Quiz #9
Alana was rushed to the hospital with severe lower left quadrant pain and diagnosed with diverticulitis. What MNT was recommended?
Correct Answer: low-fiber diet Explanation: The MNT for diverticulitis involves a low-fiber diet. An antibiotic is usually prescribed. Sometimes bowel rest is indicated if there is bleeding and/or diarrhea to the let the inflammation of colon resolve. Once the inflammation is resolved it is important to follow a high fiber diet to prevent diverticulitis from reoccurring.
How many cups of vegetables must be provided weekly to meet the School Breakfast Program requirements for grades K-8?
Correct Answer: 0 cups Explanation: Test taking strategy: find the key words Key words: vegetables, weekly, School Breakfast Program The School Breakfast Program provides breakfast daily to eligible students. Only fruit, grains, and fluid milk are required to be provided. Meats/meat alternatives and vegetables are optional.
How much fruit must be provided daily to meet the School Breakfast Program requirements for grades 8-12?
Correct Answer: 1 cup The School Breakfast Program provides breakfast daily to eligible students. Grades K-12 each receive 1 cup of fruit daily, or 5 cups per week.
The minimum number of daily vegetable servings required for children grades 9-12 in the National School Lunch Program is:
Correct Answer: 1 cup The minimum number of daily servings of vegetables required for children grades 9-12 in the National School Lunch Program (NSLP) is 1 cup. The weekly requirement for total vegetables is 5 cups. For grades K-8, the daily requirement of vegetables is 3/4 c
Schools receive funds from the USDA to provide school breakfasts for eligible children at a free or reduced price. The School Breakfast Program (SBP) is required to provide what amount of the RDA in Vitamin A?
Correct Answer: 1/4 The School Breakfast Program (SBP) is required to provide 1/4 the RDA for the following nutrients: protein, Vitamin A, Vitamin C, iron, calcium, and calories. The National School Lunch Program (NSLP) is required to provide 1/3 of the RDA for the above nutrients.
The minimum number of weekly grain servings required for children grades 9-12 in the National School Lunch Program is:
Correct Answer: 10 oz Key words: minimum weekly grain servings, grades 9-12, National School Lunch Program The minimum number of weekly servings of grains required for children grades 9-12 in the National School Lunch Program (NSLP) is 10 oz. The maximum allowed weekly is 12oz. The daily requirement for total grains is 2 oz. Grades K-8 have a minimum of 8 oz of grain required weekly. Grades K-5 have a maximum grain allowance of 9oz weekly, while grades 6-8 have a maximum of 10oz. The daily requirement for total grains is 1oz.
In your TPN order, how many calories are coming from 600 mL per day from a 50% dextrose solution?
Correct Answer: 1020 kcals Explanation: The formulas to follow are • ____ mL X ____ % dextrose solution = ____ g dextrose • ____ g dextrose x 3.4 kcals/g = ____ kcals In TPN calculations, you will need to remember that you use 3.4 kcals per g for dextrose. To convert grams of dextrose to kcals, you simply multiply the grams of dextrose by the 3.4 kcal/g conversion. • 600 mL x 50% (0.50) dextrose = 300 g • 300 g dextrose x 3.4 kcals/g = 1020 kcals
Per Liter of Jevity 1.5 there is 63.8g protein, 49.8g fat, 215.7g carbohydrates, and 760 g free water. How many calories are there per liter?
Correct Answer: 1500 kcal/L Explanation: To calculate the calories per liter, multiply 1000 mL times the kcal/mL of the formula. For Jevity 1.5, multiply 1000 mL x 1.5 mL/kcal and you get 1500 kcal/L.
For dinner, a patient admitted with type 2 diabetes ate a 3 egg omelet, 1 piece of toast with 1T whipped light butter, and 1/2 cup sugar-free gelatin. What is the total number of carbohydrates and calories according to the Diabetes Exchange List?
Correct Answer: 15g carbs and 350 calories Explanation: Test taking strategy: find the key words, eliminate the distractors, Twin Towers Key words: 3 egg omelet, 1 piece of toast, 1T whipped butter, and 1/2 cup sugar-free pudding; total carbohydrates and calories; Diabetes Exchange List Since we have to know total calories, we must include proteins and fats in our calculations. However, 1/2 cup sugar-free gelatin is considered a free food in the Diabetes Exchange List, so we do not need to calculate this. 3 eggs equal 3 medium fat protein exchanges, so you need to multiply the exchange by 3. • Medium fat protein = 0 g carbs, 7 g protein, 5 g fat, and 75 calories • 0g x 3 = 0 g carb • 75kcal x 3 = 225 calories 1 slice of toast equals one starch exchange. • Starch, the "standard exchange" = 15 g carbs, 3 g protein, 1 g fat, and 80 calories 1 T of whipped, light butter is considered one fat exchange. • Fat = 5g fat and 45 calories Now add the carbs together: 15 g (toast) = 15g carbohydrates Now add the calories together: 225 calories (eggs) + 80 calories (toast) + 45 calories (butter) = 350 calories
How many calories are coming from 750 mL per day from a 70% dextrose solution in your TPN order?
Correct Answer: 1785 kcals Explanation: The formulas to follow are • ____ mL X ____ % dextrose solution = ____ g dextrose • ____ g dextrose x 3.4 kcals/g = ____ kcals In TPN calculations, you will need to remember that you use 3.4 kcals per g for dextrose. To convert grams of dextrose to kcals, you simply multiply the grams of dextrose by the 3.4 kcal/g conversion. • 750 mL x 70% (0.70) dextrose = 525 g • 525 g dextrose x 3.4 kcals/g = 1785 kcals
The doctor wants you to calculate how many mL of lipids Mrs. Johannsen is receiving through her TPN. Each day, she is getting 40g in a 20% solution. How many mL do you report to the doctor?
Correct Answer: 200 mL Explanation: The formula to follow is ____ total kcals of lipids needed per day ÷ ____ kcals/mL = ____ mL of lipids/day Start by figuring out how many calories the patient is receiving per day. In parenteral nutrition we use 10 kcals/g. Multiply the 40g by 10 kcal/g of TPN lipids to get 400 kcals per day. Then divide by the kcals/mL of the solution. In this case it is a 20% solution, so divide by the 2 kcal/mL to get 200 mL. Try to remember that kcals of lipids are always going to be a higher number than the mL of lipids.
Alma, the dietary technician at Horizon General Hospital, is following the hospital's protocol on the method of screening patients for nutritional risks. There were so many patients admitted last night that she thinks she might not have time to go through all of them. She wonders if she needs to work overtime or if she can finish the rest tomorrow morning. How many hours does the Joint Commission require a nutrition screening to be completed within?
Correct Answer: 24 Explanation: The Joint Commission is an independent, not-for-profit organizations that accredits and sets standards for the healthcare industry. As stated on the Joint Commissions website, "The standards for nutritional and functional screening clearly state that these are performed when warranted by the patient's needs or condition. Your organization would define in writing the criteria that identify when these screenings and more in-depth assessment are performed. When applicable for the patient's condition, these screenings must be completed within 24 hours after inpatient admission." In short, the healthcare facility can decide what health conditions warrant nutrition counseling and when, but the Joint Commission has set the standard that an assessment of nutritional risk must be completed within 24-hours of admission. For example, a newly admitted patient needing a tube feeding order might need to be seen by a dietitian on day 1 or 2, but a patient admitted for an infected knee injury might not need a consult unless they have been in the hospital for 5 days. Both of these patients were assessed for nutritional risk within 24 hours, but the assigned date that they will be seen by the dietitian was determined by the healthcare facility.
How many cups of fruit must be provided weekly to meet the School Breakfast Program requirements for grades K-5?
Correct Answer: 5 cups Explanation: Test taking strategy: find the key words Key words: fruit, weekly, School Breakfast Program The School Breakfast Program provides breakfast daily to eligible students. Grades K-12 each receive 1 cup of fruit daily, or 5 cups per week.
Question #5: The following lunch menu is created: 3 oz deli ham 1 oz swiss cheese 2 slices rye bread 3 leaves of lettuce 2 slices of tomato 1 T reduced-fat mayonnaise 1/2 cup canned pears 1 cup of skim milk According to the Diabetes Exchange List, how many grams of carbs are in this menu?
Correct Answer: 57g Key words: 2 slices rye bread; 1/2 cup canned pears; 1 cup skim milk; Grams of carbs, Diabetes Exchange List We know deli ham, cheese, and reduced-fat mayonnaise do not contain protein according to the Diabetes Exchange list, therefore we can eliminate these three right away as our distractors. Lettuce and tomato are classified as free foods. We are left with 2 slices of rye bread, 1/2 cup canned pears, and 1 cup skim milk. 2 slices of bread equals two starch exchanges. • Starch, the "standard exchange" = 15 g carbs, 3 g protein, 1 g fat, and 80 calories • 15g x 2 = 30g carbs 1/2 cup of canned pears equals one fruit exchange. • Canned fruit = 15g carbs and 60 calories One cup of skim milk is considered one skim milk exchange. • Skim milk = 12 g carbs, 8 g protein, 0 g fat, and 100 calories Now add the carbs together: 30 g (bread) + 15g (fruit) + 12g (milk) = 57g protein
What is the normal lab value range for measuring pH levels?
Correct Answer: 7.35-7.45 Explanation: The normal lab value range of pH is 7.35-7.45. The lower the number, the more acid in the body. This lab value helps to diagnose respiratory and metabolic acidosis and alkalosis.
How many ounces of grains must be provided weekly at a minimum to meet the School Breakfast Program requirements for grades 9-12?
Correct Answer: 9 oz The School Breakfast Program provides breakfast daily to eligible students. Grades 9-12 will receive 9-10 oz weekly. Grades 6-8 will receive 8-10 oz weekly. Grades K-5 will receive 7-10 oz weekly. Grades K-12 each receive a minimum of 1 oz of grains daily.
A hemoglobin test of ___ with a hematocrit of ___ is indicative of iron deficiency anemia in adult women.
Correct Answer: <10g/dl, <36-44% Explanation: Test taking strategy: find the key words, eliminate the distractors Key words: hemoglobin, hematocrit, iron deficiency anemia, adult women This question requires you to know two different lab values to correctly diagnose iron deficiency anemia. A hemoglobin <12g/dl is considered anemia in people over age 12. A normal hematocrit for men is 41-50%, while a normal hematocrit for women is 36-44%
A patient is prescribed the anticoagulant medication Eliquis. What does an RD need to do differently than if the patient is taking Coumadin?
Correct Answer: Advise the patient that there are no dietary restrictions of vitamin K foods Explanation: Test taking strategy: find the key words, extreme words Key words: anticoagulant, Eliquis, do differently, Coumadin The answers are tricky, especially if you have never heard of the medication Eliquis. In some test taking strategies, it can help to eliminate more extreme words. If you look at the first word in each sentence, the only non-extreme word is "Advise" which also happens to be the right answer in this question. The medication Warfarin (aka Coumadin) is considered an anticoagulant and considered a vitamin K antagonist. In a nutshell, the medication Inhibits vitamin K epoxide reductase leading to lower levels of Vitamin K. Consequently, the medication indirectly affects the vitamin K dependent coagulation factors (proteins in the blood that help to control bleeding). Ingestion of high vitamin K foods sources can reduce or reverse the effect of the drug within 6 to 12 hours. Too much vitamin K decreases the effect of the drug and vice versa. It is very important to maintain a CONSISTENT intake of vitamin K. Also, avoid excessive vitamin E intake or supplementation because it increases the risk of a vitamin K deficiency by inhibiting its metabolism and increasing its excretion. Newer anticoagulant drugs have been approved by the FDA that DO NOT require vitamin K dietary restrictions since they are not vitamin K antagonists. Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban) are anticoagulant medications that directly target one coagulation factor, either thrombin or activated factor X. These new medications do not require monitoring of vitamin K intake.
Bly has CKD and reports pale skin, chronic fatigue, and heart palpitations. What complication of CKD does Bly likely have?
Correct Answer: Anemia Explanation: Test taking strategy: find the key words, eliminate the distractors Key words: CKD, pale skin, chronic fatigue, heart palpitations Because the kidneys are responsible for producing erythropoietin (EPO), Bly likely has anemia. EPO stimulates the bone marrow to produce red blood cells. While diabetic neuropathy, hypertension, and osteoporosis are all complications of CKD, they do not match the provided symptoms.
Jackson takes 2mg Metformin daily. What kind of medication is this?
Correct Answer: Antihyperglycemic Explanation: Metformin is used to treat high blood sugars in diabetic patients.
A patient with gout lists some of his favorite meals. Which one can he still eat without limits?
Correct Answer: Avocado toast with a banana Explanation: Test taking strategy: find the key words, eliminate the distractors Key words: gout, without limits A patient with gout should follow a low-purine diet. Foods that tend to be high in purine are animal-based. Very high purine containing foods include red meat, organ meats like liver, sweetbreads, and kidney, and seafood such as anchovies, sardines, and shellfish. The only meal that is not animal-based and completely low in purines is the avocado toast with a banana.
Josie is taking the medication Orlistat. What dietary recommendation do you provide?
Correct Answer: Avoid a high fat diet Remember this mnemonic: Give him some Orlisat. Watch his vitamins with Fat. Orlistat rhymes with fat. Orlistat is a lipase inhibitor that is intended for weight loss. It prevents dietary fats from being absorbed, therefore you need to recommend a diet low in fat and to avoid a high-fat diet. It also decreases the absorption of fat-soluble vitamins.
When solids are first introduced to an infant, which of the following should be tested first?
Correct Answer: Baby cereal Explanation: Test taking strategy: find the key words Key words: solids, first, infant Infants are typically introduced to solids between 4-6 months. Infant cereal that is iron-fortified is the best first introductory choice. This is especially important in fully breastfed infants, whose iron stores decrease by 4 months, since breastmilk is not iron-fortified. Fruits and vegetables should be introduced one at a time after the baby cereal to check for allergies. White rice is not an appropriate choice, though it may look appealing, since it is recommended for infants to eat iron-fortified infant rice cereal.
Jason's mother is complaining about how Jason is such a picky eater. She notes that he has Autism and tries to introduce him to new foods. Which food is Jason most likely to avoid on his dinner plate?
Correct Answer: Broccoli Explanation: Children diagnosed with autism tend have picky eating issues especially when it comes to the tastes and textures of food. They tend to avoid some fruit but they especially avoid vegetables.
Marjorie is receiving TPN while recovering from a bowel obstruction and receives lipids daily. Marjorie's nurse calls you this morning and reports that her triglycerides are at 306mg/dL. Nursing asks if they should hold the TPN. What do you recommend?
Correct Answer: Continue TPN and adjust lipids to be provided 3x week Explanation: Sometimes, patients on TPN can have abnormally high triglyceride levels. TPN lipids should be completely held/discontinued if triglycerides are >= 400mg/dL. However, 306mg/dL is still considered a normal range, and neither TPN nor lipids need to be held at this time. It may be wise to reduce to 3x per week and monitor triglycerides closely. It would be helpful to create a new TPN calculation reducing the overall total volume of lipids if triglycerides continue to increase.
A client takes furosemide to manage his hypertension. The most appropriate nutrition intervention is to:
Correct Answer: Encourage the client to eat more cantaloupe Explanation: Test taking strategy: find the key words, eliminate the distractors Key words: Furosemide, hypertension, nutrition intervention Furosemide is a loop diuretic to treat HTN via the sodium-potassium pump. Because this is not a potassium sparing diuretic, this client is likely to lose more potassium and may need to consume higher potassium foods. Cantaloupe is the only food item in the responses that is high in potassium. Oranges are high in Vitamin C, carrots are high in Vitamin A, and bread contains several B vitamins.
When are nutrient needs the highest per kilogram of bodyweight?
Correct Answer: Infancy Infants require nutrient needs higher per kilogram of bodyweight than at any other time due to their rapid growth. Remember, birthweight doubles by 5 months of age, and most of human growth occurs between the womb and 1 year of age.
Laurie frequently gets urinary tract infections, but came to the ER complaining of nausea, vomiting, painful urination and blood in her urine. The most appropriate nutrition intervention is to:
Correct Answer: Initiate a high calcium diet Explanation: Test taking strategy: find the key words, eliminate the distractors, echo options Key words: urinary tract infection, painful urination, blood in urine; appropriate nutrition intervention Laurie likely has nephrolithiasis, or kidney stones. These stones are a result of abnormal crystallization of calcium, oxalate, uric acid, or other minerals that aren't normally excreted in the urine. Sometimes gout or UTIs can cause kidney stones. Symptoms include hematuria (bloody urine), nausea, vomiting, and painful urination. Nutrition recommendations include consuming >3L fluid daily, high calcium diet, the DASH diet, or higher f/v intake and less animal protein.
Which nutrient deficiency is commonly found in an individual newly diagnosed with celiac disease?
Correct Answer: Iron Due to malabsorption in the small intestine, an individual newly diagnosed with celiac disease may have nutrient deficiencies of iron, folate, niacin, vitamin B-12, calcium, fiber, and the fat-soluble vitamins A, D, E, and K.
Leroy is the star of his track team. He recently learned that his ferritin level was 11 ng/mL. Which of the following should he include in his diet?
Correct Answer: Legumes, liver, fish, collard greens Explanation: Ferritin is the primary storage form of iron in cells. The normal range is approximately 12-150 ng/mL for adult females and 12-300 ng/mL for adult males. Because Leroy has low ferritin, he should include foods that are a good source of iron. Iron is found in a variety of foods. Animal sources include beef, chicken, liver, fish, and egg yolks. Plant sources include green leafy vegetables (collard greens, spinach), legumes, and enriched grain products (cereals, fortified breads). "Liver, fish, whole grains, bananas" this answer has good food choices for a runner, but bananas are a good source of potassium, not iron. Remember to answer based off the key words in the question! "Legumes, liver, fish, collard greens" includes foods that are all good sources of iron. "Collard greens, lentils, apples, cherries" includes apples and cherries which are not the best sources of iron. "Eggs, potatoes, chicken, beef" contains potatoes, which are not the best sources of iron.
A patient has Stage 2 chronic kidney disease and takes medication for hypertension. What is an appropriate list of foods that supports management of both conditions?
Correct Answer: Lentils, watermelon, apples, fish Nutrition clients frequently must manage multiple conditions that have differing nutrition interventions. With CKD Stage 2, it is important to limit dietary phosphorus intake. Since this person also takes an anti-hypertensive medication, we can assume that he also needs to monitor his potassium. Foods high in phosphorus include highly processed foods like fried chicken and deli meats, dark colas, dairy products, nuts, and hot dogs. Foods low in phosphorus include chicken, fish, eggs, white bread, apples, root beer, and lemon lime soda. High potassium foods include oranges, bananas, cantaloupe, dried fruit, potatoes, and tomatoes. Low potassium foods include berries, apples, cherries, peaches, grapes, and watermelon. Lentils, watermelon, apples, and fish is the only list that contains low potassium and low phosphorus items.
You are the dietitian on call this weekend and are filling out a TPN order. Pharmacy calls and asks if you want this as a 2-in-1 or 3-in-1 solution. What is the difference?
Correct Answer: Lipids are in a separate bag in a 2-in-1 solution, while dextrose, amino acids, and lipids are all in the same bag in a 3-in-1 Explanation: When creating a TPN bag, some pharmacies can create a 2-in-1 solution or a 3-in-1 solution. A 2-in-1 solution has amino acids and dextrose together and then "piggybacks" with a prepackaged lipid bag. If the pharmacy uses their own lipids, they will create a 3-in-1 solution, where all 3 macronutrients are together in 1 bag.
Appropriate nutrition intervention for an individual with cystic fibrosis does not include which of the following?
Correct Answer: Low fat diet There are three appropriate nutrition interventions for cystic fibrosis in this question: a high fat and salt diet, and pancreatic enzyme replacement therapy, which replaces enzymes that help digest carbohydrates, protein, and fat in the foods that are eaten. It helps to treat fat malabsorption and steatorrhea that are typical symptoms from cystic fibrosis. Looking at the question, we see 2 responses that are opposite. It is likely that one of these is the correct answer.
What lab results is respiratory alkalosis typically characterized by?
Correct Answer: Low pCO2 <35, elevated pH >7.45 Explanation: Respiratory acidosis and respiratory alkalosis occur when the pulmonary system has issues and the kidneys are called in to action to help compensate. Respiratory alkalosis has a pCO2 level below 35 and a pH value above 7.45. The kidneys would secrete bicarbonate and the patient would be hyperventilating.
Individuals with phenylketonuria will need to consume this type of diet:
Correct Answer: Low protein Phenylketonuria (or PKU) is an inherited disorder, where there is a lack of phenylalanine hydroxylase that catabolizes phenylalanine into tyrosine. Phenylalanine then accumulates in the body. These amino acids are found predominantly in protein foods, such as meat, fish, poultry, eggs, dairy products, legumes and nuts. They are also found in many grains and starchy vegetables, such as pasta, bread, potatoes, peas, and corn; however, it is not necessary to consume a low carbohydrate diet. An individual will need to consume a carefully constructed low protein diet to prevent phenylalanine accumulation from occurring.
A patient comes to your office who is taking an MAO Inhibitor. What dietary recommendation do you provide?
Correct Answer: Low tyramine diet Explanation: Test taking strategy: find the key words, echo options Key words: MAO Inhibitor, dietary recommendation Remember this mnemonic: avoid Meat And Other Indulgences The echo options are the high and low tyramine diet. It is likely that the answer is one of these opposite choices. When taking a MAO Inhibitor, also known as Phenelzine (Nardil) or Isocarboxazid, to help relieve depression, a low tyramine diet is necessary. The medication blocks the enzyme that breaks down excess tyramine which can lead to a build up. Tyramine is an amino acid that helps regulate blood pressure, so excess can lead to a dangerous spike in blood pressure. The recommendation is to avoid high tyramine foods, including hard/aged cheeses, processed meats, alcohol, and soy.
Your patient was prescribed 4 new medications. Which one would require counseling by an RD?
Correct Answer: MAOI (Monoamine oxidase inhibitor) and tyramine containing foods It would be great if our patients on each of these medications sought nutritional counseling, but in reality, the only one that requires nutritional counseling is the MAOI (Monoamine oxidase inhibitor) and tyramine containing foods. When taking a MAO Inhibitor, also known as Phenelzine (Nardil) or Isocarboxazid, to help relieve depression, a low tyramine diet is necessary. The medication blocks the enzyme that breaks down excess tyramine which can lead to a build up. Tyramine is an amino acid that helps regulate blood pressure, so excess can lead to a dangerous spike in blood pressure. The recommendation is to avoid high tyramine foods, including hard/aged cheeses, processed meats, alcohol, and soy. Meat protein intake is very important to discuss with a patient who has CKD based edema and prescribed Lasix, but in this answer we only know the patient was prescribed Lasix and we do not know why.
If a patient was prescribed a new medication, which one would require counseling by an RD?
Correct Answer: MAOI (Monoamine oxidase inhibitor) and tyramine containing foods Remember this mnemonic: avoid Meat And Other Indulgences It would be great if our patients on each of these medications sought nutritional counseling, but in reality, the only one that requires nutritional counseling is the MAOI (Monoamine oxidase inhibitor) and tyramine containing foods. When taking a MAO Inhibitor, also known as Phenelzine (Nardil) or Isocarboxazid, to help relieve depression, a low tyramine diet is necessary. The medication blocks the enzyme that breaks down excess tyramine which can lead to a build up. Tyramine is an amino acid that helps regulate blood pressure, so excess can lead to a dangerous spike in blood pressure. The recommendation is to avoid high tyramine foods, including hard/aged cheeses, processed meats, alcohol, and soy. The other answers could also be ruled out by process of elimination. Grapefruit does not actually affect Metformin. A consistent amount of Vitamin K is needed for Coumadin and B-12 containing foods are not relevant. Meat protein intake is very important to discuss with a patient who has CKD based edema and prescribed Lasix, but in this answer we only know the patient was prescribed Lasix and we do not know why.
Which of the following foods is most appropriate for a 9-month-old infant?
Correct Answer: Mashed banana Explanation: Test taking strategy: find the key words Key words: most appropriate food, 9-month-old Children under age 5 (<60 months) are at increased risk of choking on food and food-borne illnesses. Small, firm foods like nuts, seeds, popcorns, raw vegetable chunks are choking hazards. So are slippery foods such as grapes, berries, cherries, large pieces of meat, and hard candies. Finally, sticky foods, like peanut butter, gum, marshmallows, and dried fruits should also be noted as a choking hazard. Carrots are an obviously wrong choice here; while graham crackers might seem appealing, at this age, grain products should be able to melt in the infant's mouth. Graham crackers are made with whole wheat flour and are inappropriate at this age. Sliced grapes may be safe, but the most appropriate and safest option is the mashed banana.
Terrance is at a nutrition counseling session and reports eating oatmeal with sliced banana every day for breakfast. His breakfast is what kind of food?
Correct Answer: Medium glycemic Picking foods with a low glycemic index have less of an impact on an individual's blood sugar. These include non-starchy vegetables, most fruits, some beans, legumes, dairy products, and bran. Medium glycemic index foods include starchy vegetables, higher sugar fruit such as bananas and pineapple, oatmeal, and orange juice. Potatoes, white rice, honey, maple syrup, and sandwich bread are some typical foods with a high glycemic index.
An individual with uncontrolled type 2 diabetes is admitted for hyperglycemia. It is clear this patient has both macro- and micro-vascular complications. Which of his medical conditions is a microvascular complication?
Correct Answer: Nephropathy Retinopathy, neuropathy, and nephropathy are all microvascular complications of diabetes. Peripheral vascular disease, myocardial infarction (heart attack), hypertension, and dyslipidemia are all macrovascular complications.
While in the hospital, Brian will need to be fed via the vein for 2 days until his procedure. Then he will hopefully be able to eat solid food again. The doctor orders what type of nutrition support?
Correct Answer: Peripheral Parenteral Nutrition (PPN) Explanation: When the gut works the number one choice is enteral nutrition. When the gut is not functioning, parenteral nutrition is needed as in this case. •Total Parenteral Nutrition (TPN) provides an appropriate balance of nutrition that includes proteins, carbohydrates, fats, vitamins, minerals, electrolytes, and water. Total parental nutrition, or TPN, needs a Peripherally Inserted Central Catheter, also known as PICC line, inserted into a large vein and can be used long-term. • Peripheral Parenteral Nutrition (PPN) is administered through an IV into the smaller veins and is a short-term solution for up to 5-7 days. PPN feeds are hypocaloric and high in fat, which is isotonic, to keep osmolarity less than 900 milliosmoles per L. We can't feed patients as much due to the smaller vein sizes as overfeeding can lead to phlebitis, or vein inflammation.
Georgina is admitted with sepsis. Her laboratory results are: BUN 50mg/dl, serum creatinine 2.4mg/dl, and serum phosphorus 6.2mg/dl. Assuming she can tolerate PO intake, what is the best nutrition recommendation at this time?
Correct Answer: Place her on a high protein diet From the provided info, Georgina has an acute kidney injury (AKI) as well as sepsis. This is determined by the elevated renal labs. Since she can tolerate PO intake, a tube feed is inappropriate at this time. While a liberalized, protein restricted diet may look appealing, it is inappropriate at this time. For AKI nutrition therapy, a higher calorie diet without a protein restriction is recommended due to hypercatabolism. Patients may require upwards of 1.5g/kg protein if on dialysis while hypercatabolic. It is also inappropriate to place her on a renal diet, as this limits her protein intake as well.
At the hospital, Alfonzo was placed on Haloperidol to treat Schizophrenia. What is he at risk for while taking this prescription medication?
Correct Answer: hyperglycemia Remember this mnemonic: Hal is struggling with schizophrenia. He has gained weight and needs to give up his Starbucks treats. The antipsychotic medications, Haloperidol (Haldol) and Risperidone (Risperdal), as a side effect can increase appetite and lead to weight gain. They can also impair glucose regulation by decreasing insulin action leading to hyperglycemia. • Echo options: If two options are opposite, it's likely one of them is correct. In this question you have the choice of HYPOglycemia and HYPERglycemia.
Jake is a competitive runner and had a race on a very hot day. He collapsed when he was finished and it was found his blood pressure was dangerously low. He reports not consuming any sports drinks and only water on his runs. In the body, what enzyme should be secreted to fix this blood pressure issue?
Correct Answer: Renin In the kidneys, there are two main ways to increase blood pressure: Vasopressin, or antidiuretic hormone, or renin and aldosterone. Vasopressin is released when blood pressure is low, because it increases water reabsorption in the kidneys. This allows blood volume to increase, raising the blood pressure. It is not influenced by sodium levels. Renin is also secreted from the kidneys when hyponatremia occurs, which stimulates aldosterone to increase sodium absorption and return blood pressure to normal. Jake ran on a hot day, losing salt through his sweat. It's also reported that he did not replenish his salt stores with a sports drink. It is likely that Jake is hyponatremic in this situation. Since his blood pressure his low and he is hyponatremic, renin is the correct answer. Erythropoietin (EPO) helps produce red blood cells and is a distractor answer.
Which of the following foods is not classified as a lean protein according to the Diabetes Exchange List?
Correct Answer: Ricotta cheese According to the Academy of Nutrition and Dietetics Choose Your Foods: Exchange List, salmon, organ meats, and ham are all classified as lean protein. Ricotta cheese is classified as a medium-fat protein.
The renal system provides numerous functions in maintaining the body's homeostasis. Which of the following is not a function of the renal system?
Correct Answer: Secretion of wastes in the urine The renal system does not secrete wastes in the urine, but rather it excretes those wastes. The renal system is also responsible for hormone secretion, filtration of our red blood cells and proteins, reabsorption of glucose and amino acids, as well as water, sodium, and potassium in maintaining electrolyte balance.
You are participating in rounds at your hospital and note a patient was admitted with kwashiorkor. If you perform a NFPE, what will you likely find?
Correct Answer: Swollen stomach and limbs Explanation: A person with Kwashiorkor will have edema, especially in the abdomen. This a result of the body being unable to maintain fluid balance due to the low protein levels.
Which of the following foods is appropriate for a person with celiac disease to consume?
Correct Answer: Tapioca Gluten is found in wheat, barley, and rye. Gluten can also be located under many hidden names, such as modified food starch, vegetable protein, and dextrin. Couscous is made from semolina, or durum wheat, and is not gluten free. Foods that are safe to consume are all whole fruits and vegetables, corn meal, potato flour, soy and soybeans, rice, tapioca, arrowroot, quinoa, chia and flax seeds, and unprocessed nuts, nut butters, and seeds.
A patient with chronic kidney disease is on hemodialysis. Recent laboratory results have returned as follows: BMI 21 BP 140/80 mm Hg BUN 40mg/dl Serum potassium 3.4 mEq/L Serum phosphorus 5.8mg/dl Serum calcium 8.2mg/dl Hgb 9.5mg/dl What recommendations should the dietitian make to improve these laboratory values?
Correct Answer: Use an iron supplement Explanation: Test taking strategy: find the key words, eliminate the distractors, echo options Key words: CKD on hemodialysis, BUN 40mg/dl, Hgb 9.5mg/dl; improve lab values This patient is on hemodialysis and the electrolytes are stable at this time. This means we can remove the diuretic and phosphate binder. The most concerning lab value is low hemoglobin. Anemia is common in patients with CKD due to the decreased EPO production in the kidneys. Consuming iron-rich foods is not enough to improve these labs; an external supplement is recommended, likely taken intravenously.
A 75-year-old woman presents with the following diagnoses: iron deficiency anemia, Parkinson's disease, Type 1 Diabetes, and chronic fatigue syndrome. She takes Levodopa, Levemir, and Lovastatin. From the provided choices, what is the most likely cause of her anemia?
Correct Answer: Use of Levodopa Explanation: Test taking strategy: find the key words, eliminate the distractors Key words: 75-year-old woman, iron deficiency anemia, Parkinson's disease, chronic fatigue syndrome; MOST likely cause of anemia The correct answer is Levodopa. Levodopa is a common medication used to treat Parkinson's and is known to interfere with iron absorption. While a diet low in iron-rich foods is a possible answer, the question does not give us any information about her diet. Heavy menstrual bleeding could lead to an iron deficiency; however, Jezebel is past the age of menopause, so she is unlikely to be anemic due to menstrual bleeding. Levemir is a type of long-acting insulin, and is not known to interfere with iron absorption.
Natalie feels faint and her lab results indicate the following: blood pressure level of 90/58 mm Hg and serum sodium 137 mEq/L. Which of the following hormones should be released to increase her blood pressure?
Correct Answer: Vasopressin (ADH) Explanation: Test taking strategy: find the key words, eliminate the distractors Key words: BP 90/58 mmHg (hypotension), serum sodium 137mEq/L (WNL), which hormone will increase blood pressure In the kidneys, there are two main ways to increase blood pressure: Vasopressin, or antidiuretic hormone, or renin and aldosterone. Renin is secreted from the kidneys when hyponatremia occurs, which stimulates aldosterone to increase sodium absorption and return blood pressure to normal. Since Natalie's sodium is WNL, renin is not the answer. Vasopressin can also be released when blood pressure is low, because it increases water reabsorption in the kidneys. This allows blood volume to increase, raising the blood pressure. It is not influenced by sodium levels, so vasopressin is the correct answer.
Josie, Martin, and Vernon are all at the doctor's office. Based on demographics only, who is at highest risk of having chronic kidney disease? Josie is a 66-year-old Caucasian woman. Martin is a 55-year-old Hispanic man. Vernon is a 70-year-old African American man.
Correct Answer: Vernon Patients at higher risk for CKD include those with ethnic backgrounds, such as African Americans, Native Americans, and Hispanics as well as those over 65 years old. According to the CDC, women are at higher risk than men to get CKD, but some research is showing that men are actually more likely to reach renal failure first. Vernon has the highest risk of a CKD diagnosis because he is an African American man AND is over the age of 65. Josie is over the age of 65, but does not have a concerning ethnic background. Martin has an at risk ethnic background, but is not yet 65.
Diabetic ketoacidosis typically displays this unusual symptom:
Correct Answer: fruity breath odor Explanation: Diabetic ketoacidosis is caused by hyperglycemia due to insulin deficiency or excess carb intake. It is treated with insulin and rehydration. Patients often have a fruity, ketone, odor.
When a patient is taking the medication Warfarin, what is an important dietary recommendation?
Correct Answer: maintain a consistent vitamin K intake Remember this mnemonic: At WAR with blood clots. There are two answers that refer to vitamin K, so one is more likely to be correct. Warfarin (aka Coumadin) is an anticoagulant used to help prevent blood clots. Too much vitamin K decreases the effect of the drug and vice versa. It is very important to maintain a CONSISTENT intake of vitamin K. Also, avoid excessive vitamin E intake or supplementation because it increases the risk of a vitamin K deficiency by inhibiting its metabolism and increasing its excretion.
Elijah had an episode of hypoventilation and vomiting and attributed it to some bad fish he recently ate. The ER doctor checked his lab results, and the bicarbonate level was elevated at 31 and the pH was is elevated at 7.5. What was Elijah diagnosed with?
Correct Answer: metabolic alkalosis Explanation: Metabolic acidosis and metabolic alkalosis occur when the kidneys respond to an imbalance and the pulmonary system is called in to action to help compensate. Metabolic alkalosis is a condition of high pH >7.45 and a high bicarbonate > 29. The kidneys respond by releasing excess bicarbonate. The lungs compensate through hypoventilation and retain carbon dioxide in the blood.
Your patient has tuberculosis and is on the prescription medication Isoniazid. You recommend supplementation of what vitamins?
Correct Answer: niacin and vitamin B6 Remember this mnemonic: Be careful to Isolate tuberculosis Isoniazid is a prescription antibiotic that is mainly used to treat tuberculosis. This medication can cause pellagra, a niacin deficiency, and a vitamin B6 (pyridoxine) deficiency. Vitamin B6 (pyridoxine) supplementation during isoniazid (INH) therapy is necessary in some patients to prevent the development of peripheral neuropathy.
You are a dietitian in the ICU at Memorial Hospital. Your patient's mother asks you why her daughter is not receiving the full amount of nutrition through her PPN? You explain to the mother that ____ is a risk factor of providing excess PPN.
Correct Answer: phlebitis Explanation: PPN uses hypocaloric, very dilute solutions of less than 900 milliosmole per L due to the small vein sizes. If used improperly, phlebitis, or vein inflammation, can occur. Phlebitis will occur before any additional feeding or nutrition issues and must be properly addressed to maintain maximum safe nutrition status.
Which of the following is not a sign or symptom of anorexia nervosa?
Correct Answer: rectal bleeding Explanation: Rectal bleeding is a sign of bulimia nervosa as this can occur as a result of excess laxative intake.
