smell perception d. Altered cytokine levels

d. Altered cytokine levels

RH is a 49-year-old woman who has been complaining of mood changes, sleep disturbances, and hot flashes. She is most likely experiencing menopausal symptoms. Which of the following supplements could help to reduce her complains of hot flashes? a. Valerian b. Black cohosh c. Garlic d. Magnesium

b. Black cohosh

LD is a 52 year-old-woman who has recently been prescribed bioidentical hormones to reduce her side effects of menopause. She is experiencing constipation due to the progesterone cream. Which of the following supplements have been shown to be effective in treating constipation. a. Vitamin C and magnesium b. Vitamin D and calcium c. Vitamin E and selenium d. Vitamin B6 and potassium

a. Vitamin C and magnesium

For people with intermediate to advanced age-related macular degeneration, how much can a high antioxidant supplement decrease the risk of disease progression? a. 10% b. 25% c. 50% d. 90%

b. 25%

Pasteurized cow’s milk is an important source of calories, protein, and calcium for children, but should not be introduced until a child is how old? a. 6 months b. 9 months c. 12 months d. 18 months

c. 12 months

Dry, scaly dermatitis, alopecia, and easily pluckable, dull hair may be signs of which of the following deficiencies? a. Protein deficiency b. Essential fatty acid deficiency c. Vitamin and mineral deficiency d. All of the above

d. All of the above

BB is an 18-year-old female whose parents suspect she has an eating disorder. Her symptoms include esophagitis and electrolyte abnormalities, suggesting which of the following? a. BB is vomiting in an effort to keep her weight down b. BB has been taking mega doses of vitamins c. BB is using laxatives in an effort to keep her weight down d. BB has amenorrhea

a. BB is vomiting in an effort to keep her weight down

BB’s parents request that she be hospitalized immediately for observation and treatment. Which of the following criteria should be used to determine if BB needs to be managed in an in-patient hospital setting rather than on an out-patient basis? a. BB is medically unstable b. BB is 25 to 30 percent below her ideal weight c. BB is emotionally unstable d. All of the above

d. All of the above

Body mass index (BMI) is an important growth assessment tool in children over the age of two. Which of the following is the correct way to determine height for use in calculating BMI? a. Using the height stick on the scale b. Without shoes using a wall-mounted stadiometer c. Using a tape measure with the child lying on a hard surface d. By weight-for-length

b. Without shoes using a wall-mounted stadiometer

What is the AAP’s recommendation for daily juice intake for children aged 12 months to 2 years of age? a. Less than 8 ounces/day b. AAP recommends no juice for 1–2 year old children c. Less than 4 ounces/day d. Juice is a good source of vitamins, and thus should not be limited in children

c. Less than 4 ounces/day

Children under the age of two should not follow a low-fat diet because normal fat intake is required to maintain the development of which of the following systems? a. Central nervous system b. Respiratory system c. Musculoskeletal system d. Digestive system

a. Central nervous system

ST is an 11-year-old boy with hypercholesterolemia and a positive family history of heart disease (his father had a heart attack at age 40). What is the recommended initial medical nutrition therapy for children with hypercholesterolemia over the age of 2 years? a. A very high fat diet, such as the Atkins diet, to support weight loss b. A very low fat diet, with <10% calories as fat c. A balanced diet with <30% calories as fat, and <7–10% calories as saturated fat d. No dietary recommendations as age 11 is too young to restrict a child’s diet

c. A balanced diet with <30% calories as fat, and <7–10% calories as saturated fat

Head circumference indirectly measures brain growth in infants and children. Assessing head circumference is recommended for infants and children up to what age? a. 6 months b. 12 months c. 2 years d. 4 years

c. 2 years

JK is a 16 year-old boy who has been diagnosed as obese according to his BMI which is greater than the 95th percentile. His mother is very worried about this, but JK doesn’t seem too concerned. What is the recommended method and approach to address his obesity in the office-based setting? a. Work individually with JK only b. Work with both JK and his mother c. Work with JK’s mother only d. Refer JK to a multidisciplinary weight management program right away

b. Work with both JK and his mother

JT is an 8-year-old girl who comes to see her pediatrician for a well-childcare visit. Her height is 127 cm and her weight is 25 kg. Her BMI is at the 50th percentile. Which of the following weight classifications is correct for this child? a. Normal weight b. Underweight c. Overweight d. Obese

a. Normal weight

DR is an 18-year-old overweight teenager who is diagnosed with non-alcoholic fatty liver disease (NAFLD) by his family physician. Which of the following is the most appropriate therapy for DR at this time? a. Immediate drug therapy b. Weight loss c. Referral to a surgeon for bariatric surgery d. There is no treatment for this condition

b. Weight loss

TY is a 4-year-old child who presents to the hospital with wasting and apparent emaciation, yet serum albumin and protein values are normal. It is suspected, however, that protein status may be depleted. What is the most likely explanation for these normal serum values? a. Inaccurate test procedure b. Increased blood volume (hemodilution) c. Protein malnutrition d. Decreased blood volume (hemoconcentration)

d. Decreased blood volume (hemoconcentration)

According to the CDC and AAP, the maximum amount of time a child should spend engaging in sedentary activities, such as watching TV and playing computer and video games, on a daily basis is: a. 30 minutes/day b. 2 hours/day c. 3 hours/day d. Equal to the time they are playing actively each day

b. 2 hours/day

The “hallmark sign” of refeeding syndrome, an imbalance that may lead to cardiac, neuromuscular, hepatic, hematologic, and respiratory dysfunction, and ultimately organ failure, involves which of the following? a. Phosphate, magnesium, calcium, potassium b. Potassium, sodium iron, biotin c. Magnesium, niacin, folate, zinc d. Calcium, zinc, iron, pyridoxine

a. Phosphate, magnesium, calcium, potassium

Heart failure affects approximately 5 million adults in the United States and is characterized by decreased cardiac output, venous stasis, and sodium and fluid retention. Which of the following nutritional issues is also commonly associated with heart failure? a. Increased muscle wasting and malnutrition b. Decreased fat requirements c. Increased protein stores d. Decreased carbohydrate requirements

a. Increased muscle wasting and malnutrition

Omega-3 fatty acids (eicosapentanoic acid and docosahexenoic acid) are effective at reducing which of the following serum levels if they are abnormally elevated? a. Lp(a) b. LDL-cholesterol c. Triglycerides d. All of the above

c. Triglycerides

JK is a 45-year-old male who comes to see his primary care clinician for a routine physical exam. He is 5′8′′, weighs 210 pounds (BMI: 32 kg/m2). His waist circumference is 41 inches and his fasting lab data showed: glucose: 109 mg/dL; triglycerides: 345 mg/dL; LDL-C: 130 mg/dL; total cholesterol: 220mg/dL. Which of the following dietary interventions is most appropriate to suggest JK implement based on his labs? a. Reduction in sodium intake b. Reduction in fiber intake c. Reduction in calories to promote weight loss d. Reduction in monounsaturated fat intake

c. Reduction in calories to promote weight loss

The National Cholesterol Education Program ATP III guidelines include the diagnostic criteria for metabolic syndrome. Which of the following HDL-C and waist circumference measurements can support the diagnosis of metabolic syndrome in MEN. a. HDL <50 mg/dL and waist circumference >35 inches b. HDL <40 mg/dL and waist circumference >40 inches c. HDL <35 mg/dL and waist circumference >40 inches d. HDL <35 mg/dL and waist circumference >35 inches

b. HDL <40 mg/dL and waist circumference >40 inches

In addition to reducing dietary saturated fat and cholesterol, which of the following nutrition- related strategies has the greatest LDL-lowering effect? a. Decreasing total fat intake b. Increasing insoluble fiber intake c. Decreasing trans fatty acid intake d. Increasing omega-6 fatty acid intake

c. Decreasing trans fatty acid intake

Alcohol may have cardioprotective effects by increasing HDL-C levels and reducing LDL-C oxidation via the antioxidant polyphenols. Which of the following are considered polyphenols? a. Cynarin, alpha-linoleic acid b. Genistein, green tea c. Capsaicin d. Catechin, quercetin, resveratrol

d. Catechin, quercetin, resveratrol

The Dietary Approaches to Stop Hypertension (DASH) trial has developed nutritional recommendations based on effectively reducing blood pressure. Which of the following daily combined number of fruit and vegetable servings are recommended in the DASH diet? a. 2 to 4 servings of fruits and vegetables b. 3 to 6 servings of fruits and vegetables c. 6 to 7 servings of fruits and vegetables d. 8 to 10 servings of fruits and vegetables

d. 8 to 10 servings of fruits and vegetables

Including viscous or soluble fiber in the diet can decrease LDL-C levels when consumed on a regular basis by binding with and removing bile acids in the body. Which of the following amounts of soluble fiber is recommended to consume on a daily basis? a. 1 to 2 grams per day b. 3 to 4 grams per day c. 5 to 10 grams per day d. 20 to 25 grams per day

c. 5 to 10 grams per day

Epidemiologic studies suggest that eating fish is beneficial to reduce the risk of heart disease. According to the American Heart Association and the American Academy of Nutrition and Dietetics, how often should fish be consumed to reduce cardiovascular risk? a. 1 time per week b. 2 times per week c. 1 time per month d. 3 times per month

b. 2 times per week

ST is a 62-year-old man with diabetes who presents to his primary care physician to discuss his lipid levels. He does not smoke but has a family history of heart disease. According to the new guidelines, what is the target LDL-C level? a. <100 mg/dL b. <130 mg/dL c. <160 mg/dL d. <190 mg/dL

a. <100 mg/dL

Which of the following risk factors for metabolic syndrome has different criteria among various ethnic groups? a. Hypertension b. Fasting plasma glucose levels c. Waist circumference measurement d. HDL levels

c. Waist circumference measurement

SL is a 78-year-old woman who has been discharged from the hospital after being diagnosed with heart failure. What is the most appropriate medical nutrition therapy for a patient with heart failure? a. Limit potassium intake to less than 2000 mg/day b. Limit total fat intake to less than 30% of total calories c. Limit sodium intake to 2000 mg/day d. Limit cholesterol intake to less than 200 mg/day

c. Limit sodium intake to 2000 mg/day

JF is a 28-year-old female with severe Crohn’s disease who recently underwent an intestinal resection of her ileum. Which of the following is true regarding dietary management in this patient? a. Fat malabsorption is unlikely to occur b. Probiotic supplementation should be considered c. Dietary modification should include reduced intake of foods high in oxalate d. Omega-3 fatty acid supplementation should be used to help reduce the risk of disease reoccurrence following surgery

c. Dietary modification should include reduced intake of foods high in oxalate

RP is a 68-year-old man with chronic liver disease and ascites. He has lost a significant amount of weight and demonstrates signs/symptoms of protein-calorie malnutrition. Which of the following is correct regarding malnutrition and dietary management in patients with chronic liver disease? a. Iatrogenic causes of malnutrition may include restricted diets, diuresis, and frequent paracentesis b. Malabsorption may occur due to diminished bile acid production c. Restricted protein intake should be limited to periods of acute encephalopathy only d. All of the above

d. All of the above

PV is a 63-year-old man recently diagnosed with peptic ulcer disease. Nutritional management of patients with peptic ulcer disease includes which of the following? a. Counseling on avoidance of common trigger foods including coffee, tea, colas, and alcohol b. Drinking only low fat milk c. Eating less frequent, larger meals to reduce gastric acid production d. Avoiding drinking liquids with meals

a. Counseling on avoidance of common trigger foods including coffee, tea, colas, and alcohol

AL is a 45-year-old obese male with a BMI of 45 who presents for dietary counseling. AL admits to drinking one to two alcoholic drinks a week. Lab data through his primary physician showed elevations in multiple liver enzymes and a subsequent ultrasound was consistent with fatty liver disease. Which of the following should be a component of dietary counseling of this patient? a. Rapid weight loss is indicated due to elevations in multiple liver enzymes b. Regular dietary counseling and gradual weight loss programs should be encouraged c. Protein restriction should occur, both to limit calories and risk of encephalopathy d. Both b and c

b. Regular dietary counseling and gradual weight loss programs should be encouraged

Individuals who are lactose intolerant and choose to avoid products containing lactose may not meet daily calcium requirements. Which of the following is the best lactose-free source of calcium to recommend to patients who are lactose intolerant? a. Fortified whole-wheat bread b. Spinach c. Soy or almond milk (enriched) d. Ice cream

c. Soy or almond milk (enriched)

LH is a 55-year-old female who has recently been diagnosed with celiac disease. Which of the following nutrition-related statements is correct? a. A gluten-free diet should be adhered to until symptoms resolve, then certain gluten- containing grains may be gradually reintroduced based on reoccurrence of symptoms b. Vitamin/mineral supplements should be considered in patients with celiac disease c. A gluten-free diet excludes all foods containing wheat but allows rye and barley d. Oatmeal can be safely eaten on a gluten-free diet

b. Vitamin/mineral supplements should be considered in patients with celiac disease

MG is a 22-year-old man with cystic fibrosis. He is non-adherent with his pancreatic enzyme regime and subsequently suffers from fat malabsorption. He has a normal appetite and caloric intake; however, he has recently lost 20 lbs (9.1 kg) over the past 8 months. Which of the following nutritional advice is most appropriate at this time? a. Consume a low fat diet b. Add 2 to 3 Tbps of MCT oil per day c. Incorporate an appetite stimulant d. Consume a low fiber diet

b. Add 2 to 3 Tbps of MCT oil per day

Which of the following nutritional recommendations is correct for a patient experiencing abdominal pain and bloating related to irritable bowel syndrome (IBS)? a. Diets high in lactose and fructose should be encouraged b. Asparagus, broccoli, and cauliflower should be consumed due to their tendency to cause less gas c. If symptoms are particularly bothersome, skipping the next meal should be considered as foods are a common trigger of IBS d. Increased consumption of fiber, especially in constipation-predominant IBS

d. Increased consumption of fiber, especially in constipation-predominant IBS

LT is a 24-year-old woman with unintentional weight loss of 30 pounds (13.6 kg) over the past 4 months despite a normal caloric intake. LT also complains of foul-smelling stools. After several days of work-up, she is diagnosed with Crohn’s disease involving predominantly the small intestines at the level of the ileum. Which of the following is the most likely cause of her weight loss? a. Anorexia related to abdominal pain b. Colonic perforation c. Excessive fiber intake d. Vitamin deficiency

a. Anorexia related to abdominal pain

HN is a 68-year-old man with advanced liver disease. Recent labs show an elevated prothrombin time (PT). Which of the following condition is most likely to cause an elevation in PT levels in patients with advanced/end stage liver disease? a. Vitamin K deficiency b. Ascites c. Reduced production of clotting factors d. All of the above

d. All of the above

EB is a 28-year-old obese woman, recently diagnosed with gastroesophageal reflux disease (GERD). She states that her symptoms are nocturnal, occurring mostly in the middle of the night. Which of the following recommendations may be most helpful in alleviating her symptoms? a. Sleep with at least three pillows at night b. Take an over-the-counter sleeping pill c. Avoid eating at least two hours before bedtime d. Drink warm tea before bed

c. Avoid eating at least two hours before bedtime

Dietary management of adult patients with severe ascites should include which of the following? a. Sodium restriction to less than 2000 mg/day b. Protein restriction c. Carbohydrate restriction to 20 to 30% of calories due to risk of hyperglycemia d. Increase in free water to 50% above maintenance levels to avoid dehydration

a. Sodium restriction to less than 2000 mg/day

In addition to a random plasma glucose ≥200 mg/dL and classic symptoms of hyperglycemia or hyperglycemia crisis, which fasting glucose level supports a diagnosis of diabetes? a. ≥110 mg/dL b. ≥118 mg/dL c. ≥126 mg/dL d. ≥132 mg/dL

c. ≥126 mg/dL

The hemoglobin A1C is used to assess whether an individual has prediabetes and an increased risk of developing diabetes. What A1C percentile range is considered prediabetes? a. 4.5–5.0% b. 5.1–5.6% c. 5.7–6.4% d. 6.5–7.0%

c. 5.7–6.4%

Which of the following time period best reflects when expected outcomes from medical nutrition therapy would be seen in patients with diabetes? a. Within 1 week after initiation b. Within 2 to 3 weeks after initiation c. Within 4 to 5 weeks after initiation d. Between 6 weeks and 3 months after initiation

d. Between 6 weeks and 3 months after initiation

Which of the following statements best summarizes the first priority of medical nutrition therapy in patients with type 2 diabetes? a. Improve serum glucose and lipid levels b. Improve physical activity level c. Improve body image d. Improve albumin levels

a. Improve serum glucose and lipid levels

According to the American Diabetes Association, which of the following statements is correct regarding carbohydrate intake in patients with type 2 diabetes? a. Low glycemic index diet will improve lipid levels b. Increasing dietary fiber by 10 grams per day will reduce glucose levels c. The total amount of carbohydrate ingested is more important than the source or type of carbohydrate d. Basal insulin doses are based on the total amount of carbohydrates and protein in the planned eating pattern

c. The total amount of carbohydrate ingested is more important than the source or type of carbohydrate

Using the carbohydrate counting method for meal planning in patients with type 1 diabetes, which of the following amount equals one carbohydrate serving? a. 5 grams of carbohydrate b. 10 grams of carbohydrate c. 15 grams of carbohydrate d. 20 grams of carbohydrate

c. 15 grams of carbohydrate

According to the National Cholesterol Education Program Adult Treatment Panel III guidelines and the American Diabetes Association, what is the target LDL cholesterol goal for adults with diabetes? a. <100 mg/dL b. <130 mg/dL c. <160 mg/dL d. <190 mg/dL

a. <100 mg/dL

Nutritional recommendations from the American Diabetes Association, American Heart Association, and the Dietary Guidelines for Americans agree on which of the following dietary guidelines for healthy eating? a. Restrict carbohydrate intake b. Increase protein intake c. Limit saturated fat and avoid trans fats d. Use only monounsaturated fats

c. Limit saturated fat and avoid trans fats

Which of the following recommendations regarding alcohol consumption in persons with type 1 diabetes is most appropriate? a. Alcohol should be consumed without food to avoid excess calories b. Alcohol should only be consumed with food to prevent hypoglycemia c. Sweet wines should be avoided because they raise blood glucose d. Alcohol should not be consumed

b. Alcohol should only be consumed with food to prevent hypoglycemia

Two major studies showed a 58% reduction in the onset of diabetes in a population of people with prediabetes. What percentage weight loss was necessary to achieve this risk reduction? a. 7% b. 12% c. 20% d. 28%

a. 7%

Which of the following conditions increases a patient’s likelihood of developing insulin resistance? a. History of impaired glucose tolerance b. First-degree relative with type 2 diabetes c. Central obesity d. All of the above

d. All of the above

Which of the following glucose-lowering medications is frequently used as first-line drug therapy in people with type 2 diabetes? a. Alpha-glucosidase inhibitors (acarbose, miglitol) b. Thiazolidinediones (pioglitazone) c. Biguinides (metformin) d. Sulfonylureas (glyburide/glibenclamide, glipizide, glimepiride)

c. Biguinides (metformin)

Which of the following guidelines are appropriate for treating hypoglycemia in a patient taking insulin? a. Treat with 15 grams of carbohydrate, wait 15 minutes and retest, treat again if blood sugar has not increase, retest in 1 hour b. Treat with 30 grams of carbohydrates and retest in 2 hours c. Treat with a 20-ounce regular soda and retest in 1 hour d. Treat with a candy bar

a. Treat with 15 grams of carbohydrate, wait 15 minutes and retest, treat again if blood sugar has not increase, retest in 1 hour

What is the target range for the pre-meal plasma glucose levels for many non-pregnant adults with diabetes? a. 70–130 mg/dL b. 100–140 mg/dL c. 150–180 mg/dL d. 180–200 mg/dL

a. 70–130 mg/dL

DH is a 45-year-old woman with obstructive sleep apnea syndrome (OSAS). Medical nutrition therapy for patients with OSAS should focus on which of the following? a. Protein repletion b. Vitamin and mineral deficiencies c. Weight reduction d. Fluid retention

c. Weight reduction

SW is a 78-year-old man with COPD and has recently lost 5 pounds since her last visit 6 months ago. What is the most likely cause of weight loss in this patient? a. Increased metabolic rate due to work of breathing b. Side effects from her medications c. Increased respiratory muscle mass d. Vitamin toxicity

a. Increased metabolic rate due to work of breathing

Which of the following appetite stimulant has been helpful for patients with COPD by improving body composition and decreasing muscle wasting by inhibiting cytokine production? a. Metformin b. Garcinia cambogia c. Ghrelin d. Sibutramine

c. Ghrelin

There are many potential side effects of COPD medications that may interfere with a patient’s dietary intake. Which of the following are the most common side effects? a. Diarrhea b. Gastric irritation c. Dry mouth and dysgeusia d. All of the above

d. All of the above

RG is a 59-year-old female who successfully undergoes a lung transplant. She is prescribed long-term steroid treatment. Which of the following side effects of steroid therapy may require consultation for nutritional services? a. Hypoglycemia b. Hyponatremia c. Hypokalemia d. Hyperglycemia

d. Hyperglycemia

What is the primary reason why patients with cystic fibrosis require extra sodium intake? a. To maintain body weight b. To reduce blood pressure c. To replace losses in perspiration d. To reduce edema

c. To replace losses in perspiration

Children diagnosed with cystic fibrosis who have had multiple infections and are taking long-term antibiotics are more likely to develop which of the following vitamin deficiencies? a. Vitamin B12 b. Vitamin K c. Vitamin A d. Thiamin

b. Vitamin K

PW is receiving mechanical ventilation in the ICU and prescribed enteral nutrition support. Which of the following additions to enteral formula has been shown to enhance the immunological barrier in the GI tract via enterocytes and colonocytes? a. Glutamine b. Theonine c. Omega-6 fatty acids d. Magnesium

a. Glutamine

Patients receiving enteral feedings who are on mechanical ventilation need to be monitored carefully to avoid overfeeding because too many calories can result in which of the following? a. Decreased RQ b. Increased sputum production c. Excessive CO2 production d. Decreased dyspnea

c. Excessive CO2 production

PW is an 18-year-old boy with cystic fibrosis. Which of the following factors contribute to the osteopenia seen in patients with cystic fibrosis? a. Malabsorption b. Vitamin D deficiency c. Delayed puberty d. All of the above

d. All of the above

FR is a 39-year-old obese male who was recently diagnosed with obstructive sleep apnea syndrome (OSAS) and prediabetes. Recent research has shown that some patients with OSAS have lower plasma levels of which of the following neuropeptide? a. Orexin b. Amyloid beta c. Alanine d. Cannabanoid

a. Orexin

RD is a 12-year-old girl with cystic fibrosis who is admitted to the hospital with weakness and lethargy. She has had increased foul-smelling stools and a recent loss of 6 pounds. What is the most likely cause of the patient’s weight loss? a. Heart failure b. Malabsorption c. Liver disease d. Anemia

b. Malabsorption

1. BC is a 22-year-old male with acute renal failure who is admitted to the hospital. A nutrition support service consultation is requested to determine the patient’s calorie requirements. Which of the following calorie requirements should be used for individuals with acute renal failure? a. 10–20 kcal/kg per day b. 20–30 kcal/kg per day c. 30–50 kcal/kg per day d. 50–60 kcal/kg per day

b. 20–30 kcal/kg per day

2. OK is a 62-year-old woman with stage 4 chronic kidney disease. She will most likely need dialysis in the next 6 months. Medical nutrition therapy for patients with chronic kidney disease prior to initiating dialysis restricts protein for which of the following reasons? a. An attempt to slow the progression of chronic kidney disease b. To compensate for an increase in excretion of nitrogenous waste products c. To better control hypertension d. To reduce appetite

b. To compensate for an increase in excretion of nitrogenous waste products

3. AE is a 48-year-old man who recently passed a kidney stone containing calcium oxalate. Which of the following recommendations for diet modification should be made? a. Reduce calcium intake b. Increase protein intake c. Increase in daily fluid intake to 1500 cm3/day d. Increase fiber intake

c. Increase in daily fluid intake to 1500 cm3/day

4. WG is a 52-year-old woman who has recently undergone renal transplantation due to stage 5 chronic kidney disease most likely caused by diabetes and hypertension; she had been undergoing hemodialysis three times per week for 4 years. Which of the following side effects related to some immunosuppressive agents would require dietary intervention? a. Hyperlipidemia b. Hypermagnesemia c. Hypoglycemia d. Hyperphosphatemia

a. Hyperlipidemia

5. Restricting dietary phosphate intake for individuals with chronic kidney disease stage 5 with dialysis to maintain proper calcium/phosphorus balance may decrease severity of which of the following medical problems? a. Secondary hyperparathyroidism b. Vascular and soft tissue calcifications c. Rheumatoid arthritis d. All of the above

b. Vascular and soft tissue calcifications

6. Patients in early stages of chronic kidney disease who are taking which of the following therapies to control blood pressure and possibly slow the progression of chronic kidney disease may be at risk for developing hyperkalemia? a. Dietary salt substitutes b. Angiotensin converting enzyme inhibitors c. Calcium channel blockers d. All of the above

b. Angiotensin converting enzyme inhibitors

7. GN is a 46-year-old woman receiving hemodialysis (HD) in an outpatient facility. She is 5′3′′ (160 cm) and weighs 110 lbs (50 kg). Her lab data are BUN: 65 mg/dL; albumin: 3.7 g/dL; creatinine: 9.2 mg/dL. Considering GN is receiving HD three times per week, how much protein should she be consuming daily? a. <50 grams protein/day b. 60–65 grams protein/day c. 75–90 grams protein/day d. >90 grams protein/day

b. 60–65 grams protein/day

8. The kidney plays an essential role in the metabolism of which of the following metabolic conversions? a. Beta carotene to vitamin A b. Oxalic acid to ascorbic acid c. Ferrous sulfate to ferric sulfate d. 25(OH)D to 1,25(OH)2D

d. 25(OH)D to 1,25(OH)2D

9. DT is a 48-year-old woman with nephrotic syndrome. In addition to reducing dietary fat intake, protein intake should also be limited to 0.8–1.0 g/kg per day. Which of the following mechanisms explains why moderate protein intake is advised for patients with nephrotic syndrome? a. To reduce the amino acid load in the glomerulus b. To increase albumin excretion c. To reduce nitrogen balance d. To increase hepatic protein synthesis

a. To reduce the amino acid load in the glomerulus

10. TD is a 62-year-old man with chronic kidney disease and normocytic, normochromic anemia. He is undergoing peritoneal dialysis with the automated cycler machine at home. He is adequately dialyzed and felt to be adherent to his dialysis regimen. Which of the following mechanisms best explains the associated anemia in this patient with chronic kidney disease? a. Blood loss due to dialysis procedure b. Vitamin B12 deficiency c. Decreased erythropoietin production d. Folate deficiency

c. Decreased erythropoietin production

11. When assessing the nutritional status of a patient with chronic kidney disease undergoing chronic hemodialysis, it is important to use the patient’s estimated dry weight for all calculations. Which of the following is the best definition of “dry weight”? a. The weight when the patient is dehydrated b. The weight when the patient has not drunk any fluids in 12 hours c. The weight after the patient has received dialysis d. The weight of the patient when no apparent edema or hypertension is present

d. The weight of the patient when no apparent edema or hypertension is present

12. NW is a 46-year-old male with stage 4 chronic kidney disease. He weighs 200 lbs (90.9 kg), an ideal body weight for him, and he is not retaining fluid. A 24-hour urine collection indicated a loss of 2.1 grams of protein due to proteinuria, but not likely significant to add to his protein needs. What are his daily protein requirements? a. 50.3 g/day b. 56.5 g/day c. 73 g/day d. 121 g/day

c. 73 g/day

13. AP is a 64-year-old woman with type 2 diabetes who visits her internist for a yearly physical. Her serum creatinine and BUN levels are significantly elevated and the physician suspects renal disease. Which of the following parameters are appropriate to consider when she completes her 24-hour urine collection? a. Urinary red blood cells b. Protein excretion c. Creatinine excretion d. All of the above

d. All of the above

1. According to research on the link between obesity and cancer risk, which of the following women have the highest risk of developing breast cancer? a. Pre-menopausal woman with a BMI of 30 kg/m2 b. Post-menopausal woman with a BMI of 30 kg/m2 c. Pre-menopausal woman with a BMI of 22 kg/m2 d. Post-menopausal woman with a BMI of 40 kg/m2

d. Post-menopausal woman with a BMI of 40 kg/m2

2. According to the National Cancer Institute, what is the strongest and most consistent predictor of breast cancer risk? a. Amount of physical activity b. High intake of saturated fat c. Weight gain during adulthood d. History of heavy menstruation

c. Weight gain during adulthood

3. TB is a 48-year-old physically inactive man with a family history of cancer. He recently quit smoking and is eating more healthy foods. He asks his physician what additional preventive steps he can take to reduce his risk of cancer. Which of the following lifestyle changes should be recommended to TB to help reduce his risk of developing cancer? a. Eat only organic foods b. Begin a regular physical activity program for 30 minutes every day c. Eliminate all dairy foods d. Eliminate all sugar from his diet

b. Begin a regular physical activity program for 30 minutes every day

4. According to the American Institute for Cancer Research, dietary recommendations to reduce the risk of colon cancer include which of the following statements about red meat intake? a. A maximum of 18 ounces of cooked red meat per week with no processed meat consumption b. Cook meats well done, preferably using BBQ grilling methods c. A maximum of 12 ounces of cooked red meat and 4 ounces of processed meat per week d. Red meat has not been linked to colon cancer

a. A maximum of 18 ounces of cooked red meat per week with no processed meat consumption

5. Flavonoids are a class of phytochemicals that act as an antioxidant and absorb free radicals, thus potentially protecting against certain types of cancer. Flavonoids are found in high concentrations in which of the following foods? a. Dark green leafy vegetables b. Cruciferous vegetables c. Tomatoes and tomato products d. Berries, grapes, green tea

d. Berries, grapes, green tea

6. MC is a 55-year-old female who questions her gynecologist about the pros and cons of eating more foods with soy. Consumption of foods made with soy may be protective against which type of cancer? a. Breast cancer b. Colon cancer c. Stomach cancer d. Uterine cancer

a. Breast cancer

7. Several compounds in red wine have been shown to possess antioxidant and anti-angiogenic properties. Which of the following polyphenols is present in red wine? a. Quecetin b. Resveratrol c. Lycopene d. Glucosinolate

b. Resveratrol

8. FS is an 86-year-old man who was admitted to the hospital with dehydration and pneumonia. At what point should cancer cachexia be suspected? a. If he experienced an unintentional weight loss greater than 5% of his weight over the previous month b. Immediately upon first impression of the patient c. Complaining of home and joint pain d. If nausea and fatigue are present

a. If he experienced an unintentional weight loss greater than 5% of his weight over the previous month

9. AW is a 71-year-old woman who is receiving daily radiation treatment for colon cancer. Which of the following side effects of radiation treatment is most likely to affect this patient’s nutritional intake? a. Insomnia b. Radiation pneumonitis c. Nausea and vomiting d. Alopecia

c. Nausea and vomiting

10. KB is a 53-year-old female who is receiving weekly chemotherapy following surgery for breast cancer. Which of the following nutrition recommendations can help control her complaints of nausea after treatment? a. Avoid eating within 4 hours b. Eating smaller, more frequent meals c. Eating larger meals in the middle of the day d. Add more fiber to meals

b. Eating smaller, more frequent meals

11. Excessive alcohol consumption has been linked as the primary cause of liver cancer. Alcohol users also experience which of the following types of cancers six times more often than non- alcohol users? a. Pancreatic cancer b. Brain cancer c. Colon cancer d. Oral cancer

d. Oral cancer

1. In a critical care patient who has a functional GI tract but is unable to ingest adequate nutrients by mouth, when is tube feeding a useful therapy? a. Three days after coronary bypass surgery in a well-nourished patient b. A patient with Crohn’s disease who has a small bowel obstruction c. Seven days after a stroke in a patient with aspiration and dysphagia when swallowing d. Following surgery for ischemic bowel with 50 cm of remaining small bowel

d. Following surgery for ischemic bowel with 50 cm of remaining small bowel

2. When is a percutaneous endoscopic gastrostomy (PEG) tube indicated for a patient requiring tube feeding? a. Never b. When tube feeding is expected to be for greater than 4 to 6 weeks c. When a patient has gastroparesis and failed an oral diet d. When a patient is being weaned from intubation

b. When tube feeding is expected to be for greater than 4 to 6 weeks

3. When a patient is ambulatory and transitioning to eat small amounts of food, what is the best method for administering supplemental tube feeding to maintain their appetite? a. Nocturnal cycle over 8 to 12 hours b. 24-hour continuous c. Three bolus feedings daily d. Tube feeding should not be administered to patients who can eat

a. Nocturnal cycle over

4. When a patient receiving tube feeding and antibiotics develops diarrhea, which of the following tests is indicated before prescribing anti-diarrheal medications in order to avoid toxic megacolon? a. Small bowel biopsy for celiac disease b. Stool for Clostridium difficile toxin c. Bacteria culture of formula d. Blood test for parasites

b. Stool for Clostridium difficile toxin

5. What is the benefit of adding fiber to enteral formulas? a. Helps normalize bowel function b. Promotes the growth of intestinal flora c. Provides prebiotic effects d. All of the above

d. All of the above

6. Which of the following antioxidants are added to some enteral formulas? a. Copper and manganese b. Vitamin B12 and folic acid c. Vitamin C and vitamin E d. Calcium and potassium

c. Vitamin C and vitamin E

7. What is the preferred feeding tube placement in an ICU patient with severe, acute pancreatitis? a. Nasogastric b. Nasojejunal c. Percutaneous endoscopic gastrostomy d. Surgical gastrojejunostomy

b. Nasojejunal

8. Lack of enteral stimulation in the GI tract may contribute to which of the following complications? a. Gut atrophy and higher infection risk b. Vitamin K deficiency and bleeding c. Hypoglycemia and higher infection risk d. Suppressed thyroid function and muscle wasting

a. Gut atrophy and higher infection risk

9. What enteral formula density is appropriate for a patient who requires a fluid restriction? a. 0.5–0.8 kcal/mL b. 0.8–1.0 kcal/mL c. 1.0–1.2 kcal/mL d. 1.5–2.0 kcal/mL

d. 1.5–2.0 kcal/mL

10. Enteral formulas supplemented with glutamine are designed to accomplish which of the following? a. Decrease inflammation b. Improve glucose control c. Promote immune function and improve bowel integrity d. Normalization of BUN and creatinine

c. Promote immune function and improve bowel integrity

11. How can the risk of aspiration be reduced in a patient receiving enteral tube feeding? a. Feed into the stomach b. Elevate head of bed to greater than 30 degrees c. Feed at night only d. Hold tube feeding for gastric residual >200

b. Elevate head of bed to greater than 30 degrees

12. What is the most commonly reported GI complication for a patient receiving tube feeding? a. Nausea/ vomiting b. Constipation c. Reflux d. Diarrhea

d. Diarrhea

13. AK is a 65-year-old man who is undergoing radiation therapy for thoracic tumor. He has odynophagia and needs a nutrition consultation for a special diet. Medical nutrition therapy for a patient with odynophagia includes which of the following recommendations? a. Low-fat diet b. Avoidance of cooked fruits and vegetables c. Soft, blended foods d. High carbohydrate diet

c. Soft, blended foods

1. Parenteral nutrition is utilized in patients in which of the following clinical scenarios? a. Diminished motor capacity makes eating difficult b. Enteral nutrition is not possible c. When the patient has dementia d. When the patient has poor oral intake

b. Enteral nutrition is not possible

2. Central parenteral nutrition is indicated in which of the following clinical scenarios? a. Long-term parenteral nutrition support (longer than 7 days) is anticipated b. In fluid restricted patients c. A patient has a moderately-to-severely elevated metabolic rate d. All of the above

d. All of the above

3. When using peripheral parenteral nutrition solutions, what is the maximum allowable concentration to prevent vascular damage? a. 600 mosmol per liter b. 800 mosmol per liter c. 900 mosmol per liter d. 1000 mosmol per liter

c. 900 mosmol per liter

4. According to the Enteral Nutrition Guidelines for the Provision of Nutrition Support Therapy in the Critically Ill Adult, if a patient is malnourished parenteral nutrition support should be initiated in which of the following scenarios? a. 5–7 days pre-operatively b. Parenteral Nutrition should not be initiated until 5–7 days post-operatively if EN is not feasible c. Parenteral Nutrition should not be initiated unless the anticipated duration is ≥ 7 days. d. All of the above

d. All of the above

5. How much of the total energy prescription for parenteral nutrition should be supplied as protein? a. 5 to 10 percent b. 10 to15 percent c. 15 to 20 percent d. 20 to 25 percent

c. 15 to 20 percent

6. The dextrose infusion rate of parenteral nutrition should be limited to how many mg per kg per minute in a stable hospitalized patient? a. 5 mg per kg per minute b. 6 mg per kg per minute c. 7 mg per kg per minute d. 8 mg per kg per minute

c. 7 mg per kg per minute

7. Lipid emulsions should NOT be given to patients receiving parenteral nutrition in which of the following situations (may be more than one) a. In patients with hypertriglyceridemia-induced pancreatitis b. In patients have egg allergies c. In patients with serum triglycerides greater than 400 mg per dL d. All of the above

d. All of the above

8. Which of the following is the best IV access for long-term parenteral nutrition support? a. Tunneled cuffed catheter b. Non-tunneled central venous catheter c. Peripherally inserted central catheter d. Tunneled non-cuffed catheter

a. Tunneled cuffed catheter

9. Which of the following potential metabolic complications of PN should be monitored? a. Hyperglycemia b. Electrolyte imbalances c. Dehydration and fluid overload d. All of the above

d. All of the above

10. In order to reduce the risk of developing refeeding syndrome in a severely malnourished patient, which of the following PN solutions would be appropriate to administer for the first few days while closely monitoring phosphorus, potassium, magnesium, glucose, and fluid status? a. Provide a high protein and high calorie PN solution b. Provide a high electrolyte PN solution c. Provide a low-dextrose PN solution d. Provide a low protein PN solution

c. Provide a low-dextrose PN solution

11. A long-term complication of PN support includes which of the following conditions? a. Metabolic bone disease b. Multiple sclerosis c. Hyperparathyroidism d. Fibromyalgia

a. Metabolic bone disease

12. When is the most appropriate time a patient should discontinue PN when transitioning to oral feeding? a. As soon as the patient is able to tolerate any oral feeding b. When the patient tolerates 50 percent of daily nutrition requirements through the oral diet c. When the patient tolerates 75 percent of daily nutrition requirements through the oral diet d. When the patient tolerates 100 percent of daily nutrition requirements through the oral diet

b. When the patient tolerates 50 percent of daily nutrition requirements through the oral diet