ERP 6

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

"Can you tell me in your own words what changes you will make when going home?" 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.

Q. 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? $3.12 $4.00 $4.75 $5.12

$5.12 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

Q. A pound of chicken breast costs $3.50/lb. EP yield percentage is .53. What is the EP price of the chicken breast? $1.86 $2.49 $0.15 $6.60

$6.60 AP price divided by EP yield = EP price. $3.500 / 0.53 = 6.60. The edible portion price is $6.60. Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 190

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

0.36 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.

Q. What is the recommended weight gain for an obese pregnant woman? 28-40 lbs 25-35 lbs 15-25 lbs 11-20 lbs

11-20 lbs Rationale: According to the Institute of Medicine's guidelines for weight gain during pregnancy, recommended weight gain for obese women is 11-20 lbs. American Dietetic Association. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. Available at: https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/position-papers/obesityrepropreg.pdf?la=en&hash=18D6D3E5218C479CBD804CAE461145501ACF56B3. Accessed April 1, 2018

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

128 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

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

24-year-old woman with BMI of 50 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

Q. What is the recommended dietary fluid allowance for patients aged 65 years or older? 30 mL/kg 50 mL/kg 1.5 mL/kg 25 mL/kg

25 mL/kg 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

Q. A woman with a body mass index of 20 should gain _____ pounds during a single gestation pregnancy. 15-20 lb 28-40 lb 25-35 lb 35-45 lb

25-35 lb 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.

Q. If a patient needs to increase calcium intake but dislikes dairy products and fails to meet the recommended 1,000 mg calcium daily for adults aged 19-50 years, which food would provide the most sufficient calcium to address their needs? 3 ounces canned salmon (with soft bones) ½ cup of cooked spinach ½ cup of cooked collard greens ¼ cup of walnuts

3 ounces canned salmon (with soft bones) 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.

Q. 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? 200 300 400 500

400 100 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

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

6 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.

Q. For all classes of obesity, the goal of enteral feeding in the intensive care unit should be _____ of target energy expenditure by indirect calorimetry. 50% to 55% 55% to 65% 65% to 70% 70% to 80%

65% to 70% Rationale: The American Society for Parenteral and Enteral Nutrition expert consensus guidelines for critically ill patients recommends that the goal for enteral nutrition in the intensive care unit should be 65%-70% of target energy needs by indirect calorimetry or 11-14 kcal/kg/current body weight (CBW) for body mass index (BMI) higher than 30 if indirect calorimetry is not available. 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.

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

8-12 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.

Q. How long should parenteral nutrition be withheld in a well-nourished ICU patient who has been in a motor vehicle accident and is currently classified as NPO and enteral intake is not feasible? 72 hours >7 days 10 days 24 hours

>7 days 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.

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

A1c 6.5% 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.

Q. Which of the following is not a consideration when translating educational materials in a culturally sensitive way? Content should be translated for meaning rather than word for word Always select a native speaker of the language to do the translation Avoid translating until the text is written well in English Use multiple reviewers to check for cultural and linguistic appropriateness

Always select a native speaker of the language to do the translation Rationale: It cannot be assumed that native speakers of a given language are skilled at writing or at translating. Written translation and oral translation require different skill sets. 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 February 20, 2018.

Q. What is the term for genetically programmed cell death? Necrosis Apoptosis Autophagy Cornification

Apoptosis 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.

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

Avoid leaning back in chair to ensure the speaker doesn't misinterpret posture as indifference 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: https://today.duke.edu/2019/06/how-practice-active-listening

Q. 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? Decreased peristalsis Increased peristalsis Inadequate energy intake Bacterial translocation possibly resulting in infection

Bacterial translocation possibly resulting in infection 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.

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

Baked chicken at 165°F 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

Q. Which of the following is allowed in the diet of individuals with fructose intolerance? Guava Berries Papaya Watermelon

Berries Rationale: Berries are among the recommended fruits for individuals with fructose intolerance 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.

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

Branched-chain amino acids 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.

Q. Lack of appetite and rapid muscle breakdown associated with disease is known as: Anorexia Catabolism Anabolism Cachexia

Cachexia 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

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

Capon 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

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

Carnitine 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.

Q. The first milk produced by the mother, colostrum, is particularly high in which of the following compounds? Casein Lactose Carotenoids Essential fatty acids

Carotenoids 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. Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016: 164.

Q. Which condition involves damaged enterocytes caused by ingesting foods that are not harmful to most people? Food allergy Lactose intolerance Celiac disease Food sensitivity

Celiac disease Rationale: In celiac disease, enteropathy is caused by gluten in genetically predisposed individuals. Immune activation in response to proteins in certain grain foods 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

Q. Which processes do not cause hypermetabolism in the hospitalized patient? Burns Thrashing Trauma Chest pain

Chest pain Rationale: In hospitalized patients who are ambulatory or who display "thrashing" behavior, expenditure of energy caused by activity can be considerably higher. Hypermetabolism is often noted in people with active disease processes. Mann S, Westenskow DR, Houtchens BA. Measured and predicted caloric expenditure in the acutely ill. Crit Care Med. 1985;13:173-177.

Q. Which of the following ovens is most energy efficient? Convection oven Rotary oven Deck oven Microwave oven

Convection oven A convection oven has a fan on the back or side panel that creates currents of air within the cooking chamber, reduces cooking time by 30%, and cooks at 25°F to 35°F lower temperatures than other ovens, and thus conserve energy Gregoire MB. Foodservice Organizations: A Managerial and Systems Approach. 8th ed. New York: Pearson; 2013: 185

Q. Which of the following is not associated with fluid balance in the body? Aldosterone Vasopressin Renin Corticosteroid

Corticosteroid Rationale: The renin-angiotensin-aldosterone system and vasopressin regulate fluid balance while corticosteroid is related to macronutrient metabolism Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 133

Q. Counseling techniques to encourage breastfeeding include all of the following, EXCEPT: Active listening Asking open-ended questions Reflecting Creating a strict feeding plan

Creating a strict feeding plan Rationale: According to the practice paper of the Academy of Dietetics and Nutrition: Promoting and Supporting Breastfeeding, active listening, reflecting and asking open-ended question are all techniques to encourage breastfeeding. All these techniques will help the RDN addressing concerns and providing pertinent information to the mothers. In addition, infants should breastfeed on demand. A strict feeding plan is not the best approach and not a counseling technique. Academy of Dietetics and Nutrition. 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.

Q. Iodine deficiency in a pregnant woman can lead to development of which condition in the newborn? Goiter Cretinism Dwarfism Keshan disease

Cretinism Rationale: Iodine deficiency in the mother 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

Q. _____ affects any area of the gastrointestinal tract while _____ affects only the large intestine Diverticulosis; celiac disease Celiac disease; Crohn's desease Ulcerative colitis; Crohn's disease Crohn's disease; ulcerative colitis

Crohn's disease; ulcerative colitis Rationale: Crohn's disease can affect any area of the GI tract, from the mouth to the anus. Ulcerative colitis occurs only in the colon. Diverticulosis most commonly affects the colon. Celiac disease is an autoimmune disease which impacts the small intestine. Ramos de Mattos BR, et al. Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments. Mediators Inflamm. 2015; 1-11. doi: 10.1155/2015/493012

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

Cyclooxygenase 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

Q. Which is NOT a characteristic of metabolic alkalosis? Elevation in the pH Increase in plasma HCO3- concentration Compensatory hypoventilation and rise in PCO2 Decrease in plasma HCO3- concentration

Decrease in plasma HCO3- concentration Rationale: Under normal circumstances, the kidneys are able to correct metabolic alkalosis by excreting the excess HCO3- in the urine. An increase in HCO3- concentration is caused by impairment in renal excretion, resulting in metabolic alkalosis. Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th ed. New York, NY: McGraw-Hill 2001.

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

Diabetes 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.

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

Diet-induced thermogenesis 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

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

Discarding it 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

Q. Which of the following data would you record during the nutrition-focused physical exam? Inadequate protein intake Surgical history Edema Blood glucose

Edema 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: https://www.ncpro.org/pubs/encpt-en/page-019.

Q. Polypharmacy most commonly affects which population? Infants Children Teenagers Elderly

Elderly 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.

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

Farro 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.

Q. People who eat a Western diet largely have _____ in their gut microbiota. Firmicutes Fusobacteria Bacteroidetes Cyanobacteria

Firmicutes 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.

Q. A patient has an alpha-gal allergy. Which of the following foods should be avoided? Fried chicken Hamburger Almond milk Whole grain bread

Hamburger Rationale: Alpha-gal is a relatively newly identified allergy that is thought to be caused by Lone Star ticks carried by deer in rural and urban areas. The prevailing hypothesis is that after the tick bites a person, eventually IgE to alpha-gal develops. Once IgE to alpha-gal reaches sufficient levels, red meat intake can trigger an allergic response. Most red meat allergic response has been reported in the Southeast United States, which has experienced an increase in the deer population. Steinke JW, Platts-Mills TAE, Commins SP. The alpha-gal story: Lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135(3):589-597. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600073/. Accessed February 21, 2018.

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

High kilocalorie, protein, fat, and sodium 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

Q. Which of the following is NOT true for the breastmilk produced by a mother with a premature infant compared with the breastmilk of the mother of a full-term infant? Lower in lactose content Higher in vitamin A content Higher in protein content Higher in energy content

Higher in vitamin A content Rationale: Breastmilk from a woman with a premature infant is higher in protein, slightly lower in lactose, and higher in energy content. Brown JE. Nutrition Through the Life Cycle. 6th ed. Belmont, CA: Wadsworth; 2016: 214

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

Housework 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

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

Hypertrophy 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

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

Hypoglycemia 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

Q. Which immunoglobulin mediates the classical type of food allergy? IgA IgM IgG IgE

IgE Rationale: IgE is involved in the hypersensitivity response. Ig G is a "memory" antibody that engages after exposure to the allergen. IgG is involved in the protective immune response. Stukus DR, Mikhail I. Pitfalls in Diagnosing Food Allergies. Curr Allergy Asthma Rep. 2016;16(5):34. doi: 10.1007/s11882-016-0611-z.

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

Increase protein and kilocalories 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: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447319/. Accessed September 2, 2019.

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

Increases fatty acid synthesis 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.

Q. Who among the following would have difficulty with breastfeeding? Infant with extrusion reflex Infant with cleft lip Infant with cleft palate Infant with colic

Infant with cleft palate 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.

Q. The World Health Organization growth charts for children younger than age 2 are based on data from which of the following populations? Infants who were primarily breastfed until 4 months of age. Infants who were primarily breastfed until 6 months of age. Infants who were formula fed due to free formula distribution Infants who were primarily breastfed until 2 months of age.

Infants who were primarily breastfed until 4 months of age. Rationale: The WHO growth curves are expected 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 www.cdc.gov/growthcharts/who_charts.htm

Q. What are the two environments that affect metabolism? Internal and external Hot and cold Superior and inferior Height and weight

Internal and external 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.

Q. _____ is 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. Interprofessional education Multiprofessional education Collaborative practice Multidisciplinary education

Interprofessional education 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.

Q. Which Nutrition Care Process step involves approaches to promote changes in patient behavior ? Assessment Monitoring Screening Intervention

Intervention Rationale: During the nutrition care process, the RDN selects appropriate nutrition interventions to address the root cause of the diagnosed nutrition problem and alleviate the signs and symptoms. http://www.eatrightpro.org/resources/practice/practice-resources/nutrition-care-process

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

It delineates employees in the organizational hierarchy 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

Q. In 2017, the American Academy of Pediatrics issued a recommendation to remove _____ from diets of children younger than 1 year. Oatmeal cereal Juice Iron-fortified formula Vitamin D supplements

Juice 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.

Q. Which size egg is most commonly used in baking recipes? Small Medium Large Extra large

Large 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. If you were to use extra-large or even jumbo eggs instead of large eggs in the recipe, you would be adding far more liquid than the recipe proportions account for. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014:415

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

Lifestyle modifications 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.

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

Lipid oxidation prevention 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

Q. Which three foods have the largest environmental impact? Sugary drinks, meat, dairy Vegetables, bread, fruit Meat, dairy foods, poultry Fish, seafood, dairy

Meat, dairy foods, poultry Rationale: Meat has been identified as having the highest greenhouse emissions followed by dairy products, poultry, and fluid milk, respectively. 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.

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

Medium-chain triglycerides 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. https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=11&ncm_toc_id=255696#. Last accessed September 21, 2017.

Q. Which of the following is not included in the calculation for resting energy needs? Age Weight Height Muscle mass

Muscle mass Rationale: Equations used to calculate resting energy expenditure—such as Harris-Benedict and Mifflin-St Jeor—include sex, weight, height, and age. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: 65.

Q. A person with a body mass index of 30.0 kg/m2 is considered to be _____. Underweight Healthy weight Overweight Obese

Obese Rationale: The BMI cutoff for overweight is 25.0 to 29.9 kg/m2. A BMI > 30.0 kg/m2 is considered obese. Nelms MN, Sucher KP. Nutrition Therapy and Pathophysiology. 3rd ed. Belmont, CA: Cengage; 2016: page 256, 2016

Q. What is the most effective test to screen cystic fibrosis patients for diabetes? A1c Oral glucose tolerance Random blood glucose Fructosamine

Oral glucose tolerance 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.

Q. Which of the following classes of medication would require patient education on recognition and treatment of low blood glucose? SGLT2 DPP4 GLP1 Oral hypoglycemic agents

Oral hypoglycemic agents Rationale: Secretagogues, including oral hypoglycemic agents, stimulate the pancreas to release insulin; the other medications do not work in the same way. 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

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

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

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

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

Q. Which of the following processes does NOT need to be present in motivational interviewing? Engaging Focusing Evoking Planning

Planning Rationale: A client may not be ready to change, but motivational interviewing may still be used even without setting goals. http://www.mollykellogg.com/tip-114-the-four-processes-in-motivational-interviewing/

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

Polydextrose 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.

Q. Which cation has a higher concentration in the intracellular space compared to extracellular space? Sodium Potassium Chloride Phosphorus

Potassium 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

Q. What can diarrhea after meals be attributed to in patients who have had a gastric resection? Rapid entry of fats into the small intestine Lower entry of sugars into the small intestine Rapid entry of sugars into the duodenum Elevated levels of insulin

Rapid entry of sugars into the duodenum 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. Sweetser S. Evaluating the Patient With Diarrhea: A Case-Based Approach. Mayo Clin Proc. 2012; 87(6): 596-602.doi: 10.1016/j.mayocp.2012.02.015

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

Reduced inflammation 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

Q. Lost CO2 associated with hyperventilation can lead to which of the following conditions ? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis 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.

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

Rhodopsin 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.

Q. Which of the following is NOT among the "Big 8" allergenic foods? Soy beans Crustaceans Milk Rice

Rice Rationale: The most allergenic foods that account for almost 90% of all food allergies in the United States are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybean. Rice is not a major food allergen. Academy of Nutrition and Dietetics. Nutrition Care Manual. Food Allergies. https://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=269066. Last accessed October 3, 2017.

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

Rule of Nines 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.

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

Serif font 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: https://wmx-api-production.s3.amazonaws.com/courses/944/supplementary/CMS%20Written%20Materials%20Toolkit.pdf

Q. _____ sampling is a method whereby names of prospective interview subjects for a statistical study are obtained from subjects already interviewed Snowball Probability Purposive Convenience

Snowball 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.

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

Sodium 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. https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=272918&ncm_toc_id=272918&ncm_heading=&. Last accessed September 25, 2017.

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

Stevia Rationale: Stevia is made with rebaudioside A. The sweeteners neotame, aspartame, and sucralose are made with other compounds. Amir Shaghaghi M, Abumweis SS, Jones PJ. Cholesterol-lowering efficacy of plant sterols/stanols provided in capsule and tablet formats: results of a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113(11):1494-1503.

Q. 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? DASH REAP TLC CAGE

TLC 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.

Q. What is the organization that accredits and certifies hospitals? The Joint Commission The Joint Co-Investigators The Hospital Commission The Hospital Credentialing Agency

The Joint Commission 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.

Q. Which of the following is NOT a function of lipids? They act as thermal insulation for certain organs They provide energy during starvation They provide structure to hair, bones, and teeth They act as electrical insulators along myelinated nerves

They provide structure to hair, bones, and teeth Rationale: Proteins are composed of the molecules that provide structure to hair, bones, and teeth such as keratin and collagen. Lipids act as insulation for internal organs, provide energy during fasting and starvation, and also function as electrical insulators along myelinated nerves. Murray RK. Harper's Illustrated Biochemistry. 30th ed. Boston, Mass.: McGraw-Hill; 2015.

Q. Which of the following is not a potential role of probiotics? They prevent pathogenic bacteria from colonizing. They reduce fecal bulk production, which minimizes available food for other pathogens. They acidify the pH of the colon by producing fermentation products such as short-chain fatty acids. They enhance the host's immune defense system by increasing secretory IgA production.

They reduce fecal bulk production, which minimizes available food for other pathogens. Rationale: Probiotics are thought to benefit the hosts by performing all these functions except 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.

Q. 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/is lactose-intolerant. Vitamin D Vitamin A Iron Biotin

Vitamin D Rationale: Risk factors of vitamin D deficiency include lack of sun exposure, age, dark-skin, obesity, and low intake of foods high in vitamin D. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266-81. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004; 79:362-71. Ginde AA, Liu MC, Camargo CA, Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009; 169:626-32. Rodriguez-Rodriguez E, Navia B, Lopez-Sobaler AM, Ortega RM. Vitamin D in overweight/obese women and its relationship with dietetic and anthropometric variables. Obesity (Silver Spring). 2009; 17:778-82. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000; 72:690-3.

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

When patient's therapy has changed or glycemic goals are unmet 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: https://care.diabetesjournals.org/content/42/Supplement_1/S13. Accessed August 2, 2019.

Q. Prolonged use of PPIs (proton pump inhibitors) such as omeprazole can lead to bone fractures polyps constipation iron deficiency

bone fractures 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. Available at: http://www.gastrojournal.org/article/S0016-5085(17)30091-4/fulltext. Accessed February 20, 2018.

Q. Enterocytes are cells of the colon parietal cells cells of the gastrointestinal tract cells of the stomach lining

cells of the gastrointestinal tract 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

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

chalazae Rationale: Chalazae are two small bits of vitelline membrane that extend into the thickened egg white that anchors the egg yolk in the shell. Scheule B Bennion M. Introductory Foods. 14th ed. New York: Pearson; 2014: 412

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

dawn Rationale: 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.

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

gastroparesis Rationale: 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.

Q. Inquiring about cultural/religious food preferences and/or food avoidances can _____: help facilitate understanding about the patient's personality, leading to better patient satisfaction discourage cultural and religious sensitivity, leading to worse patient satisfaction improve accuracy of a diet order that is reflective of the patient's food preferences, leading to better patient satisfaction inhibit the RDN's ability to create a personalized menu using patient's food preferences, leading to worse patient satisfaction

improve accuracy of a diet order that is reflective of the patient's food preferences, leading to better patient satisfaction Rationale: The RDN may be pressed for time when seeing various patients in the hospital setting. By addressing cultural/religious food preferences at the initial assessment, the RDN will avoid causing patient discomfort if they are served a food they cannot eat or do not like. This approach leads to better patient satisfaction during their stay. Academy of Nutrition and Dietetics. Nutrition Care Manual®. Food Practices. https://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=268101. Last accessed September 29, 2017.

Q. GLP-1 is an incretin hormone that is produced in the stomach intestines colon pancreas

intestines 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

Q. A _____ diet restricts food components to reduce symptoms in those who have irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)? low-FODMAP low-fiber low-carbohydrate low-sodium

low-FODMAP 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.

Q. If a _____ deficiency is corrected, an adult with heart failure may reduce the risk of tachycardia. B12 sodium vitamin D magnesium

magnesium 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).

Q. In a nutrition diagnostic statement, signs and symptoms refer to: alterations in the patient's nutritional status that the RDN can resolve description of the factors contributing to the nutrition problem subjective and objective data used to determine if the nutrition diagnosis is accurate none of the above

subjective and objective data used to determine if the nutrition diagnosis is accurate 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.

Q. Warfarin acts as a vitamin K antagonist by inhibiting _____. gamma-carboyxlase vitamin K epoxide reductase formation of active proenzyme factor breakdown of fibrinogen

vitamin K epoxide reductase 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.