Hart Book Flashcards
Signs likely to appear abnormal on physical examination with iron deficiency?
- skin
- nails
- mouth
Serum albumin levels may be falsely elevated irrespective of nutritional status in what condition?
Dehydration
Hypokalemia is
low potassium
Tingling in hands and feet is common is what deficiency?
Vit B12
What is the best determinant of iron status in a normal 18-year-old female with regular menses?
Ferritin
What trimester are pregnant women more likely to experience anemia?
3rd
What is considered a positive diagnosis for GD following a 1-hour, 50-g glucose load?
130-140 mg/dL
Population with highest prevalence of neural tube defects?
Hispanic women
What is the approximate time for breast milk to empty from infants stomach?
1.5 hours
According to CDC, what is the minimal amount of folic acid childbearing age women should consume?
400 mg
Safe weight loss post-pregnancy?
1-2 pounds/month
AAPs recommendation of juice for kids 1-2 years?
< 4 oz daily
Fat is required to maintain the development of?
central nervous system
Pediatricians measure head circumference up to what age….
2 years of age
Refeeding syndrome involves what nutrients?
phosphate, Mg, Ca, K
DEXA scan indicating osteoporosis?
< -2.5
Dietary supplement for age-related macular degeneration (AMD)?
combo with zinc, copper, Vit E, and Vit C
An 83-year-old client is consuming enough Vit B12, but serum levels are low. What mechanism most likely explains the cause of the low vit B12 levels?
Decreased ability to absorb protein-bound vitamin B12
BMI cutoff for a red flag the client is underweight and needs further assessment?
< 22 BMI
What mechanism plays a role in the cachexia, malnutrition, and associated weight loss seen in cancer clients?
altered cytokine levels
A 62-year-old diabetic male with diabetes and has a history of heart disease, target LDL is what?
< 100mg/dL
Nutritional issue most commonly associated with heart failure?
Increased muscle wasting and malnutrition
Omega-3s are effective at reducing what? (if they are abnormally elevated)
Triglycerides
Crohn’s disease client with intestinal resection of her ileum - dietary management includes:
Reduced intake of foods high in oxalate
Malnutrition and dietary management in patients with chronic liver disease?
- Iatrogenic causes of malnutrition may include restricted diets, diuresis, and frequent paracentesis
- malabsorption may occur due to diminished bile acid production
- restricted protein intake should be limited to periods fo acute encephalopathy
Encephalopathy:
a disease in which the functioning of the brain is affected by some agent or condition (such as viral infection or toxins in the blood).
Ascites:
is a condition in which fluid collects in spaces within your abdomen. As fluid collects in the abdomen, it can affect your lungs, kidneys, and other organs. Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.
Peptic ulcer disease management:
Counseling to avoid common trigger foods such as coffee, tea, colas, alcohol
Fat malabsorption issue recommendation:
2-3 TBS of MCT oil daily
Dietary management for adult pts with severe ascites should include:
Sodium restriction to less than 2000 mg/day
Fasting glucose to support a diagnosis of diabetes?
great than or equal to 126 mg/dL
A1C that is considered prediabetes?
5.7 - 6.4%
Time period that reflects when expected outcomes from MNT would be seen in pts with diabetes?
6 wks - 3 months after initiation
According to the American Diabetes Association, what do they say about carbohydrate intake in pts with T2DM?
The total amount of carb ingested is more important than the source or type of carb
Using a carb counting method for meal planning in pts with T1DM, what is the gram amount that equal one carb serving?
15 g of carb
What is the target LDL cholesterol goal for adults with diabetes?
< 100 mg/dL
What is the recommendation regarding alcohol consumption in person with T1DM?
alcohol should only be consumed with food to prevent hypoglycemia
What weight loss is necessary to achieve a 58% reduction in the onset of diabetes?
7%
What is the appropriate guideline for treating hypoglycemia in a pt taking insulin?
treat with 15 g of carb, wait 15 min and retest, treat again if blood sugar has not increase, retest in 1 hr
What appetite stimulant has been helpful for pts with COPD by improving body composition and decreasing muscle wasting by inhibiting cytokine production?
Ghrelin
COPD med side effects that interfere with dietary intake?
- diarrhea
- gastric irritation
- dry mouth and dysgeusia
Long term steroids may require consultation for nutritional sources bc why?
Hyperglycemia
Cystic Fibrosis is what?
is a genetic condition that affects a protein in the body. People who have cystic fibrosis have a faulty protein that affects the body’s cells, tissues, and the glands that make mucus and sweat.
Why do pts with cystic fibrosis require extra sodium?
to replace losses in perspiration
Children with cystic fibrosis taking long term antibiotics are likely to develop what vitamin deficiency?
Vit K
Which of the following additions to enteral formula has been shown to enhance the
immunological barrier in the GI tract via enterocytes and colonocytes?
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?
Excessive CO2 production
Caloric requirements for acute renal failure?
20-30 kcal/kg/day
Medical nutrition therapy for patients with chronic kidney disease
prior to initiating dialysis restricts protein for which reason?
An attempt to slow the progression of chronic kidney disease
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?
Increase in daily fluid intake to 1500 cm3/day
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 side effect related to some immunosuppressive agents would require dietary intervention?
Hyperlipidemia
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?
Vascular and soft tissue calcifications
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?
Angiotensin converting enzyme inhibitors
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: 65mg/dL; albumin: 3.7 g/dL; creatinine: 9.2mg/dL. Considering GN is receiving HD three times per week, how much protein should she be consuming daily?
60–65 grams protein/day
The kidney plays an essential role in the metabolism of which of the following metabolic
conversions?
25(OH)D to 1,25(OH)2D
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?
To reduce the amino acid load in the glomerulus
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?
Decreased erythropoietin production
Which of the following is the best definition of “dry weight”?
The weight of the patient when no apparent edema or hypertension is present
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?
73 g/day
(0.8 g/kg)
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
ALL of the above
According to research on the link between obesity and cancer risk, which of the following
women have the highest risk of developing breast cancer?
Post-menopausal woman with a BMI of 40 kg/m2
According to the National Cancer Institute, what is the strongest and most consistent
predictor of breast cancer risk?
Weight gain during adulthood
Which of the following lifestyle changes should be
recommended to TB to help reduce his risk of developing cancer?
Begin a regular physical activity program for 30 minutes every day
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 maximum of 18 ounces of cooked red meat per week with no processed meat consumption
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
Consumption of foods made with soy may be protective against which type of cancer?
Breast cancer
Which of the following side effects of radiation treatment is most likely to affect this patient’s nutritional intake?
Nausea and vomiting
Alcohol users also experience which of the following types of cancers six times more often than nonalcohol users?
Oral cancer
Odynophagia refers to:
pain while swallowing
When is a percutaneous endoscopic gastrostomy (PEG) tube indicated for a patient requiring
tube feeding?
When tube feeding is expected to be for greater than 4 to 6 weeks
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?
Nocturnal cycle over 8 to 12 hours
Which of the following antioxidants are added to some enteral formulas?
Vitamin C and vitamin E
What is the preferred feeding tube placement in an ICU patient with severe, acute
pancreatitis?
Nasojejunal
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
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
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
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
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
When using peripheral parenteral nutrition solutions, what is the maximum allowable
concentration to prevent vascular damage?
a. 600mosmol per liter
b. 800mosmol per liter
c. 900mosmol per liter
d. 1000mosmol per liter
c. 900mosmol per liter
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
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
The dextrose infusion rate of parenteral nutrition should be limited to how many mg per kg
per minute in a stable hospitalized patient>
a. 5mg per kg per minute
b. 6mg per kg per minute
c. 7mg per kg per minute
d. 8mg per kg per minute
c. 7mg per kg per minute
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 400mg per dL
d. All of the above
d. All of the above
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
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
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
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
