exam 4
Which of the following is the correct Current Procedural Terminology code for Medicare initial individual assessment? 97802 97803 97804 G0270
A. 97803 is the code for reassessment; 97804 is the code for medical nutrition therapy (MNT) group; and G0270 is the code for MNT reassessment second referral. The Medicare initial individual assessment code is 97802 Indian Health Service. Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement. Available at: https://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/InstantDownloads/MNT_Reimb_Guide_Adden_508c.pdf. Accessed February 20, 2018.
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 Formative Summative Cognitive Observational
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.
Which laboratory values can be abnormally low when evaluating nutritional status in patients with liver disease? Prealbumin Potassium Chloride Vitamin D
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.
Which of the following is true of "Ask Me 3"? It is intended for patients to become more active members of their health care team It is an alternate form of the "teach back" method It is a tenet of patient safety goals by asking the patient 3 identifiers It employs "teach back" to improve patient communication
A. Ask Me 3 is an initiative that encourages the patient to be more involved in their health care by always asking the following questions: 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?
What is the role of the liver in fat metabolism? The liver is needed for fat absorption from the small intestine The liver excretes fat that cannot be used The liver stores fat when it is consumed in the form of triglycerides The liver recycles fat and converts fatty acids to carbohydrates
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.
Once full compliance with the US Food and Drug Administration's updated requirements for nutrition labels on food products is required, which nutrients must be included as an amount and a percentage on the nutrition label? Calcium, vitamin D, iron, potassium Vitamin A, vitamin D, vitamin C, and sodium Calcium, vitamin C, iron, sodium Calcium, vitamin D, iron, and vitamin C
A. Calcium, vitamin D, iron, and potassium are considered key nutrients. Percentages and amounts are included for consumers who are seeking to attain or limit their intake to a specific level. US Department of Health and Human Services, Food and Drug Administration. Changes to the Nutrition Facts Label. Last updated June 19, 2017. Available at: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#highlights. Accessed March 5, 2018.
Which milk alternative typically contains the most protein per 8-oz serving? Hemp Almond Coconut Rice
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.
Which of the following is NOT a characteristic of an individual with fetal alcohol spectrum disorder (FASD)? Macrocephaly Lacks philtrum Developmental delay Abnormally shaped ears
A. Infants with FASD are born with a small head, so they have microcephaly.
What is the term for the ratio regarding whether an organization can pay its bills when due? Liquidity Solvency Activity Profitability
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.
Which of the following is NOT true about meaningful use standards used in health information technology? Meaningful use expands institutional access to health records It is a way to improve care coordination Meaningful use has been incentivized It is a way to improve quality of health care
A. Meaningful use refers to use of electronic health record technology to improve quality, safety, and efficiency of health care; improve coordination of care; engage patients and family; and maintain the privacy and security of patient health information. HealthIT.gov. Meaningful use definitions & objectives. Available at: https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives. Accessed February 20, 2018.
_____ is the accumulation of excess fat in the liver. NAFLD NASH fibrosis Cirrhosis
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.
Which equation is the least accurate for measuring resting energy expenditure (REE) in those with liver cirrhosis? Harris-Benedict Penn State Mifflin-St Jeor RMR
A. Predictive REE equations demonstrate limited accuracy in patients with cirrhosis, as energy requirements are commonly underestimated. Of these equations, Harris-Benedict is the least reliable in this population.
The natural inclination people have to want to make things better for another person based on the assumption that we know how to "fix" their problem is _____: righting reflex develop discrepancy roll with resistance social learning theory
A. Righting reflex is common in the helping professions, including dietetics. Practitioners need to resist the righting reflex when counseling a patient via motivational interviewing. Roll with resistance and develop discrepancy are principles of motivational interviewing.
What happens to the rate of metabolism during severe acute pancreatitis? Energy expenditure increases, hypermetabolic Body temperature remains the same Energy expenditure decreases, hypometabolic Energy needs decrease
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%.
Which model of cultural competence identifies the primary and secondary features of culture. Purnell Campinha-Bacote Leiningers Sunrise Campinha
A. The Purnell and Campinha-Bacote cultural competency models are the two most popular frameworks used by health care professionals. The Leiningers Sunrise model emphasizes respect for a patient's culture but it doesn't give cultural competency context for health care professionals to use in practice. The Purnell model comprises 12 domains and focuses on primary and secondary features of culture.
What are the stages of motivational interviewing? Engaging, focusing, evoking, planning Express empathy, develop discrepancy, roll with resistance, support self-efficacy Exploring each component of DARN (desire, ability, reason, need) Affirmation, autonomy, accurate empathy, absolute worth
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.
At what age should peanut-containing foods be introduced to an infant with egg allergy and severe eczema? 4-6 months 7-12 months After age 3 Never
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. https://wmx-api-production.s3.amazonaws.com/courses/944/supplementary/Peanut%20Allergy%20Prevention%20Guidelines.pdf
_____ are responsible for catalyzing change in an organization. Managers Change agents Transactional agents Leaders
B
Which compound is found in the skin and converted to vitamin D3 through ultraviolet B exposure? Ergocalciferol 7-dehydrocholesterol Cholecalciferol Ergosterol
B. 7-dehydrocholesterol is found in the skin of humans and is converted to vitamin D3 through UVB exposure. Ergocalciferol is vitamin D2, ergosterol is previtamin D2 (forms found in plant sources), and cholecalciferol is vitamin D3 in its final form.
_____ is the terminology for timing of meals and snacks and types and amounts of foods eaten to achieve nutrition goals? Food and beverage plan Eating plan Diet plan Diabetes diet plan
B. An eating plan is used to determine timing of meals and snacks and types and amounts of food eaten to achieve nutrition goals.
Which of the following is a good strategy for fostering trust between managers and employees and preventing workplace conflict? Create homogeneous teams to minimize differences Permit employees to voice dissent with the mission and strategies Avoid praising employees so as to not cause jealousy among their colleagues Explain whenever possible that slights were only perceived and not intentional
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.
Stools that are pale in color indicate a disturbance in the production or secretion of which of the following? Lipase Bilirubin Peptidases Amylase
B. Cholestasis or disruption of bile flow leads to lack of bile in the stools. Bilirubin confers the brownish color to stools. 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.
Employment background checks typically include which of the following? Marital status Bankruptcy record Age Health records
B. Employment background checks may include records related to criminal, driving, education, and credit history, including bankruptcy
What percentage of total energy from fat should be provided through an elemental (hydrolyzed) formula to prevent essential fatty acid deficiency (EFAD)? 1%-2% 3%-4% 2%-3% 4%-5%
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.
What is the recommended parts per million of available chlorine for a lukewarm, 1-minute chlorine bath used to sanitize dishes and utensils? 10 50 100 500
B. It is recommended that a minimum of 50 ppm available chlorine be used in a lukewarm chlorine bath to sanitize dishes and utensils.
What medication is FDA-approved for long-term weight management in pediatric patients age 12 years and older? Liraglutide Orlistat Phentermine Lisdexamfetamine
B. Orlistat is the only long-term weight-management medication approved by the US Food and Drug Administration for use in pediatric patients age 12 and older. Liraglutide is a drug to treat to treat type 2 diabetes. Phentermine is a chemical component of Qsymia, which is an FDA-approved weight-management drug.
When a person has phenylketonuria, which amino acid becomes essential? Tryptophan Tyrosine Threonine Methionine
B. Phyenylalanine is converted to tyrosine by phenylalanine hydrolase, a missing enzyme in individuals with PKU; therefore, tyrosine is an essential amino acid for these individuals.
Which federal regulation requires that any intended use of color additives in meat, meat food products, or poultry products subjects the US Department of Agriculture's (USDA) inspection include a petition filed with the US Food and Drug Administration (FDA)? Standards of Additives Standard of Identity Standards of Quality Standards of Fill
B. Standards of Identity are the federal standards that identify what a given food product contains and the name of the food. If additives will be added to meat, meat products, or poultry, the FDA must receive a petition for permission, which is forwarded to the appropriate USDA inspection offices.
What is the purpose of a tabletop drill in a foodservice organization? To repair foodservice equipment For emergency preparedness For sustainability practices To reduce energy use
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.
All of the following are true regarding leptin EXCEPT It is primarily secreted in adipose tissue It increases food intake Obesity can disrupt leptin signaling It is involved in long-term regulation of body weight
B. The roles of leptin and ghrelin in weight regulation are complex and mediated by the hypothalamus. Option B is incorrect because leptin actually suppresses food intake.
What is the recommended time frame for avoiding pregnancy after bariatric surgery? 3-4 years 1-2 years 6-12 months 1-3 months
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.
What is the highest level in Maslow's hierarchy of needs? Social Self-actualization Self-esteem Physiological
B. ascending order of Maslow's hiearchy of needs are physiological, safety, love/belonging, esteem, and self-actualization.
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? 4 FTEs 5.2 FTEs 5.6 FTEs 6.4 FTEs
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 you need 4 positions x 8 hrs/day x 7 days/week = 224 hours/week. Divide hours needed by FTE (224 hours / 40 hours) and you get 5.6 FTEs.
Which of the following is NOT a side effect of anti-retroviral (ARV) medications? Fatigue Nausea and vomiting Hypoglycemia Lipidystrophy
C. ARV medications have short-term and long-term side effects, such as type 2 diabetes mellitus , hyperlipidemia, and lipidystrophy. Hypoglycemia is not a side effect of ARV medications.
Which of the following is NOT considered a hygiene factor according to Herzberg's dual theory of motivation/hygiene? Salary Company policy Recognition Working conditions
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.
Carotenoids are incorporated into _____ within the enterocyte to be taken to the lymph system and eventually the blood. Micelle Retinoic acid Chylomicrons Blood albumin
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.
Intake of _____ should be carefully monitored in patients with kidney disease because phosphorous is more easily absorbed from this source. Dairy Meat Inorganic phosphate food additive Whole grains
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.
Agenda mapping typically occurs in the _____ process of motivational interviewing. Engaging Evoking Focusing Planning
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.
The World Health Organization growth charts for children younger than age 2 are based on data from Children from the United States only Children from the United States and Europe Children from six different countries on different continents Children from the United States and Canada
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
Which of the following is a likely diagnosis if acanthosis nigricans are present? High blood sugar Hypertension in a person who is also diabetic High insulin levels in the blood Low insulin levels in the blood
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.
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? Perform 1-hour oral glucose tolerance test with a 75 g glucose load Check hemoglobin A1c levels Check fasting and 2-hour postprandial glucose levels for 1 week Perform 3-hour oral glucose tolerance test with a 100 g glucose load
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.
What type of standards must be met to attain LEED certification? Food safety Efficiency in the flow of the building Sustainability Bright lighting
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.
What should you avoid when purchasing bivalve mollusks? Shucked oysters Tightly closed shells Opened shells Canned clams
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.
Long-term use of corticosteroids can lead to which of the following? Low blood pressure Increased loss of body fluids Hyperglycemia Thickened skin
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.
What function does basal insulin perform? It manages blood sugar that is too high after meals It evens out slight increases in blood sugar that occur after eating snacks It evens out slight increases in blood sugar due to the action of glucagon It keeps blood sugar from becoming too low in people who use insulin pumps
C. Plasma glucagon concentrations are inappropriately elevated in people with diabetes, and α-cell suppression by hyperglycaemia is blunted. Evidence suggests that this contributes to greater rates of hepatic glucose production in the fasting state.
Where in a cooler would you store raw eggs? Top shelf Middle shelf Bottom shelf Next to the salad
C. Poultry, including raw eggs, should be stored on the bottom shelf.
What is the protein requirement for patients on peritoneal dialysis? 0.6 g/kg to 0 8 g/kg 0.8 g/kg to 1 g/kg 1.2 g/kg to 1.3 g/kg > 1.3 g/kg
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 . HD patients: 1.1-1.2g/kg
Protein needs for non-critically ill patients with diabetes are _____ in comparison to those without diabetes? Higher Lower The same 2.0 g/kg
C. Protein needs of patients with diabetes or hyperglycemia may vary depending on the level of stress and degree of malnutrition. Protein requirements for individuals with diabetes are the same as those for patients without diabetes: 0.8 g/kg/day or 15% to 20% of daily energy intake.
Which of the following nutrients has an important role in maintenance of body composition for older adults? fat iron protein vitamin C
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.
For adults older than 19 years, how many grams of carbohydrate are needed daily for an adequate supply of glucose to the brain? 60 g 75 g 130 g 160 g
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 Older Americans Act Nutrition Program (OAANP) offer? Nutrition counseling for older adults via federally funded clinics Food vouchers for low-income, elderly individuals Grants to support nutrition services at the state level for individuals older than 60 years of age Nutrition-related promotional materials to be distributed in nursing homes.
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
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? 135 141 145 150
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
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? Job specification Job identification Job qualifications Job description
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.
What is the term for a budget that includes rental and labor costs needed to run the business? Capital budget Forecast budget Flexible budget Operating budget
D. An operating budget includes revenue, fixed costs such as rent, variable costs such as labor, and non-operating and non-cash expenses.
People with cystic fibrosis are most likely to become deficient in thiamine and iron vitamin B12 selenium and magnesium zinc and fat-soluble vitamins
D. Both zinc and fat-soluble vitamins are lost in the stool of individuals with cystic fibrosis due to pancreatic insufficiency
What is the name of the transporter that distributes fructose to different tissues in the body? Glut-1 Glut-3 Glut-2 Glut-5
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.
Your facility has experienced a major flood, which affected the Food and Nutrition Services Department in the basement. All of the following should be thrown out EXCEPT: Jars and canisters with screw tops Foods with snap lids Liquid infant formula concentrate Foods with retort pouches
D. Jars and canisters with screw tops or snap lids and baby formula boxes are NOT waterproof and should be thrown out http://www.eatrightpro.org/~/media/eatrightpro%20files/news%20center/nutritionnews/food_safety.ashx
Cystic fibrosis is a genetic condition that affects transport of which mineral across the cell membrane? Sodium Potassium Phosphorus Chloride
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 track, reproductive tract, and skin.
Microcytic anemia is caused by deficiency of the following nutrients EXCEPT _____. protein pyridoxine iron folate
D. Protein, pyridoxine, and iron deficiency cause microcytic anemia. Folate deficiency causes macrocytic anemia
Which part of a rhubarb plant is edible? Flower Root and tuber Fruit Stem
D. Rhubarb is like celery— the stem of the plant is the edible portion.
Which of the following terms is used to denote loss of inventory? Theft Breakage Spoilage Shrinkage
D. Shrinkage refers to loss of inventory
If you need a saucepan that conducts heat well, which gauge would you choose? 4 10 14 20
D. The higher the gauge of a saucepan, the thinner the metal. Heavier stainless steel does not conduct heat well. Therefore, your best option in this case is a 20-gauge saucepan.
