EatRightPrep Simulated RD Test 2 T

When using the plan-do-study-act (PDSA) process, which of the following occurs during the plan phase? A. Determine how to collect data B. Train staff on new process C. Evaluate the effectiveness of the project D. Reduce wait time for appointments

Solution: The correct answer is A. Determination of data collection methods occurs during the planning phase. Staff training and evaluation of effectiveness occur after a project has been implemented. Reduction of appointment waiting times would be an example of a quality improvement project goal. Joint Commission Resources. Cost-Effective Performance Improvement in Hospitals. Oakbrook Terrace, IL: JCAHO; 2005:94.

The most effective treatment for non-alcoholic fatty liver disease (NAFLD) is: A. Lifestyle modifications B. Milk thistle C. Thiamine supplementation D. Pioglitizone (Actos)

Solution: The correct answer is A. Rationale: Lifestyle modifications are the most effective treatment of NAFLD. Reports of the efficacy of supplementation in NAFLD are inconclusive. Pioglitizone is used in treating nonalcoholic steatohepatitis, not NAFLD. Thiamine supplementation is used to treat Korsakoff syndrome. McCarthy E. Non-alcoholic Fatty Liver Disease. Today's Dietitian. 2014:16:48-51. Available at: http://www.todaysdietitian.com/newarchives/010614p48.shtml. Accessed February 21, 2018.

Which grain contains gluten and should be avoided by a client with Celiac Disease? A. Farro B. Teff C. Quinoa D. Millet

Solution: The correct answer is A. Rationale: Many ancient grains are gluten free, but farro does contain gluten, as it is made from wheat. Teff, quinoa, and millet are all gluten free and are safe for individuals with celiac disease. Ciacci C, Ciclitira P, Hadjivasiliou M, et al. The gluten-free diet and its current application in coeliac disease and dermatitis herpetiformis. United European Gastroenterol J. 2015; 3(2):121-135.

A delayed gastric emptying condition associated with autonomic nerve damage related to diabetes mellitus is called _____. A. steatorrhea B. gastroparesis C. gastroenteritis D. gastritis

Solution: The correct answer is B. Gastroparesis is a delayed gastric emptying condition that most commonly develops in association with autonomic nerve damage related to diabetes mellitus. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 371.

Which of the following would confirm a diagnosis of diabetes? A. A1c 5.7% B. A1c 6.5% C. Fasting blood glucose 110 mg/dL D. Fasting blood glucose 125 mg/dL

Solution: The correct answer is B. Rationale: An A1c of 6.5% would confirm a diagnosis of diabetes. An A1c of 5.7% is a criterion for diagnosing prediabetes (the range for prediabetes is 5.7%-6.4%) A fasting blood glucose would have to be measured at 126 mg/dL or higher for a diabetes diagnosis. Inzucchi S. Diagnosis of Diabetes. N Eng JMed 2012;367:542-550.

Iodine deficiency in a pregnant person can lead to development of which condition in the newborn? A. Goiter B. Cretinism C. Dwarfism D. Keshan disease

Solution: The correct answer is B. Rationale: Iodine deficiency can result in cretinism in the newborn. Goiter is a condition seen in adults with iodine deficiency, leading to compensatory enlargement of thyroid gland. Keshan disease results from selenium deficiency. Dwarfism is unrelated to nutrition. McGuire M Beerman KA. Nutritional Sciences: From Fundamentals to Food. 3rd ed. Pacific Grove, CA: Brooks Cole; 2012: 569

A child with phenylketonuria has deficiency of which enzyme? A. Phenylalanine kinase B. Phenylalanine hydroxylase C. Phenylalanine dehydrogenase D. Tyrosine kinase

Solution: The correct answer is B. Rationale: PKU is caused by deficiency of phenylalanine hydroxylase. Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016:256

What kind of service is a traditional cafeteria? A. Wait service B. Portable meal service C. Self-service D. Tray service

Solution: The correct answer is C. Rationale: Self-service is the traditional style in cafeterias. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 13th ed. Boston, MA: Prentice Hall; 2016.

Which of the following is the safe and recommended method for canning foods above pH 4.6? A. Boiling water canning B. Pressure canning C. Steam canning D. Oven method canning

Solution: The correct answer is B. Foods that are low acid (pH of 4.6 or higher) include vegetables, meats, dried beans, and all soups. These will need to be preserved using a pressure canner. High acid foods contain enough acid to have a pH level of 4.6 or lower. These will need to be preserved using a water bath canner. McWilliams M. Foods: Experimental Perspectives. 8th ed. New York City, NY: Pearson; 2016.

An employee used a #10 scoop instead of #12 scoop, which was intended for 400 servings of ice cream. How many servings are they going to be short? A. 67 B. 104 C. 125 D. 155

Solution: The correct answer is A. A #10 scoop is 3.2 oz while a #12 scoop is 2.67 oz. 400 servings × 2.67 oz = 1068 oz, 1068 oz divided by 3.2 oz = 333 servings, 400 servings - 333 servings = 67 servings that they will be short. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 192

Which of the following is the term for the group of jobs represented in union contract negotiations? A. Bargaining unit B. Arbitration collective C. Labor management team D. Negotiation team

Solution: The correct answer is A. A group of employee titles or job descriptions in a workplace with union representation in negotiations and shared interest in labor relations matters is called a bargaining unit. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 404

What is the recommendation for attenuating lean body mass loss in post-resuscitation patients recovering from sepsis? A. Increase protein and kilocalories B. Decrease protein and kilocalories C. Increase protein but decrease kilocalories D. Increase kilocalories but decrease protein

Solution: The correct answer is A. An acute catabolic response in sepsis contributes to rapid loss of lean body mass. Attenuating loss of lean body mass in post-resuscitation patients recovering from sepsis requires increased protein and kilocalories. Wischmeyer P. Nutrition in sepsis. Crit Care Clin. 2018;34(1):107-125. Available at: Website. Accessed September 2, 2019.

What leadership approach involves deciding action based on majority vote? A. Democratic B. Autocratic C. Consensus D. Participative

Solution: The correct answer is A. Democratic leaders give up ownership of a decision and allow the group to vote. The majority vote decides the action. Autocratic leaders take total control, make decisions, and assume full responsibility. Consensus leadership requires the entire group to come to an agreement. Participative leadership seeks input from others before the leaders makes a management decision. Hudson NR. Management Practices in Dietetics. 3rd ed. San Diego, CA: Cognella Academic Publishing; 2013.

When using IDDSI abbreviations (such as MM5 for minced and moist) in foodservice software, why is the number listed after the letters? A. To ensure the number isn't misinterpreted as the amount of meals or drinks being ordered B. To be in accordance with the Nutrition Care Process Terminology alphanumeric coding system C. To be in accordance with the ICD-10 alphanumeric coding system D. To avoid confusion with other medical terms with similar abbreviations

Solution: The correct answer is A. IDDSI abbreviations list letters before numbers to avoid misinterpretation that the number reflects the amount of meals or drinks being ordered. Reference: International Dysphagia Diet Standardisation Initiative. IDDSI abbreviations. January 2018. Accessed February 14, 2020. Available at:IDDSI-Abbreviations-fact-sheet_final_18Jan2018.pdf

Use the straight-line depreciation method to determine the total yearly cost for six ice machines that cost $5,000 each and will last for 10 years. A. $3,000 B. $500 C. $30,000 D. $1500

Solution: The correct answer is A. Rationale: Depreciation per year equals the total value of the fixed asset divided by years of service. $5,000 x 6 = $30,000 $30,000 is the cost of 6 ice machines or the total value of the fixed asset. $30,000 ÷ 10 years = $3,000 Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017

Which of the following is the highest source of calcium? A. 3 ounces canned salmon (with soft bones) B. ½ cup of cooked spinach C. ½ cup of cooked collard greens D. ¼ cup of walnuts

Solution: The correct answer is A. Rationale: 3 ounces of canned salmon with soft bones contains 200 mg calcium per serving, whereas spinach and collard greens contain 100 mg per serving and walnuts contain 28 mg per serving. Academy of Nutrition and Dietetics. Nutrition Care Manual. High Calcium Foods. https://www.nutritioncaremanual.org/vault/2440/web/files/NutrientList_HighCalcium.pdf. Last accessed September 25, 2017.

Dextrose solutions should not be administered at a rate higher than _____ g/kg/hour A. 0.36 B. 0.05 C. 0.63 D. 0.75

Solution: The correct answer is A. Rationale: Dextrose solutions should not be administered at a rate higher than 0.36 g/kg body weight/hour. This is the maximum oxidation rate of glucose. Excess glucose is converted to fat, which can result in fatty liver. In addition, the conversion of carbohydrate to fat can cause excess CO2 production, which is undesirable for patients with respiratory problems. McClave SA, Taylor BE, Martindale RG. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Available at: http://journals.sagepub.com/doi/abs/10.1177/0148607115621863?etoc=. Accessed March 4, 2018.

Which of the following is a fat source in an elemental (hydrolyzed) nutrition support formula? A. Medium-chain triglycerides B. Soy lecithin C. Safflower oil D. Very long-chain triglycerides

Solution: The correct answer is A. Rationale: Elemental (hydrolyzed) nutrition support formulas are typically utilized in patients with impairments in their digestive process because they are low in fat. These formulas' primary fat source is long-chain and medium-chain triglycerides, which require minimal digestive function. Academy of Nutrition and Dietetics. Nutrition Care Manual. Enteral Nutrition. Accessed October 21, 2020. Available at: https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=255693&lv2=255696&lv3=272572&ncm_toc_id=272572&ncm_heading=Nutrition%20Care

Which of the following diets restricts food components to reduce symptoms of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)? A. Low FODMAP B. Low fiber C. Low carbohydrate D. Low sodium

Solution: The correct answer is A. Rationale: FODMAP is an acronym that stands for: Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are foods components that are restricted in a low-FODMAP diet. The low-FODMAP diet is prescribed to reduce symptoms in those who have irritable bowel syndrome or inflammatory bowel disease. Academy of Nutrition and Dietetics, Nutrition Care Manual. Low-FODMAP nutrition therapy client education. Available at: https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=422. Accessed March 8, 2018.

What is the minimal internal temperature for cooking fish? A. 145°F B. 150°F C. 155°F D. 165°F

Solution: The correct answer is A. Rationale: Fish requires a minimal internal temperature of 145°F. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

The recommended meal plan for most people with cystic fibrosis is A. High kilocalorie, protein, fat, and sodium B. High kilocalorie and protein, moderate sodium C. High kilocalorie, protein, and sodium and low fat D. High kilocalorie after forgetting to take digestive enzyme pill

Solution: The correct answer is A. Rationale: High-fat diets provide the most energy while condensing the total volume of food to consume. Choosing protein and fat sources can increase an individual's total energy intake. More sodium is necessary because sodium is expired in the sweat of cystic fibrosis patients due to the defect in the sodium chloride channel. Schindler T, Suzanne Michel S, Wilson A. Nutrition Management of Cystic Fibrosis in the 21st Century. Nutr Clin Pract. 2015;30:488-500. doi: 10.1177/0884533615591604

What is the term for when two or more professionals learn with and from, each other and learn about each other's professions with the goal to improve collaboration and quality of medical care? A. Interprofessional education B. Multiprofessional education C. Collaborative practice D. Multidisciplinary education

Solution: The correct answer is A. Rationale: In multidisciplinary education and multiprofessional education, students can be taught together, but no interaction between professionals occurs. In interprofessional education, educators and learners from two or more health professions jointly create and foster a collaborative learning environment. These efforts are intended to develop knowledge, skills, and attitudes that enhance interprofessional team behaviors and competence. Reeves S, Zwarenstein M Goldman J, et al. Interprofessional education: Effects on professional practice and health outcomes. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720355/. Accessed February 20, 2018.

Which of following is a sampling method whereby names of prospective interview subjects for a statistical study are obtained from subjects already interviewed? A. Snowball B. Probability C. Purposive D. Convenience

Solution: The correct answer is A. Rationale: In snowball sampling, prospective interview subjects for a statistical study are culled from recommendations from an existing pool of interviewed subjects. Zoellner J Harris J. Mixed-methods research in nutrition and dietetics. J Acad Nutr Diet. 2017;117(5):683-697.

What are the two environments that affect metabolism? A. Internal and external B. Hot and cold C. Superior and inferior D. Height and weight

Solution: The correct answer is A. Rationale: Internal and external factors affect metabolism. Internal factors include pregnancy and increased nutrient needs secondary to wounds. An example of an external factor that affects metabolism is temperature. Blundell J, Stubbs J. Diet Composition and the Control of Food Intake in Humans. In: Bray GA, Bouchard C, eds. Handbook of Obesity. 2nd ed. Oxfordshire, UK: Taylor and Francis; 2003:427-460.

Prolonged use of PPIs (proton pump inhibitors) such as omeprazole can lead to which of the following? A. Bone fractures B. Polyps C. Constipation D. Vitamin D deficiency

Solution: The correct answer is A. Rationale: PPIs have been overprescribed and recent guidelines have directed providers when benefits outweighs risk. Gastric acid secretion can facilitate calcium absorption and acid suppressants such as PPI can decrease calcium absorption and bone density. Freedberg, DE Kim L, Yu-Xiao, Y: The risks and benefits of long term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152(4): 706-715. Accessed July 10, 2020. Available at: Website Kinoshita Y, Ishimura N, Ishihara S. Advantages and disadvantages of long-term proton pump inhibitor use. J Neurogastroenterol Motil. 2018;24(2):182-196. Accessed July 14, 2020. Available at: Website

Which of the following is considered a functional fiber? A. Polydextrose B. B-glucan C. Cellulose D. Lignin

Solution: The correct answer is A. Rationale: Polydextrose is a functional fiber. B-glucan, cellulose, and lignin are all considered dietary fibers. Slavin J. Fiber and prebiotics: Mechanisms and health benefits. Nutrients. 2013;5(4):1417-1435. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705355/table/nutrients-05-01417-t001/. Accessed February 20, 2018.

What vitamin deficiency is likely in a patient with the following characteristics: 55-years old, dark skin, works long hours indoors, spends free time indoors, body mass index higher than 30 m/kg2, avoids milk. A. Vitamin D B. Vitamin A C. Iron D. Biotin

Solution: The correct answer is A. Rationale: Risk factors of vitamin D deficiency include lack of sun exposure, age, darker skin, obesity, and low intake of foods high in vitamin D. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-281.

According to ServSafe, what is the highest acceptable receiving temperature for shucked shellfish? A. 45° F B. 50° F C. 55° F D. 60° F

Solution: The correct answer is A. Rationale: Shellfish temperature needs to be no more than 45°F when received. The product should then be placed in refrigeration at 41°F or lower for 4 hours. National Restaurant Association. Servsafe manager. Chicago, IL: NRA Educational Foundation; 2014: 5.5

What is the span for short-range operational planning? A. 1 year or less B. 2 years C. 5 years D. 5 to 10 years

Solution: The correct answer is A. Rationale: Short-range planning sets strategic goals for a time frame of 1 year or less. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017.271

What is the main positive cation present in extracellular fluid and essential for maintenance of the osmotic pressure? A. Sodium B. Hydrogen C. Potassium D. Magnesium

Solution: The correct answer is A. Rationale: Sodium is the main positive cation present in extracellular fluid and is essential for maintenance of osmotic pressure and water and electrolyte balance. Academy of Nutrition and Dietetics. Nutrition Care Manual. Hydration. Accessed November 25, 2020. Available at: Website

The World Health Organization growth charts for children younger than age 2 are based on data from which of the following populations? A. Infants who were primarily breastfed until at least 4 months of age and continued through 12 months B. Infants who were primarily breastfed until at least 6 months of age and continued through 12 months C. Infants who were formula fed due to free formula distribution for at least 12 months D. Infants who were primarily breastfed until at least 2 months of age and continued through 12 months

Solution: The correct answer is A. Rationale: The WHO growth curves are expected to offer a single international standard that represents optimal physiological growth for all children from birth to 5 years of age and to establish the breastfed infant as the normative model for growth and development. The growth curves are based on data measured in infants who were primarily breastfed until age 4 months and continued through12 months. www.cdc.gov/growthcharts/who_charts.htm

What is often present in the gut microbiota of people who eat a Western diet? A. Firmicutes B. Fusobacteria C. Bacteroidetes D. Cyanobacteria

Solution: The correct answer is A. Rationale: The typical, highly processed Western diet results in a preponderance of firmicutes in the gut microbiota. Bacteroidetes are common in the gut microbiota of Africans who consume a diet that is very high in fiber. Davis C. The gut microbiome and its role in obesity. Nutr Today. 2016:4:167-172.

What is the organization that accredits and certifies hospitals? A. The Joint Commission B. World Health Organization C. Centers for Medicare and Medicaid Services D. Agency for Healthcare Research and Quality

Solution: The correct answer is A. Rationale: Through the accreditation process, organizations learn state-of-the-art performance-improvement strategies in order to continuously improve the safety and quality of care, which can reduce the risk of errors and the cost of liability insurance coverage. This accreditation is managed by The Joint Commission. The Joint Commision. About Us. Available at: https://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx. Accessed April 11, 2018.

What word best describes secretly taking something, planned and knowingly, without force, permission, or right? A. Theft B. Pilfering C. Robbery D. Embezzlement

Solution: The correct answer is A. Theft is premeditated without force, permission, or right. An example of pilfering is when an employee steals some lunch meat to take home. Robbery may involve force, and embezzling is most commonly taking money that belongs to the employer. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

Which of the following represents variable costs? A. Raw materials B. Insurance costs C. Salaries D. Utility costs

Solution: The correct answer is A. Variable costs vary in relation to either production volume or the amount of services provided. Raw materials represent a variable cost. Fixed costs do not change over the short-term, regardless of changes in sales or other business-related activities. Salaries and insurance costs are fixed costs and while utility costs may have elements of variability, they are highly consistent and thus considered a fixed cost. Accounting Tools. Examples of Fixed Costs. December 2020. Accessed March 20, 2021. Available at: Website Accounting Tools. Variable cost definition. December 2020. Accessed March 20, 2021. Available at: Website

Which of the following is an example of a soft skill? A. Communication B. Scheduling C. Filing documents D. Knowledge of programming languages

Solution: The correct answer is A. Whereas hard skills can be taught, soft skills must be developed and nurtured within an individual's personal and professional lives. Communication and emotional intelligence are high-demand soft skills in management. Scheduling, filing documents, and familiarity with programming languages are hard skills. Payne-Palacio J, Theis M. Foodservice Management Principles and Practice. 12th ed. Upper Saddle River, NJ: Prentice Hall; 2012. Tarallo M. The hard truth about soft skills. Society for Human Resource Management. May 2019. Accessed April 4, 2020. Available at: Website

If a company with an average of 207 employees has 29 employees who quit or were fired in a given year, what is the turnover rate? A. 6% B. 14% C. 18% D. 32%

Solution: The correct answer is B. Turnover Rate = # of Separations ÷ Average # of Employees x 100 In this scenario: 29 ÷ 207 = 0.14 0.14 × 100 = 14% Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. Upper Saddle River, NJ: Prentice-Hall; 2013.

Which of the following is a transitional food? A. Honey B. Ice cream C. Oatmeal D. Pudding

Solution: The correct answer is B. "Transitional foods" are substances that change quickly to become easier to chew or swallow with added moisture (eg, water or saliva) or a change in temperature. Frozen desserts such as ice cream, sherbet, malts, and frozen yogurt and some potato chips are considered transitional foods. Reference: International Dysphagia Diet Standardisation Initiative. What are transitional foods? Accessed September 22, 2019. FAQs_IDDSI_FOOD_transitional-food_10-October_final.pdf

What is the function of BHA and BHT in food products? A. Emulsifier B. Lipid oxidation prevention C. Enzymatic oxidation prevention D. Flavor enhancer

Solution: The correct answer is B. Butylated hydroxytoluene (BHT) butylated hydroxyanisole (BHA) are added to food to prevent lipid oxidation. Scheule B, Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2015: 116

Hyperglycemia between 5 AM and 9 AM caused by cortisol and growth hormone, which stimulate gluconeogenesis, is called the _____ phenomenon. A. circadian B. dawn C. episodical D. honeymoon

Solution: The correct answer is B. Dawn phenomenon is the term for hyperglycemia that results from the effect of hormones involved in controlling circadian rhythms. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 505.

Which statement best describes the "D" component of the PDSA performance improvement model? A. Determine how changes will be implemented B. Implement the intervention C. Determine the impact of the intervention D. Maintain and continue improvement

Solution: The correct answer is B. Determination of how changes will be made is part of the P component of PDSA and impact determination is considered a component of S. Joint Commission Resources. Cost-Effective Performance Improvement in Hospitals. Oakbrook Terrace, IL: JCAHO; 2005:94.

What is defined as the increase in energy expenditure above basal fasting level divided by the energy content of the food ingested? A. Diet-induced insulin resistance B. Diet-induced thermogenesis C. Diet-induced hypothyroidism D. Diet-induced acidosis

Solution: The correct answer is B. Diet induced thermogenesis (DIT) is the increase in energy expenditure above basal fasting level divided by the energy content of the food ingested. It is commonly expressed as a percentage. It is a component of daily energy expenditure, along with basal metabolic rate and activity-induced thermogenesis, . Klaas R Westerterp. Diet Induced Thermogenesis. Nutr Metab (Lond). 2004; 1: 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524030/#B16

Which of the following improves the readability of printed nutrition education materials? A. Light colors on dark backgrounds B. Serif font C. Glossy paper D. All capital letters

Solution: The correct answer is B. Educational handouts presented on glossy paper, in all capital letters, or with light colors on dark backgrounds can be difficult for users to read. Serif fonts are recommended for regular text in printed educational handouts because they are designed for ease of reading. Sans serif fonts are recommended for headers. US Department of Health and Human Services, Centers for Medicare & Medicaid Services. Toolkit for Making Written Material Clear and Effective. Section 2: Detailed guidelines for writing and design. 2010. Available at:CMS Written Materials Toolkit.pdf

In which of the following circumstances does a product that was previously exempt from bearing a nutrition facts label lose this exemption? A. If the package design changes B. If a nutrition claim is made C. If the food is now given free to consumers or donated D. If the product provides no significant nutritional benefits

Solution: The correct answer is B. Products that originally may have been exempt from bearing a nutrition facts label (eg, foods that are not a significant source of nutrition, like powdered coffee or spices) that make a nutrition claim on the package must now bear a nutrition facts label. US Food and Drug Administration. Guidance for Industry: A Food Labeling Guide. Accessed September 10, 2020. Available at: Website

Which of the following is an example of safety needs in the workplace according to Maslow's hierarchy of needs? A. Challenging work, allowing creativity, opportunities for personal growth and advancement B. Benefits programs such as insurance and retirement plans; healthy working conditions; and competent, consistent, and fair leadership C. Friendly associates, organized employee activities such as bowling or softball leagues, picnics, parties D. Title and responsibility of job, praise and rewards as recognition for accomplishments, promotions

Solution: The correct answer is B. Rationale: According to Maslow's hierarchy of needs, challenging work meets the needs of esteem, friendly associates/organized activities and job responsibilities and rewards meet the need to belong, and benefit programs/competent leadership meet safety needs. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017.300

How long should parenteral nutrition be withheld in a well-nourished ICU patient who is classified as NPO and enteral intake is not feasible? A. 72 hours B. 7 days C. 10 days D. 24 hours

Solution: The correct answer is B. Rationale: According to the American Society for Parenteral and Enteral Nutrition guidelines, parenteral nutrition is not initiated until after 7 days following ICU admission if enteral nutrition is not feasible. Parenteral nutrition can result in an increased risk of morbidity and mortality and increased blood glucose, among other complications. McClave et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in Critically Ill Patients: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN. 2016, 40 (2);159-211.

Based on the following patient data, which of these individuals would be eligible for bariatric (metabolic) surgery? A. 53-year-old man with sleep apnea, hypertension with body mass index (BMI) of 32 B. 24-year-old woman with BMI of 50 C. 48-year-old woman with BMI of 39 and no comorbid conditions D. 42-year-old man with BMI of 36 and steroid-induced obesity

Solution: The correct answer is B. Rationale: Bariatric surgery recommendations are as follows: BMI > 40 or BMI is between 35-40 with comorbid conditions. The 24-year-old with BMI of 50 clearly meets the criteria. https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery

Which of the following is best practice when translating educational materials from English to another language in a culturally sensitive way? A. Contract with a native speaker of the language to do the translation B. Avoid translating until the text is written well in English C. Contract with one reviewer to check for cultural and linguistic appropriateness D. Translate the content word for word

Solution: The correct answer is B. Rationale: Before translating a document, it should be written well in English, because if the original English text is too difficult, the translated text will probably also be too difficult. It cannot be assumed that native speakers of a given language are skilled at writing or at translating, so the person contracted to translate should it is more important that the translator be a professional translator than simply a native speaker. More than one individual should review the translation. Word-for-word, or literal, translations do not account for linguistic and cultural differences. Centers for Medicare and Medicaid Services. Toolkit for Making Written Material Clear and Effective: Detailed guide for translations. Available at: https://www.cms.gov/Outreach-and-Education/Outreach/WrittenMaterialsToolkit/Downloads/ToolkitPart11.pdf. Accessed September 20, 2020.

Which of these fruits is safest for consumption by individuals with fructose intolerance? A. Guava B. Berries C. Papaya D. Watermelon

Solution: The correct answer is B. Rationale: Berries are among the recommended fruits for individuals with fructose intolerance. Guava, papaya, and watermelon are potentially safe in individuals with fructose intolerance but intake should be limited. Academy of Nutrition and Dietetics. Fructose Intolerance Nutrition Therapy. https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=27. Last accessed September 28, 2017.

Which of the following compounds is necessary for transporting non-esterified fatty acids (NEFA) into mitochrondria for beta-oxidation? A. Lecithin B. Carnitine C. Taurine D. Glutamine

Solution: The correct answer is B. Rationale: Carnitine is a part of carnitine acyltransferase (CAT) and necessary for transporting NEFA into the inner mitochondria for beta-oxidation. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 789.

What does a fasting blood glucose (FBG) of 129 indicate? A. Normal blood sugar B. Diabetes C. Sugar spilling over into the urine D. Pre-diabetes

Solution: The correct answer is B. Rationale: FBG >126 indicates diabetes American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. Available at: http://care.diabetesjournals.org/content/41/Supplement_1.

GLP-1 is an incretin hormone that is produced in the A. stomach B. intestines C. tongue D. pancreas

Solution: The correct answer is B. Rationale: GLP-1 is synthesized in and secreted from enteroendocrine cells found throughout the small and large intestine. Secretion is upregulated with the presence of food in the GI tract. Campbell JE, Drucker DJ. Pharmacology, Physiology, and Mechanisms of Incretin Hormone Action. Cell Metabolism. 2013;17(6):819-837. https://doi.org/10.1016/j.cmet.2013.04.008

Which of the following denotes an enlargement of an organ or tissues caused by growth in cell size? A. Hyperplasia B. Hypertrophy C. Maturation D. Cellular replication

Solution: The correct answer is B. Rationale: Hypertrophy is an enlargement of an organ or tissues caused by cell growth. Hyperplasia is when this enlargement is caused by increase in number of cells. Brown JE, Isaacs J, Krinke B, Murtaugh M. Nutrition Through the LIfe Cycle. 4th ed. Boston: Cengage; 2010: 99

Which of the following is a function of insulin as an anabolic hormone? A. Decreases glucose uptake into muscle B. Increases fatty acid synthesis C. Decreases glycogen synthesis D. Increases gluconeogenesis

Solution: The correct answer is B. Rationale: Insulin increases fatty acid synthesis using excess glucose and fructose. Insulin increases glucose uptake into muscles and adipose tissue, increases glycogen synthesis in liver and skeletal tissue, and decreases gluconeogensis in the liver. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Belmont, CA: Thompson-Wadsworth; 2018.

What is the term for genetically programmed cell death? A. Necrosis B. Apoptosis C. Autophagy D. Cornification

Solution: The correct answer is B. Rationale: Necrosis is cell death caused by swelling and rupture of the cell membrane with loss of cellular contents, whereas apoptosis is programmed cell death. Kroemer G, Galluzzi L, Vandenabeele P, et al. Classification of cell death. Cell Death Differ. 2009; 16(1):3-11. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744427/. Accessed February 21, 2018.

Omega-3 fatty acids have been associated with which of the following outcomes? A. Increased clotting activity B. Reduced inflammation C. Promotion of inflammation to assist immune function D. Increased bone density

Solution: The correct answer is B. Rationale: Omega-3 fatty acids produces prostaglandins that help to reduce inflammation and keep blood thin by interfering with clotting. Simopoulos A. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Experiment Biol Med. 2008; doi: 10.3181/0711-MR-311

What is the most effective test to screen cystic fibrosis patients for diabetes? A. Hemoglobin A1c B. Oral glucose tolerance C. Random blood glucose D. Fructosamine

Solution: The correct answer is B. Rationale: Oral glucose tolerance is the most effective test for screening cystic fibrosis patients for diabetes. Fructosamine and A1c levels have low sensitivity in patients with cystic fibrosis. Moran A, Brunzell C, Cohen R, et al. Clinical guidelines for cystic fibrosis related diabetes. A position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care. 2010;33:2697-2708.

Ribose is synthesized by which of the following pathways? A. Glycolysis B. Pentose phosphate pathway C. The citric acid cycle D. Urea cycle

Solution: The correct answer is B. Rationale: Pentose phosphate pathway, which is also known as the hexose monophosphate pathway, produces NADPH and ribose as well as other monosaccharides Rodwell VW, et al. Harper's Illustrated Biochemistry. 30th ed. New York: McGraw-Hill; 2015. Page 198

Which cation has a higher concentration in the intracellular space compared to extracellular space? A. Sodium B. Potassium C. Chloride D. Phosphorus

Solution: The correct answer is B. Rationale: Potassium is a cation that is located in both the intracellular and extracellular spaces but it has a higher concentration in the intracellular space. McGuire M Beerman KA. Nutritional Sciences: From Fundamentals to Food. 3rd ed. Pacific Grove, CA: Brooks Cole; 2012: 523

Which of the following is a potential role of probiotics? A. They reduce fecal bulk production B. They prevent pathogenic bacteria from colonizing C. They prevent colon pH from acidifying D. They inhibit the host's immune defense system

Solution: The correct answer is B. Rationale: Probiotics prevent bacteria from colonizing. Instead of reducing fecal bulk, they actually increase fecal bulk, reducing transit time and shortening the time that toxic substances remain in the colon. Gropper SS Smith JL. Advanced Nutrition and Human Metabolism, 6th ed, Belmont, CA: Wadsworth; 2012: 55-56.

Which of the following is recommended for exclusion from the diets of children younger than 1 year? A. Oatmeal cereal B. Juice C. Iron-fortified formula D. Vitamin D supplements

Solution: The correct answer is B. Rationale: The American Academy of Pediatrics reports that juice accounts for the rising rates of obesity and expresses concern regarding dental health based on evidence accumulated over the years. Heyman B, Abrams SA. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. http://pediatrics.aappublications.org/content/139/6/e20170967. Accessed September 25, 2017.

Three judges on a sensory panel are testing five products. One product receives judge ratings of 3, 2, and 2. What is the mean of these ratings? A. 2.0 B. 2.3 C. 5.2 D. 7.0

Solution: The correct answer is B. Rationale: The mean is an average of the acceptance values. Add all judge ratings, then divide by 3 (the number of ratings). The mean rating for this product is (3 +2 + 2) ÷ 3 = 2.3 Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017

Warfarin acts as a vitamin K antagonist by inhibiting which of the following? A. gamma-carboxylase B. vitamin K epoxide reductase C. formation of active proenzyme factor D. breakdown of fibrinogen

Solution: The correct answer is B. Rationale: Warfarin inhibits the epoxide reductase enzyme in the vitamin K cycle. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Belmont, CA: Thompson-Wadsworth; 2018.

Which of the following business concepts represents marketing? A. Emphasis on product, sales-volume-oriented, needs of seller B. Customer wants, profit-oriented, future growth C. Sales-volume-oriented, customer wants, planning for today D. Profit-oriented, future growth, needs of seller

Solution: The correct answer is B. Successful businesses are those that focus on producing goods that customers want while forecasting future growth. Marketers may also focus on being profit oriented, which aims to maximize net profit rather than focus on total sales. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

When is it recommended to test A1C quarterly? A. When patient is newly diagnosed with type 2 diabetes B. When patient's therapy has changed or glycemic goals are unmet C. When patient is meeting treatment goals and has stable glycemic control D. When patient is an older adult with advanced diabetes

Solution: The correct answer is B. The American Diabetes Association recommends quarterly A1C testing for patients whose treatment has changed or who are not meeting glycemic goals and that patients who are meeting treatment goals and have stable glycemic control be tested twice per year. The ADA also has noted that there is very little need for monitoring and lowering A1C in older adults with advanced diabetes. American Diabetes Association. Classification and Diagnosis of Diabetes. Standards of Medical Care in Diabetes Care—2019. Diabetes Care. 2019;42(Suppl 1):S13-S28. Available at: Website. Accessed August 2, 2019.

Which agency maintains the GRAS (generally recognized as safe) list for food additives? A. US Department of Agriculture B. US Food and Drug Administration C. Environmental Protection Agency D. Federal Trade Commission

Solution: The correct answer is B. The FDA monitors safety of food additives and maintains the GRAS list. US Food and Drug Administration. Generally recognized as safe. Updated January 4, 2018. Available at: https://www.fda.gov/food/ingredientspackaginglabeling/gras/. Accessed August 22, 2018.

A pot of chili was left on the counter for 5 hours after service. The next step should be: A. Reheating it to 140°F and refrigerate in a shallow pan B. Discarding it C. Reheating it to 165° F and refrigerate it D. Refrigerating it in shallow pans

Solution: The correct answer is B. The Food Code indicates that if a food hasn't been cooled within 2 hours from 135°F to 70°F, it becomes a potentially hazardous food. The pot of chili has been in the temperature danger zone for a large period of time and is no longer considered safe to eat. The chili should be discarded. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 243

Why should meat be heated to 160°F before drying to make jerky? A. To facilitate forming the meat into jerky shape B. To destroy bacteria via wet heat C. To prevent oxidation that could affect color of final product D. To maximize the flavor retention

Solution: The correct answer is B. The USDA recommends heating meat to 160°F (poultry to 165°F) before dehydrating process to ensure that wet heat will destroy any bacteria present. US Department of Agriculture. Jerky and Food Safety. November 2016. Accessed April 1, 2020. Available at: Website

A cafeteria seats 100 customers. Lunch runs from 11:00 AM to 1:00 PM. Turnover is two customers per hour. How many customers can be served during that time? A. 200 B. 300 C. 400 D. 500

Solution: The correct answer is C. 100 seats × 2 per hour = 200 customers per hour × 2 hour of lunch = 400 customers Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013

What number of productive FTEs are needed for two 7-day-per-week positions, working 6:30 am to 3:00 pm, with a 30-minute lunch? A. 1.4 B. 2 C. 2.8 D. 2.975

Solution: The correct answer is C. 2 × 8 hours × 7 days = 112 hours40 hours week112 hours40 hours week = 2.8 FTES Keiser J, DeMicco FJ. Contemporary Management Theory: Controlling and Analyzing Costs in Foodservice Operations. Upper Saddle River, NJ: Prentice Hall; 2000:260.

Which of the following is a condition that can cause bacteria to grow and spoil food? A. Fat content B. Sodium content C. Acid content D. Grain content

Solution: The correct answer is C. Bacteria need six conditions to grow and induce spoilage: food, acidity, time, temperature, oxygen, and moisture. National Restaurant Association. Servsafe manager. Chicago, IL: NRA Educational Foundation; 2014: 2.4

What is the KEY element in disciplining employees? A. Identifying solutions to correct undesirable behavior B. Providing feedback C. Being consistent D. Identifying causes for unacceptable behavior

Solution: The correct answer is C. Consistency allows an employee to feel that any other employee would receive the same discipline for committing the same offense. Disciplinary action is the result of an employee's behavior and not personality conflicts. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

A facility director is charged with evaluating whether it is worthwhile to complete a project. The best approach would be to A. conduct a productivity study. B. determine the startup funds needed. C. conduct a cost-benefit analysis. D. determine the number of people involved.

Solution: The correct answer is C. Cost-benefit analysis (CBA) estimates and totals the monetary value of the benefits expected to be derived from a project and compares those to the costs of the project to determine whether the planned project is worthwhile financially. For example, if the costs of remodeling a foodservice kitchen is $3.4 million and the expected revenue generated after the renovation is $2.7 million, then the renovation would be judged as not being a good investment. A cost-benefit analysis would include all the other options listed as parts of the determination of project profitability. Hess MA. Review of Dietetics 2014-2016. Chicago, IL: Hess & Hunt Inc; 2014.

Which of the following data would be recorded during the nutrition-focused physical exam? A. Inadequate protein intake B. Surgical history C. Edema D. Blood glucose

Solution: The correct answer is C. Edema (swelling caused by excess fluid in tissues) is an evaluation parameter in the nutrition-focused physical findings section of nutrition assessment, according to the Nutrition Care Process. Blood glucose data would be recorded under biochemical data, medical tests, and procedures, and surgical history would be recorded under client history. Inadequate protein intake is a nutrition diagnosis. Academy of Nutrition and Dietetics. eNCPT. Nutrition Assessment and Monitoring and Evaluation Terminology: Nutrition-Focused Physical Findings. Accessed March 26, 2020. Available at: Website.

Which of these foods is among the highest in phospholipids? A. Turkey B. Eggplant C. Liver D. Brown rice

Solution: The correct answer is C. Phospholipids are present in all plant and animal membranes. They occur naturally in food and are both water soluble and fat soluble. The foods highest in phospholipid include pork and chicken liver, eggs, soybeans, wheat germ, and peanuts. Rolfes SR, Pinna K, Whitney E. Understanding Normal and Clinical Nutrition. 10th ed. Boston, MA: Cengage; 2015.

How many carbohydrate servings, or exchanges, are in a meal comprising 1 cup granola, 1 cup skim milk, and 1 small banana A. 4 B. 5 C. 6 D. 7

Solution: The correct answer is C. Rationale: 1 cup granola = 60 g carbohydrate. 1 cup milk = 12 g carbohydrate. 1 small banana 15 g = carbohydrate. 60 + 12 + 15 = 87 g carbohydrate. With 1 carbohydrate serving = 15 g, there are 6 carbohydrate servings (rounded up) in this meal (87/15=5.8). Academy of Nutrition and Dietetics and American Diabetes Association. Choose Your Foods: Food Lists for Diabetes. Chicago, IL: AND/ADA: 2014.

Which of the following managerial skills is essential for executive management? A. Communication B. Human C. Conceptual D. Organizational

Solution: The correct answer is C. Rationale: All of these management skills listed are necessary; however, conceptual managerial skills are required to lead the organization. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 13th ed. Boston, MA: Prentice Hall; 2016.

Who among the following would have difficulty with breastfeeding? A. Infant with extrusion reflex B. Infant with cleft lip C. Infant with cleft palate D. Infant with colic

Solution: The correct answer is C. Rationale: Babies born with cleft palates cannot create enough suction to withdraw milk from the breast. Infants with cleft lip have few feeding problems, extrusion reflex is normal , and there is no association between colic and feeding difficulties. Thompson J, Manore M Vaughn L. Science of Nutrition. 4th ed. New York: Pearson Publishers; 2017.

Which of the following is a young, castrated male chicken, which is very tender and meaty? A. Broiler B. Poussin C. Capon D. Fryer

Solution: The correct answer is C. Rationale: Broilers and fryers are young chickens of either sex. Poussin are small, immature chicken. Capons are young, castrated male chickens. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014:479

The first milk produced by the mother, colostrum, is particularly high in which of the following compounds? A. Casein B. Lactose C. Carotenoids D. Iron

Solution: The correct answer is C. Rationale: Colostrum is high in carotenoids, which is why it tends to be yellowish in color; it is low in lactose and fat and rich in protein and antibodies. Although breastmilk is eventually high in casein, this is not true of early breastmilk. The whey/casein ratio in human milk fluctuates between 70/30 and 80/20 in early lactation and decreases to 50/50 in later lactation. Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016: 164. Martin CR, Ling P-R, Blackburn GL. Review of infant feeding; Key features of breast milk and infant formula. Nutrients. 2016;8(5):279. Accessed July 29, 2020. Available at: Website

What can diarrhea after meals be attributed to in patients who have had a gastric resection? A. Rapid entry of fats into the small intestine B. Slower entry of sugars into the small intestine C. Rapid entry of sugars into the small intestine D. Slower entry of water into the small intestine

Solution: The correct answer is C. Rationale: Dumping syndrome is a common complication after gastric surgery. It occurs when food rapidly passes directly from the stomach to the intestine without being digested, resulting in diarrhea. The onset of these symptoms is common after the consumption of simple carbohydrates or sugar. Ellsmere JC. Late complications of bariatric surgical operations. UptoDate. August 2019. Accessed August 3, 2020. Available at: Website

What risk is associated with a type 1 diabetes patient trying to maintain hemoglobin (Hgb) A1c at 6.0 %? A. Increase in occurrence of retinopathy B. Hyperglycemia C. Hypoglycemia D. Decrease in occurrence of retinopathy

Solution: The correct answer is C. Rationale: In a long-term major trial of intensive vs. conventional control of blood sugar in persons with type 1 diabetes, hypoglycemia occurred more frequently in the intensive group in which patients were aiming for lower blood sugar goals than usual. Writing Group for the DCCT/EDIC Research Group. Association Between 7 Years of Intensive Treatment of Type 1 Diabetes and Long-term Mortality. JAMA. 2015;313(1):45-53. doi: 10.1001/jama.2014.16107 http://www.ndei.org/ADA-diabetes-management-guidelines-glycemic-targets-A1C-PG.aspx.html

Which condition involves damaged enterocytes caused by ingesting foods that are not harmful to most people? A. Food allergy B. Lactose intolerance C. Celiac disease D. Fructose intolerance

Solution: The correct answer is C. Rationale: In celiac disease, enteropathy is caused by gluten in genetically predisposed individuals. Immune activation in response to proteins in certain grain foods that are not harmful to most results in intestinal damage. Castillo NE, Theethira TG, Leffler DA. The present and the future in the diagnosis and management of celiac disease. Gastroenterology Report. 2015; 3(1): 3-11. Doi.org/10.1093/gastro/gou065

Which size egg is most commonly used in baking recipes? A. Small B. Medium C. Large D. Extra large

Solution: The correct answer is C. Rationale: Large eggs are about 57 g or 3¼ tbsp of egg. Extra-large eggs are about 64 g 4 tbsp of egg. Most baking recipes call for large eggs. If a recipe calls for two large eggs, that means the proportions of the recipe are counting on about 6½ 1tbsp of liquid egg. Using extra-large or even jumbo eggs instead of large eggs in the recipe means there would be far more liquid added to the recipe than the proportions account for. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014:415

Maple syrup urine disease (MSUD) is caused by the inability to metabolize which of the following amino acids? A. Pheylalanine B. Aromatic amino acids C. Branched-chain amino acids D. Sulfur-containing amino acids

Solution: The correct answer is C. Rationale: MSUD is an amino acidemia caused by autosomal recessive gene affecting branch-chain amino acids. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 767.

Which of the foods listed has the highest environmental impact? A. Orange B. Salmon C. Cow's milk D. Broccoli

Solution: The correct answer is C. Rationale: Meat has been identified as having the highest greenhouse emissions, and thus the highest environmental impact, followed by dairy products, poultry, and fluid milk. Heller M Keoleian G Greenhouse gas emission estimates of US dietary choices and food loss. J Industr Ecol. 2014;19(3):391-401. Academy of Nutrition and Dietetics. Position Paper: Vegetarian Diets. J Acad Nutr Diet. 2016;116(12):1970-1980.

In a nutrition diagnostic statement, signs and symptoms refer to: A. alterations in the patient's nutritional status that the RDN can resolve B. a description of the factors contributing to the nutrition problem C. subjective and objective data used to determine if the nutrition diagnosis is accurate D. the medical nutrition therapy that will be required to treat the effects of the diagnosed condition

Solution: The correct answer is C. Rationale: Signs and symptoms are the subjective and objective data an RDN uses to determine if a nutrition diagnosis is accurate. Academy of Nutrition and Dietetics. https://www.andeal.org/vault/2440/web/files/20140527-ND%20Snapshot.pdf. Accessed April 3, 2018.

A member of the staff had to go on a medical leave of absence. How many weeks of leave are they entitled to? A. 4 weeks B. 8 weeks C. 12 weeks D. 16 weeks

Solution: The correct answer is C. Rationale: The Family and Medical Leave Act requires that eligible employees have 12 weeks of protected leave. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

What is the weight gain recommendation during a single gestation pregnancy for person with a body mass index of 20? A. 15-20 lb B. 28-40 lb C. 25-35 lb D. 35-45 lb

Solution: The correct answer is C. Rationale: The Institute of Medicine recommends normal weight women gain 25-35 lb. The recommendation for overweight women is 15-25 lb and 35-45 lb for twin gestation. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines; Rasmussen KM, Yaktine AL, eds.. Weight gain during pregnancy: Reexamining the guidelines. Natl Acad Collect. 2009. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20669500. Accessed February 20, 2018.

Which diet plan for patients with cardiovascular disease follows the US Dietary Guidelines for physical activity, saturated and trans fat, cholesterol, sodium, and consumption of fiber, stanol esters, and whole grains? A. DASH B. REAP C. TLC D. CAGE

Solution: The correct answer is C. Rationale: The Therapeutic Lifestyle Changes (TLC) diet incorporates physical activity; decreased saturated and trans fat, cholesterol, and sodium intake; and increased consumption of fiber, stanol esters, and whole grains. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 318.

Enterocytes are A. cells of the colon B. parietal cells C. cells of the gastrointestinal tract D. cells of the stomach lining

Solution: The correct answer is C. Rationale: The gastrointestinal tract is lined by a continuous sheet of epithelial cells, also known as "enterocytes," which are responsible for processing and moving nutrients from the lumenal space into the vasculature for distribution to peripheral tissues. McConnell RE. Proteomic analysis of the enterocyte brush border Am J Physiol Gastrointest Liver Physiol. 2011; 300(5): G914-926. doi: 10.1152/ajpgi.00005.2011

What is the minimal final rinse temperature for a nonchemical dishwasher? A. 145°F B. 155°F C. 180°F D. 185°F

Solution: The correct answer is C. Rationale: The minimal temperature requirement for a nonchemical dishwasher final rinse is 180°F . Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

A barbequed flavor seitan roll sells for $1.80/pound and has a 10% cooking loss and a 5% handling loss. What is the edible portion price per pound? A. $1.65 B. $1.89 C. $2.12 D. $2.39

Solution: The correct answer is C. Rationale:AP price / EP yield = EP price. In this example, $1.80/0.85=2.117, or $2.12. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017

How many 5-oz servings are in a 5-gallon tub of ice cream? A. 25 B. 25.6 C. 100 D. 128

Solution: The correct answer is D. 5 gal × 128 oz/gal = 640 oz divided by 5 oz = 128 servings Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 194

An apple cobbler requires 5 lbs of of peeled, cored apple slices. A raw apple has 78% yield. What is the edible portion (EP) price of the cobbler if apples costs $.80 per lb? A. $3.12 B. $4.00 C. $4.75 D. $5.12

Solution: The correct answer is D. 5 lb apples EP divided by .78 = 6.4 lbs of apples needed 6.4 lbs of apples x $.80= $5.12 Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 190

A manager was instructed to prepare a budget without relying on the figures from previous years. This is known as a A. top-down budget. B. bottom-up budget. C. baseline budget. D. zero-based budget.

Solution: The correct answer is D. A top-down budget is prepared by top management and given to each operating units. In a bottom-up budget, individual units prepare their own budget that is then sent to upper management. A baseline budget starts with the previous budget and adjusts for current conditions. A zero-based budget starts with no previous figures before costs, outlay, and inflows are determined. Keiser J, DeMicco F, Grimes R. Contemporary Management Theory. 4th ed. Upper Saddle River, NJ: Prentice Hall; 2000.

What is the best approach when counseling a mother who is reluctant to breastfeed? A. Read off a list of the benefits of breastfeeding B. Send the client home with handouts to read on her own time C. Prescribe a strict plan to guide the feeding process D. Ask open-ended questions about this reluctance

Solution: The correct answer is D. Active listening, reflecting, and asking open-ended question are all effective techniques for encouraging breastfeeding. Assigning a strict feeding plan is not a counseling technique, assigning homework eliminates the opportunity for dynamic conversation to answer questions, and simply reading off a list of benefits risks being perceived as a lecture. Academy of Nutrition and Dietetics. Position of the Academy of Dietetics and Nutrition: Promoting and Supporting Breastfeeding. http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers/practice%20papers/practicepaperpromotingandsupportingbreastfeeding.ashx. Last accessed September 21, 2017.

Which of the following is classified as a body systems assessment when evaluating functional status in older adults? A. Using a phone B. Using the toilet C. Taking prescribed medication D. Housework

Solution: The correct answer is D. Assessment of functional status evaluates instrumental activities of daily living (such as chores, cleaning, cooking, driving or using public transportation, grocery shopping, home repair, paying bills or other financial tasks, taking prescribed medications, and using a phone), activities of daily living (such as dressing, eating meals/snacks, bathing, using the toilet, walking) and body systems assessment (such as ambulation status; cognitive status; functional independence like exercise, housework, work outside of the home; and sensory status like hearing, vision, and speech). Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016: 456

Improper food cooling methods can result in foodborne illness. Which of the following is the recommended time frame for cooling foods from 70ºF to 41ºF? A. 1/2 hour B. 1 hour C. 2 hours D. 4 hours

Solution: The correct answer is D. Cooling foods from 70ºF to 41ºF should be done within 4 hours. Cooling foods from 140ºF to 70ºF should be completed within 2 hours. Proper food cooling techniques include use of shallow pans to reduce and divide the food, stainless steel storage containers to transfer heat from the food, and ice cubes. National Restaurant Association. Servsafe manager. Chicago, IL: NRA Educational Foundation; 2014: 6.16.

The AP price of chicken breast with bones and skin costs $3.50 per pound and the EP yield percentage is .53. What is the EP price for 1 pound of cooked, boneless, skinless chicken breast? A. $1.86 B. $2.49 C. $0.15 D. $6.60

Solution: The correct answer is D. EP price = AP price ÷ EP yield EP price = $3.50 ÷ .53 = $6.60 Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 190

Which of the following is a tenet of active listening? A. Assist the speaker with completing their sentence once it's clear where their thought is headed B. Periodically offer an opinion on what's being communicated to demonstrate the speaker's thought is being heard C. Avoid eye contact to ensure the speaker doesn't misinterpret neutral facial expressions D. Avoid leaning back in chair to ensure the speaker doesn't misinterpret posture as indifference

Solution: The correct answer is D. In active listening, it's important to be mindful of posture, as body language can be misinterpreted. Toward that end, it is recommended that active listeners lean forward to demonstrate engagement. Maintaining eye contact, not interrupting, and withholding opinion and judgment are also important tenets of active listening. Jahromi VK, Tabatabaee SS, Abdar ZE, Rajabi M. Active listening: The key of successful communication in hospital managers. Electron Physician. 2016;8(3):2123-2128. Black J. How to practice active listening. June 18, 2019. Duke Today. Accessed February 3, 2020. Available at: Website.

Which of the following is best practice for writing a job description? A. Target it specifically for the ideal candidate B. Present all information as short phrases in bulleted lists C. Include responsibilities no longer part of the job in case they are restored as requirements in the future D. Limit the job duties section to only 3-5 key accountabilities

Solution: The correct answer is D. In best practice, a job description will include only 3-5 key accountabilities in the duties section. The description should be tailored to the basic skills and experience required of the job rather than targeting it for an ideal candidate, and it should only include what is currently required of the job and omit past or potential future requirements. Using complete sentences is recommended. University of Pittsburgh, Department of Human Resources. Writing a job description. Accessed February 13, 2020. Available at:JobDescriptionWritingGuide.pdf

What is an organizational chart for? A. It organizes an employee's list of duties B. It organizes departmental activities C. It is an evaluation tool for productivity D. It delineates employees in the organizational hierarchy

Solution: The correct answer is D. Organizational charts depict the basic hierarchy of employment positions and job functions. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 298

Which of the following questions is the best example of the "teach back" method? A. "Does that make sense?" B. "Do you know how many grams of sodium are in a can of chicken noodle soup?" C. "What questions do you have for me?" D. "Can you tell me in your own words what changes you will make when going home?"

Solution: The correct answer is D. Rationale: "Because asking if something makes sense or if there are any questions call for yes or no answers, they are not examples of the teach back method. A question that quizzes about knowledge, as in Option B, is incorrect because it is a direct question that feels like a test. Option D is the correct answer because it is open-ended and allows the patient/client to demonstrate the knowledge they have attained. Plainlanguage.gov. Write for your audience. Available at: https://www.plainlanguage.gov/guidelines/audience/. Accessed April 3, 2018.

How many 4 oz servings are in a #10 can of peaches? A. 4 B. 8 C. 16 D. 26

Solution: The correct answer is D. Rationale: A #10 can contains 104 oz. 104 / 4 oz = 26 four-ounce servings of peaches in a #10 can. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

What is the recommended weight gain for an obese pregnant person? A. 28-40 lbs B. 25-35 lbs C. 15-25 lbs D. 11-20 lbs

Solution: The correct answer is D. Rationale: According to the Institute of Medicine (now called National Academy of Medicine) guidelines for weight gain during pregnancy, recommended weight gain for obese people is 11-20 lbs. Stang J, Huffman LG; Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet. 2016;116(4):677-691.

"Affective commitment" is defined as a commitment to an organization because A. the personal cost of leaving is too great. B. there is a contractual obligation for a specific time frame. C. the employee believes no one else is qualified for the role. D. the employee is satisfied with working for the organization.

Solution: The correct answer is D. Rationale: Affective commitment refers to an employee's positive emotional regard for an organization. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017: 304

Monitor, spokesperson, and disseminator are tenets of which type of managerial role? A. Decisional B. Interpersonal C. Transactional D. Informational

Solution: The correct answer is D. Rationale: An information manager is a monitor, spokesperson, and disseminator. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017.266

Which of the following is a concern in patients who are unable to initiate an oral diet or enteral nutrition and need to start parenteral nutrition? A. Decreased peristalsis B. Increased peristalsis C. Inadequate energy intake D. Infection from bacterial translocation

Solution: The correct answer is D. Rationale: Bacterial translocation is a common concern in patients without oral or enteral nutrition and can possibly result in infection. McClave et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in Critically Ill Patients: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN. 2016;40 (2):159-211.

Lack of appetite and rapid muscle breakdown associated with disease is known as: A. Anorexia B. Catabolism C. Anabolism D. Cachexia

Solution: The correct answer is D. Rationale: Cachexia is the increased breakdown of muscle protein, along with decreased protein synthesis, which leads to overall muscle loss. Lok C. Cachexia: The last illness. Nature. 2015; 528 (7851): 182-183. doi: 10.1038/528182a

The structure that anchors the yolk in the center of an egg is called _____. A. vitelline membrane B. albumen C. cholesterol D. chalazae

Solution: The correct answer is D. Rationale: Chalazae are two ropey egg white strands on opposite ends of the egg that anchor the egg yolk in the shell. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014: 412

Non-steroidal anti-inflammatory drugs (NSAID) inhibits which enzyme to reduce inflammation? A. Cytokines producing enzymes B. Histamine producing enzyme C. Lipooxygenase D. Cyclooxygenase

Solution: The correct answer is D. Rationale: Cyclooxygenase—COX 1 and COX 2—are blocked by NSAIDs. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016:173

What is the recommended dietary fluid allowance for patients aged 65 years or older? A. 20 mL/kg B. 50 mL/kg C. 1.5 mL/kg D. 25 mL/kg

Solution: The correct answer is D. Rationale: For adults older than 65 years, 25 mL/kg is appropriate. A simple calculation is: 25 mL × body weight in kg = estimated fluid needs. Nelms Marcia N. Nutrition Therapy and Pathophysiology. Boston, MA: Cenegage Learning; 2016

Which of the following is likely to be found in a burn patient? A. Hypothyroidism B. Hyperthermia C. Hypoplasia D. Hypermetabolism

Solution: The correct answer is D. Rationale: Hypermetabolism is often noted in people with active disease processes, including in patients with burns. Mann S, Westenskow DR, Houtchens BA. Measured and predicted caloric expenditure in the acutely ill. Crit Care Med. 1985;13:173-177.

Which immunoglobulin mediates the classical type of food allergy? A. IgA B. IgM C. IgG D. IgE

Solution: The correct answer is D. Rationale: IgE is involved in the hypersensitivity response. IgG is a "memory" antibody that engages after exposure to the allergen. IgA levels play a role in autoimmune conditions. IgM is the first antibody secreted when the body is fighting a new infection. Stukus DR, Mikhail I. Pitfalls in Diagnosing Food Allergies. Curr Allergy Asthma Rep. 2016;16(5):34. doi: 10.1007/s11882-016-0611-z.

Polypharmacy most commonly affects which population? A. Infants B. Children C. Teenagers D. Elderly

Solution: The correct answer is D. Rationale: Polypharmacy most commonly occurs in the older adult population. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 230.

Lost CO2 associated with hyperventilation can lead to which of the following conditions ? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

Solution: The correct answer is D. Rationale: Reduced CO2 and excessive amount of base (bicarbonate) lead to a shift in acid-base balance, causing respiratory alkalosis. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 152.

An adult with heart failure may reduce the risk of tachycardia if what deficiency is corrected? A. B12 B. Sodium C. Vitamin D D. Magnesium

Solution: The correct answer is D. Rationale: Research suggests magnesium supplementation may reduce ventricular ectopic beats, couplets, episodes of non-specific ventricular tachycardia, or premature ventricular contractions. Academy of Nutrition and Dietetics Evidence Analysis Library. Heart failure systematic review (2006-2008). Available at: Website (login required). Accessed January 25, 2018.

Which of the following sweeteners is made with rebaudioside A? A. Neotame B. Aspartame C. Sucralose D. Stevia

Solution: The correct answer is D. Rationale: Stevia is made with rebaudioside A. The sweeteners neotame, aspartame, and sucralose are made with other compounds. Das A, Chakraborty R. Sweeteners: Classification, sensory, and health effects. Encyclopedia of Food and Health. 2016;234-240. https://doi.org/10.1016/B978-0-12-384947-2.00677-2

What is the designation for a person with a body mass index of 30.0 kg/m2? A. Underweight B. Healthy weight C. Overweight D. Obese

Solution: The correct answer is D. Rationale: The BMI cutoff for overweight is 25.0 to 29.9 kg/m2. A person with a BMI of at least 30.0 kg/m2 is considered obese. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 256.

Which of the following is used to estimate body surface area related to severity of burns? A. Mifflin-St Jeor B. Curreri C. Ireton-Jones D. Rule of Nines

Solution: The correct answer is D. Rationale: The rule of nines is used to make a rapid estimation of body surface area that has been burned. Estimation of affected body surface area assists in assessment of the extent of the injury and helps provide the basis for prescribing fluids and medications. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 678.

Which of the following best demonstrates theory Y leadership style? A. A manager who is indifferent, exerts minimal effort to get work done, and assumes little responsibility B. A manager who manipulates and exploits others by persuading them to do work that benefits the manager personally C. A manager who emphasizes work performance and production outcomes D. A manager who cares about the well-being of their subordinates and encourages the team to achieve high standards.

Solution: The correct answer is D. Rationale: Theory Y, developed by McGregor, defines a participative management style that assumes employees take pride in their work and see performance as a challenge.The managerial grid model defines five different leadership styles based on a range in concern for people and concern for production. An indifferent or impoverished leadership style is described in option A. Response B describes the opportunistic leadership style, where workers adopt behaviors based on manipulated directives from supervisors. Option C describes a management style that is concerned only with production, not with well being, that is also known as "produce or perish." Option D describes a team style that has the most regard for both individuals and production, reflecting the principles of theory Y. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017.310

What is the meaning of "saponify"? A. To turn fat into liquid by reaction with an acid B. To turn fat into soap by reaction with an acid C. To turn fat into liquid by reaction with an alkali D. To turn fat into soap by reaction with an alkali

Solution: The correct answer is D. Rationale: To saponify is to turn fat into soap via an alkali agent. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 13th ed. Boston, MA: Prentice Hall; 2016.

Within the first few weeks of life, what is the average recommended number of feedings for an infant in a 24-hour period? A. 2-4 B. 4-6 C. 7-10 D. 8-12

Solution: The correct answer is D. Rationale: Until lactation is well established and infants are demonstrating adequate weight gain, infants should be fed every 2 to 3 hours and should receive 8 to 12 feedings in 24 hours. Academy of Nutrition and Dietetics: Pediatric Nutrition Care Manual. Breastfeeding and lactation support: feeding options. Available at: https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=12&lv1=255490&lv2=255502&ncm_toc_id=255502&ncm_heading=Normal%20Nutrition. Accessed January 25, 2018.

Which protein is important for vision and requires vitamin A for synthesis? A. Retinol binding protein B. Retinoic acid C. Beta-carotene D. Rhodopsin

Solution: The correct answer is D. Rationale: Vitamin A is needed to form rhodopsin, a pigment protein for vision. Retinol-binding protein is one of two transport proteins of retinol. Beta-carotene doesn't play a role in vision. Retinoic acid in the forms of all-trans-retinoic acid and 9-cis-retinoic acid are needed for the other functions of vitamin A. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Belmont, CA: Thompson-Wadsworth; 2018.

Which of the following classes of medication would require patient education on hypoglycemia? A. SGLT2 B. DPP4 C. GLP1 D. Sulfonylureas

Solution: The correct answer is D. Sulfonylureas work by increasing the amount of insulin the body produces and can lower blood sugar levels by approximately 20% and can cause hypoglycemia. Sodium-glucose co-transporter 2 (SGLT2) inhibitors lower blood sugar by increasing the excretion of sugar in the urine. They do not cause low blood sugar. DPP4 inhibitors lower blood sugar levels by increasing insulin release from the pancreas in response to a meal. These medicines do not cause hypoglycemia. GLP-1 receptor agonists are given by injection that increase insulin release in response to a meal and slow digestion. They do not usually cause low blood sugar when used without other medications that cause low blood sugar. Andelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology - Clinical Practice Guidelines for developing a diabetes mellitus comprehensive care plan. Endocrine Pract. 2015;21(suppl 1):1-87

Which of the following foods is safe to eat? A. Potato salad at 80°F B. Tuna casserole at 100°F C. Egg salad at 50°F D. Baked chicken at 165°F

Solution: The correct answer is D. Temperature for bacterial growth is best between 41°F and 135°F. Baked chicken is safe to eat at 165°F. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 230

When diagnosing malnutrition in older adults, what is the measurement for determining diminished functional status? A. Continence B. Ambulation C. Ability to self-feed D. Handgrip strength

Solution: The correct answer is D. There are six characteristics recommended for identifying malnutrition in older adults: Insufficient energy intake Weight loss Loss of muscle mass Loss of subcutaneous fat Localized or generalized fluid accumulation Diminished functional status as measured by handgrip strength Because there is no single, definitive parameter for diagnosing adult malnutrition, it is recommended that diagnosis be contingent on presence of at least two of these parameters. Dorner B, Friedrich EK. Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings. J Acad Nutr Diet. 2018;118:724-735.

A continuous and systematic process in which decisions are made about intended future outcomes, and how success is measured and evaluated is known as: A. accountability. B. effectiveness. C. organizing. D. strategic planning.

Solution: The correct answer is D. This is the definition of strategic planning: it is a continuous and systematic process in which people make decisions about intended future outcomes, how outcomes are to be accomplished, and how success is measured and evaluated. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

Which of the following is associated with unregulated vasopressin? A. GERD B. HDL C. CSID D. SIADH

Solution: The correct answer is D. Vasopressin is an antidiuretic hormone, or ADH. Unregulated vasopressin can lead to syndrome of inappropriate ADH, or SIADH. It occurs when ADH is released in excessive unregulated quantities. SIADH results in excess water reabsorption and thus creates dilutional hyponatremia. Cuzzo B, Padala SA, Lappin SL. Vasopressin (Antidiuretic Hormone, ADH). StatPearls. Updated April 2020. Accessed September 20, 2020. Available at: Website