Nutrition Care for Individuals and Groups (40%)

Question 1

Which diet is often used following gastrointestinal surgery?

Answer 1

Soft diet

If a patient is just out of surgery, the doctor may choose a full liquid, clear liquid or a soft diet. The soft diet contains foods bland in flavor, soft in texture and are easily digested.

Question 2

Which would equal 1 medium fat meat exchange?

Answer 2

One medium fat meat exchange is equal to 1 egg1 oz cheese containing 4-7 grams of fat (such as feta, mozzarella, processed cheese), 2 oz ricotta cheese, and 1 oz of each of the following: pork chop, fried fish, fried chicken, chicken with skin, and lamb.

Question 3

A Nutrition Diagnosis:

Answer 3

Identifies the problem, relates it to risk factors, and evaluates the signs and symptoms

A Nutrition Diagnosis first identifies the problem “Significant weight loss”. Then relates the problem to risk factors “related to depression and change in appetite”. And finally evaluates signs and symptoms “as evidenced by meal intakes of less than 50%”.

Question 4

Which of the following is open to the community to come and get a free meal and does not require proof of a need for food or any other criteria to be met?

Answer 4

Soup kitchen

A local soup kitchen is run by volunteers and is open to the community. There is no need for a person to prove they are in need of a meal, nor do they need to be elderly (such as the Congregate Meal Program), a single mother with a child (WIC), or low income (Food Pantry).

Question 5

An African American male has sickle cell anemia. Which of the following supplements may be beneficial?

Answer 5

Zinc

Sickle cell anemia should not be mistaken for iron-deficiency anemia, which can be treated with an iron supplement. Ascorbic acid can produce free radical release and should be avoided. Zinc can increase oxygen affinity and may be beneficial to individuals with sickle cell anemia.

Question 6

According to My Plate, which would count as a one ounce (1 oz) equivalent from the Protein group?

Answer 6

One ounce of meat, poultry or fish, 1/4 cup cooked dry beans, 1 whole egg (white + yolk), 1 tablespoon of peanut butter, or 1/2 ounce of nuts or seeds can be considered as 1 ounce equivalent from the Protein group.

Question 7

For which of the following would a low-fiber diet NOT be recommended?

Answer 7

Diverticulosis

Diverticulosis would benefit from a high-fiber diet, not a low-fiber diet. The other conditions would benefit from a low-fiber diet. Diverticula is a sac or pouch formed in weak areas of the intestinal wall. Diverticulosis is the condition of having diverticula, or these pouches. The reason pouches form in the colon is not completely understood. It is believed that diverticula form when high pressure inside the colon pushes against weak spots in the colon wall. Constipation and a diet low in fiber may be contributing factors of developing diverticula. Treatment and prevention of diverticulosis includes avoiding constipation by increasing fiber intake from fruits, vegetables, beans and grains, increasing fluid consumption, and a regimen of physical activity. Diverticulosis is commonly confused with diverticulitis. Remember, “osis” means condition of, and “itis” means inflammation.

Question 8

Which would be an appropriate snack for a diabetic?

Answer 8

Cheese and crackers would be a good choice. There is a balance of carbohydrates to protein and fat, which will cause only a moderate rise in blood sugar. Simple sugars, as in orange juice and a popsicle, may cause a rapid rise and fall in blood glucose levels.

Question 9

How many calories from protein does a 130 pound HIV patient need to consume if she is in the maintenance phase?

Answer 9

You need to find the amount of protein an HIV patient needs. The protein factor for HIV in maintenance is 1.0-1.4 g/kg. Her weight in kg is 59 (130 lbs / 2.2).

Multiply her weight in kg by the protein factor to find amount of protein in grams:
Low end of range: 59 kg x 1.0 = 59 grams protein
High end of range: 59 kg x 1.4 = 82.6 grams protein

The question is asking for calories from protein, so multiply the grams of protein by 4 (there are 4 calories per gram of protein):
Low end of range: 59g protein x 4 cals per gram = 236 calories
High end of range: 82.6g protein x 4 cals per gram = 330 calories.

Question 10

A patient who has undergone an ileostomy should follow which diet when oral intake is allowed?

Answer 10

Low fiber, bland

In an ileostomy, the entire colon, rectum and anus are removed. A stoma is formed from the ileum. A low fiber, bland diet can prevent obstructions, promote healing and prevent GI upsets. New foods should be introduced in small amounts and one at a time.

Question 11

In speaking with an overweight client who weighs 240 pounds, what is a good goal to set?

Answer 11

Lose 20 pounds

You want to set realistic, short-term goals with clients - something they can achieve and see results without getting discouraged. When losing weight, a good goal to set would be to lose 10%, or in this case 20 pounds. This is an achievable goal and has an endpoint.

Question 12

Which of the following is not true about a mechanically soft diet (also referred to as ground diet)?

Answer 12

If a patient is tolerating a mechanically soft diet well, the dietitian may upgrade the diet to regular consistency

The mechanically soft diet (may also be called the “chopped diet” or “ground diet”) is a diet order that is ground up so the patient has an easier time eating the foods.

This diet does not affect the nutrition of the diet. A patient with a difficulty chewing as a result of poor dentition or pain in the mouth may be ordered on this diet.

Foods that are difficult to chew, like meats and vegetables, are ground up into smaller pieces.

Speech language pathologists (SLPs) determine the appropriate consistencies of foods and fluids for the patient.

Nutrition professionals rarely make any recommendations to the consistency of foods and fluids. We may only downgrade a patient’s diet (for example, from a regular consistency to a mechanically soft diet) if we find the patient may be at risk of choking and the SLP hadn’t evaluated the patient yet.

Registered dietitians and dietetic technicians may never upgrade a diet from ground to regular. Instead, if you find a patient is doing well on their current consistency, recommend a consult with the SLP to determine if the upgrade is possible.

Question 13

An enteral nutrition formula runs from 7am to 7pm at 70 ml/hr. Per 1,000 ml of formula, there is 848 ml of free water. Part of the feeding regimen is to provide the patient with 250 ml of water flushes 3 times per day. What is the total volume of fluid that is counted towards this patient’s fluid needs?

Answer 13

First, find the total volume of enteral nutrition formula provided. The feeding runs from 7am to 7pm, so the total time is 12 hours. Multiply the total hours by the feeding rate to find the volume of formula:
70 ml per hour X 12 hours = 840 ml of formula

In 1,000 ml of formula, there is 848 ml of free water as part of the ingredients. This is a known fact for this specific formula.

Each enteral formula will contain slightly different amounts of free water as part of the ingredients, which would get counted towards the patient’s fluid needs for the day.

The feeding regimen only provides 840 ml of formula, not 1,000 ml, so you need to calculate the amount of free water in this regimen:
848 ml free water in formula per 1 liter X 0.840 liter of formula provided = 712 ml free water in this regimen

Then add the additional water flushes provided (250 ml extra given 3 times per day):
712 ml water in formula + 750 ml additional water = 1,462 ml total fluid counted towards this patient’s fluid needs.