All Questions
Ranges of recommended macronutrient intakes associated with reduced risk of chronic disease are __________ of total daily energy. A. Carbohydrates: 45-65%; protein: 10-35%; fat: 20-35% B. Carbohydrates: 45-65%; protein: 20-35%; fat: 10-35% C. Carbohydrates: 55-65%; protein: 10-40%; fat: 5-10% D. Carbohydrates: 55-65%; protein: 5-10%; fat: 25-30% E. Carbohydrates: 45-65%; protein: 20-35%; fat: less than 10%
A. Carbohydrates: 45-65%; protein: 10-35%; fat: 20-35%
In addition to the U.S. - Style Eating Pattern previously recommended in the 2010 Dietary Guidelines for Americans, the 2015 - 2020 Dietary Guidelines for Americans recommend the Healthy Mediterranean-Style Eating Pattern and the Healthy Vegetarian Eating Pattern. A. True B. False
A. True
Pharmacists can play an integral role in screening patients for nutritional problems and referring them to a registered and licensed dietetics professional for Medical Nutrition Therapy or other related dietetics services where indicated. A. True B. False
A. True
Which of the following are functions of the USDA Supertracker? A. Food-A-Pedia B. Sample Meal Plans C. My Top 10 Goals D. A and B E. A, B, and C
D. A and B
The 2008 Physical Activity Guidelines call for the following: A. Children and adolescents should do 60 minutes or more of physical activity daily; including muscle-strengthening on 4 days of the week. B. Children and adolescents should do 90 minutes or more of physical activity daily; including muscle- strengthening on 2 days of the week. C. For substantial health benefits, adults should do at least 180 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous- intensity aerobic activity. D. For substantial health benefits, adults should do at least 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. E. None of the above is correct.
D. For substantial health benefits, adults should do at least 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity.
Which of the following is not true for food sources and/or body functions of macrominerals? A. Good sources of calcium (Ca) are dairy products, fruits, vegetables, beans, eggs, fish, and meat B. Magnesium and calcium are both important for muscle function (eg, contraction). C. Sodium (Na) can be found in many foods, including cheese, potato chips, deli meats, and corn bread. D. Good sources of potassium (K) are processed foods, such as commercially available breads and cereals. E. All of the above are true
D. Good sources of potassium (K) are processed foods, such as commercially available breads and cereals.
A TPN given via a peripheral line should not exceed: a. 12.5% Dextrose b. GIR 5 mcg/kg/minute c. 30% Dextrose d. 20% lipids e. 900 mOSm
a
Which of the following cardiovascular medications could be contributing to Mrs. Shirley's weight loss (hint: think about the mechanisms of action)? A. Spironolactone B. Nebivolol C. Lisinopril D. Amlodipine E. Isosorbide dinitrate
a
In the conversation, the patient mentions her desire to quit smoking soon and describes her success cutting down her daily cigarette use from 20 to 14. The patient is most likely in which Stage of Change? a. Maintenance b. Preparation c. Contemplation d. Action e. Precontemplation
b
Initiating enteral feeding too quickly after a prolonged period of being on parenteral nutrition can result in which of the following? a. Acute malnutrition b. Refeeding syndrome c. Hypoglycemia d. Hypertriglyceridemia e. Cholestasis
b
Linda H. is a cardiovascular disease patient who comes into your pharmacy to pick up her monthly refills. While she is waiting, she walks off to the vending machine and grabs a regular coke. After coming back to the waiting area, she starts a conversation with one of the pharmacy technicians about how bad artificial sweeteners are for you. You overhear the conversation when the pharmacy technician fuels the discussion by telling Linda that she has read in the paper that aspartame causes cancer. By now, her prescriptions are ready and since you need to check with Linda on any new issues with her medications, you step to the front and enter the conversation. Being knowledgeable about the topic, which of the following comments is most appropriate for you in this situation? A. You state that from a scientific perspective, there is evidence in humans that aspartame but no other artificial sweetener causes cancer within the Acceptable Daily Intake (ADI) limits. B. You state that from a scientific perspective, there is no evidence in humans that aspartame or any other artificial sweetener causes cancer, toxicity, or any other significant adverse effects within the Acceptable Daily Intake (ADI) limits. C. You mention that not all artificial sweeteners available on the US market have been approved by the Food and Drug Administration as safe for human consumption. D. You agree with and reiterate the information about aspartame given by the pharmacy technician. E. You tell patient and technician that you will google the information before commenting.
b
M.E. is a 45 year old male who is diagnosed with diabetes. He presented to the pharmacy today to order a refill for his insulin and insulin supplies. He states he recently took a trip to Saudi Arabia to see his extended family and was not adherent to his insulin therapy. He states he was not able to follow his usual diet when he was abroad. His 24-hour meal call plan consists of eggs, cheese, and bread dipped in olive oil with cardamom coffee for breakfast, lamb dish with rice and potatoes for lunch, and chicken and rice with flat bread for dinner. He snacks on dates and nuts in the morning and crackers and cheese in the evening. Patient would like to know what lifestyle modifications he could make to improve his diabetes. What would be the best lifestyle recommendation for this patient to control his diabetes? A. Eat more fruits and vegetables B. Decrease portion sizes, avoid excessive snacking, and increase physical activity C. Avoid consumption of eggs and cheese D. Adjust insulin dose E. Adopt a Western diet to better control his diabetes
b
Which of the following MICRONUTRIENTS should be covered at a minimum (micronutrients of concern in older adults)? A. Vit. B12, folic acid, calcium, calories B. Vit. B12, vit. D, folic acid, calcium C. Vit. K, vit B12, vit. D, magnesium D. Vit. K, vit. E, vit. D, calcium E. Vit. E, vit. B12, vit D, fiber
b
From his Food Frequency Screening Questionnaire you know that Anthony's diet is too high in sodium. Which of the following foods do you identify as NOT being high in sodium? A. Soy sauce B. Deli meats C. Eggs D. Bread E. Regular cheese
c
Which of the following is a hypoallergenic therapeutic infant formula? a. Enfamil AR b. Enfamil Lactofree c. Enfamil Pregestimil d. Enfamil Prosobee e. Enfamil Good Start
c
A.S. is a 48 year old female who is diagnosed with celiac disease and follows a gluten free diet. She presents to the pharmacy to pick up her diabetes medications and asks you if you can also ring some of her in-store purchases. You learn she was recently diagnosed with diabetes and is now choosing low glycemic index foods to better manage her diabetes. Patient's shopping basket contains bananas, vegetables, peanut butter, gluten-free pancake mix, steel cut oatmeal and beans. Which of these foods is most likely a high glycemic index food? A. Gluten-free pancake mix B. Steel cut oatmeal C. Beans D. A and B E. B and C
d
A patient walks up to the register with a bottle of Alli® (Orlistat 60mg capsules; OTC). Which of the following counseling points should be covered? A. Dietary fat restriction necessary to minimize GI side effects (steatorrhea, bloating and distension, and anal leakage) B. GI side effects possible even if dietary fat is restricted C. Risk of fat-soluble vitamin deficiencies with long-term use D. A, B, C E. A and C
d
Anthony knobs his head and signals you that he is ready to make changes. He has heard that "trans fats are bad for your heart." He would like to know which types of products are most commonly containing trans fats. Your best response is_________. (from Olendzki et al article) A. Tree nuts B. Peanuts C. Albacore tuna D. Cookies E. Olive oil
d
Because weight gain, overweight, and obesity are modifiable risk factors in the development of many cancers, you should recommend which of the following to overweight/ obese individuals asking for cancer-preventing strategies? A. Avoid sugary drinks B. Consume fast foods sparingly C. Limited intake of energy-dense foods D. A, B, and C E. B and C
d
Brian F. is a 35-year old construction worker who has been struggling with his weight. He has seen the amazing transformation someone has made on TV after undergoing weight loss surgery. He asks you whether you could tell him whether he would qualify for such a surgery. Based on the National Institutes of Health selection criteria, your best answer is: A. Your physician will determine your Body Mass Index (BMI), which is your weight divided by your height squared (kg/m2). To qualify for bariatric surgery, you must have a BMI of at least 40. B. You physician will determine your Body Mass Index (BMI), which is your weight divided by your height squared (kg/m2). To qualify for bariatric surgery, you must have a BMI of at least 35 and two chronic conditions (comorbidities). C. As an adult under the age of 65 years, you will be considered for Roux-en-Y gastric bypass surgery only. D. A and B E. B and C
d
Which of the following is NOT an individuallevel mediator (factors related to the patient only) explaining the link between socioeconomic position and health for persons with chronic diseases (e.g., diabetes), such as Sarah? A. Less effective communication between patient and provider among individuals of lower socioeconomic position B. Cultural norms, views, and attitudes of specific racial/ethnic groups that influence health beliefs among individuals of lower socioeconomic position C. Higher rates of mental health problems among individuals of lower socioeconomic position D. Inferior diabetes care provided to individuals of lower socioeconomic position (e.g., lower rates of preventive services) E. Lower levels of social support among individuals of lower socioeconomic position
d
Which of the following is a micronutrient included in parenteral nutrition? a. Iron b. Copper c. Selenium d. B and C E. A, B, and C
d
Which of the following laboratory values should be monitored weekly in pediatric patients on prolonged TPN? a. Triglycerides b. Phosphorus c. Prealbumin d. A, B, and C e. A and B
d
You use the Food Frequency Screening Questionnaire for an assessment of Anthony's diet. Looking over what you filled out together, which of the following dietary habits do you identify that should be addressed specifically to improve his blood pressure? A. Drinking 2-4 servings of caffeinated sugar-sweetened soda/ day. B. Eating a Subway sandwich with regular bread, deli ham, and mayonnaise every day for lunch. C. Eating a lot of processed foods on a regular basis. D. A, B, and C E. A and B
d
Your rationale behind identifying Mrs. Shirley's potential state of protein-energy malnutrition is to prevent which of the following? A. Anemia B. Sarcopenia C. Altered drug metabolism D. A, B, and C E. A and C
d
Brian is still confused about what it means to eat "gluten-free" to resolve his symptoms. What suggestions do you have for him? A. Learn to identify food items that contain wheat, rye, or barley, such as bread, bagels, pasta, pretzels, cookies, cakes, and crackers and avoid these foods. B. Be aware that even if some foods do not contain gluten, they may be crosscontaminated (processed foods). C. Recommendations made by the US Dietary Guidelines for Americans regarding whole grain consumption still apply to you. Gluten-free whole grain products include rice, buckwheat, or quinoa. D. Although oats do not contain gluten, they may have been contaminated with glutencontaining products during processing E. All of the above are true
e
Brian needs to pick up his mother's prescription for Lisinopril 20mg po qd. Knowing from your previous conversation about her diagnosis of CD, you carefully screen the inactive ingredients list of the generic Lisinopril stock bottle for gluten-containing agents. She had complained that one of the brands you had previously filled had upset her GI tract, but at the time you did not know she had CD. Which of the following ingredients contain gluten? A. Modified starch B. Dextrates C. Dextrimaltose D. Pregelatinized starch E. All of the above
e
Failure to thrive is defined as a. Chronic malnutrition b. Below the 5th percentile on the CDC growth chart with no other explanations c. Decrease in weight by 2 major percentiles on growth chart d. A, B, and C e. B and C
e
J.S. goes out to eat with his wife once a week. Their favorite restaurant is Olive Garden. Which of the following would be the most helpful recommendation for J.S. when eating at an Italian restaurant? A. Avoid salad dressing B. Drink tea instead of soda C. Ask if the restaurant has any sugar free desserts D. Patients with diabetes can't eat Italian food E. Try a dish that also includes lean protein, such as chicken
e
J.S. has some questions about his diet, specifically carbohydrates. His doctor told him he has to cut back on carbs but he's not really sure what that means. Which of the following foods is likely LOWEST in glycemic index? A. Corn on the cob B. Bagel C. Grapes D. Mini Wheats cereal E. Peanut butter
e
Jenna is grateful for the advice. She would like to learn more about what FODMAP foods are and how they affect IBS. Which of the following properties do high FODMAP foods have in common? A. They are poorly absorbed in the small intestine. B. They contain small and osmotically active molecules that rapidly draw excessive fluid into the intestine. C. They are rapidly fermented by bacteria into a number of gases that cause intestinal distention. D. They result in excessive gas, abdominal pain, abdominal bloating, and diarrhea. E. All of the above
e
You come to the front to counsel Sarah on how to give the antibiotic to Jenny and follow up on how she is taking the Metformin. After having her repeat back to you the instructions provided, you scan the barcode at the cash register. Her copayment for the Metformin refill is 50 cents higher than last time she refilled the prescription. Should you be expecting cost-related non-adherence? A. Yes B. No
yes
True or False: There is strong evidence that cognitive behavioral therapy in addition to diet and physical activity leads to additional weight loss.
True
Which of the following general recommendations on nutritional strategies to improve cardiovascular risk should you NOT make? (from from Olendzki et al article key recommendations for practice) A. As a patient with risk factors for cardiovascular disease, he should receive dietary counseling. B. He could increase consumption of animal proteins. C. He could increase consumption of plant proteins. D. He could consume more omega-3 fatty acids (e.g., fatty fish, green leafy vegetables, flaxseed, canola oil, soybeans, walnuts), particularly if he has or is at risk for coronary heart disease or sudden cardiac death. E. He could increase his consumption of dietary fiber and whole grains.
b
Which of the following symptoms is NOT typically associated with Celiac Disease (CD)? A. Depression B. Acne C. Itchy skin rash D. Unexplained weight loss E. Discolored teeth
b
"So which foods do I avoid if I want to eliminate high FODMAP foods from my diet?" A. All dairy products B. Whole grains and gluten-containing foods C. Foods containing lactose, fructans, polyols, and excess fructose D. Green leafy vegetables E. Artificial sweeteners
c
A pharmacist practicing collaborative care with Sue will most likely: a. Educate the patient on all the dangers of smoking b. Tell the patient that the best way to quit is to use nicotine gum c. Explore the patient's understanding of the relationship of cholesterol and smoking d. Tell the patient to lower cholesterol by eating a diet <10% saturated fat e. Share that quitting smoking is very difficult and starting atorvastatin is her best bet to prevent a heart disease.
c
Anthony now wants to know about alcohol intake and heart health. Which of the following statements is NOT correct regarding recommendations for alcohol intake? (from online video) A. Moderate drinking is recommended. Moderate drinking means 1 standard drink per day for women. B. Moderate drinking is recommended. Moderate drinking means 2 standard drinks per day for men. C. 1 standard drink is one 10 oz cocktail. D. 1 standard drink is one 12 oz beer E. 1 standard drink is 5 oz of wine.
c
You assess her dietary intake via a 24-dietary recall and identify that in addition of several micronutrients, she is not meeting intake of several other nutrients. Based on your readings, these are most likely __________. A. Energy, protein, carbohydrates B. Energy, protein, fat C. Energy, protein, fiber D. Protein and fat E. Fat and refined carbohydrates
c
You suggest to Jenna stress management in addition to avoidance of high FODMAP foods in order to control her IBS before they leave the pharmacy. She would like to know if any dietary supplement would help alleviate her IBS symptoms. Which of the following would you recommend? A. St. John's wort B. Catnip C. Melatonin D. Vitamin C E. Mineral oil
c
You suggest to M.E. to adopt the DASH diet to better manage his diabetes. Which of the following statements is not true: A. The DASH diet has been shown to help lower blood pressure and risk of CVD risks B. The DASH diet emphasizes fruits, vegetables, and low-fat dairy C. There is a lot of evidence demonstrating the health outcomes of the DASH diet in patients with diabetes D. High consumption of saturated fats and red meats is not recommended in the DASH diet E. DASH stands for Dietary Approaches to Stop Hypertension
c
The pharmacist responds, "Tell me some of the strategies you are using to cut back on your cigarettes." This an example of: a. Reflective listening b. Summaries c. Setting an agenda d. Open-ended question E. Rolling with resistance
d
A confidence ruler is best used to understand a patient's: a. Subjective norms b. Susceptibility to risk of disease c. Family health history d. Knowledge e. Self-efficacy
e
Anthony has seen on TV that fish oil supplements containing omega 3 fatty acids can prevent cardiovascular diseases. He is a little concerned about the cost of the supplement and the fishy taste which leads you to educate him about good dietary sources of omega- 3-fatty acids, such as leafy vegetables, flaxseed, canola oil, soybeans, and walnuts. He is curious: "Why do omega 3 fatty acids reduce your cardiovascular risk?" Your response is: Omega 3 fatty acids _______. (from Olendzki et al article) A. Contribute to the production of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which inhibit inflammatory immune response and platelet aggregation. B. Contribute to the production of EPA and DHA, which are mild vasodilators. C. Contribute to the production of EPA and DHA, which may have antiarrhythmic properties. D. B and C E. A, B, and C
e
Anthony's Food Frequency Questionnaire results also revealed that he is consuming almost no dietary fiber, an important dietary target of cardiovascular disease prevention and management. You counsel him on increased fiber consumption. Which of the following should be part of your advice? A. He should increase fiber intake slowly over a period of several days to a few weeks. B. He should drink more water to ameliorate possible gastrointestinal discomfort. C. Good sources of fiber are fruits and vegetables. D. The nutrition facts panel is a useful tool to compare fiber content of different products. E. All of the above
e
Which of the following is/are (a) compensatory behavior resulting from her inability to afford foods that puts her at risk for the development of diabetes? A. Intake of few low-cost, energy-dense foods that are generally rich in refined carbohydrates, added sugars, fats, and sodium B. Skipping meals and reduced caloric intake when resources run out alternated with periods of binge eating when resources become available C. Unstable weight management D. Impaired self-management capacity E. All of the above
e
The 2015 - 2020 Dietary Guidelines for Americans recommend the following: A. Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while limiting intakes of red meat B. Consume less than 10 percent of calories per day from saturated fats. C. Consume less than 2,500 milligrams (mg) per day of sodium. D. Choose and prepare foods with little or no artificial sweeteners. E. Choose and prepare foods with little potassium (less than 2,500 milligrams)
B. Consume less than 10 percent of calories per day from saturated fats.
Water is considered a micronutrient, because it is required in amounts of 1 milliliter (ml) per kcal of energy expended, or about 2,500 ml per day (depending on physical activity level, climate, illness). A. True B. False
B. False
Which of the following nutrition screening tools has been validated for geriatric evaluation in clinics, hospitals, and nursing homes? A. Malnutrition Universal Screening Tool B. Mini Nutritional Assessment C. Nutritional Risk Screening 2002 D. Short Nutritional Assessment Questionnaire E. Malnutrition Screening Tool
B. Mini Nutritional Assessment
Which of the following is NOT one of the four distinct action steps of the ADA Nutrition Care Process (NCP)? A. Nutrition Diagnosis B. Nutrition Screening C. Nutrition Assessment D. Nutrition Monitoring and Evaluation E. Nutrition Intervention
B. Nutrition Screening
You are employed as staff pharmacist at an independent pharmacy that serves predominantly low-income patients due to its location and good prices. You have identified a patient that would greatly benefit from a shift to a healthier diet, but the patient is unable to afford and not willing to see a dietitian. Because the patient trusts you, he has agreed to undergo nutrition assessment and diagnosis (as well trained pharmacist you are using the standardized nutrition care process). Your next step is to plan a nutrition intervention. Which of the following is not part of the nutrition intervention step in the NCP framework? A. Formulate achievable goals B. Document the intervention plan and goals C. Measure outcome indicators D. Think critically and creatively about the appropriateness of planned action E. Choose evidence-based recommendations
C. Measure outcome indicators
Which of the following is TRUE about Food Frequency Questionnaires (FFQs)? A. The method requires the patient to report all foods eaten within the past 7 days. B. FFQs do not require patient literacy. C. Results indicate habitual intake over a longer time period (30 days or 1 year). D. Results indicate meal patterns; for example, specific foods consumed on weekdays vs. weekends. E. None of the above are true statements about FFQs.
C. Results indicate habitual intake over a longer time period (30 days or 1 year).
Which of the following lists contains only nutrients? A. Macrominerals, fiber, alcohol B. Food additives, emulsifiers, antioxidants C. Sodium, copper, selenium D. Stabilizers, water, spices E. Thiamin, folate, emulsifiers
C. Sodium, copper, selenium
Which of the following is true about dietary protein? A. Dietary protein is broken down to peptides and monosaccharides. B. In healthy individuals, protein is the primary fuel source used for the body's energy production. C. The daily dietary protein requirement is 0.8 grams per kilogram body weight for all healthy individuals. D. Of the 20 existing amino acids protein can be comprised of, 9 are essential amino acids individuals need to consume through the diet because the human body is unable to produce them. E. During catabolic states (eg, starvation, infections, burns), less protein may be used (because body tissues are broken down) than is absorbed
D. Of the 20 existing amino acids protein can be comprised of, 9 are essential amino acids individuals need to consume through the diet because the human body is unable to produce them.
A commonly used tool for assessment of dietary intake is the 24 - hour dietary recall (e.g., USDA Super Tracker). All of the following are disadvantages of the interviewer-administered 24-hour dietary recall, EXCEPT: A. Patients may not recall some of the snacks they consumed in between meals. B. Patients may have very different food intakes on weekdays versus on weekends. C. Intake information from 1 individual day may not reflect the typical dietary pattern of the patient. D. Requires patient literacy. E. Patients may underestimate serving sizes of foods consumed
D. Requires patient literacy.
Based on population-based research we know that most Americans _________. A. Exceed recommendations for sodium intake. B. Exceed recommendations for saturated fat intake. C. Do not meet recommendations for dairy intake. D. A and B E. A, B, and C
E. A, B, and C
Individual assessment of nutritional status encompasses not only assessment of dietary intake, but also _________. A. Family history B. Past medical history C. Social history D. A and B E. A, B, and C
E. A, B, and C
Brief dietary assessment instruments ("screeners") are useful in situations that do not require a quantified assessment of the total diet. Which of the following are examples of such brief screeners that could be used to examine specific dietary problem areas? A. Sodium screener B. Soy Foods Screener C. Nutrition Screening Initiative D. Folic acid screener E. All of the above are brief screeners to be used.
E. All of the above are brief screeners to be used.
The Malnutrition Universal Screening Tool (MUST) takes into account which of the following parameters to identify malnourished adults or adults at risk for malnutrition? A. BMI, unplanned weight loss, severity of disease B. BMI, decreased appetite, mid-arm circumference (MAC) C. Unplanned weight loss, decreased appetite, need for tube feeding D. Unplanned weight loss, amount of weight lost, decreased appetite E. BMI, unplanned weight loss, acute disease affecting dietary intake
E. BMI, unplanned weight loss, acute disease affecting dietary intake
Which of the following chronic conditions can be prevented or minimized with effective and timely dietary and lifestyle intervention? A. Obesity, cardiovascular diseases, cancers, zika infection B. Cardiovascular diseases, cancers, urinary tract infections C. Osteoporosis, cardiovascular diseases, urinary tract infections D. Diabetes, obesity, cardiovascular diseases, urinary tract infections E. Obesity, Osteoporosis, obesity, cancers
E. Obesity, Osteoporosis, obesity, cancers
True or False: "Portion distortion is a new term created to describe the perception of large portions as appropriate amounts to eat on a single day."
False
True or False: Information only patient education improves clinical outcomes as successfully as teaching self-management skills.
False
Anthony mentions that he has gone online and found some information about heart healthy diets. However, he still seems quite confused about what these actually mean. Adoption of which of the following diet would help him reduce cardiovascular risk(blood pressure, blood lipids etc.)? A. Dietary Approaches to Stop Hypertension (DASH) diet B. Juice cleanse C. Atkins diet D. All-you-can-eat diet E. None of the above
a
Dr. Ashmore is an older local primary care physician with whom you maintain a great professional relationship. Today, he calls you, because he has heard that you are well-informed on lifestyle and cancer relationships. He would like to find out which of the following statements is TRUE about common lifestyle and cancer relationships: A. Physical activity has shown to reduce the risk of cancers through management of overweight/ obesity in addition to weight-independent effects on colorectal, postmenopausal, and endometrial cancers. B. Excessive intake of sweetened foods fuels the growth of cancer cells, because cancer cells consume more glucose than normal cells. C. Feeling sad, angry, and discouraged while undergoing cancer treatment has been linked to increased cancer mortality. D. About 50% of all cancers are inherited; this means if someone in your family has cancer, you are likely to develop the same type of cancer in your lifetime. E. Vitamin C supplements can prevent cancer due to antioxidant properties.
a
Fatigue can be a very burdensome side effect of cancer treatment. Of the following, which would you NOT recommend to reduce fatigue? A. Switch to a vegetarian meal plan. B. Balance activity with rest that does not interfere with your nighttime sleep. C. Exercise regularly at light-to-moderate intensity. D. Set up a daily routine that allows activity when you are feeling best. E. All of the above recommendation may help the patient reduce fatigue.
a
Given Mrs. Shirley's situation, you suggest that her caregiver starts looking into nutrition assistance programs that would help Mrs. Shirley better meet her basic needs. Which of the following programs is best suited to meet her needs (choose 1 program only)? A. Older Americans Act Nutrition Program (OAANP) B. Supplemental Nutrition Assistance Program (SNAP or Food Stamps) C. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) D. Food Distribution Program on Indian Reservations E. Nutrition Services Incentives Program
a
How much and what type of exercise should you convince someone undergoing cancer treatment, who does not feel up to exercising but is not bed-bound, to do at a minimum per day? A. 10 min of stretching B. 15 min of brisk walking C. 20 min of brisk walking D. 30 min of weight lifting E. Someone who is undergoing treatment should not exercise at all.
a
J.L states she has been confused about her insulin dose. She missed her morning dose yesterday and thus took the morning and the evening dose at the same time. She states she feels tired and is unable to be as active lately. She is trying to increase her intake of fruits and vegetables, but states it's hard - "I love my pasta and bread". What is most likely the cause of patient's symptoms in question 3? A. Increased intake of insulin B. Increased intake of fruits and vegetables C. Decreased physical activity D. Advanced age E. Increased intake of pasta and bread
a
J.S. tells you that his father and one of his sisters have diabetes. He reports that his father recently had a foot amputation secondary to uncontrolled blood sugar, and has questions about diabetes complications. Which of the following is NOT a complication of diabetes? A. End-stage liver disease B. Retinopathy C. Nephropathy D. Neuropathy E. End-stage kidney disease
a
Kimberly M. is a regular patient in your pharmacy. You know that she has earned a BS degree in nutrition 20 years ago, but switched careers to work as an accountant. Kimberly is trying to lose weight and discusses with you that to her best knowledge the best strategy to lose weight and prevent cardiovascular conditions (CVDs), frequent comorbidities of obesity, is to follow a low-fat, reduced-energy diet, because fat is the most energy-dense nutrient and reduced dietary saturated and trans fat intake are associated with reduced risk of CVDs. She would like to know from you whether there is strong scientific evidence that low carbohydrate diets are also leading to weight loss. Your best answer based on the American Dietetic Association (ADA) Evidence Analysis Library (EAL) from the ADA Position Statement is _____________. A. An individualized reduced calorie diet is the basis of the dietary component of a comprehensive weight management program. Reducing dietary fat and/or carbohydrates is a practical way to create a caloric deficit of 500 to 1,000 kcal below estimated energy needs and should result in a weight loss of 1 to 2 lbs per week. B. An individualized reduced calorie diet is the basis of the dietary component of a comprehensive weight management program. Reducing dietary fat (~but not carbohydrates) is a practical way to create a caloric deficit of 500 to 1,000 kcal below estimated energy needs and should result in a weight loss of 1 to 2 lbs per week. C. Consumption of a low carbohydrate diet is associated with greater weight and fat loss than traditional reduced-calorie diets during the first 12 months. D. A and C E. None of the above is correct
a
Mrs. Shirley may be at risk of inadequate fluid intake because of potential physiologic changes occurring in older adults, including blunted thirst sensation, endocrine changes, alterations in mental status and cognitive abilities, adverse effects of medications, and impaired mobility. A. True B. False
a
What is the maintenance fluid requirement for a 3 year old female weighing 15 kg who is admitted for mild dehydration in ml/kg/hr? a. 50 ml/hr b. 40 ml/hr c. 100 ml/hr d. 85 ml/hr e. 25 ml/hr
a
Which of the following is not part of A Personal Action Plan: a. A prescription from the Doctor b. A patient-determined goal c. Steps to achieve the goal d. Barriers to achieving the goal and a plan to overcome barriers e. Confidence scale
a
Which of the following other nutrition assistance programs would she be eligible for? A. Supplemental Nutrition Assistance Program (SNAP) B. Senior Farmer's Market Nutrition Program C. Meals on Wheels D. A and C E. A, B, and C
a
You respond to her concerns by mentioning that there are a few nutrition assistance programs available to her she could apply for. She is currently not accepting any "extra help." You tell her that some of the nutrition assistance programs come with nutrition education and can help individuals to develop knowledge and strategies to improve their dietary intake despite being on a budget. You suggest she should look into the WIC program, because WIC provides not only food packages that meet the needs of women, infants and children, but also provides nutrition education and counseling at WIC clinics as well as screening and referral to other health, welfare, and social services, including immunization referrals for infants and children. A. True B. False
a
You share with Brian that you suspect he may have CD. Thereupon he mentions that his mother has the condition. You educate him that CD is an autoimmune disorder that runs in families. This means that if your blood relatives have CD, you are more likely to be affected. A. True B. False
a
Brian is concerned. He wants to know how he can find out whether he has CD. Which of the following methods will NOT lead to an accurate diagnosis of CD? A. Serologic testing on a gluten containing diet B. Serologic testing on a gluten-free diet C. Small intestine endoscopy on a gluten containing diet D. Small intestine biopsy on a gluten containing diet E. All of the above will lead to an accurate CD diagnosis
b
Nancy P. is an overweight patient with hypertension and diabetes. Last week, she asked you about weight loss strategies. After your initial conversation, she agreed to come back on Saturday with the additional information you requested (assessment). Based on the information you were provided with, you know she lives a sedentary lifestyle, has a BMI of 29, and some significant deficits in her diet. Today, you have planned to discuss the next steps (goal setting; discuss an action plan). You recommend: A. A goal of 20% loss of body weight within 6 months by following a very low calorie diet (800 kcal/day), and increased physical activity (walking 30 min on 3 days/ week). B. A goal of 10% loss of body weight within 6 months by following a combined intervention of behavior therapy, lower calorie diet (cut by 500 kcal/day), and increased physical activity (walking 30 min min on 5 days/ week); meal replacements can be used in conjunction if caloric restriction is a challenge. C. A goal of 20% loss of body weight within 12 months by following a combined intervention of behavior therapy, very low calorie diet (800 kcal/day), and increasing physical activity (walking 30 min on 3 days/ week). D. A goal of 10% loss of body weight within 6 months by following a very low calorie diet (800 kcal/day) and increasing physical activity (walking at least 45 min on 5 days/ week). E. A goal of 10% loss of body weight within 12 months by following a combined intervention of behavior therapy, reduced caloric intake (cut by 500 kcal/day), and increasing physical activity (walking at least 45 min on 5 days/ week).
b
Tanesha W. comes to your pharmacy to pick up prescriptions for a beta blocker and a statin. At her appointment yesterday, she discussed weight loss through dietary modification and exercise with her physician to help improve her current conditions. In her rush of motivation to make changes, Tanesha went online and read everything she could find about different diets. The information online was pretty confusing which is why today she has a lot of questions for you, her trusted pharmacist. Her next doctor's appointment is not until next month, thus she cannot ask him. She wants to know which diets would fall under the category low-carbohydrate diets. She has heard that these diets are better at improving her blood lipid profile. Choose the best answer based on the online video. A. Paleo, South Beach, Medifast B. Atkins, Paleo, South Beach C. Ornish, Low Glycemic Index, Jenny Craig D. DASH, Ornish, South Beach E. Atkins, Paleo, Ornish
b
The American Academy of Pediatrics recommends: a. That whole cow's milk be introduced at 6 months of age b. Exclusive breast feeding for the 1st 6 months of life c. Exclusive bottle feeding for the 1st year of life d. That solid foods be introduced at 1 year of age e. That breast feeding be stopped by 6 months of age
b
The pharmacist states, "Your commitment to quit smoking is evident with your success tapering the number of cigarettes each week. Trying different strategies to resist the urge to smoke is an important part of successful quitting." Is an example of: a. Rolling with resistance b. Affirmation c. Setting an agenda d. Open-ended question e. Reflective listening
b
You learn that Sarah is really worried about developing diabetes. She knows that insulin is very expensive and she wants to avoid it all costs. However, she is challenged every day to put food on the table for Jenny and herself. She tells you that sometimes, she has to cut the size of their meals or stretch the meals to have enough for the rest of the month. How is this measurable phenomenon termed? A. Food insufficiency B. Food insecurity C. Food inaccuracy D. Food dependency E. Food depletion
b
After collecting more information on Anthony's medical history and obtaining lab values from the physician's office upon Anthony's request, you find out he is overweight and his blood lipid values are slightly abnormal (LDL-C 130 mg/dl; HDL-C 35 mg/dl; TG 160 mg/dl). Which of the following dietary strategies is most likely to improve all of his abnormal his blood lipid values and his weight? (from Olendzki et al article table 3) A. Eating a burger each day. B. Increased intake of soluble dietary fiber (whole grains, nuts, seeds, fruits, and vegetables) and decreased intake of refined grains. C. Choose non-hydrogenated cooking oils. D. Decrease intake of meats, mayonnaise, eggs, margarine, full-fat dairy products (e.g., whole milk, cheese, ice cream, butter), baked goods, and processed foods. E. Limit alcohol intake to < 2 drinks per day for men and < 1 drink for women per day.
b and d?
J.L. is a 68 year old Caucasian female who comes to your pharmacy to refill her medications. You note on her medication profile that she is on insulin for her diabetes. You leave the dispensing area to ask her a few questions regarding her medications. You find the patient in the OTC aisle looking at blood glucose gels and tablets. She states "I think I need these, but I do not know how to use them." She continues "I feel shaky and sweaty in the middle of the night; I am not sure why." What would be the most appropriate follow up question to ask this patient? A. How would you like to pay for these? B. When were you first diagnosed with diabetes? C. What was your blood glucose level when you had these symptoms? D. What do you think caused these symptoms? E. What did you eat for breakfast this morning?
c
J.S. presents to your pharmacy with a new prescription for Metformin, stating his doctor told him today that he has diabetes. J.S. states, "I thought patients with diabetes had to be on insulin. Am I going to have to give myself shots?" Which of the following is the most appropriate response to this patient? A. You probably need to be on insulin, I will give your doctor a call. B. Insulin therapy is only for Type 1 Diabetes, and you have Type 2 Diabetes. C. You may need to be on insulin in the future, but taking your oral medications for diabetes along with a healthy diet and exercise can help control your blood sugars in the meantime. D. Metformin works the same way as insulin in your body. E. Metformin isn't used for diabetes, I will give your doctor a call to change your prescription.
c
Patients with cancer who are undergoing treatment can prevent treatment-related side effects and improve their well-being by dietary and physical activity intervention. As a community or clinical pharmacist, you would ideally refer them to professionals that can be identified by the following credentials (choose the best correct answer): A. A Registered Dietician (RDN) B. A Board-certified Oncology Nurse Practitioner (NP) and a ACSM-certified Cancer Exercise Trainer (CET). C. A Registered Dietician Board-certified in Oncology Nutrition (RDN, CSO) and a ACSM-certified Cancer Exercise Trainer (CET). D. The Primary Care Physician (MD) E. None of the above is correct
c
Sarah has heard of SNAP (Food Stamps) and is considering giving it a try. She would like to know which criteria she needs to fulfill to qualify for benefits. Which of the following is NOT an eligibility criterion? A. You are a citizen of the United States or a legal immigrant. B. You may not have more than $2,250 in countable resources, such as a bank account. C. You live in an underprivileged ZIP code area as determined by Census bureau data. D. You and/or other household members comply with employment requirements. E. Your household's monthly income does not exceed the income limits based on the number of people who live in the household.
c
Taylor C. is a 39-year old patient who is coming to your pharmacy to pick up a refill on her oral contraceptive. At the register, she asks for the pharmacist. You come to the front and she tells you: "My OB/GYN told me I should lose weight to prevent chronic diseases and I am trying to figure out how to do that. She mentioned a few commercial weight loss programs and I am trying to figure out which one would be worth giving a try." Based on the article by Gudzune et al. (2015), which of the following commercial weight loss programs have shown consistent long-term efficacy? A. SlimFast, Lose It! B. eDiets, Atkins C. Weight Watchers, Jenny Craig D. OPTIFAST, Atkins E. Medifast, Nutrisystem
c
Which of the following would you NOT advise cancer patients undergoing treatment to focus on as important lifestyle goal? A. Counteracting loss of lean muscle mass B. Meeting appropriate nutrient and calorie needs C. Aggressive weight loss treatment for overweight patients D. Management of nutrition-related side effects of treatment E. Improvement of quality of life
c
You are concerned about Mrs. Shirley's status. You know that rapid involuntary weight loss and malnutrition are associated with an increased risk of mortality. But before you can proceed with addressing potential nutritional problems and/or preparing for referral, you need to find out more about her situation. You consider screening the patient in a standardized way for nutrition-related problems. Which tool(s) would you be using that has/have been validated for the use in older adults? A. The Mini Nutritional Assessment (MNA) B. The US Household Food Security Survey Module C. A and B D. The Long Nutritional Assessment Questionnaire (LNAQ) E. A, B, and D
c
Brian comes back 3 weeks later with a confirmed diagnosis of CD. He is devastated. "The doc told me I cannot have any more burger buns! I love burgers. What am I going to eat?!" Which of the following would he NOT be able to consume on a gluten-free diet? A. Chick-Fil-A chicken garden salad B. Arby's vanilla shake C. Wendy's baked potato with sour cream D. McMuffin with egg and sausage E. Taco Bell Mexican rice
d
Empowering patients to manage their disease through the development of personalized strategies and problem solving skills describes: a. Social cognitive theory b. Health Belief Model c. Decisional balance d. Self-management education e. Traditional patient education
d
J.S. thanks you for all of the information about diabetes. He has one last question about food-"I love cereal, but it sounds like a lot of carbs- what's the best choice?" A. Patients with diabetes should never eat cereal B. Wheat pancakes are a better option than most cereals in terms of glycemic index C. Kashi whole grain is a better choice than Special K in terms of glycemic index D. Select a cereal without added sugar and pay attention to the serving size E. Avoid adding more than one tablespoon of sugar per serving
d
Melinda B. is not one of your regular patients, but comes to your pharmacy because she is convinced all pharmacists are comprehensively trained on disease prevention and management, including how specific strategies to lose weight. She asks for the pharmacist on duty and you step to the front. Throughout your conversation, you learn that she is a PhD student in Environmental Health Science. She wants to know from you whether scientific evidence supports the use of meal replacements in weight loss. Your BEST answer is: A. Several studies comparing isocaloric diets have shown equivalent or greater weight loss efficacy with structured meal replacement plans compared to reduced-energy diet treatments. B. Substituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance strategy. C. Structured meal replacement plans and weight loss efficacy in severely obese individuals or as a weight gain prevention strategy have not been sufficiently studied. D. A, B, and C E. A and B
d
Mrs. Shirley and her caregiver are truly grateful for your help. They have read about innovative healthcare models and would like to see if they could enroll Mrs. Shirley in a community/ transitional care model available in the community. Which community/ transitional care models would you suggest them to look into? A. Geriatric Resources for Assessment and Care of Elders (GRACE) B. Program of All-Inclusive Care for the Elderly (PACE) C. Patient-Centered Medical Home (PCMH) D. A, B, and C E. A and B
d
Sarah wants to learn more about how she can improve her diet on a budget and agrees to come back the next day when it is less busy with a food diary. You know about the importance of physical activity on diabetes outcomes, and encourage Sarah to exercise more. Which of the following barriers would you need to take into consideration when making suggestions and developing a plan for more physical activity? A. High crime rate in her neighborhood B. Toxic environmental exposures C. Transportation to facilities, such as the YMCA D. A, B, and C E. A and C
d
Someone asks you, as healthcare professional, which specific lifestyle measures can be taken to prevent cancers. You respond: A. Limit red meat intake to less than 500 g (18 oz) per week and consume as little processed meat (e.g., deli meat) as possible. B. Limit the consumption of alcohol to no more than 2 drinks/ day for men and 1 drink/day for women. C. Limit the consumption of salt-preserved foods, salted, or salty foods to less than 6 grams (2.4 grams of sodium) per day. D. A, B, and C E. A and C
d
Two weeks later, Brian comes in with his girlfriend "Jenna." You have made an impression on him with your knowledge on GI disorders and although this is a rather sensitive topic for Jenna, Brian convinced her to talk to you. You learn that she took her BAR exam in the summer which really stressed her out. Ever since, she has had abdominal discomfort and pain for the past 4 months (usually 3 days per month) unrelated to her menstruation. She has had diarrhea-like stool and her symptoms improve with defecation. She has tested negative for CD and inflammation in the GI tract which lead her doctor to a diagnosis of Irritable Bowel Syndrome (IBS), she tells you. She is not clear on strategies to improve her symptoms. Which of the following could you suggest to her as strategies to alleviate her symptoms? A. Eliminate high FODMAP foods from her diet B. Start consuming probiotics such in Align C. Alleviate GI spasms with peppermint oil capsules D. A, B, and C E. A and B
d
Which if the following goals meets all the recommended components of an effective short term (SMART) goal. a. Exercise 30 minutes 3 days per week. b. Add more vegetables to dinner every day c. Lose 5 pounds by November 1 d. Eat one cup of fruit (i.e. 1 small apple or 1c grapes) for lunch on Tuesday and Thursday E. Start the DASH diet tomorrow
d
Which of the following indications would be appropriate for initiating parenteral nutrition? a. A 27 week premature infant in the neonatal intensive care unit weighing 1100 grams b. A 14 year old patient admitted to the psychiatric ward for anorexia who weighs 44 kg and refuses to eat c. A 9 month old infant with short bowel syndrome due to necrotizing enterocolitis d. A and C e. A, B, and C
d
Jenny is enrolled in Medicaid/ PeachCare for Kids, which is a comprehensive healthcare program for uninsured children living in Georgia. Because healthy nutrition is essential to the development and health of children, Medicaid/ PeachCare for Kids coverage includes nutrition services and nutrition counseling services. Jenny's mother Sarah is also eligible for Medicaid due to meeting certain categorical and income requirements. Of the following, who is NOT eligible for Medicaid benefits? A. A pregnant mother living with a 17-year old son B. A married man receiving Supplemental Security Income who lives with his wife and a 21-year old son C. A single blind woman living by herself D. A single mother living with a 20-year old daughter E. All of the above are eligible for Medicaid benefits
e
John B. who you know to be a stomach cancer survivor comes to your pharmacy and picks a garlic supplement off the shelf while waiting to pick up his monthly prescription for Plavix 75 mg qd (platelet aggregation inhibitor; at high doses garlic has significant platelet aggregation inhibition properties). During your conversation with Mr. B, you learn that he believes taking garlic supplements will naturally prevent a stomach cancer relapse. How would you address this in the counseling situation? A. You support Mr. B in his decision to take a garlic supplement, because there is not only convincing scientific evidence that garlic from foods or supplements protects from stomach cancer, but garlic would also allow him to reduce the dose of his Plavix due to its platelet aggregation inhibiting properties. B. You tell Mr. B that there is convincing scientific evidence that garlic from foods or supplements protects from stomach cancer. However, you advise him to refrain from taking garlic supplement due to a significant interaction which would increase his bleeding time and put him at unnecessary risk. C. You tell Mr. B that there is convincing scientific evidence that garlic from foods but not from supplements protects from stomach cancer. However, you advise him to refrain from taking garlic supplement due to a significant interaction which would increase his bleeding time and put him at unnecessary risk. D. You tell Mr. B that there is convincing scientific evidence that garlic fromsupplements but not from foods protects from stomach cancer. However, you advise him to refrain from taking garlic supplement due to a significant interaction which would increase his bleeding time and put him at unnecessary risk. E. You tell Mr. B that there is no convincing scientific evidence that garlic from foods or supplements protects from stomach cancer. You further advise him to refrain from taking garlic supplement due to a significant interaction which would increase his bleeding time and put him at unnecessary risk.
e
The inability to access enough food for an active healthy life due to limited household resources is often linked to other phenomena low-income individuals struggle with in their daily lives. The GA Department of Human Services Division of Family and Children Services (DFCS) therefore maintains the Common Point of Access to Social Services (COMPASS) website to assist people in determining for which services they may be eligible for applying. You recommend this website to Sarah. Which of the following services is NOT available to GA residents? A. Mental health and substance abuse services B. Home energy assistance C. Healthcare assistance D. Housing assistance E. All of the above are available to GA residents
e
The pharmacist responds, "You heart health is important to you but you question if starting a cholesterol medication is too aggressive at this point." This an example of: a. Affirmation b. Summaries c. Setting an agenda d. Open-ended question E. Reflective listening
e
Throughout your conversation you find out that Anthony's main concern is to improve his diet. He would like to learn about the characteristics of a heart healthy diet. Which of the following nutrition recommendations do NOT reflect recommendations of following a more heart healthy diet? A. Increase omega-3 fatty acid intake. B. Decrease intake of saturated and trans fats. C. Increase intake of soluble dietary fiber. D. Decrease caloric intake for weight loss, if indicated. E. Maintain a high ratio of animal to plant proteins.
e
When counseling a patient on weight loss, which of the following additional information should you collect in order to adequately assess the patient history in preparation to propose a weight loss plan? A. Psychological factors B. Medical history C. Environmental factors D. Exercise history E. All of the above
e
Which of the following is NOT a safety concern for physical activity during cancer treatment you should talk to a patient about? A. Use of heavy weights and fracture risk in patients with metastases, osteoporosis, arthritis, and general weakness B. Swimming after radiation treatment due to the risk of skin irritation and infection. C. Resistance training and water exposure when the patient is still wearing a catheter due to risk of dislodging and infection. D. Use of public gyms and low leucocyte (white blood cell) due to the inability to fight infections. E. All of the above are safety concerns you should discuss with the patient
e
Which of the following things should you consider when initiating parenteral nutrition for a pediatric patient? a. The type of IV access they have (central or peripheral) b. The risk of refeeding syndrome c. The indication for the parenteral nutrition d. The patient's current nutritional intake e. All of the above
e
You learn that Mrs. Shirley has lost a significant amount of weight throughout the past few weeks. Aside from possible side effects of her medication regimen which you check as potential cause, which other contributing factors do you have to take into consideration that could cause her weight loss? A. Shopping and meal preparation problems B. Mental and cognitive health status C. Oral problems D. Socioeconomic status E. All of the above
e
You want to examine whether dental problems are the cause of her situation and use the dental screening initiative's tool to determine whether she may be in need to get dental care. Which of the following criteria are included in your screening (Morley et al paper)? A. Dry mouth B. Eating difficulty C. Tooth loss D. Alternative food selection because of chewing problems E. All of the above
e
