ERP 3

To make sure clients can recognize carbohydrate foods, an RDN administers a short quiz at the start of the appointment. This is considered a _____ type of assessment a. Formative b. Summative c. Cognitive d. Observational

Solution: The correct answer is A. A formative assessment is conducted during the learning process to identify learner misconceptions, difficulties, and gaps. It allows the RDN to adjust the approach to teaching based on participants' understanding. A summative assessment evaluates student learning, knowledge, or proficiency upon completion of a course. Yale Center for Teaching and Learning. Formative and summative assessments. Accessed June 1, 2021. Available at: Website

Which of the following populations has the highest prevalence of diagnosed and undiagnosed type 2 diabetes? a. American Indian/Alaska Native b. Asian, Non-Hispanic c. Hispanic d. Black, Non-Hispanic

Solution: The correct answer is A. According to data on US adults in 2013-2016, American Indians/Alaska Natives had the highest prevalence of diagnosed diabetes (14.7%). Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Accessed August 13, 2020. Available at: CDC 2020 national-diabetes-statistics-report.pdf

What is the recommended way to serve fruit on the IDDSI Level 5 diet? a. Mashed b. Cubed c. Sliced d. Julienned

Solution: The correct answer is A. According to the International Dysphagia Diet Standardisation Initiative, fruits served on Level 5 Orange Minced & Moist should be served mashed with excess thin juice drained and skin and pips removed. International Dysphagia Diet Standardisation Initiative. IDDSI Framework. Accessed March 4, 2020. Available at: IDDSIFramework-CompleteFramework.pdf

Which laboratory values can be abnormally low when evaluating nutritional status in patients with liver disease? a. Prealbumin b. Potassium c. Chloride d. Vitamin C

Solution: The correct answer is A. Albumin and prealbumin may be moderately or abnormally low in patients with liver disease, even in the presence of good nutrition. These proteins decrease in production in a diseased liver. Lieber CS. Relationships between good nutrition, alcohol use, and liver disease. Alcohol Res Health. 2003; 27(3):1139-1143.

Promptly removing rotten apples from produce storage helps to prevent the formation of what toxin on other apples? a. Patulin b. Fusarium c. Aflatoxin d. Aspergillus

Solution: The correct answer is A. Apples are particularly vulnerable to patulin, a toxic chemical that produces a mold that infects produce. Promptly removing rotten apples helps to protect the other apples in produce storage. National Agricultural Library. Patulin. Accessed August 13, 2020. Available at: Website

What is the term for accumulation of fluids in the peritoneal cavity? a. Ascites b. Sepsis c. Paracentesis d. Asterixis

Solution: The correct answer is A. Ascites is the accumulation of fluid in the peritoneal cavity. It may be caused by portal hypertension. Asterixis is an uncommon type of negative myoclonus characterized by irregular lapses of posture of various body parts. Sepsis is a life-threatening chain reaction triggered when the body's response to infection-fighting chemicals is out of balance. Paracentesis is a procedure to obtain a sample of ascitic fluid for diagnostic or therapeutic purposes. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 443

What should a dietetics practitioner consider before recommending curcumin supplements to an athlete? a. There is currently not enough evidence to support this recommendation b. The therapeutic dose to see benefits is very low, so excessive intake is a potential side effect c. It may exacerbate an injury because curcumin induces inflammation d. Excessive curcumin use has been linked to bone fracture in athletes

Solution: The correct answer is A. At this time, curcumin has not been the subject of extensive research in humans, and particularly in rehabilitation, so there is no specific evidence that supports curcumin supplementation in athletes. However, it has been noted that curcumin may have potential to reduce inflammation after eccentric exercise and during healing, though the therapeutic dose is notably high. Academy of Nutrition and Dietetics. Sports Nutrition Care Manual. Dietary supplements for rehabilitating athletes. Accessed April 23, 2020. Available at: Website

Which of the following nutrient deficiencies are associated with dementia? a. B12, B6, folate, omega-3 fatty acids b. Vitamin D, calcium, phosphorous c. Vitamin A, B6, vitamin C, omega-3 fatty acids d. B12, vitamin K, vitamin D, calcium

Solution: The correct answer is A. B12, B6, folate, and omega-3 fatty acid deficiencies are associated with dementia. Inability to meet nutritional requirements orally,a common occurrence in dementia, makes older adults with advanced dementia potential candidates for nutrition support. Deficiency of certain micronutrients need to be evaluated before enteral nutrition support initiation. Dangour AD, Whitehouse PJ, Rafferty K, et al. B vitamins and fatty acids in the prevention and treatment of Alzheimer's disease and dementia: a systematic review. J Alzheimers Dis. 2010; 22(1):205-224.

Which of the following is an example of benchmarking? a. Evaluating the organization's pricing model by comparing against competitors' models b. Establishing which equations are preferred for establishing energy intake in a health care organization c. Evaluating employee performance using a predecessor's performance as baseline d. Comparing revenue and expenses over a 5-year period

Solution: The correct answer is A. Benchmarking comprises internal performance evaluation, including external criteria such as what competitors are doing. This process helps to establish best practices based on understanding what actions led to successful outcomes. Lenet S. The imporance of benchmarking. Forbes. December 2018. Accessed August 3, 2020. Available at: Website

What is the role of the liver in fat digestion? a. The liver is needed for fat absorption from the small intestine b. The liver excretes fat that cannot be used c. The liver stores fat when it is consumed in the form of triglycerides d. The liver recycles fat and converts fatty acids to carbohydrates

Solution: The correct answer is A. Bile from the liver is needed for fat absorption. Bile is released and breaks down fats. When bile is not present, the liver can retain fatty acids, resulting in fatty liver. Werner A, Kuipers F, Verkade HJ. Fat absorption and lipid metabolism in cholestasis. Accessed May 4, 2020. Available at: Website

Calculate the labor cost percent of the following: Salaries: $40,240 Benefits: $3,100 Wages: $20,000 Total sales: $560,420 a. 11% b. 22% c. 8% d. 16%

Solution: The correct answer is A. Calculate total cost of labor (salaries + wages + benefits) /total number of sales. In this scenario, the organization has a labor cost of 11% Payne-Palacio J, Theis M. Foodservice Management: Principles and Practice. 12th ed. Boston: Pearson; 2011: 474

The anatomical structures of the lungs where gas exchange of carbon dioxide and oxygen occurs are the a. alveoli b. trachea c. bronchioles d. bronchi

Solution: The correct answer is A. Carbon dioxide and oxygen exchange occurs in the alveoli. Disruptors of the gas exchange of carbon dioxide and oxygen include inadequate 02 consumption, impairment of alveolar-capillary membrane, decreased blood flow, and decreased blood oxygenation. Understanding of this element of homeostasis is necessary to appreciate the role that nutrition support plays in positively or negatively affecting lung function. Petersson J, Glenny RW. Gas exchange and ventilation-perfusion relationships in the lung. Eur Respirat J. 2014;44:1023-1041. Available at: http://erj.ersjournals.com/content/44/4/1023. Accessed March 5, 2018.

Which substance is necessary for production of bile? a. Cholesterol b. Long-chain fats c. Medium-chain fats d. Vitamin E

Solution: The correct answer is A. Cholesterol is of one of many components of bile; it is the primary sterol in bile. Boyer JL. Bile Formation and Secretion. Compr Physiol. 2013;3(3):1035-1078. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC4091928/. Accessed March 4, 2018.

An extended-care facility has one central kitchen in which foods are purchased in different preparation stages. Production, distribution, and service are completed on the same premises. What type of foodservice operation is this? a. Conventional b. Ready prepared c. Commissary d. Assembly/serve

Solution: The correct answer is A. Conventional foodservice involves purchasing foods in different stages of preparation for an individual operation, and production, distribution and service are completed on the same premise. In ready-prepared foodservice, menu items are produced and held chilled or frozen until heated for serving. Cook-chill, cook-freeze and souse vide are all types of ready prepared food-service. Commissary foodservice comprises centralized procurement and production facilities with distribution of prepared menu items to several remote areas for final prep and service. With assembly/serve foodservice, menu items are purchased preprepared and require minimal cooking before service. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

In which type of foodservice is food processed onsite and then prepared and distributed on the premises and served after holding for a short period of time? a. Conventional b. Ready prepared c. Commissary d. Assembly/serve

Solution: The correct answer is A. Conventional foodservice prepares food on the premises, which is served after production. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

Diabetic ketoacidosis is most commonly seen in which type of diabetes mellitus? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Maturity onset diabetes of the young (MODY)

Solution: The correct answer is A. Diabetic ketoacidosis is commonly present when type 1 diabetes is diagnosed, though it is often mistaken for the flu. Symptoms include elevated urine ketones, severe weight loss, extreme thirst, blurred vision, lethargy, and disorientation. Inadequate insulin leads to increased lipolysis and beta-oxidation of fatty acids, resulting in overproduction of ketone bodies and loss of ketone bodies in the kidneys. This leads to retention of hydrogen ions, lowering the serum pH. It is a serious, life-threatening condition. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 153.

Which milk alternative typically contains the most protein per 8-oz serving? a. Hemp b. Almond c. Coconut d. Rice

Solution: The correct answer is A. Hemp milk generally contains 5 g protein per 8 oz as compared to almond milk, coconut milk, and rice milk, which contain 1 g protein per 8 oz. Singhal S, Baker R, Baker S. A Comparison of the Nutritional Value of Cow's Milk and Nondairy Beverages. J Pediatr Gastroenterol Nutr. 2017;64(5):799-805.

The liver makes bile salts from which of the following? a. Cholesterol b. Triglycerides c. Gastric acid d. Protein

Solution: The correct answer is A. Hepatocytes are located within a functional unit of the hepatic lobule where bile is formed. Bile salts, soluble products of cholesterol metabolism, are produced in the liver. Boyer JL. Bile Formation and Secretion. Compr Physiol. 2013; 3(3): 1035-1078. doi: 10.1002/cphy.c120027

What effect does irradiation have on foods? a. It controls spoilage and eliminates foodborne pathogens b. It increases the nutrient density of foods c. It decreases the nutrient density of foods d. It decreases food quality without affecting safety

Solution: The correct answer is A. Irradiation controls spoilage and eliminates foodborne pathogens using radiant energy and no heat. Irradiation helps fresh produce, eggs, and meat and seafood stay fresh longer. Klemm S. Safe food processing. March 2019. Accessed June 10, 2020. Available at: Website

What is the term for the ratio that reflects whether an organization can pay its short-term bills? a. Liquidity b. Solvency c. Activity d. Profitability

Solution: The correct answer is A. Liquidity ratio is the ratio between liquid assets and liabilities. This ratio represents the relationship between the organization's cash on hand/assets that can be readily converted to cash and the current financial obligations. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Women with gestational diabetes typically require less carbohydrates at which meal, compared to the others? a. Breakfast (morning) b. Lunch (afternoon) c. Dinner (evening) d. Bedtime snack

Solution: The correct answer is A. Many women with gestational diabetes are more insulin resistant in the early morning and can thus tolerate less carbohydrate at breakfast. Academy of Nutrition and Dietetics. Nutrition Care Manual. Accessed September 4, 2020. Available at: Website

Calculate the menu sales price using the factor pricing method. The raw cost of an item is $.42 and the pricing factor is 2.5. a. $1.05 b. $0.42 c. $0.82 d. $2.08

Solution: The correct answer is A. Menu sales price = Raw food cost (.42) x pricing factor (2.5) = $1.05 Payne-Palacio J, Theis M. Foodservice Management: Principles and Practice. 12th ed. Boston: Pearson; 2011: 478

What happens to the rate of metabolism during severe acute pancreatitis? a. Energy expenditure increases, hypermetabolic b. Body temperature remains the same c. Energy expenditure decreases, hypometabolic d. Energy needs decrease

Solution: The correct answer is A. Severe acute pancreatitis resembles the hypermetabolic, hyperdynamic state similar to sepsis, which increases energy needs due to the increase of the metabolic rate by up to 139%. Di Carlo V, Nespoli A, Chiesa R, et al. Hemodynamic and metabolic impairment in acute pancreatitis. World J Surg. 1981;5:329-339.

Which of the following is a recommendation for fruit juice consumption in infants and children? a. Toddlers aged 1 to 3 years can be given 4 oz of fruit juice daily b. Fruit juice can be introduced in diluted form at age 6 months c. Children aged 4-6 years can be given up to 10 oz fruit juice daily d. Sippy cups should be used when serving fruit juice to toddlers

Solution: The correct answer is A. The American Academy of Pediatrics recommends fruit juice not be given to an infant until age 1. Before age 1, infants can be encouraged to consume whole fruit that is mashed or pureed. After 1 year of age, because infants consume <1600 kcal/day, the AAP believes 4 oz juice per day is more than adequate. Heyman MB, Abrams SA, AAP Section on Gastroenterology, Hepatology, and Nutrition, AAP Committee on Nutrition. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics. 2017;139(6):e20170967. Available at: http://pediatrics.aappublications.org/content/pediatrics/early/2017/05/18/peds.2017-0967.full.pdf. Accessed October 20, 2020.

Which part of the foodservice systems model encompasses human labor and skill? a. Input b. Output c. Control d. Transformation

Solution: The correct answer is A. The primary components of the foodservice system model include input, transformation, and output. Additional components in the foodservice system model include control, memory, environmental factors, and feedback. Input categories include human, materials, facilities, and operational. Human labor and skills are required to meet the objectives of the system. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

What are the stages of motivational interviewing? a. Engaging, focusing, evoking, planning b. Express empathy, develop discrepancy, roll with resistance, support self-efficacy c. Exploring each component of DARN (desire, ability, reason, need) d. Affirmation, autonomy, accurate empathy, absolute worth

Solution: The correct answer is A. The stages of motivational interviewing are engaging, focusing, evoking, and planning. The principles listed in option B are components of motivational interviewing, but they do not represent the stages in the process. To explore DARN is to consider the reasons someone would change and can be part of evoking. The items listed in option D are the 4 components of acceptance. Miller W, Rollnick S. Helping People Change. 3rd ed. New York: Guilford Press; 2013.

What is the intrinsic factor in B12 absorption? a. It is a glycoprotein that is secreted by parietal cells of the stomach that binds to B12 and is taken up by the distal ileum b. It is a fatty acid that attaches to glycerol c. It is a protein that contributes to osmosis to allow for B12 to enter through the small intestine d. It is any enzyme secreted by the stomach that breaks down B12

Solution: The correct answer is A. This glycoprotein is required in order for B12 to be absorbed properly. This condition is not present in any other vitamins. B12 is essential for consumption and deficiency can cause serious harm. Matarese LE, Mullin GE, Raymond JL. The Health Professional's Guide to Gastrointestinal Nutrition. Chicago, IL: Academy of Nutrition and Dietetics; 2014.

At what age should peanut-containing foods be introduced to an infant with egg allergy and severe eczema? a. 4-6 months b. 7-12 months c. After age 3 d. Never

Solution: The correct answer is A. To reduce risk of peanut allergy, it is recommended that infants with severe eczema, egg allergy, or both be introduced to age-appropriate, peanut-containing foods as early as age 4-6 months. Infants should be introduced to other solid foods first to determine developmental readiness. The NIAID-Sponsored Expert Panel. Addendum Guidelines for the Prevention of Peanut Allergy in the United States. 2017. Accessed March 20, 2020. Available at:Peanut Allergy Prevention Guidelines.pdf

Which of the following complications can result from persistent hyperglycemia in diabetes? a. Microvascular disease resulting in neuropathy, nephropathy, and retinopathy b. Decreased urine output, increasing risk for urinary tract infection c. Improved gut microbiota as a result of increased glucose availability d. Improved wound healing and circulation

Solution: The correct answer is A. When hemoglobin A1c rises above 7%, there is a progressive increase in the risk of retinopathy, nephropathy, and neuropathy. American Diabetes Association. Executive summary: standards of medical care in diabetes-2011. DiabetesCare. 2011;34(Suppl 1): S4-S10.

Which of the following processes occurs in response to an increase in plasma glucose concentrations? a. Glycogen synthesis occurs b. Gluconeogenesis is stimulated c. Insulin decreases d. Glycogenolysis takes place

Solution: The correct answer is A. With an increase in plasma glucose, glycogen synthesis occurs. Gluconeogenesis is stimulated by glucagon, growth hormone, epinephrine, and cortisol; insulin increases; and glycogenolysis takes place when there is a decrease in glucose levels. Gropper SS, Smith JL and Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Belmont, CA: Thompson-Wadsworth; 2018.

_____ is the accumulation of excess fat in the liver. a. NAFLD b. NASH c. Fibrosis d. Cirrhosis

Solution: The correct answer is A. Nonalcoholic steatohepatitis (NASH) is fatty buildup in the liver with inflammation or scarring, and NAFLD is the accumulation of fat in the liver. Cirrhosis is the most severe consequence of NASH. European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. Clinical practice guidelines for the management of nonalcoholic fatty liver disease. J Hepatol. 2016;64:1388-1402. Available at: http://www.journal-of-hepatology.eu/article/S0168-8278(15)00734-5/fulltext. Accessed February 21, 2018.

Which of the following correctly reflects what is required on a Nutrition Facts label? a. Vitamin D, 2 mcg, 10% DV b. Vitamin A, 5% DV c. Potassium, 240 mg d. Magnesium, 63 mg, 2% DV

Solution: The correct answer is A. Nutrition Facts labels include both the actual amount of a nutrient as well as its % daily value. Vitamin D, calcium, iron and potassium must appear on the label and all others are declared voluntarily. US Department of Health and Human Services, Food and Drug Administration. Changes to the Nutrition Facts Label. Content current as of July 10, 2020. Available at: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#highlights. Accessed September 5, 2020.

Which compound is found in the skin and converted to vitamin D3 through ultraviolet B exposure? a. Ergocalciferol b. 7-dehydrocholesterol c. Cholecalciferol d. Ergosterol

Solution: The correct answer is B. 7-dehydrocholesterol is found in the skin of humans and is converted to vitamin D3 through UVB exposure. Ergocalciferol is vitamin D2 (largely human-made and added to foods), ergosterol is previtamin D2 (forms found in plant sources), and cholecalciferol is vitamin D3 in the final form after synthesis in the skin. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Belmont, CA: Thompson-Wadsworth; 2018.

Which of the following is the term for "a general or modified diet prescribed and documented in a client's medical record"? a. Nutrition prescription b. Diet order c. Diet plan d. Eating plan

Solution: The correct answer is B. A diet order is a general or modified diet prescribed and documented in a client medical record by a credentialed provider as part of a medical treatment plan Academy of Nutrition and Dietetics. eNCPT: Diet order (FH-2.1.1). Accessed August 3, 2020. Available at: Website

Which of the following is a calibrated device used to measure height? a. Sphygmomanometer b. Stadiometer c. Height stick d. Dynamometer

Solution: The correct answer is B. A stadiometer is used to measure human height. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 37.

Which of the following would restrict a nutrition services employee from food handling? a. Acne b. Hepatitis A c. HIV d. Hepatitis B

Solution: The correct answer is B. Because hepatitis A can be transmitted through food, infected workers are restricted from food handling. US Food and Drug Administration. Employee Health and Personal Hygiene. Available at: https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/IndustryandRegulatoryAssistanceandTrainingResources/UCM184252.pdf. Accessed February 19, 2018.

Bioactive compounds can be described as: a. trace elements b. extra nutritional constituents of foods c. conditional amino acids d. minor minerals

Solution: The correct answer is B. Bioactive compounds are not vitamins nor minerals; they are substances found in small quantities in a wide variety of foods. The myriad compounds differ in chemical structure but can be classified into groups. Many bioactive compounds confer a health benefit. Kris-Etherton PM, Hecker KD, Bonanome A, et al. Bioactive compounds in foods: Their role in the prevention of cardiovascular disease and cancer. Am J Med. 2002;113 Suppl 9B):S71-S88.

Which of the following is a good strategy for fostering trust between managers and employees and preventing workplace conflict? a. Create homogeneous teams to minimize differences b. Permit employees to voice dissent with the mission and strategies c. Avoid praising employees so as to not cause jealousy among their colleagues d. Explain whenever possible that slights were only perceived and not intentional

Solution: The correct answer is B. Building trust in the workplace helps to prevent development of workplace conflicts. Welcoming dissent that focuses on tasks, strategies, and mission is a good strategy for creating trust. Creating teams with diverse expertise, backgrounds, and skill sets also helps to build trust. Praising employees as appropriate can help to create an environment where employees feel comfortable addressing problems. And although a slight may not have been intended, instructing an employee to not take something personally often does not succeed. Lytle T. How to resolve workplace conflicts. HR Magazine. July 13, 2015. Accessed February 24, 2020. Available at: Website

Which non-essential compound is used to transport non-esterified long-chain fatty acids into the mitochondria for beta oxidation? a. Cysteine b. Carnitine c. Choline d. Cholesterol

Solution: The correct answer is B. Carnitine, found in most body tissues, is needed for the transport of fatty acids. This is especially true for long-chain fatty acids, which need carnitine across the inner mitrochondrial membrane for oxidation. Gropper SS Smith JL. Advanced Nutrition and Human Metabolism, 6th ed, Belmont, CA: Wadsworth; 2012: 216

What is the predominant protein in cow's milk? a. Albumin b. Casein c. Whey d. Soy isolate

Solution: The correct answer is B. Casein makes up 80% of the protein in cow's milk Verduci E, De'Elios S, Cerrato L, et al. Cow's milk substitute for children: Nutritional aspects of milk from different mammalian species, special formula and plant-based beverages. Nutrients. 2019;11(8):1739. Accessed April 6, 2020. Available at: Website

stools that are clay-colored indicate a disturbance in the production or secretion of which of the following? a. Lipase b. Bilirubin c. Peptidases d. Amylase

Solution: The correct answer is B. Clay color in stool may indicate biliary obstruction of the flow of bile to the intestine. This obstruction may be caused by a tumor or gallstone in the bile duct or pancreas. The change in stool color as related to these conditions is often a gradual process. Wildhaber BE. Biliary Atresia: 50 Years after the First Kasai. ISRN Surgery. 2012;1-15. Available at: https://www.hindawi.com/journals/isrn/2012/132089/. Accessed March 3, 2018. Beckhingham IJ, Ryder SD. Investigation of liver and biliary disease. BMJ. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119305/. Accessed March 19, 2018.

An employee who goes out of their way to succeed in one area or activity to make up for deficiencies in another area or activity is exhibiting what type of behavior? a. Subsitution b. Compensation c. Aggression d. Projection

Solution: The correct answer is B. Compensation is a defense mechanism wherein a person tries to make up for deficiencies by overachieving in other areas or activities. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Which of the following is the BEST example of an educational objective? a. Participant will understand components of a Mediterranean eating pattern b. Given a list of foods, participant will identify those highest in MUFA c. Participant will verbalize components of a Mediterranean eating plan d. Instructor will provide a list of foods high in MUFA

Solution: The correct answer is B. Educational objectives specify the means to achieve an outcome, whereas educational goals do not specify how an outcome will be reached. Because options A and C do not specify the means to achieve an outcome, they are educational goals. Furthermore, educational objectives focus on what participants will learn, not what an instructor will do, so option D is not correct. That the student will learn something specific (foods high in MUFA) and how (by being given a list of foods), Boston University. Writing clear learning objectives. Accessed July 26, 2020. Available at: tips_for_writing_objectives.pdf

Which of the following refers to successfully producing a desired result? a. Efficiency b. Effectiveness c. Accuracy d. Accountability

Solution: The correct answer is B. Effectiveness refers to successfully producing the desired result. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Employment background checks typically include which of the following? a. Marital status b. Bankruptcy record c. Age d. Health records

Solution: The correct answer is B. Employment background checks may include records related to criminal, driving, education, and credit history, including bankruptcy Puckett RP. Foodservice Manual for Health Care Institutions, 4th ed. Hoboken, NJ: Wiley; 2012: 157

What percentage of total energy from fat should be provided through an elemental (hydrolyzed) formula to prevent essential fatty acid deficiency (EFAD)? a. 1%-2% b. 3%-4% c. 2%-3% d. 4%-5%

Solution: The correct answer is B. Enteral formulas should provide the patient with at least 3%-4% of total energy as fat in order to decrease the chances of developing EFAD. Academy of Nutrition and Dietetics. Nutrition Care Manual. Enteral Nutrition. https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=11&ncm_toc_id=255696. Last accessed September 20, 2017.

Practices and associated attitudes that predetermine what, when, why, and how a person eats is referred to as _____. A. Food preferences b. Food habits c. Meal pattern d. Meal plan

Solution: The correct answer is B. Food habits are the practices and associated attitudes that predetermines what, when, why, and how a person eats. Food preference informs which foods a person likes and would rather eat when given a choice. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Which of the following should be the frontline test when diagnosing food allergy? a. Mediator release assay (LEAP diet) b. Double-blind placebo-controlled challenge c. Allergen-specific IgG, cytotoxicity assay d. Endoscopic allergen provocation

Solution: The correct answer is B. For diagnosing a true food allergy, the gold standard is the double-blind, placebo-controlled food challenge. According to the National Institute of Allergy and Infectious Diseases, basophil histamine release/activation, lymphocyte stimulation, facial thermography, gastric juice analysis, endoscopic allergen provocation, hair analysis, applied kinesiology, provocation neutralization, allergen-specific IgG, cytotoxicity assays, electrodermal test (Vega), and mediator release assay (LEAP diet) all lack the requisite evidence to be recommended for use in diagnosing food allergy. Coleman Collins S. Practice Paper of the Academy of Nutrition and Dietetics: Role of the Registered Dietitian Nutritionist in the Diagnosis and Management of Food Allergies. J Acad Nutr Diet. 2016;116(10):1621-1631.

Which of the following budget types requires justification for all expenses at each new budgetary period? A. Incremental B. Zero based C. Activity based D. Value proposition

Solution: The correct answer is B. In zero-based budgeting, all expenses must be justified for each new period. In this budgeting type, the process begins from a "zero base," with every function within an organization analyzed for needs and costs. The budget is then developed based on what is needed for the upcoming period, regardless of whether the budget represents an increase or decrease compared to the previous one. Kagan J. Zero-based budgeting. Investopedia. Updated January 2020. Accessed November 10, 2020. Available at: Website

A person with diabetes has an insulin to carbohydrate ratio of 1:10. How much rapid-acting insulin would this person need to cover a 72 g carbohydrate meal? a. 6 units b. 7 units c. 9 units d. 15 units

Solution: The correct answer is B. Insulin to carbohydrate ratios are calculated based on the total amount of insulin used in one day divided by 500. To calculate the amount of insulin needed for an individual meal or snack, divide by the total grams of carbohydrate in the meal by the ratio (72/10=7). Franz M, Evert A. American Diabetes Association Nutrition Therapy for Diabetes. 2nd ed. Arlington, VA: ADA; 2012.

What is the recommended parts per million of available chlorine for a lukewarm, 1-minute chlorine bath used to sanitize dishes and utensils? a. 10 b. 50 c. 100 d. 500

Solution: The correct answer is B. It is recommended that a minimum of 50 ppm available chlorine be used in a lukewarm chlorine bath to sanitize dishes and utensils. Payne-Palacios J, Theis M. Foodservice Management Principles and Practice. 12th ed. Boston: Prentice-Hall; 2012: 105.

Where in the body does leptin relay the status of fat stores? a. Stomach b. Hypothalamus c. Pancreas d. Pituitary gland

Solution: The correct answer is B. Leptin is a satiety factor that represents a major signal that relays the status of fat stores to the hypothalamus and plays a significant role in energy homeostasis Schwartz N, Rigby B, LaBounty P, et al. A review of weight control strategies and their effects on the regulation of hormonal balance. J Nutr Metab.2011; doi: 10.1155/2011/237932. Available at: https://www.hindawi.com/journals/jnme/2011/237932/. Accessed February 20, 2018.

What compound in tomatoes is considered a potential anticancer agent, especially in prostate cancer? a. Tocopherol b. Lycopene c. Retinol d. Quinone

Solution: The correct answer is B. Lycopene, a non-provitamin A carotenoid also found in pink grapefruit, has demonstrated anticancer properties, especially in prostate cancer. Story EN,Kopec RE, Schwartz SJ, Harris GK. An update on the health effects of tomato lycopene. Annu Rev Food Sci Technol. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850026/. Accessed February 20, 2018.

Which of the following is associated with cheilitis? a. Grapefruit-statin interaction b. Vitamin B12 deficiency c. Excess vitamin D intake d. Insulin resistance

Solution: The correct answer is B. Nutritional deficiencies, particularly iron and B-vitamins, are associated with the development of cheilitis. Devani A. Answer: Can you identify this condition? Can Fam Physician. 2007;53(6):1022.1023.

What is the edible portion (EP) price for 2 pounds of ground beef if the as purchased (AP) price is $3.99 per pound and EP yield is .64 lb cooked, drained lean meat? a. $6.23 b. $12.47 c. $15.96 d. $22.17

Solution: The correct answer is B. Solution: AP price ÷ EP yield = EP price First, get AP price by multiplying the price per pound by the number of pounds (3.99 x 2) Then, divide the AP price by the EP yield (7.98 ÷ .64) (3.99 x 2) ÷ .64 = 12.47 Puckett RP. Foodservice Manual for Health Care Institutions, 4th ed. Hoboken, NJ: Wiley; 2012: 419

Which of the following is a non-nutritive sweetener? a. Sorbitol b. Stevia c. Mannitol d. Agave

Solution: The correct answer is B. Stevia, which is produced from stevia leaves, is a purified glycoside. Agave is a nectar and sorbitol and mannitol are sugar alcohols, and all three are considered nutritive sweeteners. Shwide-Slavin C, Swift C, Ross T. Nonnutritive sweeteners: Where are we today? Diabetes Spectrum. 2012;25(2):104-110. doi: 10.2337/diaspect.25.2.104

Which of the following actions would likely be the result of systems thinking? a. Select a produce vendor who could deliver high-quality produce twice daily. b. Reschedule kitchen staff to prepare more foods from scratch to meet customer expectations. c. Develop a catering menu for department meetings to generate revenue for equipment purchases. d. Select cleaning chemicals that do not harm the environment.

Solution: The correct answer is B. Systems thinking is the management approach to considering the entire organization when making decisions or allocating resources. Rescheduling kitchen staff to prepare food to meet customer expectations changes the kitchen and staff/resource entirely. Making a change to the produce delivery does not change the kitchen. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 12th ed. Upper Saddle River, NJ: Prentice-Hall; 2011:49.

What is the purpose of a tabletop drill in a foodservice organization? a. To repair foodservice equipment b. For emergency preparedness c. For sustainability practices d. To reduce energy use

Solution: The correct answer is B. Tabletop drills are facilitator-guided, discussion-based exercises in which team members convene in a classroom-type setting to discuss their respective roles and expected responses during an emergency situation. These drills are used to help train department managers in preparedness for emergency situations. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

Which federal legislation established an insurance program that protects covered employees against loss of earnings resulting from retirement, unemployment, or disability? a. American Disability Act b. Social Security Act c. Family and Medical Leave Act d. Employment Retirement Income Security Act

Solution: The correct answer is B. The Social Security Act of 1935 established an insurance program to protect employees against wage loss resulting from retirement, unemployment, or disability. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Which of following are defined by standards of identity? a. How full a food product container must be b. What ingredients must be declared on a label c. Minimum specifications for quality requirements d. Serving size and nutrient analysis

Solution: The correct answer is B. The Standards of Identity define what a given food product is, its name, and the ingredients which must or may be used, and which ones must be declared on the label. Science Direct. Standards of Identity. Accessed September 10, 2020. Available at: Website

What is the recommended time frame for avoiding pregnancy after bariatric surgery? a. 3-4 years b. 1-2 years c. 6-12 months d. 1-3 months

Solution: The correct answer is B. Women are encouraged to avoid pregnancy for 1 to 2 years after bariatric surgery. Pregnancy during this time frame could result in complications related to potential nutrient deficiencies secondary to reduced food intake and malabsorption. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet. 2016;116:677-691.

When a person has phenylketonuria, which amino acid becomes essential? a. Tryptophan b. Tyrosine c. Threonine d. Methionine

Solution: The correct answer is B. Phenylalanine is converted to tyrosine by phenylalanine hydrolase, a missing enzyme in individuals with PKU; therefore, tyrosine is an essential amino acid for these individuals. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 768.

Calculate the kcal from a 500 mL 20% intralipid in a parenteral nutrition regimen a. 500 b. 750 c. 1,000 d. 1,250

Solution: The correct answer is C. 500 mL × 2.0 kcal/mL = 1000 kcal Charney P, Malone A. Academy of Nutrition and Dietetics Pocket Guide to Parenteral Nutrition. Chicago, IL: Academy of Nutrition and Dietetics; 2007.

If a facility requires 80 hours of work per week, how many full-time equivalents should be hired? a. 1 b. 1.5 c. 2 d. 2.5

Solution: The correct answer is C. A full-time equivalent employee is 8 hours per day, 5 days per week. Puckett RP. Foodservice Manual for Health Care Institutions, 4th ed. Hoboken, NJ: Wiley; 2012: 117

A long-term care facility requires a cook, server, trayline personnel, and supervisor for 8 hours daily to serve residents. How many full-time equivalents (FTEs) are needed to run the foodservice operation at this facility? a. 4 FTEs b. 5.2 FTEs c. 5.6 FTEs d. 6.4 FTEs

Solution: The correct answer is C. A full-time equivalent is based on the work done by a full-time employee, typically 8 hours per day, 40 hours per week, or 2,080 hours a year. In this question, the facility is open 7 days/week, so 4 positions x 8 hrs/day x 7 days/week = 224 hours/week. Divide hours needed by FTE (224 hours / 40 hours). The result is 5.6 FTEs. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

How does one typically become a union shop steward? A. Appointed by supervisor B. Hired by human resources C. Elected by employees D. Selected based on tenure

Solution: The correct answer is C. A shop steward—also known as a union steward or union representative—is a volunteer position held by an employee who serves as a labor official representing and defending nonmanagement employees' interests. The person serving in this role is typically selected by democratic election, though a higher union body may appoint the individual. Society for Human Resource Management. What is a shop steward? Accessed November 7, 2020. Available at: Website

Which of the following is an example of a sol? a. Balsamic vinaigrette b. Egg white meringue on a pie c. Turkey gravy d. Flan

Solution: The correct answer is C. A sol is a colloidal dispersion of a solid in a liquid and has flow properties, so turkey gravy is the correct answer. The egg white meringue is a foam. The flan, which is baked custard, is a gel and doesn't flow. The vinaigrette is an example of an emulsion. McWilliams M. Foods: Experimental Perspectives. 8th ed. New York City, NY: Pearson; 2016.

According to Herzberg's dual theory of motivation/hygiene, which of the following is considered a motivator? a. Salary b. Company policy c. Recognition d. Working conditions

Solution: The correct answer is C. According to Herzberg, hygiene factors do not motivate but simply prevent employee dissatisfaction and act as a precondition for motivation. In Herzberg's theory, salary, company policy, and working conditions are all hygiene factors, whereas recognition is a motivator. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practice. 12th ed. Boston: Pearson; 2011: p 383

Which of the following might need to be excluded from the diet of patients with celiac disease? a. Hominy grits b. Rice noodles c. Oatmeal d. Potato flour

Solution: The correct answer is C. Although patients with celiac disease cannot tolerate wheat or gluten, there are also some celiac patients who cannot tolerate oats. Patients with celiac disease should always check packaging for oat-containing foods to ensure they are labeled as gluten free. Mahan LK, Raymond JL, Escott-Stump S. Krause's Food, Nutrition, and Diet Therapy. 15th ed. Philadelphia, PA: WB Saunders Company; 2011.

Which of the following indicates a breastfeeding infant has a good latch? a. Infant's swallowing is inaudible b. Infant makes smacking noises c. Infant's cheeks are rounded d. There is space between infant's chin and mother's breast

Solution: The correct answer is C. Among the signs that a breastfeeding infant has a good latch are that the infant's cheeks are rounded, swallowing is audible, there are no clicking or smacking sounds, and the infant's chin is touching the breast. American Pregnancy Association. Breastfeeding latch. Available at: http://americanpregnancy.org/breastfeeding/latch/. Accessed December 20, 2019.

Which of the following may develop from taking antiretroviral therapy? a. Hypoglycemia b. Pruritus c. Type 2 diabetes d. Blount's disease

Solution: The correct answer is C. Antiretroviral therapy (ARV) is a treatment for HIV/AIDS and includes a host of long-term and short-term side effects. Type 2 diabetes is a potential side effect with ARV. National Institutes of Health Common and/or Severe Adverse Effects Associated with Antiretroviral Therapy. Accessed August 3, 2020. Available at: Website

In a taste test evaluation, which of the following foods would have a notable "astringency" as part of its flavor profile? a. Lemons b. Grapefruit c. Tea d. Milk

Solution: The correct answer is C. Astringency is a taste sensation that is most often associated with the tannins in foods. It should not be confused with sour taste like in lemons and grapefruit. Astringency has a puckering and "dry" sensation in the mouth and is found in tea, coffee, wine, chocolates, and certain fruits (most notably underripe fruit). McWilliams M. Foods: Experimental Perspectives. 8th ed. New York City, NY: Pearson; 2016.

What are COLAs based on? A. Lifetime contribution to Social Security B. Childhood disability history C. Increases in cost of living D. Duration of benefits collection

Solution: The correct answer is C. COLAs are cost-of-living adjustments applied to Social Security general benefits. Increases to COLAs have been based on Consumer Price Index measurements. Social Security Administration. Cost-of-living adjustment (COLA. Accessed November 11, 2020. Available at: Website

Calculate the energy content (kcal) of a 100-g piece of apple pie with the following macronutrient contents: 37 g water, 3 g protein, 16 g fat, 44 g carbohydrate. a. 144 b. 176 c. 332 d. 396

Solution: The correct answer is C. Carbohydrate (CHO), fat, and protein contribute energy to the food 3 g protein × 4 kcal/g = 12 kcal from protein 16 g fat × 9 kcal/g = 144 kcal from fat 44 g CHO × 4 kcal/g = 176 kcal from CHO Total = 332 kcal Whitney EN, Rolfes SR. Understanding Nutrition. 15th ed. Boston, MA: Cengage; 2018.

Carotenoids are incorporated into _____ within the enterocyte to be taken to the lymph system and eventually the blood. a. Micelle b. Retinoic acid c. Chylomicrons d. Blood albumin

Solution: The correct answer is C. Chylomicrons are formed within the enterocyte and carry carotenoids along with triacylglycerols out of the basolateral membrane of the enterocyte and enter the lymph system. Micelles carry carotenoids into the apical membrane of the enterocyte. Retinoic acid can leave the enterocyte and directly enter the blood and travels bound to blood albumin to the liver. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Belmont, CA: Thompson-Wadsworth; 2018.

What are protein recommendations for a person with diabetes based on? a. Hydrogen breath test b. Average of a series of A1c measurements c. RDA for healthy individuals d. Resting metabolic rate

Solution: The correct answer is C. Currently there is insufficient evidence to support a recommendation for ideal protein intake in people with diabetes. The Recommended Daily Allowance (RDA) of protein for healthy Americans can serve as the basis for protein recommendations in individuals with diabetes. McLeod J, Franz MJ, Handu D, et al. Academy of Nutrition and Dietetics Practice Guideline for type 1 and type 2 diabetes in adults: Nutrition intervention evidence reviews and recommendations. J Acad Nutr Diet. 2017;117(10):1637-1658.

Intake of _____ should be carefully monitored in patients with kidney disease because phosphorous is more easily absorbed from this source. a. Dairy b. Meat c. Inorganic phosphate food additive d. Whole grains

Solution: The correct answer is C. Dietary phosphorus is found in organic and inorganic sources. Organic sources are animal and vegetarian; inorganic sources are food preservatives. A concern for patients with chronic kidney disease is that the body could absorb as much as 100% of inorganic phosphorus via processed foods. Because absorption rate is variable among different sources, whether a phosphorus source is organic or inorganic and whether it is animal or vegetarian, is noteworthy for this population. Emphasize intake of plant-based proteins and foods containing no inorganic phosphorus additives in these patients. Noori N, Sims JJ, Kopple JD, et al. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iran J Kidney Dis. 2010;4(2):89-100.

At what point in the process of motivational interviewing does agenda mapping typically occur? a. Engaging b. Evoking c. Focusing d. Planning

Solution: The correct answer is C. During the focusing process of motivational interviewing, agenda mapping is an effective technique that is used in the preliminary phases of consultation to create a plan or goal for a client's appointment or treatment. Sanders KA, Whited A, Martino S. Motivational interviewing for patients with chronic kidney disease. Semin Dial. 2013;26(2):175-179

A foodservice has a 35% labor cost, 23% fixed costs, and a desired profit of 12%. Given a raw food cost of $4.55, what would be the selling price of an item when rounded up to $0.99 on the dollar? a. $13.99 b. $14.99 c. $15.99 d. $16.99

Solution: The correct answer is C. First determine the divisor: Divisor - (labor cost + fixed costs + desired profit). In this case 100% - (35% + 23% +12%) = 100% - 70% = 30%. To calculate sales price: Cost/Divisor = $4.55/0.3 = $15.16. Round up to $15.99. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 12th ed. Upper Saddle River, NJ: Prentice-Hall; 2011

The World Health Organization growth charts for children younger than age 2 are based on data from a. Children from the United States only b. Children from the United States and Europe c. Children from six different countries on different continents d. Children from the United States and Canada

Solution: The correct answer is C. Growth chart data were measured in the United States, Oman, Norway, Brazil, Ghana, and India for a global representation of normal growth based on a foundation of exclusive breastfeeding for at least 4 months www.cdc.gov/growthcharts/who_charts.htm

When is it OK to store raw poultry immersed in ice? (Assume all other conditions for safe storage have been met.) a. If it will be used by the end of the day b. If it will be used by the end of the week c. If it was received that way d. Never

Solution: The correct answer is C. If raw poultry or raw fish is received immersed in ice in shipping containers, they may be stored in that condition until preparation, display, service, or sale. US Public Health Service. Food Code 2017. Accessed June 25, 2020. Available at: Website

Which of the following is a likely diagnosis if acanthosis nigricans are present? a. High blood sugar b. Hypertension in a person who is also diabetic c. High insulin levels in the blood d. Low insulin levels in the blood

Solution: The correct answer is C. Insulin crosses the dermoepidermal junction to affect the keratinocytes. The binding of excess insulin to insulin-like growth factors stimulates proliferation of keratinocytes and fibroblasts, leading to acanthosis nigricans. Phiske MM. An approach to acanthosis nigricans. Indian Dermatol Online J. 2014; 5(3): 239-249. doi: 10.4103/2229-5178.137765

What is the recommended test to screen for gestational diabetes in a client who has a history of roux-en-Y gastric bypass surgery and is experiencing dumping syndrome? a. Perform 1-hour oral glucose tolerance test with a 75 g glucose load b. Check hemoglobin A1c levels c. Check fasting and 2-hour postprandial glucose levels for 1 week d. Perform 3-hour oral glucose tolerance test with a 100 g glucose load

Solution: The correct answer is C. It is recommended to check fasting and 2-hour postprandial blood glucose levels for 1 week during 24-28 weeks gestation. A 1-hour glucose tolerance test (GTT) or 3-hour GTT could trigger dumping syndrome, as a high glucose load causes a hyperosmolar environment in the small bowel and the GTT can also result in hypoglycemia in patients who are post gastric bypass surgery. Checking Hgb A1c levels is not recommended for diagnosing gestational diabetes since it is not as reliable as oral glucose tolerance testing. Harreiter J, Schindler K, Bancher-Todesca D, Gobl C, et al. Management of pregnant women after bariatric surgery. J Obes. 2018; doi: 10.1155/2018/4587064. Rollins G. Assessing the role of HbA1c in gestational diabetes. American Association for Clinical Chemistry. April 2012. Accessed February 14, 2020. Available at: Website.

Which of the following is a ketone body? a. Beta carotene b. Acetaminophen c. Beta hydroxybutyrate d. Acetyl CoA

Solution: The correct answer is C. Ketone bodies are produced in the liver when carbohydrate availability is reduced. They serve as an alternative fuel source for peripheral tissues including the brain, heart, and skeletal muscle. The three ketone bodies are acetone, acetoacetate, and beta-hydroxybutyrate. Rodwell VW, et al. Harper's Illustrated Biochemistry. 30th ed. New York: McGraw-Hill; 2015. Page 227

What type of standards must be met to attain LEED certification? a. Food safety b. Efficiency in the flow of the building c. Sustainability d. Bright lighting

Solution: The correct answer is C. LEED stands for Leadership in Environmental and Energy Design certification, a green building rating system. There are four levels of LEED certification: certified, silver, gold, and platinum. LEED is intended to promote design and construction practices that minimize the negative environmental impacts of buildings and improve the interior of buildings for their occupants. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

What should be avoided when purchasing bivalve mollusks? a. Shucked oysters b. Tightly closed shells c. Opened shells d. Canned clams

Solution: The correct answer is C. Living bivalve mollusks have tightly closed shells. Open shells indicate that they are dead and should not be consumed. Shucked and canned mollusks are safe to eat. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014:495

Long-term use of corticosteroids can lead to which of the following? a. Low blood pressure b. Increased loss of body fluids c. Hyperglycemia d. Thickened skin

Solution: The correct answer is C. Long-term use of corticosteroids like prednisone leads to hyperglycemia, hypertension, increased risk of infection, osteoporosis, and bone fracture, thin skin, suppressed adrenal gland hormone production. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765115/. Accessed March 9, 2018.

Tyramine is a pressor agent in food that can affect which class of drugs? a. Statins b. H blockers c. MAO inhibitors d. Lithium

Solution: The correct answer is C. Monoamine oxidase inhibitors interact with pressor agents in food such as tyramine, dopamine, histamine, and phenylethylamine, which can result in a sudden increase in blood pressure. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 242.

A foodservice employee dissatisfied with a newly implemented policy in the department tells the supervisor that another employee is displeased with the policy rather than admitting personal displeasure. What type of defensive behavior is this? a. Substitution b. Withdrawal c. Projection d. Compensation

Solution: The correct answer is C. Projection occurs when a person assigns their own thoughts or feelings to someone else. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2017.

What is the protein requirement for patients on peritoneal dialysis? a. 0.6 g/kg to 0 8 g/kg b. 0.8 g/kg to 1 g/kg c. 1.2 g/kg to 1.3 g/kg d. > 1.3 g/kg

Solution: The correct answer is C. Protein needs are higher in peritoneal dialysis. For stable patients receiving peritoneal dialysis, 1.2 g protein per kg to 1.3 g protein per kg is recommended . McCarthy MP, Pavlinac JM, Aoun A. Chronic Kidney Disease and the Nutrition Care Process. Chicago, IL: Academy of Nutrition and Dietetics; 2014.

Which of the following nutrients has an important role in maintenance of body composition for older adults? a. fat b. iron c. protein d. vitamin C

Solution: The correct answer is C. Rationale: Declines in skeletal muscle mass and strength are major contributors to increased mortality, morbidity, and reduced quality of life in older people. Recommended Dietary Allowances/Dietary Reference Intakes have failed to adequately consider the protein requirements of the elderly with respect to function. There is good, consistent evidence that consumption of 1.0 g/kg/day to 1.3 g/kg/day dietary protein combined with twice-weekly progressive resistance exercise reduces age-related muscle mass loss. Nowson C, O'Connell S. Protein Requirements and Recommendations for Older People: A Review. Nutrients. 2015; 7(8): 6874-6899. doi: 10.3390/nu7085311

For adults older than 19 years, how many grams of carbohydrate are needed daily for an adequate supply of glucose to the brain? a. 60 g b. 75 g c. 130 g d. 160 g

Solution: The correct answer is C. The National Academy of Sciences recommends consuming at least 130 g (520 kcal) carbohydrate per day, the minimum amount of carbohydrates needed to produce enough glucose for the brain to function. https://www.ncbi.nlm.nih.gov/pubmed/12449285

What does the National Restaurant Association consider to be the temperature danger zone? a. 32°F-212°F b. 41°F-165°F c. 40°F-140°F d. 32°F-165°F

Solution: The correct answer is C. The National Restaurant Association defines the danger zone as 40°F-140°F. This is the range where bacteria can grow most rapidly. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 13th ed. Boston, MA: Prentice Hall; 2016.

What does the Older Americans Act Nutrition Program (OAANP) offer? a. Nutrition counseling for older adults via federally funded clinics b. Food vouchers for low-income, elderly individuals c. Grants to support nutrition services at the state level for individuals older than 60 years of age d. Nutrition-related promotional materials to be distributed in nursing homes.

Solution: The correct answer is C. The OAANP offers state grants to support nutrition services for older adults, including programs that provide health-promoting meals in a variety of group settings, such as senior centers, and faith-based settings, as well as in the homes of frail, isolated homebound older adults Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016: page 477

Which of the following is true about I-9 forms? a. The I-9 form needs to be completed only by the individual being hired b. I-9 forms are needed for employees who are awaiting a green card c. The I-9 form needs to be completed by all US employers and employees to verify the individual's identity and employment authorization d. I-9 forms need to be completed by all non-US citizens.

Solution: The correct answer is C. This form is required for all individuals hired for employment as outlined by the US Citizenship and Immigration Services. US Department of Homeland Security. I-9, Employment Eligibility Verification. Available at: https://www.uscis.gov/i-9. Accessed February 19, 2018.

Which vitamin deficiency is likely to develop in a patient with liver disease? a. A b. E c. D d. K

Solution: The correct answer is C. Vitamin D deficiency is frequently reported in liver disease patients and is thought to result from impaired synthesis and absorption. Barchetta I, Angelico F, Del Ben M, et al. Strong association between non alcoholic fatty liver disease (NAFLD) and low 25(OH) vitamin D levels in an adult population with normal serum liver enzymes. BMC Med. 2011;9(1):85.

How many pressure ulcer/injury stages are there? a. 2 b. 3 c. 4 d. 5

Solution: The correct answer is C. The National Pressure Ulcer Advisory Panel has identified four stages of pressure ulcer/injury. NPUAP. Pressure injury staging illustrations. Accessed December 1, 2020. Available at: Website

The cook's tally shows 141 grilled chicken breasts for lunch. However, the hospital anticipates a 2% increase in hospital census during this time and the foodservice company restricts food waste to no more than 3% waste. How many chicken breasts should the cook prepare based on the information and answer options provided? a. 135 b. 141 c. 145 d. 150

Solution: The correct answer is C. Cooking 145 chicken breasts would meet the census increase and is within the food waste limitations. To make this calculation: Adjust the cook's tally for the increase in hospital census by multiplying the number of chicken breasts to be cooked (141) by the increase in hospital census (2%) 141 chicken breasts planned x 1.02 = 143.82 chicken breasts Round up to 144 chicken breasts B. Determine how many chicken breasts would exceed the 3% food waste guideline by multiplying the amount of chicken to be cooked (141) by the waste factor (3%) 141 chicken breasts planned x 1.03 = 145.23 chicken breasts Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

The standard recipe for the entrée makes 24 servings and each entrée serving is sold for $3.99. The sales goal for the entrée is $1200 total in one day. How many batches of the standard recipe should be prepared to meet the goal? a. 10 b. 11 c. 12 d. 13

Solution: The correct answer is D. 1200/3.99= 300.75 entrees 300.75 entrees/24 servings= 12.5 Round up to make 13 batches of the recipe to have enough entrees to sell to meet the sales goal. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

What is the labor turnover if 7 employees in a department of 52 were terminated or quit? a. 10% b. 11% c. 12% d. 13%

Solution: The correct answer is D. 7/52 × 100 = labor turnover of 13% Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Which of the following lists the tasks, duties, and responsibilities of a job, the job's working condition, and the tools, materials, and equipment used to perform it? a. Job specification b. Job identification c. Job qualifications d. Job description

Solution: The correct answer is D. A job description details the tasks, duties, and responsibilities of a job, as well as the working conditions and tools and equipment to be used on the job. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Xerostomia is a condition marked by which of the following? a. Abnormal smell and taste b. Cloudiness of cornea c. Inflammation of lips and gums d. Decreased salivary secretion and dry mouth

Solution: The correct answer is D. A person with xerostomia experiences decreased saliva production and dry mouth Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: `343, 351.

Which of the following is the best option for a vegan menu? a. Honey-roasted carrots b. Coffee with nondairy creamer c. Cauliflower prepared with buffalo sauce d. Quinoa mixed with tamari

Solution: The correct answer is D. Among those listed, quinoa mixed with tamari is the best option for a vegan diet. Many nondairy creamers contain a small percentage of sodium caseinate, which is derived from milk; honey is derived from animals; and buffalo sauce often contains butter. Academy of Nutrition and Dietetics, Nutrition Care Manual. Vegan Nutrition. https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=38544&lv2=38735&lv3=267991&ncm_toc_id=267991&ncm_heading=&. Accessed March 2, 2018.

What is the term for a budget that includes rental and labor costs needed to run the business? a. Capital budget b. Forecast budget c. Flexible budget d. Operating budget

Solution: The correct answer is D. An operating budget includes revenue, fixed costs such as rent, variable costs such as labor, and non-operating and non-cash expenses. Grim JA, Roberts SR, eds. Clinical Nutrition Manager's Handbook: Solutions for the Busy Professional. Chicago, IL: Academy of Nutrition and Dietetics; 2014.

People with cystic fibrosis are most likely to become deficient in a. thiamine and iron b. vitamin B12 c. selenium and magnesium d. zinc and fat-soluble vitamins

Solution: The correct answer is D. Both zinc and fat-soluble vitamins are lost in the stool of individuals with cystic fibrosis due to pancreatic insufficiency. Escobedo Monge MF, Barrado E, Alonso Vicente C, et al. Zinc nutritional status in patients with cystic fibrosis. Nutrients. 2019;11(1):150. doi: 10.3390/nu11010150 Kalnins D, Wilschanski M. Maintenance of nutritional status in patients with cystic fibrosis: New and emergingtherapies. Drug Des Devel Ther. 2012;6:151-161. Available at: Website.

Which chemical compound causes irritation that stimulates nerve endings to provide the sensation of spicy-hot? a. Bromelain b. Papain c. Piperine d. Capsaicin

Solution: The correct answer is D. Capsaicin is a chemical compound in hot chili peppers. Bromelain and papain are enzymes found in pineapple and papaya, respectively. Piperine is chemical compound found in black peppers. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014: 108.

What is the minimal internal temperature for cooking chicken breast? a. 145°F b. 150°F c. 155°F d. 165°F

Solution: The correct answer is D. Chicken requires a minimal internal temperature of 165°F. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

Which of the following heat-transfer methods uses direct contact of one object or substances with another? a. Radiation b. Convection c. Microwave d. Conduction

Solution: The correct answer is D. Conduction transfers heat through direct contact from one object or substance to another. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016

Which of the following is present in steatohepatitis? a. Benign accumulation in the liver b. Excess glycogen in the liver c. Protein toxicity in the liver d. Fat accumulation and inflammation of the liver

Solution: The correct answer is D. Damage occurs to hepatocytes due to an excess of primary metabolic substrates (glucose, fructose, and fatty acids) in the liver, resulting in diversion of fatty acids into pathways that promote cellular injury and a dysfunctional response to that injury. Neuschwander-Tetri B. Non-Alcoholic Fatty Liver Disease. BMC Medicine. 2017: 15:45. doi 10.1186/s12916-017-0806-8

Which acts as an emulsifier in food preparation? a. Egg white b. Whole milk c. Bananas d. Egg yolk

Solution: The correct answer is D. Egg yolks are high in phospholipids, which contain both lipophilic fatty acid groups and hydrophilic head groups. These allow aqueous and fatty substances to become stable in an emulsion. Zorba O, Kurt S. Response surface optimization of pH and ionic strength for emulsion characteristics of egg yolk. Poult Sci. 2009;88(11):2422-2427. Available at: doi.org/10.3382/ps.2008-00567. Accessed March 5, 2018.

Among the following foods, which would be reintroduced last after bowel resection? a. Mashed potatoes b. Tea c. Bananas d. Strawberries

Solution: The correct answer is D. Fluids and soft foods are reintroduced to the diet first following bowel resection. Although caffeine-containing products are not recommended, decaffeinated tea is acceptable. It is recommended that eating any fresh fruit except bananas be delayed until 4-6 weeks postsurgery. Cleveland Clinic. Eating right and avoiding dehydration after surgery. Accessed March 12, 2021. Available at: Bowel resection diet.pdf

After a major flood, which of the following is OK to retain? a. A screw-top jar of peanut butter b. A snap-top container of snack chips c. A box of infant formula d. A retort pouch of cashews

Solution: The correct answer is D. Foods with retort pouches and cans are waterproof and safe to retain, so long as certain precautionary measures are followed, such as removing labels, thoroughly washing the pouches or cans with hot water (if available), brushing or wiping away any silt, and sanitizing by immersion. Jars and canisters with screw tops or snap lids and baby formula boxes are not waterproof and should be thrown out. Academy of Nutrition and Dietetics. Emergency preparedness. Accessed August 2, 2020. Available at: Website

Which transporter distributes fructose across the intestinal apical membrane? a. Glut-1 b. Glut-3 c. Glut-2 d. Glut-5

Solution: The correct answer is D. Glut-5 is primarily located in the apical membrane of the jejunum and is the main transporter of fructose from the lumen to the enterocytes. Fructose is passively transported by glut-5 across the intestinal apical membrane and then glut-2 transports fructose from the cytosol to the blood. Devlin TM. Texbook of Biochemistry with Clinical Correlations. 7th ed. Hoboken, NJ: Wiley Publications; 2010. Ferraris RP, Choe J, Patel CR. Intestinal absorption of fructose. Annu Rev Nutr. 2018;38:41-67.

Which of the following foods would be recommended for a patient being treated for gastroparesis? a. Ginger ale b. Oranges c. Bran cereal d. Rice

Solution: The correct answer is D. High-fiber foods like oranges and bran cereal can delay gastric emptying and lead to early satiety, which may result in bezoar formation. Carbonated beverages like ginger ale are inappropriate as they may cause distension. Rice is recommended for patients with gastroparesis. Parrish CR, McCray S. Gastroparesis and Nutrition: The Art. Pract Gastroenterol. 2011:26-40. Available at: https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/ParrishGastroparesisArticle.pdf. Accessed February 20, 2018.

What may develop as a result of excessive milk consumption? a. Megaloblastic anemia b. Hemolytic anemia c. Intestinal bleeding disorder d. Microcytic anemia

Solution: The correct answer is D. Milk is low in iron content and larger intakes of milk (cow, goat, and soy) may displace high-iron foods, leading to iron-deficiency anemia. The most common cause of microcytic anemia is iron-deficiency anemia. Megaloblastic anemia is caused by folate or vitamin B12 deficiency. Hemolytic anemia does not have nutrient-related etiology and can be caused by certain viral or bacterial infections, medications, and medical conditions. Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016: 270

Cystic fibrosis is a genetic condition that affects transport of which mineral across the cell membrane? a. Sodium b. Potassium c. Phosphorus d. Chloride

Solution: The correct answer is D. Mutation of cystic fibrosis transmembrane conductance regulator gene (CFTR) on chromosome 7 results in the abnormal CFTR protein that transports chloride across the membranes of lungs, liver, pancreas, digestive tract, reproductive tract, and skin. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 650.

What term is defined as an obsession with avoiding unhealthful foods and eating a "correct" diet? a. Binge-eating disorder b. Bulimia nervosa c. Avoidant restrictive food intake disorder d. Orthorexia

Solution: The correct answer is D. Orthorexia was coined in 1998 and has been gaining awareness in the health community but it has not yet been recognized as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Orthorexia refers to behavior that may begin with the desire to eat healthy but then ultimately turns to fixated thoughts on healthful eating and drastically changed eating behaviors. The other answer options are eating disorders with specific diagnostic criteria and that are marked more by a fixation on the amount of food consumed rather than the source of food. National Eating Disorders Association. Orthorexia. 2018. Accessed March 18, 2020. Available at: Website.

Eating seasonally is a principle of which of the following eating practices? a. Organic b. Orthorexic c. Biodiverse d. Sustainable

Solution: The correct answer is D. Principles of sustainable eating include growing at home, shopping locally, and eating seasonally. Focusing on local, fresh, in-season foods supports sustainability because it helps to eliminate the need to ship foods from farther locales. Wolfram T. Sustainable eating. February 2019. Accessed April 17, 2020. Available at: Website

Which part of a rhubarb plant is typically eaten? a. Flower b. Root and tuber c. Fruit d. Stem

Solution: The correct answer is D. Rhubarb is like celery— typically the stem of the plant is the portion that is eaten. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014:317

Which of the following is the best example of a SMART goal? a. Lose 7% of my body weight b. Incorporate 150 minutes a week of physical activity c. Begin using mindfulness techniques when eating d. Purchase a pair of walking shoes that fit before I meet with my RDN next week.

Solution: The correct answer is D. SMART goals are specific, measurable, achievable, results focused, and time bound. Losing a specific percentage of body weight is potentially not achievable and doesn't specify a time frame by which the goal will be achieved. The goal of incorporating 150 minutes a week of physical activity and using mindfulness techniques while eating should be more specific regarding what kind of activity/what kind of mindfulness techniques and the time frame in which it will be achieved. The goal of purchasing walking shoes specifies a time frame and is specific, measurable, and achievable. Miller CK, Headings A, Peyrot M, Nagaraja H. Goal difficulty and goal commitment affect adoption of a lower glycemic index diet in adults with type 2 diabetes. Patient Educ Couns. 2012;86:84-90.

Which of the following is an effect of lung disease on nutritional status? a. Increased appetite b. Increased intake due to fluid restriction c. Decreased energy expenditure, altered metabolism, decreased work of breathing d. Difficulty preparing food due to fatigue

Solution: The correct answer is D. Shortness of breath related to lung disease can cause fatigue, which may affect a person's ability to procure and prepare food and could result in poor nutritional intake. Florian I. Nutrition and COPD. Todays Dietitian 2009; 11:54-

Which of the following terms is used to denote loss of inventory? a. Theft b. Breakage c. Spoilage d. Shrinkage

Solution: The correct answer is D. Shrinkage refers to loss of inventory Puckett RP. Foodservice Manual for Health Care Institutions, 4th ed. Hoboken, NJ: Wiley; 2012: 443

Strategic management of a foodservice system is represented by which of the following? a. Effectively responding to environmental threats b. Integrated systems thinking of internal and external events c. Evaluation of stakeholders and the competition d. Organizational and environmental analysis to achieve goals

Solution: The correct answer is D. Strategic management process involves analysis of the company and its environment, creating and implementing strategies to move a company toward its goals and evaluating progress. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Approach. 9th ed. Upper Saddle River, NJ: Pearson; 2016.

When working with adults with intellectual disabilities, it is suggested that the dietetics professional _____. a. use the MyPlate for kids because it contains pictures b. speak initially to the guardian rather than the client c. test the client to make sure they understand specific topics d. ask the client what they would like to be taught

Solution: The correct answer is D. Teaching rather than challenging is the most effective approach when working with this population. Frequently adults with intellectual disabilities are tested on what they know rather than asked what they want to be taught. Practitioners should treat this population the same as they would when working with adults without intellectual disabilities. Lipscomb R. Person-First practice: treating patients with disabilities. J Am Diet Assoc. 2010;110(5 Suppl):S8-12.

The DASH diet increases which of the following nutrients? a. Sodium b. Vitamin C c. Chloride d. Magnesium

Solution: The correct answer is D. The Dietary Approaches to Stop Hypertension, or DASH, diet is rich in magnesium, potassium, calcium, protein, and fiber. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 303.

If a saucepan that conducts heat well is needed, which gauge should be used? a. 4 b. 10 c. 14 d. 20

Solution: The correct answer is D. The higher the gauge of a saucepan, the thinner the metal. Heavier stainless steel does not conduct heat well. Therefore, the best option in this case is a 20-gauge saucepan. Payne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 13th ed. Boston, MA: Prentice Hall; 2016.

Which of the following would be the lowest priority when designing a menu? a. Food cost b. Type of service c. Production capability d. Sodium content of food

Solution: The correct answer is D. The menu is a tool used to control cost and production. Food cost, production capability, type of service, and availability of foods are the factors used to create menu design. Sodium content is not typically a factor in menu design. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

An inventory control tool that uses high, medium and low value system is known as the _____ method. a. minimum-maximum b. economic order quantity c. inventory valuation d. A-B-C Inventory

Solution: The correct answer is D. The principle of the ABC inventory method is that effort, time, and money for inventory control should be allocated among products according to their value. Gregoire MB. Foodservice Organizations, A Managerial and Systems Approach. 9th ed. Boston: Pearson; 2016.

In type 1 diabetes, what is the risk of trying to keep the blood sugars very low (as close to the non-diabetic range as possible)? a. Increase in occurrence of nephropathy b. Increase in occurrence of retinopathy c. Hyperglycemia d. Hypoglycemia

Solution: The correct answer is D. Attempts to keep blood glucose levels within a narrow range via aggressive insulin dosing will inevitably result in some low levels of blood glucose, which can have significant adverse effects, particularly in children. McCrimmon RJ, Sherwin RS. Hypoglycemia in Type 1 Diabetes. Diabetes. 2010;59(10):2333-2339. doi: 10.2337/db10-0103

If a company's total revenue for the year was $1,800,000, and the food cost was 40%, labor cost was 40%, and overhead cost was 5%, what is the company's profit? A. $90,000 B. $270,000 C. $720,000 D. $1,080,000

Solution: The correct answer is B. Rationale: Profit = Revenue - Expenses Step 1. Determine actual dollar costs for food cost, labor cost, and overhead costs. Food cost: $1,800,000 x 0.4= $720,000 Labor cost: $1,800,000 x 0.4= $720,000 Overhead cost: $1,800,000 x 0.05= $90,000 Step 2: Add all dollar costs for food, labor, and overhead to comprise one total number for expenses. $720,000 + $720,000 + $90,000 = $1,530,000 Step 3: Determine the total profit by subtracting the total expenses (from step 2) from the total revenue ($1,800,000). $1,800,000 - $1,530,000=$270,000 Therefore, the company's total profit is $270,000. Reference: Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. Upper Saddle River, NJ: Prentice-Hall; 2013.