MNT Final: Quiz Questions

Which of the following should be included in the nutrient recommendations for the short-term post-transplant patient?

1.5 to 2 g protein/kg -Due to the need to promote healing and combat catabolism, the patient should consume 1.5-2 g protein per kg after transplant. This should accompany an energy intake of BEE ´ 1.3 to 1.5 to provide sufficient calories. Calcium supplementation is not an immediate concern after transplant; however, it may need to be provided long-term to prevent the development of steroid-induced osteoporosis. Fluid restriction is not necessary after heart transplantation.

A fasting blood glucose of greater than ________ mg/dl indicates a diagnosis of diabetes?

125

If a diabetic patient is prescribed a 1,600 kcal diet, approximately how many grams of total carbohydrate would be recommended?

200 gm (50%)

Screening for gestational diabetes should occur

24-28 weeks gestation

___________/kgBW is the usual calorie recommendation for a patient with Alcohol Dependency/Alcoholic Hepatitis

30-35

What percentage of weight loss is recommended to manage prediabetes?

5-7%

How many servings of fruits and vegetables should be consumed each day to reduce risk for cancer?

5-9 servings

What causes pernicious anemia?

A deficiency of vitamin B12 - Pernicious anemia results from a vitamin B12 deficiency, usually resulting from a lack of intrinsic factor to ensure adequate absorption. GI blood loss and inadequate iron intake are more likely to be associated with an iron-deficiency anemia. Sideroblastic anemia results from an impairment in heme synthesis, which is dependent upon adequate pyridoxine availability.

What pulmonary condition is a common complication of critical illness?

Acute respiratory distress syndrome - Acute respiratory distress syndrome is a pulmonary condition that is characterized by severe hypoxia, bilateral pulmonary fluid infiltration, and decreased lung compliance. This may be caused by trauma, surgery, or medical conditions associated with critical illness. Cor pulmonale is heart failure associated with right ventricular hypertrophy. Emphysema is caused by smoking or environmental pollution and genetic susceptibility. Pneumonia occurs as a result of a nosocomial infection or as a consequence of aspirating food, fluid, or secretions into the lung.

A goal of nutrition therapy during palliative care is to

Alleviate symptoms. Palliative care focuses on promoting optimal quality of life and does not continue to address curative measures. Nutrition therapy during palliative care should alleviate symptoms that affect quality of life. Examples of these include pain, weakness, loss of appetite, early satiety, constipation, weakness, dry mouth, and dyspnea. Curative measures associated with nutrition therapy would focus on goals such as replenishing nutrient stores, promoting weight gain, and alleviating symptoms.

Which of the following is an inhibitor of carcinogenesis?

Antioxidants

Which of the following is synthesized in the lungs?

Arachidonic acid - Arachidonic acid is synthesized in the lungs from precursor fatty acids. The lungs also secrete angiotensin-converting enzyme (ACE), which converts angiotensin I to angiotensin II. Hemoglobin is produced in the bone marrow.

Movement of food or fluid into the lungs is known as _________________.

Aspiration

Which dietary modification would be used when a patient has neutropenia?

Avoid raw or uncooked foods. -Neutropenia is a decrease in white blood cells that could increase the patient's risk of developing infections. Because of this, food safety must be followed when providing foods for these patients. A typical diet modification for this includes avoiding raw or uncooked foods. Patients who develop mucositis, mouth pains, or xerostomia in response to cancer treatments may tolerate oral intake better when bland liquids and soft solids are provided, strong flavors and acidic or spicy foods are avoided, and sauces and gravies are provided with food.

Which hepatitis virus is primarily transmitted by blood and body fluids? a. A b. B c. D d. E

B - Hepatitis B and C are transmitted via blood, blood products, semen, and saliva. Hepatitis D also may be transported by blood and body fluids; however, it is rare in the United States and depends on HBV for survival and propagation in humans. Hepatitis A and E are the infectious forms that are transmitted by the fecal-oral route.

How is BMR altered during cancer?

BMR is increased

Medium chain triglyceride oil is sometimes provided to patients with steatorrhea. This is because

Bile is not needed for absorption

Diabetic ketoacidosis (DKA) is diagnosed with

Blood glucose and ketones

Which of the following is TRUE about chronic obstructive pulmonary disease?

COPD can progress to cor pulmonale. - Cor pulmonale is a type of heart failure involving right ventricular enlargement that can develop late in the course of COPD. COPD can be characterized as either emphysema (type I) or chronic bronchitis (type II). Emphysema involves an abnormal, permanent enlargement of the alveoli, effectively causing damage and the loss of their function. Chronic bronchitis is characterized by a chronic, productive cough associated with inflammation of the bronchi. Patients who develop emphysema tend to be thin or cachectic, whereas patients who develop chronic bronchitis are normal weight or overweight.

Which of the following presents with the symptoms of progressive weight loss, anorexia, wasting, and immunosuppression?

Cancer cachexia -Cancer cachexia is a secondary diagnosis in patients with advanced cancer that is similar to protein-energy malnutrition. The patient exhibits progressive weight loss, anorexia, wasting, immunosuppression, altered basal metabolism, and electrolyte and fluid abnormalities.

Which of the following is NOT a characteristic associated with insulin resistance? a. Glucotoxicity b. An increase in serum free fatty acids c. An increase in hepatic glucose production d. A decrease in breakdown of fat stores in adipose tissue

D. A decrease in breakdown of fat stores in adipose tissue Insulin resistance results in both hyperglycemia and hyperlipidemia. The hyperglycemia occurs due to the decreased sensitivity to insulin at cellular receptors. Hyperglycemia promotes glucotoxicity of the pancreatic beta cells, reducing their effectiveness to respond to the high glucose levels through insulin secretion. At the adipocyte, decreased sensitivity to insulin triggers lipolysis, which results in an increased circulation of free fatty acids. The increased free fatty acids continue to decrease insulin sensitivity, impair pancreatic insulin secretion, and promote hepatic glucose production.

Which of the following would be the most easy to aspirate? a. Raw carrot chunks b. Whole wheat bread c. Hard candy mint d. Water

D. Water -Water and liquids are easy to aspirate as they are difficult to control during the swallowing process. After liquids, the foods that are most easily aspirated include small, round foods such as nuts, popcorn, hot dog pieces, and hard candies. Also, chunks of food that are inadequately chewed, such as meat and raw vegetables, may be aspirated.

What should the person with type 1 DM do when planning to exercise?

Decrease insulin dosage dependent on duration and intensity of exercise and carry a supply of glucose, ie., glucose tabs. -Decreasing the amount of insulin injected is necessary to prevent hypoglycemia that can occur during exercise. Prolonged or intensive exercise may require a modest decrease of 1-2 U of rapid- and short-acting insulin, before and possibly after exercise. As an alternative, the person with type 1 DM may ingest carbohydrate before or after exercise to prevent hypoglycemia. Exercising at the time of insulin peak action and providing extra insulin can increase the likelihood of hypoglycemia occurring.

What is a major reason for constipation in the elderly?

Decreased gastric motility

Diuretics work to lower blood pressure by

Decreasing Blood Volume -Diuretics lower blood pressure by promoting the excretion of fluid and sodium from the body. Vasodilators are medications that promote an increase in blood vessel diameters. ACE inhibitors are medications that inhibit the release of angiotensin-converting enzyme, an important component in the function of the renin-angiotensin system. Many diuretics promote the excretion of potassium as well as sodium.

For which of the following problems associated with cancer treatment should a high-calorie diet supplemented with calorically dense foods be provided?

Early satiety -Early satiety may result from surgical treatment of lung, stomach, or gynecologic cancers. As the patient may become full quickly due to diminished stomach capacity or pressure on the stomach, use of high-calorie supplements or calorically dense foods will ensure that the patient will receive adequate calories while consuming smaller amounts of food. Constipation treatment would include increased fluid intake, activity, and increased fiber for stimulation of the bowel. Xerostomia would be treated by providing liquids and foods that are moist. Neutropenia results in increased susceptibility to infection, and therefore, food safety guidelines must be strictly followed in preparation and handling of foods for the patient.

What is the recommendation for self-monitoring of blood glucose?

Four or more times daily for type 1 DM and 1-4 times for type 2 DM -Patients with type 1 DM should perform SMBG four times or more daily, including before each meal and at bedtime. Patients with type 2 DM should perform SMBG from 1-4 times daily to help in achieving glucose goals. Whenever they add to or modify their therapies, patients with either DM should test more often.

What must a patient demonstrate to be a candidate for use of oral glucose-lowering medications?

Functioning beta cells in the pancreas --Oral glucose-lowering medications may be used in the treatment of patients with type 2 DM, and therefore, the patient has to have beta cell function for the production of insulin. The mechanisms of action for the oral glucose-lowering medications include the stimulation of pancreatic insulin secretion. Other mechanisms of action include reducing insulin resistance at muscle and adipose tissue and decreasing hepatic glucose output.

Patty is diagnosed with Type 2 diabetes and has been experiencing erratic glucose control. Recently she has been complaining of feeling full, bloated, and having diarrhea every other day. Her dietitian recommended she eat several smaller meals throughout the day that are low in fat and fiber. The condition Patty most likely has is:

Gastroparesis

Which method of food preparation is linked to increased risk for cancer?

Grilling

Which protein is most responsible for the transport and absorption of vitamin B12 in the GI tract?

Holotranscobalamin II --Holotranscobalamin II protein is important in the delivery of vitamin B12 to all cells needing it. Although only 25% of the vitamin B12 is bound to TC II, lack of TC II develops into megaloblastic anemia. Haptocorrin, or TC I, binds about 75% of the circulating vitamin B12. Intrinsic factor is involved with the transport and absorption of vitamin B12 in the GI tract.

What would you first advise a constipated patient to do?

Increase fluid and fiber intakes

Which of the following explains why nutritional wasting is commonly seen in patients with COPD?

Increased energy expenditure, decreased energy intake, and impaired oxygenation - COPD patients may experience nutritional wasting due to a combination of factors. Increased energy expenditure occurs due the increased work undertaken by the respiratory system to breathe. This increase results from the obstruction of airflow. On the other side of the cause is decreased food intake. This is brought on by fatigue and confusion caused by lack of oxygen and the buildup of carbon dioxide in the blood.

What is the effect of pulmonary disease on a patient's energy requirements?

Increased need for energy due to increased work of breathing - Pulmonary disease promotes an increase in energy requirements due to increased muscular work to promote breathing, possible chronic infection, and medical treatments. Malnutrition in relation to pulmonary disease can contribute to a loss of lean body mass and decreased capacity to perform physical activity. Additionally, malnutrition could impair immune function and contribute to the likelihood of infection.

Children and adolescents with cystic fibrosis have _______ needs. The easiest way to boost energy and nutrient intake is to:

Increased; add mayonnaise to sandwiches, add milk and cheese to soups, eat desserts with fruit in them, and drink milk with meals

The most common type of anemia is

Iron

Which nutrient deficiency is most likely to cause an anemia that appears microcytic and hypochromic?

Iron -Microcytic, hypochromic anemia results from iron deficiency. This occurs because the body produces small red blood cells and has decreased circulation of hemoglobin. --Folic acid, pyridoxine, and vitamin B12 deficiencies result in macrocytic anemias due to the release of immature red blood cells from the bone marrow.

What does the plasma ferritin value provide a measure of when iron status is evaluated?

Iron stores - Plasma ferritin levels reflect total iron stores. Transferrin saturation is a measure of the iron supply available for the tissues of the body and in use for developing red blood cells. Transferrin iron-binding capacity is a measure of the capacity of transferrin to take on and become saturated with iron.

Which of the following is the most important nutritional assessment parameter to evaluate in the infant with BPD? a. Length b. Weight c. Head circumference d. Serum albumin

Length -Linear growth or length is important for the growth of healthy lung tissue and for the resolution of BPD. Length reflects long-term nutritional status, and as long as an infant continues to have adequate nutrition, length increases. Short stature in relation to weight or age is an indicator of chronic malnutrition. Weight gain tends to reflect short-term nutritional insults.

Which nutrient is a smooth-muscle relaxant and anti inflammatory agent useful for patients with asthma?

Magnesium

Which of the following may be avoided after cancer therapy as the result of alteration in taste sensation?

Meats - Meat aversions can result from chemotherapy or radiation therapy that affects oral/mouth cancers. Meat aversions may be acquired due to changes in taste acuity

In carcinogenesis, which step does NOT necessarily occur in tumor development?

Metastasis -Metastasis is the process involving the spread of tumor cells to tissues and organs distant from the initial site of development. Not all cancers metastasize, and discovery of the cancer early in its development can prevent metastasis. Initiation, promotion, and progression are all necessary steps in tumor development.

Which of the following is an example of a dietary carcinogen?

Nitrates

Which of the following is NOT part of the treatment of prediabetes? a. Oral glucose medications b. Weight loss c. Decreased energy intake d. Physical activity

Oral glucose medications -Oral glucose medications is used, when appropriate, with Type 2 DM.

Nosocomial (hospital-acquired) pneumonia tends to be more serious than other lung infections. Why might this be?

Patients in the hospital are often sicker and unable to fight off infections

What is one of the distinguishing physical characteristics between patients with emphysema and chronic bronchitis?

Patients with emphysema are often thin and cachectic while patients with chronic bronchitis are usually normal or overweight

Which of the following is recommended in the medical nutrition therapy for a patient undergoing surgical treatment of esophageal tumors?

Placement of a feeding tube at the time of surgery -As surgical treatment of esophageal cancer involves partial or total removal of the esophagus, placement of a feeding tube at the time of surgery will allow early post-surgical feedings to promote healing. During the surgery, part of the stomach is used for esophageal reconstruction. Provision of oral liquids or solids may impair the healing after surgery. Parenteral nutrition should only be used if the distal bowel is incapable of performing its regular digestion and absorption functions.

Mr. Jones has just been prescribed a thiazide diuretic to reduce blood pressure, what mineral should he be advised to consume more of while taking this drug and why?

Potassium -the drug causes increased urinary output of potassium causing hypokalemia.

What risk is involved with using nocturnal enteral feedings for the nutrition support of patients with COPD?

Potential aspiration - Due to the positioning of the patient during sleep and depending on the placement of the tube, nocturnal enteral feeds could cause aspiration. This will aggravate and worsen the COPD patient's respiratory condition. Nocturnal feedings are usually provided to ensure adequate nutrient provision to patients. Clogging of feeding tubes happens as a result of improper flushing and care. Not all patients with COPD require ventilation support.

What causes the hypoglycemia that occurs after meals in patients who have had a gastrectomy? a. Poor dietary intake b. Rapid digestion and absorption of sugars and elevation of insulin levels c. Pancreatic insufficiency d. Elevated levels of secretin and pancreozymin

Rapid digestion and absorption of sugars and elevation of insulin levels -Alimentary hypoglycemia is a consequence of the dumping syndrome that results from rapid delivery and absorption of carbohydrate into the blood system, producing an exaggerated increase in insulin and then a decrease in blood glucose levels. The gut peptides glucose insulinotropic polypeptide and glucagon-like polypeptide-1 play some role in this. Alimentary hypoglycemia is aggravated by intake of simple carbohydrates. The pancreas is functioning normally as evidenced by the secretion of insulin in response to the carbohydrate load.

Which biochemical measure is useful in evaluating the body's folate stores?

Red cell folate level - The level of folate in red blood cells measures the actual folate stores and is the first, best indicator of folate depletion. --Serum folate level may initially reflect a negative balance of folate at the time of the blood draw. Urinary FIGLU and serum homocysteine levels increase when folate deficiency occurs as folate is necessary for the conversion of histidine to glutamic acid, in the case of the former, and in homocysteine to methionine.

A patient who requires oxygen through nasal cannula or mechanical ventilation is said to have

Respiratory failure

Patients with end stage renal disease are at risk for anemia. What laboratory value should be monitored to assess iron status?

Serum ferritin

Which of the following meal patterns would be the most appropriate for a woman diagnosed with gestational diabetes?

Small frequent meals -Gestational Diabetes is typically diagnosed in the third trimester of the pregnancy. At that time, the fetus is growing and the mother usually tolerated smaller, more frequent meals because of the growing size of the fetus.

A primary cause of COPD is

Smoking

Which of the following is secreted by the alveolar cells of the lungs to maintain lung stability?

Surfactant

Hepatomegaly is defined as:

Swelling of the liver

Encephalopathy is defined as:

Syndrome of impaired mental status and abnormal neuromuscular function.

What situation might cause hypoglycemia in a diabetic client?

Taking to much insulin

Two important recommendations dietitians should enforce when encouraging fiber intake are:

To slowly increase fiber consumption, and maintain adequate water intake

A benign tumor is one that is lacking the ability to invade other tissues True or False

True

Bronchitis is a condition characterized by inflammation and eventual scarring of the lining of the bronchial tubes. True or False

True

Dysomia is defined as difficulty speaking. True of False

True

Hemophilia is an inherited disorder of blood clotting, with pronounced bleeding upon tissue injury. True or False

True

Neutropenia is defined as a low white blood cell count. True or False

True

Palliative care is defined as non-curative but effective in reducing symptoms such as pain. True or Fasle

True

Which results from a sweat test indicate that a patient may have CF?

a. Elevated levels of sodium and chloride - Elevated levels of sodium and chloride >60 mEq/L in collected sweat samples are used to diagnose cystic fibrosis. This is performed in combination with evaluation for chronic lung disease, failure to thrive and malnutrition, and family history of CF.

What, combined with blood loss, causes iron deficiency anemia seen in patients after gastric surgery? a. Impaired iron absorption b. Poor dietary intake of heme iron and ascorbic acid c. Bacterial overgrowth in the proximal small bowel d. Lack of intrinsic factor

a. Impaired iron absorption - Gastric surgery may result in the decrease or loss of acid secretion. Gastric acid normally facilitates the reduction of iron compounds, allowing for an increase in iron absorption. Of course, poor dietary intake of iron, regardless of form, may contribute to iron deficiency anemia and should be assessed as a possibility when treating gastric surgery patients. Vitamin B12 deficiency is more likely to develop from both bacterial overgrowth and lack of intrinsic factor.

Which of the following statements is TRUE regarding medium-chain triglycerides? a. MCTs are rapidly hydrolyzed and absorbed in the absence of bile acids b. MCTs require pancreatic lipase for digestion. c. MCTs must be administered intravenously in TPN. d. MCTs are contraindicated in steatorrhea and other malabsorptive conditions.

a. MCTs are rapidly hydrolyzed and absorbed in the absence of bile acids -Medium-chain triglycerides of 8 and 10 carbon length are short enough to be absorbed directly into portal circulation without relying on bile acids for micelle formation or pancreatic lipase for digestion. Because of these benefits, MCTs may be provided to patients experiencing fat malabsorption caused by various conditions. They are provided to the patient in either enteral formula or through the intake of MCT oil.

Which of the following groups is LEAST likely to need vitamin B12 supplementation? a. Pregnant women b. Elderly c. People who follow a strict vegetarian diet d. People who take metformin to treat diabetes

a. Pregnant women A pregnant woman who eats the typical American diet will consume adequate vitamin B12. Due to the probability of developing atrophic gastritis, the Dietary Guidelines recommend that elderly should eat either fortified cereals or take a supplement. People who follow a strict vegetarian diet are likely to develop deficiency as vitamin B12 is only available in foods of animal origin. Metformin has been shown to decrease the absorption of vitamin B12.

Which of the following is true of patients with Type 2 diabetes? Select one: a. They may not experience the classic symptoms of uncontrolled diabetes b. Being overweight or obese for a significant portion of your lifetime is almost a guarantee of developing type 2 diabetes at some point c. Type 2 diabetes accounts for 75-80% of all newly diagnosed cases of diabetes d. Persons with type 2 diabetes never have to resort to insulin to control blood-sugar levels - combined diet, exercise and medication will regulate levels

a. They may not experience the classic symptoms of uncontrolled diabetes

Which of the following recommendations should be made to the parents of an infant who has both BPD and esophageal reflux? a. Thicken formula with baby cereal b. Thin formula with a glucose solution. c. Feed the infant positioned in the supine position. d. Delay introduction of baby food until 9 months of age.

a. Thicken formula with baby cereal. - Gastroesophageal reflux can exacerbate BPD by promoting possible aspiration. Parents of infants who have these conditions can minimize the risk of aspiration by thickening the infant's formula with infant cereal and placing the infant in an upright sitting position. Introducing solid foods should not be delayed as formula and breast milk alone do not provide adequate nutrition and calories after 6 months of age.

A deficiency of vitamin B12 can cause which type of anemia a. pernicious b. hemochromotosis c. folate d. iron deficiency

a. pernicious

What can be done to lower the respiratory quotient of a tube fed pulmonary patient?

add MCT oil to decrease energy required for growth

The diet for stomatitis is

avoid spices, very hot, very cold, sour, tart foods

Which of the following would be considered high risk for aspiration? a. A 17 year old with obesity and HTN b. A 45 year old with severe GERD c. A 35 year old with severe asthma d. A 50 year old with recent CABG procedure

b. A 45 year old with severe GERD

Patient A.S. has an extensive past medical history. He has had multiple surgeries and a few chronic conditions including obesity, type 2 DM, and multiple deficiencies. A.S. has iron deficient anemia. What is one thing that may have caused A.S.'s anemia? a. An ileus located in the patient's distal esophagus b. A past gastric bypass surgery causing altered absorption c. Defective globin in A.S.'s hemoglobin formation d. Patient was placed on enteral nutrition for too long

b. A past gastric bypass surgery causing altered absorption

Which of the following is one of the Academy's MNT goals for ALL people with diabetes? Select one: a. Promote weight loss. b. Achieve blood pressure control. c. Prevent diabetes ketoacidosis. d. Limit intake of simple carbohydrates.

b. Achieve blood pressure control. -The first MNT goal for all people with diabetes is to achieve and maintain normal blood glucose levels and lipid and lipoprotein profiles and blood pressure levels that reduce the risk for vascular disease. The other MNT goals include preventing or slowing the progression of chronic complications of diabetes mellitus, addressing the individual's nutritional needs, and limiting food choices only based on evidence while maintaining the pleasure of eating. As diabetes may affect children and pregnant women, weight loss is not important to maintaining health in these population groups. Diabetes ketoacidosis is an acute complication that can occur in patients with diabetes. Research evidence does not substantiate a recommendation to limit simple carbohydrate intake in the treatment of diabetes.

Which of the following could be a cause of iron deficiency anemia? a. Inadequate iron intake b. All of the above c. Poor iron absorption d. Heavy menstrual bleeding

b. All of the above

__________ is NOT a symptom of type 1 DM. a. Hyperglycemia b. Loss of thirst sensation c. Weight loss d. Polydipsia

b. Loss of thirst sensation The common symptoms of type 1 diabetes mellitus include hyperglycemia, polyuria, polydipsia, weight loss, dehydration, electrolyte disturbance, and ketoacidosis. Type 1 DM tends to increase the thirst sensation as opposed to blocking it.

Which of the following statements about glycemic index (GI) is TRUE? a. Consuming low GI meals (<70) improves overall glycemic control. b. Specific carbohydrate foods can have a variable GI. c. When compared to an equal amount of starch, sucrose promotes a greater glycemic response. d. The GI of glucose is lower than the GI of white bread.

b. Specific carbohydrate foods can have a variable GI. The difficulty of working with the GI concept is that the GI of an individual food may vary. This is part of the reason that the ADA has not fully adopted GI and glycemic load as approaches to meal planning. Low GI foods are those with a GI less than 55. Selection of low GI foods may help in fine-tuning postprandial glycemic response, but research presents inconsistent results in relation to overall glycemic control. Equal amounts of starch and sucrose result in identical glycemic responses. The GI of glucose is 100. The GI of white bread is 70.

Which food would be considered a "carbohydrate" when using the carbohydrate counting method of diet instruction? a. 1 tsp. olive oil b. 4 oz grilled chicken c. 8 oz low-fat milk d. 1/2 cup cooked spinach

c. 8 oz low-fat milk

Which of the following would be considered high risk for iron deficiency anemia? a. Post menopausal women b. Athletes c. Adolescents d. Hypertensive patients

c. Adolescents

Folic acid deficiency is associated with which group? a. Individuals with celiac b. Pregnant women c. All of the above d. Individuals taking certain medications

c. All of the above -Individuals with celiac -Pregnant women -Individuals taking certain medications

Which of the following foods provide significant amounts of folate in the diet? a. Fish and seafood b. Milk products c. Fresh fruit and vegetables d. Eggs and poultry

c. Fresh fruit and vegetables - Fresh, uncooked fruits and vegetables are good sources of folate, along with legumes, tofu, and organ meats. Poultry, fish, eggs, meat, and dairy products provide small amounts of folate but not as much as fruits and vegetables. Due to fortification, grain products are also significant sources of folate in the United States.

All of the following are basic types of insulin administration regimes except: a. Conventional/standard insulin therapy b. Continuous subcutaneous insulin infusion c. Scheduled intermittent insulin therapy d. Flexible/intensive insulin therapy

c. Scheduled intermittent insulin therapy

Which of the following food groups should be limited to maximize the absorption of iron? a. Meat, fish, and poultry b. Ascorbic acid, tea, and vegetable fiber c. Vegetable fiber, tea, and soybeans d. Fish, unrefined cereals, and egg yolks

c. Vegetable fiber, tea, and soybeans -Vegetable fibers containing oxalates and phytates, such as would be found in unrefined cereals and soybeans, inhibit nonheme iron absorption. The tannin in teas and coffees chelates with iron to form insoluble and unabsorbable compounds. Foods of animal origin provide heme iron, which is more bioavailable than nonheme iron. These foods also provide MFP factor, which increases absorption. Both ascorbic acid and MFP increase absorption of nonheme iron as well.

Which of the following enhances the absorption of dietary iron and iron supplements? a. Calcium-containing foods b. Carbohydrates c. Vitamin C d. Magnesium

c. Vitamin C -Factors in food related to improved bioavailability of iron include heme form, MFP factor, and vitamin C. Factors in food that may decrease bioavailability of iron include chelators such as phytate, oxalate, carbonate, and phosphate, which are often found in fibrous foods; tannins in tea and coffee; phosvitin in egg yolk; and possible competition with other minerals.

The primary cause of anemia that presents in chronic renal failure is a. lack of heme and nonheme iron intake. b. loss of iron through the diseased kidney. c. deficiency of the hormone erythropoietin. d. loss of blood through dialysis.

c. deficiency of the hormone erythropoietin. The kidneys produce the hormone erythropoietin, which is involved in the production of red blood cells. The anemia that results in kidney failure is due to a deficiency of EPO. Ensuring adequate dietary intake will provide adequate iron for hemoglobin formation when synthetic EPO is given to the renal failure patient. The kidneys are not the primary route of iron excretion, and so their failure does not promote iron loss. Dialysis involves minimal blood loss.

Megaloblastic anemia indicates that RBCs are ______ a. mature b. pale color c. large d. small

c. large

Individuals with folate deficiency should consume fresh or uncooked fruits and vegetables because a. all of the above b. they are higher in fiber c. less folate destruction d. they are easy to administer

c. less folate destruction

Research suggests that in order to guard against cancer you should ingest

carotene and vitamin C

If a patient with Type 2 DM receives a nutrition prescription for a 2000 kcal diet, which of the following should be used? a. 50% carbohydrate, 20% protein, 30% fat b. 40% carbohydrate, 30% protein, 30% fat c. 20% carbohydrate, 40% protein, 40% fat d. A macronutrient distribution individualized based on the patient's metabolic profile

d. A macronutrient distribution individualized based on the patient's metabolic profile Prior to 1994, the American Diabetes Association attempted to define optimal percentages of macronutrients for control of metabolic complications of diabetes. However, since then, the ADA's focus has been on individualizing nutrition care to accommodate the patient's lifestyle, culture, and socioeconomic status. When planning for patient diets, the RD should maintain the acceptable macronutrient distribution ranges (AMDRs) established by the DRIs.

Adverse effects of lung disease on nutrition status include which of the following? a. Anorexia b. Difficulty with food preparation c. Increased energy expenditure d. All of the choices

d. All of the choices

Which of the following is NOT a potential acute complication of type 1 DM? Select one: a. Hypoglycemia b. Hyperglycemia c. Ketoacidosis d. Blood vessel damage

d. Blood vessel damage Blood vessel damage may be either microvascular or macrovascular in nature; however, this occurs due to long-term exposure of the blood vessels to the physiologic changes that commonly occur with diabetes, such as hyperglycemia, hyperlipidemia, and hypertension. Hypoglycemia, hyperglycemia, and ketoacidosis are acute complications of diabetes mellitus as each of these can occur rapidly in relation to alterations in the patient's lifestyle, health, or use of medications.

Which of the following is a heme source of iron? a. Bread b. Vegetables c. Eggs d. Fish

d. Fish

Which of the following is NOT a microvascular disease associated with hyperglycemic patients? a. Retinopathy b. Neuropathy c. Nephropathy d. Peripheral vascular disease

d. Peripheral vascular disease Microvascular diseases are ones that affect smaller blood vessels and nerves. Retinopathy, neuropathy, and nephropathy have been the three primary microvascular diseases that develop from uncontrolled diabetes mellitus. Peripheral vascular disease is classified as a macrovascular disease as it involves larger blood vessels.

Phytochemicals, which may influence the development of tumors, are found in

fruits, vegetables, and grains

HbA1c represents the

glycosylation or glycation of hemoglobin in red blood cells. -Glycosylation of hemoglobin is a long-term measure of glucose control. When hemoglobin and other proteins are exposed to glucose, the glucose becomes attached to the protein. The amount of glycosylation that occurs is dependent upon the concentration of glucose in the blood. For every 30 mg/dL increase in plasma glucose concentration, an additional 1% of hemoglobin becomes glycosylated.

Pregnant women commonly experience anemia, primarily because of

increased blood volume

The spread of cancer to distant tissues and organs is called

metastasis

To qualify for a liver transplant, the patient must abstain from alcohol for a period of

six months

Which of the following is NOT a key nutrient for the pulmonary system? a. calcium b. protein c. vitamin E d. iron

vitamin E

Fiber-rich diets are associated with a protection from which type of cancer?

Colon

A patient with asthma has requested advice in terms of food to help their condition. Which of the following would be the best recommendation?

Consume fish to boost omega fatty acids, because these may decrease production of bronchoconstrictive leukotrienes

Which nutrient deficiency is associated with the development of hemolytic anemia?

Vitamin E - Vitamin E is involved in protecting cell membranes against oxidation damage, and one of the signs of vitamin E deficiency is the hemolysis of red blood cells. The cells become fragile and break open. --Iron and vitamin B6 deficiencies result in smaller than normal red blood cells. Folate deficiency is evidenced by large, immature red blood cells.

Tumors can place the patient in

a hyper metabolic state

An adult male may be put at highest risk for iron-deficiency anemia with

a recent blood loss.

Which of the following contributes to the development of type 1 DM? a. Autoantibodies that contribute to the destruction of beta cells b. Insulin resistance and beta cell failure c. Increase in insulin-antagonist hormone levels d. Diet and sedentary lifestyle

a. Autoantibodies that contribute to the destruction of beta cells Immune-mediated diabetes mellitus is the form of type 1 DM that results from autoimmune destruction of the pancreatic beta cells. This results in the patient's inability to produce insulin. Idiopathic type 1 DM is the other form, and it is DM that has no known etiology. Insulin resistance and beta cell failure are what lead to the development of type 2 DM. Diet and sedentary lifestyle can contribute to this development. Gestational diabetes mellitus develops due to an increase in the release of insulin-antagonist hormones during pregnancy. These increased hormone levels contribute to an insulin resistance in the pregnant woman.

Bronchopulmonary dysplasia (BPD) is characterized by all of the following EXCEPT: a. BPD can be avoided in premature infants b. Impaired growth and development of the alveoli c. Needing supplemental oxygen for at least 28 days d. Pulmonary inflammation

a. BPD can be avoided in premature infants

Which of the following may reduce the absorption of iron when consumed in large amounts? a. Coffee or tea with meals b. Leavened bread c. Pork d. Fish

a. Coffee or tea with meals Taken with meals, coffee and tea can reduce the absorption of iron by 50% because of their tannin content. Unleavened breads tend to be higher in phytates, which can chelate iron. The iron in pork and fish tends to be heme iron, and MFP factor in these foods promotes improved absorption of the iron.