ADA Test Questions

8. Kwashiorkor patients have all of the following characteristics except? A.loss of somatic B. Preservation of stomatitis stores C. Loss of visceral protein stores D. Large, protruding abdomen

A. A loss of somatic stores. Kwashiorkor is malnutrition from lack of amino acids. It usually affects weaned children between 12 months and 3 years old in third world countries with famine, drought, political unrest or traditional eating habits. The victim's diet is protein - deprived. Most calories are derived from a restricted carbohydrate source, such as corn or sugar water. Kwashiorkor is uncommon in the US, WHERE IT APPEARS ONLY IN SEVERLY ABUSED CHILDREN AND NEGLECTED NURSING HOME RESIDENTS. THE MAIN Characteristics include preservation of stomatitis or fat sources and loss of visceral protein stores. The signs and symptoms are: a large, protruding belly;significant edema;changes in hair and skin pigment;skin rash; fatigue;irritability; diarrhea and decreased immune function. Victims never reach their height potential.

20. The Mini NutritionalAssessment (MNA) is: A. A validated nutrition screening and assessment tool to identify the presence or risk of malnutrition in patients 65 years or older. B. A validated nutrition screening and assessment tool to identify malnutrition in infants and children. C. A nutrition screening tool used to enroll elderly patients into appropriate food assistance programs. D. A nutrition screening tool that identifies children and their families who require enrollment into food assistance programs.

A. A validated nutrition screening and assessment tool to identify the presence or risk of malnutrition in patients 65 and older. The Mini Nutritional Assessment (MNA) is a toll developed for people over age 65 to screen for malnutrition. The MNA IS AN. EASY, VALIDATED TOOL THAT PROVIDES TALKING POINTS FOR practitioners to obtain additional necessary information, when indicated. MNA helps to identify malnutrition in the elderly, to enable nutrition intervention and to prevent worsening of the condition. Age, gender, weight, height, food intake,weight loss, mobility level, presence of stress, change in disease status, change in mental capacity, living situation, changes in mental capacity, living situations, prescription drug use, and skin condition.

58. The nutrition care process is documented on the following forms: A. ADIME OR PGIE B. SOAP OR PAR C. PIE OR PAR D. PGIE OR ADIOP

A. ADIME or PGIE Documentation of the nutrition care process may include one of six formats using acronyms. It helps to incorporate the PES statements, interventions, monitoring and evaluation as a part of the nutrition care process. The first is called ADIME and shards for Assessment, Diagnosis,or PES Statement, Intervention and Evaluation. The second is PGIE which stands for Problem or diagnosis,Goal,Intervention and Evaluation. Nest is SOAP, which stands for Subjective, Objective,Assassment/diagnosis and Plan. DAR stands for Data/diagnosis, Action /nutrient prescription / nutrition intervention and Response. This can also be documented as DAR-O if it includes output. Lastly, PIEis another format that stands for Problem/diagnosis,Intervention and evaluation.

13. Which of the following statements best describes a normal infant's growth during the first year of life? A. An infant loses weight initially after birth, regains it by Day 10, doubles birth weight by 6 months, triples. Birth weight and doubles length by his/her first birthday. B. An infant loses weight initially after birth, regains it by Day 10, doubles birth weight by 4 months, quadruples weight by and triples length during the first year. C. After birth, the growth of an infant depends solely on the nutrition he/she receives. D. The growth, percentiles determine at birth the best predictor of an infants growth during infancy and childhood.

A. An infant loses weight initially after birth, regains it by Day 10, doubles birth weight by 6 months, triples birth weight and doubles length by his/her first birthday. An infant's birth weight is determined by gestational age, mother's weight before pregnancy, and weight gain during the gestation period. It's normal for a newborn infant to lose up to 10% of its birth weight in the first few days of life. This is not cause for concern, unless the infant continues to lose weight after the tenth day of life. Most infants doubles birth weight by 6 months and triple it by their first birthday. Length usually doubles within the first year. Weight gain and growth are influenced by both nutrition and genetics. The growth percentiles determined at birth are not usually the best indicators of overall growth. The. Majority of infants settle into their own growth curve somewhere between 3 and 6 months of age.

87. The lowest quality of beef is? A. Canner B. Cutter C. Select D. Choice

A. Canner. Inspectors grade beef according to its tenderness, amount of marbling, and flavor. Only certain types of cattle are eligible to quality for each grade. For example,meat obtained from mature cows cannot be prime grade. Only meat must from steers or heifers of a certain age and specification qualify for prime grade. The eight grades of meat are: Prime, Choice, Select, Standard, commercial, Utility, Cutter and Canner. The lowest three grades of beef are rarely used is commercial food service eatablishments. Manufactures use cheap cuts for highly processed products such as hot dogs or canned corned beef.

122. A food manager is least likely to evaluate customer satisfaction in the hospital cafeteria by: A. Enterance interviews B. Customer surveys C. Talking to customers at the end of their meals D. Customer comment cards

A. Entrance interviews. The food service manager can evaluate the food service operation by customer perception. Customers determine if they are satisfied as they are eating. Entrance interviews do not capture any real information because the customer has not yet selected food and eaten it. Exit interviews or talking to customers I the dining area are preferable ways to obtain useful information. However, personal exit interviews are difficult when the customer is ready to leave an appointment. Use customer surveys or customer comment cards, instead. Hand the cards to the customers as they leave and ask them to return the cards at a specific place, likely an anonymous suggestion box. Limit the card to a few questions. All customers should answer exactly the same questions. Usually, only customers who are very happy or very upset complete a survey. Therefore, the results could be skewed.

6. Which of the following statements about excessive protein intake is false? A. Excessive protein intake is difficult to achieve and therefore is not a danger. B. Excessive protein intake increases calcium excretion, which can potentially lead to osteoporosis. C. Excessive protein in the diet is broken down in the kidneys and excreted in the urine as urea. D. Excessive protein intake will not help an athlete build more muscles, but will instead convert into fat, if it is not used as an energy source.

A. Excessive protein intake is difficult to achieve and therefore, is not a danger. The majority of Americans consume protein in excess of requirements. Many people consume at twice as much as thy need. So,e excess protein become a calorie source or converts to fat. Studies demonstrated an increase in calcium excretion related to an increase in protein intake, especially animal protein, due to acidified blood. As the digestive system breaks down the large amounts of protein the bones release calcium to neutralize the blood. Acidified blood leads to osteoporosis in predisposed people. Normally functioning kidneys excrete nitrogenous wastes, including urea derived from the breakdown of protein. Athletes often consume more protein in the false hope that it will build bigger muscles. There is no benefit to massive protein intake. Actual muscle development results from exercise, weight training and proper nutrition.

80. Select the major reason an institution implements a no selective or preselected menu: A. Financial B. Quality C. Balanced diet D. Catering for special request

A. Financial . Healthcare institutions implement nonselective or preselected menus for financial benefit. Dietary staff or the ward clerk visits the patient on admission to obtain food preferences and potential allergies. A computer generated menu is released for the patient each day, based on the master menu that has already been planned. Labor costs are reduced because the patient is not seen by staff every day for menu selection. Fewer personnel are required for food production and the tray. Line. Non selective and preselection are limiting the menu to a few main items provides a balanced diet and allow excellent preparation of specialities.

93. Which form of hepatitis do infected food service workers transmit? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis E

A. Hepatitis A is inflammation the liver caused by one of five viruses. The five known types of Hepatitis A, B, C, d, and E. Usually hepatitis A spreads through contaminated food or water. Sometimes it spreads through oral/anal contact with an infected person. Hepatitis A spreads quickly in food services establishments when an infected employee does not wash his/her hands thoroughly after using the bathroom. The incubation period for Hepatitis A is 28 days. Hepatitis A is transmit table for 2 weeks before these symptoms appear : fever, anorexia, nausea; abdominal pain; and jaundice. Instruct any food service worker infected with Hepatitis a to stay out of work at least 2 weeks after symptoms appear. Most people who get Hepatitis A recover completely. Hepatitis E spreads through infected water. Hepatitis B, C and D spread through infected blood or sexual contact with an infected person. Twinrix vaccine prevents the spread of hepatitis A and B only and Employee Health offers it free to hospital workers.

46. Choose the appropriate treatment for hypoglycemia: A.if the patient's blood glucose level is less than 70 mg/dl, give 4 ounces of juice or 1 tablespoon of sugar. Recheck the patient's blood glucose level in 15 minutes. If the level remains less than 70 mg/dl, give another 15 mg of carbohydrate B. If the patient's blood sugar is less than 70mg/dl, give 8 ounces of juice or 6 glucose tablets. Recheck the blood glucose in 30 minutes. If the level remains less than 70 mg/dl, give another 15 to 30 grams of carbohydrates C. If the patient's blood glucose level is less than 70mg/dl, give 8 oz of juice or 4 glucose tablets. Recheck the blood glucose level in 30 minutes. If the level remains less than 70mg/dl, give another 15 to 30 gm of carbohydrates D. If the patient's blood glucose level is less than 70 mg/dl, give 8 ounces of juice or 10 to 12 lifesavers. Recheck the blood glucose level in 15 minutes. If the level remains less than 70mg/dl give another 15 to 30 grams of carbohydrates.

A. If the patient's blood glucose level is less than 70 mg/dl, give 4 oz of juice or 1 tablespoon of sugar. Recheck the patient's blood glucose in 15 minutes. If the level remains less than 70 mg/dl, give another 15 gm of carbohydrates. A blood glucose level is less than 70mg/dl is hypoglycemia and requires immediate attention. Use the Rule 15 to remember the treatment guidelines: if the blood glucose level is low give 15 gm of carbohydrates. For example 4 oz of juice or sugary beverage,3 to 4 glucose tBlets, 6 to 8 lifesavers or 1 tablespoon of sugar or honey. Recheck the blood glucose level again in 15 minutes and if it is still low give another 15 grams of carbohydrates. Recheck the blood glucose level again in 15 minutes. Blood glucose levels may drop again within the hour. Therefore, if a meal or substantial snack is not planned within the hour, give another 15 grams of carbohydrates.

68. All of the following techniques are appropriate for the client who resists dietary changes except: A. Ignore the individual's perception B. Be empathetic to the client's issues C. Recognize cultural factors that create resistance to change D. Prevent the client from becoming defensive about his or her lack of motivation.

A. Ignore the individual's perception. An effective counselor recognizes certain behaviors on the dietitian's part influence the client behavior. The RD should always try to be empathetic when a client expresses concerns about implementing change. Empathy is an important toll for effecting change. Cultural issues have a significant impact on change and the RD should be aware of these. For example, Koreans may automatically agree with everything someone in charge says, even though they may have no intention of implementing any of the suggestions. The RD must not place the client in a position where he/she becomes defensive. The RD tries to offer support and encouragement. An impasse means a change in counseling strategy is in order. The RD should not ignore a client's perception, through. Identify any perception that may interfere with change and explore it.

53. Your elderly patient with COPD has difficulty maintaining weight, lives alone, and has trouble preparing meals. Choose the correct nutritional interventions: A. Instruct the patient to: eat small frequent meals and snacks containing nutrient dense foods and or supplements; eat slowly, chews thoroughly and swallow safely to prevent aspiration. Arrange assistance with the meal preparation and shopping. Refer to congregate meal programs or Meals onWheels B. Stock freezer with easy to prepare frozen dinners and commercially prepared supplements, in case the patient is unable to prepare frozen dinners and commercially prepared supplements, in case the patient is unable to prepare a meal Increase the patient's fluid intake to 8 to 10 cups of fluid per day for adequate hydration. Refer the patient to a home health aid. C. Provide a variety of take out menus from restaurants that provide free delivery service. Limit meals to 3 per day to lessen meal preparation time. Provide high calorie, high protein snack recipes. Ensure fiber intake to 20 to 36 gm per day to increase GI motility, D. Enlist help from family and friends for food preparation and clean up at each mealtime. Encourage the patient to eat the main meal later in the day, after he/she had a chance to rest. Instruct the patient to lie down immediately after eating to ease digestion.

A. Instruct the patient to: east small frequent meals and snacks containing nutrient dense foods and or supplements; eat slowly, chew throughly and swallow safely to prevent aspiration. Arrange assistance with meal preparation and shopping. Refer to congregate meal program or meals on wheels. Tell your elderly patient with COPD with who lives alone to consume small, frequent meals and snacks, to emphasize nutrient dense foods and eat the main meal early in the day. Foods should be relatively easy to chew to help the COPD patient swallow safely and reduce the risk of aspiration. Arrange a visiting homemaker to assist the patient with shopping and meal preparation. Book the patient for a congregate meal program, if possible. If the patient finds congregate dining too stressful, arrange Meals of Wheels delivery. Stocking the freezer with frozen dinners is not a good option because it increases sodium intake. Commercially prepared supplements (eg. Ensure) provide calories and protein, but they should not be used consistently as meal replacements. If the patient is using diuretics, discuss the amount of fluid needed each day with the physician.

110. An effective manager possesses the following skills: A. A. Interpersonal, technical, conceptual B. Interpersonal, supervisory, technical C. Conceptual, analytical, conceptual D. Technical, behavioral, conceptual

A. Interpersonal, technical, conceptual. Three main skills that make an effective manager, who is likely to be promoted, are interpersonal, technical and conceptual. Interpersonal skills help the manager relate to people and to understand different behaviors. Communication skills fall into the interpersonal category. Conceptual skills help the manager see the organization's "big picture", rather Han just what affects the kitchen. Conceptualization helps the manager evaluate how many different issues relate to each other in the end. Technical skills are specific planning and kitchen skills required for the area the manager oversees. The manager's technical must Newell rounded so that he/she can be seconded to work in more than one area during periods of short staffing. The RD must understand and analyze both kitchen and business process to effectively evaluate and manager the operation.

76. Select the requirement for multi cultural nutrition counseling: A. Knowledge of different cultures, including eating habits, family traditions, food practices, food preparations and relevant specific research. B. Translation of standard nutrition education materials from English into the. Appropriate language. C. Knowledge of appropriate cultural substitutions for Americanized food, to make dietary changes easier D. Reluctance to provide personalized nutrition education to a minority culture, if it is not predominant in your area.

A. Knowledge of cultures, including eating habits, family traditions, food practices, food preparations and relevant, specific research. The RD must counsel client's who are not of his/her culture,race, religion, ethnicity or socioeconomic status. Multicultural nutrition counseling skills are a job requirement for RD's in the US. Review the Patient's Bill of Rights of 2001 and the AmericanHospital Association's article entitled Communication with Patients at http://www.aha.org/issues/Communicating-with-Patient's/index

76. Select the requirement for multi cultural nutrition counseling: A. Knowledge of different cultures, including eating habits, family traditions, food practices, food preparations and relevant specific research. B. Translation of standard nutrition education materials from English into the. Appropriate language. C. Knowledge of appropriate cultural substitutions for Americanized food, to make dietary changes easier D. Reluctance to provide personalized nutrition education to a minority culture, if it is not predominant in your area.

A. Knowledge of cultures, including eating habits, family traditions, food practices, food preparations and relevant, specific research. The RD must counsel client's who are not of his/her culture,race, religion, ethnicity or socioeconomic status. Multicultural nutrition counseling skills are a job requirement for RD's in the US. Review the Patient's Bill of Rights of 2001 and the AmericanHospital Association's article entitled Communication with Patients at http://www.aha.org/issues/Communicating-with-Patient's/index Your professional code of ethics requires you to give the highest quality of nutrition counseling available to all your patient's. Research the specific cultures you contact. Learn their food practices, eating habits, family traditions, food preparation and food storage practices. Get a translator to tailor your existing English material to the target population. Do not merely translate material verbatim. Remember than many immigrants in the US. Continue to eat their native foods. Ask your supervisor to schedule cultural sensitivity training for you.

24. Which of the following categories does not represent how the Nutritional Diagnosis portion of the Nutrition Care Process is organized? A. Nutrition focused Etiology B. Intake C. Clinical D. Behavioral/environmental

A. Nutrition focused Etiology. The second step of the Nutrition Care Process is Nutrition Diagnosis. The goal of a Nutrition Diagnosis is recognize and delineate a particular nutrition issue that can be treated with nutrition intervention, with positive results.a registered dietitian (RD) completes a Nutrition Diagnosis. The RD utilizes the data gathered in step 1 of the Nutrition Care Process to identify and assign a specific nutrition diagnosis. Nutrition Diagnosis are organized into three categories: 1. Intake, which compares the amount of food or specific nutrient consumed to what the estimated or actual requirements are 2. Clinical, which links nutrition issues to a particular medical disorder 3. Behavioral/environmental which looks at the specific nutrition knowledge, belief and access to nutrition and food safety.

89. Select the item that determines your production schedule: A. Planning what needs to happen throughout the day, how much food to prepare, yields, employee assignments and general instructions. B. A timeline of when certain events need to happen throughout the day. C. Employees work hours,scheduled meals and breaks D. Weekly work schedule for the entire food service operations.

A. Planning what needs to happen throughout the day, how much food to prepare, yields, employee assignments and general instructions. The production schedule, also known as the. Production worksheet, is the main tool for controlling what goes on within the kitchen on a given day. The production schedule sets menu preparation in motion. Always base production of the planned menu on standard recipes. Individualize the production schedule for your institution. Include on the production schedule for each day: the. Umber of customers; type of weather; pertinent special events; individual employee assignments; timeline for delivery, storage, food preparation and clean up; any substitutions; actual yield; notations on under production or over production; specialized instructions. You require all of this information for accurate future forecasting.

31. Positive nitrogen balance occurs in: A. Pregnant women B. Normal, healthy adults C. An elderly person who is confined to bed D. Starvation

A. Pregnant women. Nitrogen balance is a way to assess overall protein status. To calculate nitrogen balance, determine how much protein is ingested, hoe much nitrogen is excreted, and how much nitrogen disappears through insensible losses such as sweating and skin sloughing. The equation is: NITROGEN BALANCE= NITROGEN INTAKE ( grams/24 hrs)- (URINARY NITROGEN( grams/24hrs) + 2gms/24 hrs Normal healthy adults have zero nitrogen balance. A positive nitrogen balance is seen on pregnant women, growing children and patients rebounding from an injury or sickness. Negative nitrogen balance occurs in starvation.

40. The initial treatment for acute pancreatitis is to allow the pancreas to rest and: A. Provide IV fluids for hydration until the patient is pain free and nausea and vomiting have resolved. Initiate a clear liquid diet and gradually advance to a soft, low fat diet based on patient tolerance. B. Initiate Parenteral nutrition immediately. When the patient is pain free and nausea and vomiting have resolved, initiate a clear liquid diet. Gradually advance to a soft, low fat diet. C. Initiate enteral feeling immediately, using a defined formula fed into the jejunum. When the patient is stable, initiate a clear liquid diet. Slowly advance to a soft, low fat diet. D. Initiate a clear liquid diet when the patient pain has subsided. Advance to a soft, low fat diet with supplemental pancreatic enzymes to improve tolerance.

A. Provide IV fluids for hydration until the patient is pain free and nausea and vomiting have resolved. Initiate a clear liquid diet and gradually advance to a soft, low fat diet based on patient tolerance. Acute pancreatitis is sudden inflammation of the pancreas, causing intense abdominal pain, nausea and vomiting. Systems worsen when the patient consumes food, due to pancreas stimulation. Treatment for acute pancreatitis is: 1. Allow the pancreas to rest by keeping the patient NPO (nothing by mouth) 2. Start IV FLUIDS for hydration 3. If the acute illness does not resolve promptly, start enteral feelings for patients who require nutrition support. Use a chemically defined formula fed into the jejunum for the least pancreatic stimulation.. 4. Initiate Parenteral nutrition after 5 to 7 days if the patient remains severely ill. 5. When the patient can tolerate oral feedings, initiate a clear liquid diet and progress to a soft, low fat diet. Small, frequent meals are often better tolerated the three large males. Added pancreatic enzymes are typically not required for acute pancreatitis patients

70. What communications strategies might an RD employ for the client who is not ready to make any dietary changes ? A. Reflective listening and affirming the client issues B. Summarizing and making an action plan for change C. Problem recognition and goal setting. D. Sending the client away to reflect on the barriers to change and bookings follow up session for 1 week later.

A. Reflective listening and affirming the client's issues. Effective communication skills help client address reasons why change will be difficult. Reflective listening means listening closely to what a client is saying, then rephrasing as a short statement to show you comprehend the issue. Affirmation means demonstrating your appreciation of a client's attempts at changing behavior. Let the client know you understand the issues and that it is normal to have roadblocks to progress. Summarize what your client says. Identify and label the conflicting issues. Ask open ended questions that allow your client to expand on his or her thoughts, rather than provide a yes or no answer. Do not immediately set goals or action plan for a client who is not yet ready to change.

36. Which of the following best describes the nutritional care for dumping syndrome? A.small frequent meals with high protein, moderately fatty foods. Limited concentrated sweets ; and drinking liquids separately from meals. B. Three moderately sized meals and three snacks containing moderate protein and fat; lactose free foods; and fluids limited to 4oz per meal C. Small frequent meals with high protein, low fat and high fiber foods; ingesting liquids and concentrated sweets separately from meals; avoiding foods containing lactose. D. Three moderately sized meals and three snacks with moderate protein. Low fat, and low fiber; liquids limited to 4oz per meal; concentrated sweets limited to one to two servings per day.

A. Small frequent meals with high protein, moderately fatty foods; limited concentrated sweets; and drinking liquids seperately from meals. Dumping syndrome may occur following GI Surgery, and due to changes in gastric emptying in response to a meal. The goal of medical nutrition therapy is to prevent dumping symptoms from occurring by manipulating the diet and timing of meals: Small frequent meals spread throughout the day Moderate fat intake of 35% to 45% of total calories to slow transit time Protein intake increased to 20% of total calories Complex carbohydrate intake Fluids consumed separately from meals, as too many fluids may increase transit time Lactose intolerance Fiber does help to slow transit time; however, fibrous foods may cause bowel obstruction

114. Which best describes the difference between a nutritionist and a RD? A. State licensure laws defines the term nutritionist and the scope varies greatly. Only candidates who pass the dietetic registration examination can legally use the title Registered Dietitian and they must remain in good standing with the commission on Accreditation for Dietetics. B. A Registered Dietitian holds a masters degree and passed a national registration examination. A nutritionist completed a 4 yr Bachelor of Nutrition degree but did not take the registration examination. C. A registered dietitian completed the minimum requirements set forth by the Commission on Dietetic Accreditation for Dietetic Education And passed the registration examination. A nutritionist provides any type of nutrition advice or counseling and is accredited by the NationalAssociation of Nutritionist. D. A Nutritionist has a Master's or doctoral degree in nutrition related field but is not a registered dietitian. A registered dietitian complete the minimum requirements set forth by the Commission on Accreditation for Dietetics Education and successfully completed the registration examination.

A. State licensure laws defines the term nutritionist and the scope varies greatly. Only candidates who pass the dietetic registration examination can legally use the title Registered Dietitian and they must remain in good standing with the commission on Accreditation for Dietetics. The use of the term registered dietitian (RD) or dietetic technician, registered (DTR) is tightly regulated by the Commission on Accreditation for Dietetic Education (CADE) . Misuse of either title can result in legal action. RD's complete specific academic requirements and a supervised practice in the form of an internship or dialectic program. The RD passes s national registration exam and is in good standing with CADE. The RD keeps current by fulfilling a continuing education requirement, required to maintain registration. By contrast the term nutritionist varies widely by education requirements. Some nutritionists may actually have boor all training or education in nutrition. Many states enacted licensure laws to help define who is entitled to use the title nutritionist. Consumers are safest consulting an. RD or DTR for credible nutrition advice.

26. Select the statement concerning medical and nutrition diagnosis that are true: A. The physician determines the medical diagnosis while the RD determines the nutrition diagnosis. B. The physician must determine both the medical diagnosis and nutrition diagnosis. C. The medical diagnosis and the nutrition diagnosis must be identical. D. The nutrition diagnosis cannot be resolved unless the medical diagnosis is also resolved.

A. The. Physician determines the medical diagnosis, while the RD determines the nutrition diagnosis. Part of the reason for the introducing the Nutrition Care Process was to standardize nutrition care in a systematic way. Using the terminology is a step in this direction. Medical diagnoses are made by the physician, whereas the nutrition diagnosis are determined by theRD. Both diagnoses can be mutually exclusive. Nutrition diagnoses can also be different, based on individual patients with the same diagnosis. For instance, two different patients have heart disease, but one is overweight and the. Other is not. The RD must address the overweight patients' weight reduction in the diagnosis as excessive energy intake.

117. Choose the process the the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) uses to survey healthcare organizations. A. Tracer process B. Performance measurement process C. Self Study process D. Patient centered process

A. Tracer process. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) oversees a voluntary accreditation process. The mission of JCAHO is to insure patient safety and a high standard for quality of care. In 2004, JACHO changed the way it conducts its surveys to the tracer process. JACHO selects certain patients and allows the care the patient receives throughout his or her hospital stay or outpatient clinic visits. All care, services, procedures and tests are evaluated for quality and adherence to regulations, such as safety initatives. JACHO evaluates the relationship between various departments and disciplines for continuity and patient focus. For example, JACHO looks at how Dietary, Biochemistry and nursing interact to provide diabetics with the correct diet and insulin.

59. The School Breakfast Program and National School Lunch Programs are administered by the: A. USDA B. CDC C. EFNEP D. HHS

A. USDA . THE school Breakfast and Program and National School Lunch Program Re administered by the United States Department of Agriculture (USDA). The CDC stands for Centers for Disease Control. EFNEP stands for Expanded Food and Nutrition Education Program. HHS stands for Department of Health and Human Services. HHS IS RESPONSIBLE FOR PROTECTING THE HEALTH OF ALL Americans and for providing essential human services, such as the Headstart Program or improving child and maternal health . The USDA administers other types of program, such as WIC, SNAP (food stamps), Child and Adult Care FoodProgram and the Special Milk Program. HHS IS ALSO IS INVOLVED IN OTHER NUTRITION initiatives, such as the Web site nutrition.gov for consumer nutrition information and meat and poultry hotlines for consumer food safety information.

105. A performance Appraisal is all of the following except: A. An opportunity for the employee to demand more salary, regardless of the details of the appraisal B. A chance of the employee and manager to discuss job preformance C. A method of identifying goals and objectives in the coming year for the employee D. A chance to list strengths and weakness and to identify strategies for meeting unmet job performance standards.

A.An opportunity for the employee to demand more salary, regardless of the details of the appraisal although the performance appraisal is the time when pay raises, promotions or transfers are awarded, its primary objective is not to obtaining more money or a more desirable position. Ideally, the PA is a way to review the employee's past performance and set his/her course for the further. Identify the employee's strengths and weaknesses. Gently point out any performance standards that have not been met. Agree on a plan that will help the employee address these weak areas. Set goals and objectives for the coming year. The PA is a good opportunity for the employee and manager to meet one on one . To discuss performance and other pertinent issues, such as tuition bursaries and time off for classes and teach back.

73. Which Internet source is not a primary source for evidence based practice? A.Web MD B. Ovid C. PubMed D. American Dietetic Association Evidence Analysis Library

A.Web Md Many legitimate Internet sources for evidence based research exists, such as the USNational Library of Medicine's PubMed, Ovid and the Centers for Disease Contril. Do not use WebMD is a primary information source because it is geared to patient's, rather than professionals. . It may contain valuable information for consumers, but is too simplistic for healthcare professionals. Use Web MD site ending in.org, .edu, .gov for reliable research. The American Dietetic. Association's analysis Library. Is database that sorts through important and relevant nutrition research. Two other appropriate databases are SCHARR( school of health and related research) and EMBASE( excerpts medical database). Individual resources for medical professionals include, Up To Date, Harrison's Principles of Internal Medicine, and Clinical Evidence

35. Metabolic syndrome can be identified by the presence of: A. Central obesity ( waist circumference greater than 40 inches for men,35 for women), fasting glucose levels greater than or equal to 100mg/dl, blood pressure greater than 130/85 mmHg B. Central obesity (waist circumference greater than 40 inches for men,35 for women), blood pressure greater than 130/90 mmH, fasting glucose greater than 110mg/dl C. Central obesity (waist circumference greater than 40inchesfor men,35 for women), serum triglycerides levels greater than equal to 150 mg/dl, HDL cholesterol level less than 35 mg/dl men and 45 or less for women D. Serum triglyceride levels greater than or equal to 150 mg/dl, blood pressure greater than 130/85 mmHg, fasting glucose levels greater than or equal to 120 mg/dl.

A.central obesity (waist circumference greater than 40 inches for men, 35 for women), fasting glucose levels greater than or equal to 100mg/ dl, blood pressure greater than 130/85 mmHg. Metabolic syndrome means the patient has a group of risk factors related to overweight or obesity, lack of exercise and predisposing genetic factors , which increase his/her risk for developing coronary heart disease. At least three of the following risk factors are required for a diagnosis of metabolic syndrome. Central or abdominal obesity with a waist circumference of 40 inches for men and 35 inches for women; fasting serum triglyceride level greater than or equal to 150 mg/dl; and HDL LEVEL LESS THAN 40mg/dl for men and 50mg/dl for women; fasting glucose level greater than or equal to 100mg/dl; or a blood pressure reading greater than or equal to 130/85 mmHg.

97. Take all of the following precautions to prevent slips and falls in your work area except: A. Duct tape electrical cords to equipment to prevent tripping B. Keep aisles free from obstructions and excessive storage. C. Clean spills immediately and mark wet areas with appropriate signage D. Provide adequate lighting and clean only one side of the work area at a time to allow safe passage through the dry side.

A.duct tape electrical cords to equipment to prevent tripping. Slips and falls can cause very serious injuries to employee and customers. The RD is responsible for ensuring the kitchen staff take proper precautions to prevent injuries. The Occupational Safety and Health Administration (OSHA) has many regulations in place to help maintain a safe environment, online at http://www.osha.gov. Ideally, plug electrical equipment into floor or ceiling outlets to prevent tripping on the cord. If you require a wall plug temporarily, tape the cord into place. This should not be a permanent solution. Keep aisles and hallways free from obstructions and clutter. Ensure the kitchen and dining room are well lit. Inspect carpets to insure they are appropriately installed, so now bunching occurs. Removes worn carpeting. Remember that tile floor are more hygienic. Report spills and wet areas to housekeeping immediately for clean up. Mark wet areas with warning signs. Provide staff with ladders or step stools, instead of chairs or boxes, so they can reach items on high shelves safely.

118. Which documentation is prohibited according to the Joint Commission on Accreditation of Healthcare Organizations (JACHO)'s Do Not Use List? A. 90 ml of sterile water B. 10.0 mg of Lipitor QD C. 10 mg morphine sulfate D. 400 international units vitamin D

B. 10.0 mg of Lipitor QD. THE joint Commission on Accreditation of Healthcare Organizations (JACHO) developed a dDo not use list to reduce potential medication errors due to unclear or erroneous documentation. Question 118 breaches the Do Not Use List I five ways: 1. Including the decimal point in10.0 -if nurses misses the decimal point and incorrect dose of 100 could be delivered 2. Unacceptable abbreviation the nurse or pharmacist could mistake QD for QOD so the doctor should write out daily for clarity 3. Obsolete abbreviation - the USA prefers the Systeme Internationale "ml" over the Imperial "cc" since the 1970's 4. Confusing abbreviation - write out morphine sulfate because it can be confused with magnesium sulfate 5. Illegible abbreviation - write out International Units instead of abbreviating to IU because it can be mistaken for IV (intravenous) or the number 10

96. What is the appropriate temperature for sanitizing utensils and dinnerware in a dishwasher? A. 195 F B. 180 F C. 120 F D. 150F

B. 180F the two types of dishwasher machines available to food service establishments are high temperature machines and chemical sanitizing machines. A human dishwasher is also required to scrape plates, load and unload, troubleshoot, inspect the results, discard rejects and store clean dishes. The wash cycle's temperature varies between different dishwasher machines. However the Food and Drug Administration (FDA) Food Code requires the final rinse temperature must be 180F for proper sanitation. The 180F rinse is hot enough to kill most fungi, bacteria and viruses but does not kill spores. The plate and cutlery are clean but not sterile. A rinse temperature about 195F vaporizes water and does not flush any debris stuck on plates and utensils.

92. Which of the following temperature ranges is in the danger zone? A. 50 -150 F B. 40 -140 F C. 60 -160 F D. 45 -145 F

B. 40 -140 F.the danger zone is the temperature range at which bacteria are likely to grow and causes illness if consumed. The danger zone spans 40 -140 F. Bacteria multiply very quickly within this temperature range. Keep serving dishes hot with warmers or the range. Do not leave serving dishes at room temperature for more than 2 hours. Cool cooked foods as quickly as possible. Refrigerate all cooked foods within 2 hours. Do not thaw frozen on the counter or at room temperature greater than 145F . Follow the USDA guidelines for cooking meats, chicken and egg products to the proper internal temperature at: http:www.fsis.usda.gov/facts sheets/basics for handling food safety

7. How many grams of protein are in a meal containing 6 oz baked fish, 1 cup cooked pasta, 1 cup steamed broccoli, 1 slice of whole wheat bread, 1cup skim milk, 1/2 cup sliced strawberries and 1 slice of angle cake A. 54 grams B. 66 grams C. 75 grams D. 83 grams

B. 66 grams I. The above meal protein content is 66 gems, as follows: fish 42 g; pasta 6g, broccoli 4g, whole wheat bread 2g, milk 8g, and angle cake 3 g. The American Dietetic Association's 2007 book, Choose Your Foods: Exchange Lists for Meal Planning, offers a quick way to calculate macronutrient content of many foods: Meats and meat substitutes contain 7 g per ounce Starches contain 2-3 g of protein per serving Vegetables contain 2 G protein per serving Milk contains 8 g of protein per 8oz serving There is no significant protein in fruit Check serving size, as portion sizes vary between food items.

34. Which of the following statements about homocysteine levels and cardiovascular disease(CVA) if false? A. High homocysteine is an independent risk factor for developing CVD. B. A patient with low homocysteine has an increased risk of developing CVD. C. Supplementation with folate, vitamin B6, and vitamin B12 will improve homocysteine levels, thus reducing the risk of CVD D. A patient with elevated homocysteine has an increased Rick of developing CDV

B. A patient with low homocysteine has an increased risk of developing CVD. Homocysteine levels are linked to the development of cardiovascular disease as an independent risk factor. Elevated homocysteine levels, even in the upper normal range, correlate with an increased CVD risk. Elevated homocysteine levels, even in the upper normal range, correlate with an increased CVD risk. HOMOCYSTINE levels are affected by diet. Folate, Vitamin B6, and Vitamin B12 supplements will help lower HOMOCYSTINE levels. Clinical trials are being conducted to determine if lowering HOMOCYSTINE levels actually has a positive impact on the reduction of CVD. It currently appears that those patients who would benefit most from lowered HOMOCYSTINE levels are those with a history of CVD, but without other major risk factors, such as smoking, hypertension or high serum cholesterol.

51. Lifestyle modifications that may help to prevent or manage hypertension include: A. Achieve a healthy body weight; limit alcohol intake to 2 ounces of ethanol for men and 1 ounce for women; increase exercise to a minimum of 60 minutes per day: limit sodium to 3000 mg/day; quit smoking and reduce saturated fat and cholesterol intake. B. Achieve a healthy body weight; limit alcohol to 1 ounce of ethanol per day for men and .5 ounce for women; increase exercise to at least 30 minutes per day; restrict sodium intake to 2400 mg per day; quit smoking and reduce saturated fat and cholesterol intake. C. Achieve a healthy body weight; ensure adequate calcium and magnesium intake; eliminate alcohol; restrict sodium to 2000 mg per day; increase potassium intKe to at least 100mEq per day. D. Achieve a healthy body weight; adequate calcium and magnesium ; limit potassium 90mEq per day; limit sodium intake 2400 mg per day; reduce saturated fat and cholesterol intake; increase exercise to at least 60 minutes per day.

B. Achieve a healthy body weight; limit alcohol to 1 ounce per day for men and .5 ounces for women; increase exercise to T least 30 minutes per day; restrict sodium intake to 2400 mg per day; quit smoking and reduce saturated fat and cholesterol intake. Lifestyle modifiable risk factors makes the biggest impact on blood pressure: 1. Achieve and maintain a healthy body weightilpopo 2. Limit alcohol intake 1 ounce of ethanol (24 ounces of beer, 10 ounces of wine or 2 ounces of hard liquor) for men and .5 ounce ethanol for women. 3. Restrict sodium intake to 2400 mg per day 4. Increase physical activity to at least 30 to 45 minutes per day for the majority of the week Other lifestyle changes that improve blood pressure modestly are: increasing calcium and magnesium intake; receiving at least 90 mEq of potassium per day; lowering saturated fat and cholesterol and quitting Tabasco use.

102. A hospital cook develops unexplained leg pain that prohibits him from standing for long periods. Allowing him to sit while preforming his duties is not a reasonable accommodation. Safe cooking and use of food service equipment requires him to stand. Management offers the cook a temporary office assignment, working on production schedules and reviewing standardized recipes. Name the federal law that protected the cook from job loss: A. Civil Rights Act B. Americans with disabilities Act C. Family Medical Leave Act D. Worker Adjustment and Retraining Act

B. American with Disabilities Act. The Americans with Disabilities Act(ADA)is a federal law implemented in 1990. ADAM prohibits discrimination against anyone with a disability, whether it is physical or mental impairment, or a history of the impairment. ADA isa comprehensive, in that it deals with the workplace, transportation, retail establishments, restaurants, bathroom facilities, parking lots and. Much more. Ada requires employers to provide reasonable accommodations to enable employees to preform their job duties in an acceptable manner. ADAM also provides specific allowances for anyone who is hearing or sight impaired, or uses assistive devices or service animals. ADA has many facets, so legal assistance is often required to ensure compliance, especially in health care facilities.

120 you are a food service manager. Two of your workers do not work well together. You frequently hear them bicker and yell at each other. You call a conflict resolution meeting with both of them. How should you initiate conflict resolution ? A. Ask each worker for his/her side of the story. Assess the situation. Gently point out the person who needs to make changes B. Ask each worker to relate his/her versions of events calmly. Restate the issue in your pun words. Get additional information. Mutually agree on what the problem actually is. Brainstorm possible resolutions. Negotiate an acceptable resolution for both of them C. Tell your two employees their behavior is inappropriate. Listen to both sides. Determine if there is an easy was to fix the problem. Warn your employees they must both roe olive the issue or they will be disciplined D. Allow the senior employee to tell his/her side of the story first. Reprimand the employee who is at fault. Offer anger management classes to both employees.

B. Ask each worker to relate his/her versions of events calmly. Restate the issue in your pun words. Get additional information. Mutually agree on what the problem actually is. Brainstorm possible resolutions. Negotiate an acceptable resolution for both of them. Always conduct conflict resolutions calmly and patiently. Show both parties respect. Convey that you understand the situation by rephrasing it in your own words. Use active listening skills and assertiveness. Obtain any additional information you require to clarify the situation, such as checking old schedules to identify an attendance pattern. Get both parties to agree on what the problem really is, the make them work together to find possible solutions. Negotiate to ensure everyone is satisfied with the outcome. Remember, conflict is the workplace is dangerous and should not be ignored. Kitchen tools can be weapons and there is an opportunity for poisoning. The manager's positive attitude is leadership in the right direction. If you think a threat is likely to become a reality, then you are legally liable to report the situation to the police.

125. The leadership style of a Clinical Nutrition Manager who manages a staff of clinical dietitians strictly "by the book", with a clear division between the manager and the clinical staff, is known as: A. Participative B. Authoritarian C. Delegative D. Diplomatic

B. Authoritarian. Several leadership styles can be used to manage employees. In the case,the Clinical Nutrition Manager demonstrates an Authoritarian or Autocratic style of leadership. It is one of the least effective styles. The manager strictly enforces policies and procedures and makes decisions independently without input from employees. The Participative style is usually a more effective style of leading the manager invites from employees but still has the final say in any decision making. Delegative style is also known a Laissez Faire. The manager does not give real guidance to employees. Decisions are not made exclusively by the manager. Roles are not well defined motivation among employees is not very strong.

116. What is the purpose of Press Ganey Associates, Inc? A. Consulting B. Benchmarking C. Job redesign D. Quality Assurance

B. Benchmarking. Press Ganey associates, Inc is a company that provides benchmarking data to food service organization. Benchmarking compares your team's current performance against those who are widely considered to be the best. Press Ganey distributes satisfaction questionnaires to patients who received impatient performs a comparative analysis for all hospital care or who used outpatient hospital care or who used outpatient services. Press Ganey performs a comparative analysis for all healthcare facilities that that participate in this benchmarking process. Press Ganey Owens an extensive database and validates its results. Benchmarking is a tool that food service operations can use to help improve overall patient/customer satisfaction.

32. Which of the following is a positive in acute phase protein? A. Albumin B. C-reactive protein C. Retinal binding protein D. Transferrin

B. C-reactive protein. Inflammatory stress an be caused by acute trauma or injury. During stress response, acute phase proteins are released or utilized to meet the crisis. Examples of positive acute phase proteins are C reactive protein and fibrogen. The level of acute phase proteins during the immediate stage reflects the degree of injury. Examples of negative acute phase proteins include albumin, retinal- binding protein and transferrin. The levels of negative acute-phase protein vary, based on the rate of increased catabolism or a decrease in synthesis.

91. Which food bone illness incubates 3 to 5 day and causes diarrhea, nausea, abdominal pain and headache for 1 to 4 days. A. Escherichia coli B. Campylobacter jejuni C. Rotavirus D. Salmonella

B. Campylobacter jejuni has a long affective animals and has now crossed over to humans. It is a severe form gastroenteritis, featuring diarrhea, fever, nausea, stomach and headache. The incubation period is 3 to 5 days. Symptoms last up to 4 days. Campylobacter jejuni is can found on in raw vegetables, chicken, pork, beef and lamb. Avoid cross contamination by careful hand washing. Use separate cutting boards and utensil is for cutting meats and vegetables. Cook foods thoroughly. Wash raw foods extremely well before consuming and peel them, if possible, to prevent transmission.

45. When discussing sick days guidelines with a diabetic patient, you would include all of the following instructions except: A. Continue to take insulin as ordered by your physician, because your insulin requirements may increase due to sickness causing fever or stress. B. Consume only sugar free fluids to prevent hyperglycemia from an excessive sugar intake. C. Consume adequate fluids, especially if you vomit. Drink 1 ounce every 15 to 30 minutes in small sips. D. Check your blood glucose levels and your urine ketones at least 4 times daily. Call your doctor if ketones appear or if your blood glucose level is greater than 240 mg/dl.

B. Consume only sugar free fluids to prevent hyperglycemia from an excessive sugar intake. Emphasize the importance of a sick day management for your Type 1 diabetic patients. Failure to follow these guidelines could cause diabetic ketoacidosis (DKA) Always take insulin as prescribed during il ess. Sometimes insulin requirements increase due to infection, fever or stress. Test blood glucose levels, urine or blood ketones at least four times throughout the day. The presence of ketones along with a glucose level greater than 240 mg/dl signals DKA is developing. If regular foods are intolerable, substitute soft foods or liquids containing carbohydrates. Sugar free or low carbohydrate foods are not indicated. Consume at least 50 gems of carbohydrate every 3 to 4 hours and maintain adequate hydration. If illness continues beyond 24 hours, contact a physician

12. Which of the following statements about zinc absorption is true? A. Zinc absorption is lower during pregnancy and lactation. B. Consuming a high protein meal promotes zinc absorption through the formation of zinc amino acid chelates, a more easily absorbed form of zinc. C. Both phytates and tannins affect zinc absorption. D. Consuming soy protein inhibits zinc absorption.

B. Consuming a high protein meal promotes zinc absorption through the formation of zinc amino acid chelates, a more easily absorbed form of zinc. A high protein meal does promote zinc absorption. Zinc is absorbed at the brush border of the small intestine. The human body typically absorbs only 20% to 40% of zinc ingested. Pregnancy and lactation actually increases zinc absorption. Zinc must be protein - bound to be absorbed. Therefore the protein in the meal helps to form zinc-bound to be absorption. Phytates interfere with the absorption of zinc; however, it appears that tannins do not. Soy protein improves zinc absorption.

88. Food production forecasts rely on all of the following except: A. Historical records B. Customer demand C. Institution D. Menu or event planned

B. Customer demand. The RD reads the requirements of the planned event, reviews historical data, intuits what food customers may demand, and determines a menu. The RD must keep careful production records that document differing factors that influence production, such as: Day of the week; special conditions, such as a holiday or weather events; type of food prepared; quantity prepared; and quality served. Customer satisfaction is most likely to result when customers get what they ordered and expected, but this is not the deciding factor in a for cast. During a disaster, war, pandemic or drought, giving adequate nutrition to the greatest number of people is more important than customer satisfaction. For casting models are available to reduce the RD's forecasting time. However, they require computer resources, so are usually an option for food services managers only, rather than junior dietitians.

69. During the first counseling session, the RD USES INTERVENTION MODEL TO: A. Get as much information from the client as quickly as possible B. Establish rapport with the client and set the tone for the future C. Problem recognition and goal setting D. Sending the client away to reflect on the barriers to change and booking the. Follow up session for a week later.

B. Establish rapport with the client and set the tone for future session . Establishing a rapport with a client is essential to the counseling process. Establish rapport by asking a few general questions about the client's personal life. Try to find a common ground. Examples of this may be mutual enjoyment of a certain sport or type of animal. Use your first session for information gathering. Do not rush due to time constraints or money. Use the corner of a desk for note taking but do not use it as a barrier between you and the client. Seating yourself beside the client is less intimidating than sitting across from the client, behind a desk. Never try to take charge of the session immediately, as this does not invite effective change. First, complete the assessment piece and. Identify the patient's stage of readiness. Give positive reinforcement for changes the client has already performing correctly.

124. The type of pricing strategy that a food service manager uses to price menu items by adding a markup value is known as: A. Prime cost B. Factor pricing C. Actual cost D. Combination pricing

B. Factor pricing. The three most common ways to determine pricing for menu items are factor pricing, prime cost and actual cost. Factor pricing involves determining a factor that will be used as the make up. Typically, Accounting selects a percentage of the food cost as the mark up. Multiply the raw food cost by the pricing factor to get the menu sales price. Do not take direct labor costs into account when factor pricing. The prime cost involves the raw food cost and the direct labor cost of producing the item. General assumption are made to determine various factors, so the cost of the item using standardized reciepies, adding labor costs and any other variables costs, to determine the price point.

63. A"house" enteral tube feeding is: A. Hydrolyzed B. Polymeric C. Elemental D. Modular

B. Poly metric formulation is typically known as a "house" formulation. Polymeric formulae contain an intact protein source, such as casein ate, or soy protein isolate. Polymeric formulae are isotonic, can be initiated at full strength, and are usually tolerated very well. The calorie density of a polymeric formula is 1 to 1.2 calorie/ml. Polymeric formulae can also contain fiber to aid Bowery function. Hydrolized formulae contain dipeptides as the protein source. Elemental formulae contain free amino acids. A modular product means single nutrients were added in house to change the overall composition of a commercially prepared product.

85. What are Standards of Identity ? A. Any food that crosses US borders must be appropriately labeled B. Food must contain specific ingredients in specified amounts to be labeled with a certain name such as ice cream C. All foods purchased by food service institutions are labeled with nutrition information and omit any health claims D. A voluntary program that institution can participate to receive federal funding

B. Food must contain specific ingredients in specified amounts to be labeled with a certain name, such as ice cream. Standards of Identity is a part of the Food Drug and Cosmetics Act 1938, which requires any food item that is shipped across state lines to be labeled in a way that accurately reflects what is in the package. If a product is a given a certain name, then it must contain specific ingredients in a certain percentage to qualify. For that name. For example, ice cream is a frozen product that must contain no less than 10% milk fat and 20% total milk solids by weight. If it does not meet these standards, it is labeled with another name, such as reduced fat, light or fat free ice cream. Standards of Identity help the consumer identify what a food product actually contains.

62. Which of the following is not a nutrition issue that will affect a burn patient's outcome ? A. Healing of burn injury B. Frequently assessing nitrogen balance to indicate anabolism C. Providing sufficient calories, so weight loss is less than 10% throughout the burn treatment D. Indicating enteral feedings within 4 to 8 hours of hospitalization with burn injury, and advanced as quickly as possible to optimal nutrient requirements.

B. Frequently assessing nitrogen balance to indicate anabolism. Nutrition support is a cornerstone in the treatment of burn injuries. Actual healing is the best outcome one can observe and is directly related to nutrition. Accurately assessing nitrogen balance for burn patient is difficult, due to potential nitrogen losses through large wounds, but it can be calculated.it is better to assess wound healing and the progress of graphs as an outcome measure. Maintain the patient's weight within 10% of normal to promote overall healing. Very early enteral nutrition helps decrease the catabolic rate and improves the overall outcome for the burn patient. Lower catabolism decreases the overall length of hospital stay. Enteral nutrition stimulates immune function and protects against GIbleeds.

75. Effective nutrition education material should have all of the following characteristics except: A.plain language instead of medical terminology B. Grade 12 reading level C. Clear, concrete recommendations D. Language style that closely reflects that used by the target audiences

B. Grade 12 reading level. It is difficult for the RD to develop written patient education material. Because the education levels of the whole population varies and English is not the first language for many readers. Write nutrition information at a Grade 5 or 6 level. Follow plain language guidelines from the federal government at http:// plain language.gov. Deliver your message in the easiest, simplest way possible. Omit medical terminology if you can. If medical jargon is required, explain the term within the text and in a glossary. Write in a conversational style mimics the way your target audience speaks. Use short sentences and paragraphs. Use 12 point font in a standard typeface (arial, Time Roman or Verdana). Leave white space and ragged right margins to make reading easier for the elderly and learning disabled. Make clear concise recommendations with common examples. Place a relevant illustration above an explanation.

49. The dietitian who begins nutrition therapy for a cardiovascular disease patient realizes the outcome measures are influenced mostly by: A. Family history, age, gender socioeconomic status and cigarette smoking. B. HDL cholesterol, dietary modification and LDL cholesterol. C. Oxidative stress, triglycerides, HDL cholesterol and total cholesterol. D. Obesity, physical activity and thrombogenic factors such as fibrinogen

B. HDL cholesterol, dietary modifications and LDL cholesterol. Reducing or eliminating modifiable risk factors has a direct impact on lowering cardiovascular events. Modifiable risk factors include: quitting smoking: lowering LDL cholesterol; lowering blood pressure; making diet dietary changes to reduce fat and cholesterol; effective diabetes control; exercise; increasing HDL cholesterol; weight loss; lowering triglycerides levels. Modifiable risk factors are measurable. Document patient outcomes to measure progress other modifiable risk factors that may or may not influence CVD risk are reducing oxidative stress levels, lowering homocysteine and reducing alcohol intake. Non modifiable risk factors are age gender, family history and the mere presence of diabetes.

94.the Hazard Analysis Critical Control Point(HACCP) Model is a concept that: A. Deals with hazardous waste disposal in food service environments B. Implements quality control procedures for the prevention of potential microbial or other contaminations C. Address proper hand washing techniques within the food service environment D. Is a mandatory program run by the Food and Drug Administration to promote food safety and to protect the general public.

B. Implements quality control procedures for the prevention of potential microbial or other contaminations. The Hazard Analysis Critical Control Point (HACCP) Model is a plan to microbial contamination through Quality Control. HACCP is voluntary program sponsored by the Food and Drug Administration that aims to protect public health through food sanitation and safety. It's seven guiding principles are: 1. Analyze hazards 2. Identify critical control points(CCPs, a certain step in the preparation of a recipe or in the cooling process) 3. Institute preventive measures 4. Develop procedures to monitor CCPs 5. Develop a corrective action plan and rewrite procedures to fix the faulty CCPs 6. Keep records diligently 7. Base the QA program on appropriate research and studies

60. The. Purpose of the Child and Adult Care FoodProgram is to: A. Provide guidelines for serving nutritious meals and snacks to daycare programs for children and adults. B. Provide guidelines for meal patterns and reimbursement for nutritious meals and snacks to child care centers, emergency shelters and adult day care programs based on income eligibility C. Provide food for meal and snacks for childcare centers, emergency shelters, adult day care programs. D. Provide guidance and resources on appropriate feeding practices throughout the lifecycle. For eligible participants.

B. Provide guidelines for meal patterns and reimbursement for nutritious meals and snacks to child care centers, emergency shelters, and adult day care programs based on income eligibility. The Child and Adult Care Food Program is a program administered by the USDA. IT IS GEARED TO LOW INCOME and families. The program provides meal planning guidelines for all ages, including infants and edderly. The location of the program may include childcare centers, after school programs for at risk children, group day care homes, emergency shelters and adult daycare centers. Meal reimbursement is provided according to guidelines set forth by the agency.

39. Which statement best describes protein in liver disease ? A. In uncomplicated hepatitis or cirrhosis without encephalopathy, protein requirements are 1 to 1.2 grams per kilogram of actual weight to promote nitrogen balance. B. In uncomplicated hepatitis or cirrhosis without encephalopathy protein requirements are 1 to 1.2 grams per kilogram of dry weight to promote nitrogen balance C. A protein restriction of less than 0.6 grams per kilogram is recommended for acute encephalopathy D. Protein requirements for most patients with compensated liver disease are 1.5 to 2 grams per kilogram

B. In uncomplicated hepatitis or cirrhosis without encephalopathy, protein requirements are 1 to 1.2 grams per kilogram of dry weight to promote nitrogen balance. Protein requirements in chronic liver disease remain controversial. The European Society of Parenteral and Enteral Nutrition ( ESPEN) recommends giving patients with compensated liver disease 1 to1.3 grams of protein per kilogram, including patients with chronic cirrhosis without encephalopathy . Measure the patients dry weight to calculate his/her protein requirements, as many patients with liver disease have as cites. For patients with acute encephalopathy, the generally accepted practice is to restrict protein intake to 0.6 to 0.8 gm per kilogram, but only during the acute phase. After the encephalopathy clears, restore protein intake to 1 to 1.2 grams per kilogram. Patients with compensated liver disease and malnutrition may require up to 2 grams of protein per kilogram providing their renal function.

109.all of the following are components of a total budget except the: A. Operating budget B. Labor budget C. Master budget D. Capital budget

B. Labor budget. A total budget has four parts: the operating budget, cash budget, capital budget and master budget. The operating budget is the amount of sales, expenses and revenue that is predicted for a certain period of time, usually one fiscal year, which does not necessarily begin in January and end in December. The cash budget is the predicted cash flow to ensure money planned for equipment, buildings, grounds keeping or renovations. The master budget puts all these pieces together to provide the organization's financial plan. If you are responsible for kitchen finances, ask the accountant assigned to dietary to outline your department's financial picture when you start your new job and again at six month intervals.

41. Which of the following goals are appropriate medical nutrition therapy for diabetics except: A. Maintain blood glucose levels as close to the normal range as possible to help prevent or delay complications of diabetes. B. Adjust nutrient intake to help address possible complications resulting from obesity, heart disease and nephropathy C. Learn to make healthier food choices and improve physical activity level to help improve overall health status. D. Modify fat intake to help prevent the development of cardiovascular disease and improve lipid panel; modify protein intake to help prevent the development of nephropathy and other kidney related complications

B. Meal planning that incorporates the individual's usual eating and exercise habits, following by development of an insulin regimen. Presently, the insulin options available to help the patient get diabetes under control and fast acting and slow acting injections and pumps. The RD's main priority for treating an insulin dependent Type 1 diabetic is to determine the patient's usual eating and exercise patterns. Try to maintain consistent meal timing and carbohydrate distribution. Assigning an inflexible meal and snack pattern is unrealistic and encourages non compliance. Many diabetics learn how to manage flexible insulin regimens based on the amount of carbohydrate consumed at a given meal. Take into account the patient's established physical activity routine. Advise the patient t who does not engage in regular exercise to incorporate physical activity into his/her lifestyle gradually. Adjust diabetes regimen accordingly.

106. What is an advantage of scheduling personnel for a cook chill food service? A.Fewer FTE's are required overall because it is simpler type of food service system to operate B. Most production and inventory FTE's are scheduled during off peak hours Monday to Friday, leaving a few FTE's for meal times and weekends. C. Most FTE's are scheduled in the early morning hours and weekends D.scheduling is closely related to the tray line operation, and this type of the system has peaked and trough employee activities.

B. Most production and inventory FTE's are scheduled during off peak hours Monday to Friday, leaving a few FTE's for meal times and weekends. A cook- chill system streamlines the scheduling process. Many FTE's required for production and inventory can be scheduled Monday to Friday leaving a limited number of FTE's for rethermalization and patient service. Cook -chill also helps the RD to Taylor the schedule to provide more flexible shifts for employee satisfaction. Often times, the early morning and weekend production shifts are undesirable to employees. Therefore, the RD can adjust the shifts to give most full time staff the weekends off, and schedule students and part timers on the weekends. The overall schedule is not directly related to the tray line operation. Cook-chill allows you to schedule employees for when they are needed, with less down time. For example, employees can be scheduled for a 3 hour meal service shift. Production employees do not rush to prepare food for tray line operation, to be served immediately, which can reduce accidents.

37. Crohn's disease and ulcerative colitis are the two main forms of inflammatory bowel disease (IBD) All of the following are the true about IBD except: A. The average age of onset IBD is 15 to 30 years old, and. IBD occurs equally in both males and females. B. Nutrition is a major issue for both Crohn's disease and ulcerative colitis patients however, malnutrition is likely to be more of a lifelong concern for patients with ulcerative colitis. C. Crohn's disease can present in any part of the GI tract; however it most frequently involves the distal ileum and the colon. D. Ulcerative colitis involves the colon and is a continuous disease.

B. Nutrition is a major issue for both Crohn's disease and ulcerative colitis patients; however malnutrition is likely to be more of a lifelong concern for patients with ulcerative colitis. Crohn's disease and ulcerative colitis are the two main forms of IBD. The age of onset is usually between the ages of 15 to 30 and sometimes between 50 & 60. Both diseases of IBD are likely to cause malnutrition. However patients with Crohn's disease are more likely to have prolonged malnutrition over the course of a lifetime, due to management issues. Crohn's disease can occur in segments anywhere within the GI tract but most likely to occur in the distal ileum and colon. Patients with Crohn's disease often require surgical treatment but surgery does not cure the disease. Many Crohn's patients develop additional complications, such as short bowel syndrome. Ulcerative colitis occurs only in the colon

77. Identify the body language the indicates a client is open to intervention : A. A. Lowering eyes, looking away or lack of eye contact B. Pupil dilation, nodding head up and down, leaning forward C. Pursed lips and shaking head from side to side D. Shrugging shoulders, hanging head down towards chest

B. Pupil dilation, nodding head up and down, leaning forward. Reading body language is an important skill an RD uses to assess a client's stage of readiness. Assume your client is open to nutrition intervention if his/her pupils are slightly dilated, signifying interest, and he or she leans forward and nods his or her head up and down Ina greement. Look for direct eye contact, smiling positive behavior, or a change in position from sitting back to leaning forward. Lowered eyes or looking away an mean fixation on something else or avoidance of the situation in an American born client but in other cultures direct eye contact is considered rude and challenging. Pursed lips may mean the client is stressed, angry or taking psychiatric drugs. Shaking the head from side to side may signal disagreement. Shrugging the shoulders can mean indifference or uncertainty. If the client hangs his or her head down, this may mean sadness, anxiety or lordosis from deteriorating spine

57. Megestrol acetate is for: A. Nausea and vomiting B. Stimulate appetite C. Mucositis D. Saliva replacement

B. Stimulating appetite. Megestrol acetate is commonly used to stimulate appetite in oncology and other disease states that produce anorexia, such as HIV. IT is synthetic form of progesterone. Do not use megestrol as a preventative measure. It helps to increase weight gain by increasing the appetite and thus food intake. Known side effects of megestrol acetate include endocrine suppression, edema of the hands and feet, thrombophlebitis and change in blood glucose levels. Therefore, monitor fluid balance, hormone levels, hormone levels and clutter closely. Other medications used to stimulate appetite include dronabinol and dexamethasone.

47. Choose the best description of cardiac risk, according to the ATP III guidelines of the National Cholesterol Education Program( NCEP). A. The HDL is the primRy marker, followed by the presence of any type of athlerosclerotic disease, such as coronary heart disease, carotid artery disease, or peripheral artery disease and risk factors (smoking hypertension, LDL levels greater than 100 mg/dl, age greater than 45 or significant family history). B. The LDL cholesterol level is the primary marker, followed by the presence of coronary artery disease and risk factors (smoking, hypertension, , HDL LEVELS LESS THAN 40 mg/dl, age greater than 45 or significant in family history. C. The total cholesterol level is the primary marker, followed by the presence of coronary heart disease and risk factors such a smoking, hypertension, HDL levels less than 40 mg/dl; family history and age 45. D. The patient's total number of risk factors are significant for ATP III, such as : smoking , hypertension , LDL level less than 40 mg/dl, total cholesterol greater than 240mg/dl, family history, especially heart disease in a first degree male family member younger than age 55, diabetes and age (men older than 45 and women older than 55.

B. The LDL cholesterol is the primary marker, followed by the presence of coronary artery disease and risk factors (smoking, hypertension, HDL LEVELS less than 40 mg/dl, age greater than 45 or significant family history. ATP III guidelines are part of the National Cholesterol Education Program (NCEP). Use the patient's LDL cholesterol level as the primary marker for initiating therapy. A level less than 100 mg/dl is optimal; 100 to 129 is near optimal; 130 to 159 is borderline high; 160 to 189 is hig; greater than 190is very high and dangerous. ATP III also uses total cholesterol and HDL LEVELSas a secondary markers. Evaluate the presence of coronary heart disease or other types of atherosclerotic diseases such as carotid artery disease or peripheral artery disease. Next, assess the number of modifiable and non modifiable risk factors: smoking; HDL Level less than 40 mg/dl; hypertension: family history of early heart disease, such as a male first degree relative diagnosed prior to age 55 or a female first degree relative diagnosed earlier than age 65; patients age ( men older than 45 women 55) categorize the patients overall risk. Base initial treatment on LDL cholesterol levels.

2.Which of the following statements is true about glycogen ? A. Glycogen is a ling term energy source B. The liver stores approximately 100 grams of glycogen. C. Glycogen is stored primarily in the liver but also appears in the skeletal and heart muscle. D. The glycogen found in skeletal muscles is catabolized for use anywhere in the body.

B. The liver stores approximately 100 grams of glycogen. Glycogen is a form of short -term carbohydrate storage of the body. It is not long - term energy source. Approximately 100 grams of glycogen is stored in the liver, which when catabolized provides approximately 400 kcal. About 300 - 400 g of glycogen is stored in the skeletal muscles, which yields less than 1600 kcal. Glycogen is not stored in the heart muscle. The glycogen is stored in the skeletal muscles provides energy. Anywhere in the body, whereas the glycogen stored in the skeletal muscles provides energy only to skeletal muscles cells. The amount of stored glycogen is sufficient to sustain a 70 kg male for approximately 1 day.

111. Classical management theory is the belief that: A. Improving employee relations, such as conflict resolution, group dynamics. And increasing motivation, is the way to increase productivity. B. The means to increasing productivity and efficiency is through process improvement C. Computer models and mathematical equations can improve productivity D. Management has the final say in all matters and employees must learn to accept this

B. The means to increasing productivity and efficiency is through process improvemen. The classical style of management developed during the Industrial Revolution ( about 1760 to 1830) it evolved from the belief that managers must find the best way to preform a certain function. Classical management theory focuses on employees completing tasks assigned to them by managers. Classical management theorists Frederick Taylor, frank and Lillian Gilberto and Max Weber. Taylor looked at process improvement as a way to increase productivity. The Gilbreths preform end time motion studie, developed procedures and trained employees in the more productive procedures. Weber believed all organization's needed common characteristics, such as hierarchy of control, standard policies and procedures and division of responsibilities, so each employee known exactly what to do for his/her own job.

16. Which of the following statements most accurately describes nutrition screening? A. A registered dietitian must complete nutritional screening B. The purpose of a nutritional screen is to identify people with malnutrition who are at high risk for developing malnutrition . C. The elderly population benefits most from nutritional screening. D. A proper nutritional screen requires the patient's height, weight, and laboratory data.

B. The purpose of a nutritional screen is to identify people with malnutrition who are at high risk for developing malnutrition. Nutrition screening is a part of the nutrition assessment process. Screening can be completed by a RD, dietetic tech, registered nurse or an appropriately trained delegate. The main purpose of nutritional screening is to identify malnourished individuals or those who are at risk for developing malnutrition. Screening enables the practitioner to identify those individuals who are in need of a full nutrition assessment by the RD. Although the elderly do greatly benefit from frequent nutrition screening, the tool is most useful for all age groups. The major components of a nutritional screening are: measuring height & weight; determining weight changes; and checking lab data. However, the information gathered for the screen varies depending on its setting, the target population and its identified goals.

25. Critical thinking skills the dietitian requires to evaluate the PES statement in the Nutrition Care Process are: A. To evaluate the etiology, diagnosis to use for a patient and select the broadest scope to maximize impact B. To evaluate the etiology, determine if the least "root cause" has been identified, and determines if the signs and symptoms can at least be improved with nutrition intervention C. To evaluate changes in the patient's sign and symptoms, but to use clinical judgement to ultimately determine the appropriate resolution for the nutrition diagnosis D. To select the nutrition diagnosis most likely to be treated quickly and efficiently, with a clear resolution of symptoms.

B. To evaluate the etiology, determine if the best "root cause" has been identified, and determine if the signs and symptoms can at least be improved with nutrition intervention. The RD requires critical thinking skills to preform nutrition care, particularly when assigning a nutrition diagnosis. The RD documents the nutrition diagnosis with PES statement (problem etiology signs/symptoms). The nutrition diagnosis the RD selects should be the most important that requires the most immediate attention. It is not necessarily the diagnosis that will see the fastest results. The diagnosis the RD selects should be most related to the. RD's role in the nutrition care process and be specific enough to measure concrete improvement. Clinical judgement is still important. However, nutrition intervention must be measured and documented. At the very least, the RD's involvement should help to minimize ant symptoms that are present.

66. The stage of change model (precontemplation, contemptation, preparation, action, maintenance,relapse ) is also known as the : A. Cognitive behavioral model B. Transtheoretical model C. Interventional model D. Motivational model

B. Trains theoretical model. The stages of change model (trains theoretical model) describes six alterations a patient experiences when trying to adjust change. The RD assesses which stage of change the patient is in during a counseling session. In the precontemplation stage, the patient has not yet thought about making any changes. In the contemplation stage the patient begins to think of reasons why he should or should not make changes. In the preparation stage the patient maybe ready to move ahead and requires assistance finding a strategy that will work. In the action phase, the patient begins to make the necessary changes. In the maintenance stage, the patient must continue to follow through with positive behaviors. Lastly, in the relapse stage, the patient must begin the change process again after a failure, to achieve the action phase.

56. Enteral nutrition support for oncology patients is contraindicated for all of the following conditions except: A. Bowel obstruction B. Nausea and vomiting for one or two days following chemotherapy C. Low platelet count D. Severe nausea vomiting or diarrhea

B: Nausea and vomiting for one or two days following chemotherapy. Enteral nutrition may be appropriate for cancer patients who are not expected to regain improved oral nutrition with in 5 to 7 days after chemotherapy. If the patient's GI tract is fully functional, then choose enteral nutrition in the form of tube feedings. If the patient is only symptomatic for one or two days following chemotherapy, but then able to maintain reasonable oral intake, tube feedings are not indicated. Define contraindications to tube feeding include bowel obstruction, severe nausea or vomiting and diarrhea. Oncology patients with low platelet counts should not receive tube feedings as a risk of bleeding is increased. Other contraindications include overall low white or red counts, as these may signify infection.

98. You plan to serve employees hamburgers and hot dogs at an outdoor luncheon. You must purchase enough 80% lean ground beef to yield 300 hamburgers weighing 3.5 oz each. Calculate how much ground beef you need: A. 66 lbs B. 53 lbs C. 82 lbs D. 95 lbs

C. 82 lbs. yield is how much product is produced at the end of the production process. As purchased (Ap) is the amount of product you need to buy to achieve the yield. Edible portion(EP) is how much product is available after the production process, including peeling and cooking. In the example, if the final yield is 300 hamburgers at 3.5 oz after cooking, a total of 1050 oz of 80% ground beef is required (after cooking weight). One pound of 80% lean ground beef yields .80 pounds of edible portions. The AP WILL BE 1,312 ounces ( 1050 ounces /.80). Divide by 16 to convert to pounds. Your result should equal 82 lbs of 80% lean ground beef.

67. Identify the true statement for implementing dietary change: A. Resistance and denial signal noncompliance with the intervention B. A patient progresses through the stages of change in a fluid, forward moving process C. A patient will only change when he or she is good and ready D. Prevent the client from becoming defensive about his or her lack of motivation.

C. A patient will only change when he or she is good and ready. When a RD tries to help a patient make dietary changes, the RD must remember the patient will only make a change when he or she is ready to do so. The patient who is in the action or maintenance stage of change is ready to adjust. A patient who resists or is in denial may eventually make dietary changes, but at the moment, he or she is not ready yet. The rate of progress through the stages of change is an individual journey. The patient may move forward or backward at any time. People do not move along in a predetermined sequence. It is important for theRD to determine which stage of change the patient tailor counseling escorts appropriately. The RD's counseling style, personality, and what he or she addresses motivate the patient to make a change.

43. Which of the following statements is the best advice the RD can give a diabetic patient regarding alcohol intake? A. Both men and women should limit their alcohol intake to 1 drink per day. B. Limit your alcohol consumption to 2oz on an empty stomach, as alcohol increases blood glucose levels C. Alcohol is an energy source that is not converted to glucose, unlike food. Alcohol inhibits gluconeogenesis, which can lead to hypoglycemia if you drink alcohol on an empty stomach. D. Alcohol is metabolized quickly; therefore, your risk of low blood glucose is lower if you consume alcohol after exercise.

C. Alcohol is an energy source that is not converted to glucose, unlike food. Alcohol inhibits gluconeogenesis which can lead to hypoglycemia if you drink alcohol effect on metabolism to the diabetic, so he/she can make an informed decision about drinking alcohol. Alcohol is an energy source and adds calories to the diet. It is not metabolized into glucose, as food is. Alcohol inhibits gluconeogenesis, which in turn prevents glucose from entering the bloodstream in response to insulin secretion, leading to low blood glucose. The low glucose response is potentiated if the patient drinks alcohol on an empty stomach. Exercise also lowers blood glucose levels, so drinking alcohol after exercise and taking insulin or oral hypoglycemics greatly increases the risk of hypoglycemia. It also makes recovering from a low blood sugar reaction more difficult until the alcohol is metabolized completely. Limit alcohol consumption to one drink per day for women and two for men.

90. All of the following are advantages of centralized ingredient control except: A. Allowing the cook or chef to focus on production, rather than gathering and measuring ingredients B. Cost control C. Allowing the chef to improvise recipe pies to improve customer satisfaction D. Allowing partially used packaged to be reuse and not wasted if the entire package is not required for a recipe.

C. Allowing the chef to improvise recipes to improve customer satisfaction. Centralized ingredient control is an important part of a cost effective food service operation. Use an.ingredient room to distribute menu items or recipe components, as it helps control cost. Do not require the chef or cook to preform tasks for which he/she is overqualified, such as storage and cleaning, as it raises costs. Delegate scut work to less qualified staff and allow the chef to focus on food preparation and presentation. Store Incompletely used packages for another recipie. Prevent the chef or cook from trying to use up the product in one session, thus changing the standard recipe you develop for Quality Control. Centralized ingredient control allows you to combine the same task for different recipes, such chopping peppers for pizza and chili.

38. Which of the following must the dietitian consider to assess the nutritional status of a patient with end-stage liver disease accurately. A. Nitrogen balance studies B. Creatinine height index C. Anthropometric data including information on weight changes and visual assessment D. Serum albumin level

C. Anthropometric data, including information on weight changes and visual assessment. Nutritional assessment of patients with end stage liver disease is often difficult because many test parameters are adversely affected: BUN is useless because nitrogen builds up in the form of ammonia, so BUN cannot be interrupted in the usual way CREATININE height index is compromised by decreases liver function ( synthesis of creatine to creatinine occurs in the liver) Serum albumin and other visceral proteins are unreliable, as liver synthesizes visceral proteins Anthropometrics are unreliable, due to fluid retention and use of diuretics. Instead take a weight history and preform a visual assessment. Look for muscle wasting and the presence of fat stores. Added to the overall subjective assessment, these two parameters are most useful.

103. During your job interview, your prospective employers says, give me an example of a time where you were dealing with a difficult situation and how you resolved the situation. The. Employers request is an example of: A. Structural interviewing B. Stress interviewing C. Behavioral interviewing D. Situational interviewing

C. Behavioral interviewing. The employer's request is an example of behavioral interviewing. Behavioral interviewing seek to uncover how perspective employees reacted in the past to certain types of situations, because they are likely to repeat the same behaviors in the future. The benefit of a behavioral interview is as a predictor of future performance, critical thinking skills, motivation, cooperation, teamwork and conflict resolution skills. Your interviewer expects a three step answer from you: 1. State the situation or problem 2. Describe your action 3. Explain the result and what you learned from the situation If you do not have any experience in Dietary, then draw an example from your schooling life or unrelated jobs

112. Identify the management theory that incorporates Maslow's Hierarchy of Needs A. Classical B. TQM C. Behavioral D. Integration

C. Behavioral. Maslow's Hierarchy of Needs of behavioral Management Theory. Abraham Maslow(1908 - 1970) was a psychologist who believed people are: Never totally satisfied Ultimately motivated by their need to be satisfied Driven by their needs in order of importance According to Maslow, the five basic needs are psychological, safety, self esteem and self actualization, in that specific order. Psychological needs mean adequate food, water and warmth. Safety mean freedom from fear and a basic sense of security. Social needs include love,acceptance, belonging and establishing deep relationships with others. Esteem means developing self confidence and achieving a certain status or level of fame. Self actualization means personal growth and development, which can only be met after four previous levels of the hierarchy. Since Dietary meets the physiological needs of patients, it ranks highly and is vital to the organization.

119. All of the following are valid ways to reduce food costs except: A.set up a security measures in production areas B. Use seasonal items for special menus or meals whenever possible C. Change menu prices in the employee cafeteria all at once, rather than one at a time D. Frequently compare competitive vendor prices to ensure you receive the lowest prices

C. Change menu prices in the employee cafeteria all at once, rather than one at a time. To control or reduce food costs: 1 reduce theft by setting up security measures in tempting areas 2 but seasonal items and plan meals around cheap and abundant produce 3. Rotate inventory so it does not spoil, thereby decreasing discards 4. Create standardized recipes and do not add extraneous ingredients to recipes 5 use portion control 6 schedule production for the greatest efficiency 7. Create par levels for ingredients to avoid too much or too little of a product being prepared 8 implement price increases gradually to prevent loyal customers from getting angry and taking their business elsewhere

79. A hospital menu that rotates daily on a predicted schedule, such as every three days or every week, is called a: A.limited menu B. Rotating menu C. Cycle menu D. Table d'hôtel menu

C. Cycle menu. A cycle menu rotates everyday on a predetermined schedule such as every week or two weeks. Due to shorter patient stays in hospital, some food services reduce their cycle to a three day rotation. At the end of the cycle, the menu repeats. The purpose of a cycle menu is to help the patient or visitor feels that meals are not repetitive. Cycle menu save time because when the cycle is planned once, menu planning and recipient are complete. The menu planner should take seasonal produce into account. The purchaser knows what foods need to be ordered and available for each day of the cycle, which help control costs. Training of production and preparation personnel is tailored to the cycle.

The Nutrition Screening Initiative uses a check list with the acronym DETERMINE, which stands for: A. Dental problems,Eating poorly, Transportation issues, Economic Hardship, Reduced Social Contact, Multiple medicines,Involuntary Weight Loss/Gain, Needs Assistance in Self Care, Elder Tears Above age 80 B. Disease,Eating Problems, Transportation Issues, Economic Hardship, Reduced Mobility, Multiple Medicines, Involuntary Weight Loss/ Gain Needs Assistance in Self Care, Elder Years Above age 80. C. Disease, Eating Poorly, Tooth/Mouth Pain, Economic Hardship, Reduced Social Contact, Multiple Medicines,Involuntary Weight Loss/Gain, Needs Assistance in Self Care, Elder tears above Age 80. D. Disease, Eating Problems, Tooth Loss/Mouth Pain, Extreme difficulty with mobility, Reduced Gastrointestinal Function,Multiple Medicines,Involuntary Weight Loss/Gain, Needs Assistance in Self-Care, Elder Years Above Age 80.

C. DISEASE, EATING POORLY, TOOTH LOSS/MOUTH PAIN, ECONOMIC HARDSHIP, REDUCED SOCIAL CONTACT, MULTIPLE MEDICINES, INVOLUNTARY WEIGHT LOSS/GAIN, NEEDS ASSISTANCE IN SELF CARE, ELDER YEARS ABOVE AGE 80. The acronym DETERMINE was developed as part of a nutrition checklist to help remind patients and caregivers about warning signs and risk factors in the elderly population for developing malnutrition. The checklist asks the questions that delineate warnings such as "I have an illness or condition that made me change the kind and /or amount of food I eat". The evaluator tallies the patient's responses to determine the overall level of nutritional risk, which varies from low, to moderate to high risk.

115. Total Quality Management includes all of the following maxims except: A. Processes are charged, not people B. The customer is the main focus C. Employees must follow their job descriptions with minimal variation from procedure D. A team approach is the optimal way to improve quality and ensure long term change

C. Employees must follow their job descriptions with minimal variation from procedure. Top Quality Management (TQM) is a strategy to improve customer satisfaction through best practices. W. Edwards Deming created TQM. TQM was used heavily in the 1990's but has gradually evolved to quality improvement. The bottom line remains customer satisfaction. Teamwork is integral to the success of TQM. A facilator, usually the facility's CPHQ moves the process forward. The facilitator empowers employees and encourages then to suggest better ways to accomplish tasks. The CPHQ, Quality Assurance Manager, Risk Manager and Infection Control Practitioner analyze workflows closely. Explain to your staff that the goals of a TQM review are to eliminate waste and continuous improvement. The steps of TQM ARE: Identify the problem, determine the possible causes; develop measurable and identifiable improvements; implement a solution; measure outcome; fine tune the improvement through feedback. Emphasize to your staff that the QA TEAM scrutinizes flaws in the process. The QA team does not seek to lay blame on individuals.

101. The Family Medical Leave Act of 1993 requires: A. All employees to provide 8 weeks of paid maternity leave coverage to female employees B. Employers with more than 50 employees must provide all employees up to 10 weeks of unpaid leave with job protection status to care for a newborn, or immediate family member (spouse or child) with a serious health issue or to deal with a personal health crisis C. A Employers with more than 50 employees must provide all employees who have worked at least 1250 hours in the previous 12 months up to 12 weeks unpaid leave with job protection status to care for a new born immediate family member (spouse or child) with serious Heath issue, or deal with a personal health crisis. D. All employers must provide up to 12 weeks of unpaid leave to any employee to care for a newborn, I'll family member, adopt a child or take intermittent time off to receive personal healthcare, such as chemotherapy or physiotherapy.

C. Employers with more than 50 employees must provide all employees who have worked at least 1250 hours in the previous 12 months up to 12 weeks unpaid leave with job protection status to care for a new born immediate family member (spouse or child) with serious Heath issue, or deal with a personal health crisis. The US Dept of Labor Administers the Family andMedical Leave Act of 1993 ( FMLA) and it applies to any employer of more than 50 people in a 75 mile radius. FMLA applies to any employee who has worked a minimum of 1250 hours in the previous 12 months and at least one year for the same employer. FMLA enables the employee to take up to 12 weeks of unpaid leave to care for a newborn or to adopt a child. It also allows leave to care for an immediate family member (parent,spouse or child) who suffers with a serious health crisis.

27. Your patient is a 65yr old man, diagnosed with heart disease. He lives alone and has limited cooking skills. He frequents fast food restaurants because they are within walking distance of his house. He is 20 lbs overweight, with a BMI of 26. Select and appropriate PES based on the information you have: A. Heart disease related to fast food consumption, as evidenced in diet history. B. Excessive energy intake related to limited cooking skills, as evidenced by obesity. C. Excessive energy intake related to frequent consumption of fast food, as evidenced by BMI and diet history. D. Inadequate exercise related to heart disease, as evidenced by BMI weight gain.

C. Excessive energy intake related to frequent consumption of fast food, as evidenced by BMI and diet history. The new RD develops an appropriate PES as his/her skills increase. In this scenario, we do not know what additional exercise the patient gets besides walking to restaurants. His 20 lbs overweight and has been diagnosed with heart disease, which we know is a modifiable risk factor. We do not know the period in which he Gaines weight. The best PES would be defining the problem as excessive energy intake. The etiology of the problem would be increased consumption of fast foods. The signs and symptoms would be the BMI at 26 and his diet history.

23. Data obtained for the Nutrition Assessment piece of the Nutrition Care Process is organized into these five categories: A. Food/nutrition related history; laboratory data and medical tests; social history; nutrition focuses physical findings and client history. B. Food/nutrition related history; laboratory data; anthropometric measurements; physician exam; client history. C. Food/nutrition related history; biochemical data and medical tests; anthropometric measurements; nutrition focused physical findings and client history. D. Diet history; biochemical data and medical tests; anthropometric measurements; nutrition focused physical findings and medical exam findings.

C. Food/nutritional related history; biochemical data and medical tests; anthropometric measurements; nutrition focused physical findings; and client history. Nutrition assessment is the first step in the Nutrition Care Process. The purpose of an assessment is to gather and explain all the appropriate data needed to determine any nutrition related issues, why they occurred and their level of importance. Data for the Nutrition Assessment piece of Nutrition Care Process can be obtained from a variety of places, including conversation with the patient, medical records, or from consulting another healthcare practioner. The data is organized into 5 categories: food/nutrition related history, biochemical data and medical tests, anthropometric measurement , nutrient focused physical findings and client history.

123. All of the following factors influence an employee's job satisfaction except: A. Personality and values B. Work environment and the job itself C. Gender D. Social influences, such as co workers and culture

C. Gender. The four factors that most influence an employee 's level of job satisfaction are personality, values, overall work environment and social influences. Personality is the top indicator. A generally happy person, who is satisfied with his/her overall life, is typically a good, productive worker. Values related to the job itself and the of the work depend on the workers culture of origin and the corporate culture. The work environment includes the physical facility the hours of work, salary, benefits and coworkers on the same team. Social influences include the status conferred by the. Job and. The culture of the organizations. For example, the organization that values hard working employ and rewards them generously is more likely to recruit and retain top chefs, dietitians and aids than an exploitative organization that expects fast turnover. Gender is not as important as the other factors.

3.Which of the following statements about controlling blood glucose level is false? A. Beta cells is the islets of Langerhans produce insulin, which is released when blood glucose levels respond to a meal. B. Alpha cells is the the isles of Langerhans secrete glucagon when the patient is fasting, which stimulates the liver to break down glycogen to maintain blood glucose levels in the normal range of 80 to 100 gm/dl C. The adrenals secrete epinephrine and norepinephrine when the patient is fasting which stimulates muscles to release glycogen to maintain blood glucose levels.x D. Glucocorticoid, such as cortisol, stimulates glycolysis to increase blood glucose levels.

C. Glucocorticoid, such as cortisol, stimulate glycolysis to increase blood levels. Blood glucose levels are influenced by hormones, drugs, and vagus nerve activity. The isles of Langerhans in the pancreas produce insulin when the patient feed and glucagon when the patient fasts. In the postprandial period, beta cells release insulin to. Or alive blood glucose levels. In the. Fasting state the alpha cells release glucagon to stimulate glycogenolysis, which in glycogen is breakdown. Epinephrine and norepinephrine increase glucose levels during stress by promoting catabolism of muscles for glycogen and adipose cells for triglycerides. Glucocorticoids increase blood glucose levels by stimulating gluconeogenesis, not glycolysis. Glycolysis is the breakdown of of glycogen. Gluconeogenesis is glucose formation, which occurs mainly in the liver. Glycolysis and gluconeogenesis do not occur at the same time.

72. The purpose of evidence based practice is to : A. Search the Internet to find new therapies to treat patients B. Use data from cohort studies to change practice C.improve patient's outcomes by incorporation the best research available in new treatments and therapies D. Use meta analysis, review articles or consensus statement to change the way patient care is provided

C. Improve patient's outcomes by incorporating the best research available in new treatments and therapies. Evidence based practice incorporates the best available with clinical expertise and an individual patient beliefs and situation into a comprehensive treatment plan. The gold standard for research is randomized, controlled trials that are well designed. Cohort studies, meta analyses, review articles and. Consensus statements are useful supplements, but are not primary mode of obtaining information. Beware of Internet misformation: ensure any web addresses you will rely on end in edu., gov or org. Utilizing evidence based practices is a way for clinicians to remain well informed and to the. Change practice when new treatments or therapies are available. National accreditation standards require dietitians to follow best practice guidelines and. Evidence based practice.

64. Select in intermittent drip feeding schedule when a patient needs home enteral nutrition because: A. A pump supported regimen is more cost effective B. It is better tolerated than other types of feedings C. It allows the patient more mobility and free time from the pump D. It reduces aspiration risk

C. It allows the patient ore mobility and time free from the pump. Intermittent feeding schedules are often the schedule of choice for patients who require tube feedings at home and are able to ambulated fairly well. Plan an intermittent schedule with or without the use of a feeding pump. The schedule is generally four to six feedings per day of a specific volume administered over a period of 30 to 60 minutes. Many patients who are alert, ambulatory and are able to preform self care tolerate an intermittent schedule very well. Patients who are at risk for aspiration should not receive an intermittent feeding schedule. Intermittent feedings used without a pump can be more cost effective than a continuous feeding schedule.

1.Which of the following carbohydrates is not a monosaccharides ? A. Fructose B. Galactose C. Maltose D. Glucose

C. Maltose - a monosaccharide is the smallest carbohydrate unit with the formulas (CH2O). Fructose is a sugar found in fruit and is the sweetest of all monosaccharides. Galactose is not found freely in foods but is derived from the hydrolysis of the milk of the milk sugar lactose process during digestion. Glucose is the primary monosaccharides used for energy. Glucose is generally part of a disaccharide linked to fructose in the form of sucrose or linked to lactose I the form of galactose. When glucose is linked with another glucose molecule, it forms maltose and is considered a disaccharide.

33. All of the following statements about serum albumin are true except: A. The half-life of albumin is approx 20 days B. Albumin is a negative acute-phase reactant that responds slowly to change in nutritional status C. Measuring serum albumin is a valuable tool in assessing short term changes in protein status D. Serum albumin levels decrease during infections

C. Measuring serum albumin is a valuable tool in assessing short term changes in protein status.serum albumin is a negative acute phase reactant with a half life of 20 days. This means albumin is very slow to show changes in protein status. It is a better indicator of long term changes in protein status or to measure maintenance of albumin in a stable long term patient. Since albumin is an acute phase reactant, levels decrease during infection, trauma, inflammation and acute injury. Prealbumin is a better marker of short term changes in protein status. The half life of prealbumin is 2 days. It is also known as thyroxin-binding prealbumin (TTHY)

86. Which best qualifies as a Standard of a quality for Apple juice? A. The quality of apples used to make apple juice B. The type of container used to package apple juice C. The Brix Acid Ratio D. The type of apple used to make apple juice

C. The Brix Acid Ratio. Standard of Quality is a part of the Food, Drug and Cosmetic Act 1938, which specifies certain factors that must be present in a food product and objective measures to determine compliance. Standard of Quality helps the consumer to determine the value or use of a product. For example, quality standards can describe: how much water is added to canned foods; how fibrous green beans should be, or what mixed nuts are called, based on the composition of nuts. The quality of Apple juice includes its color, clarity, defects, flavor, acidity and aroma. All of these factors are grades to determine if the juice is of A,B or Std. Quality. The Brix Acid ratio explains the amount of soluble solids in the juice (the number of grams of acid per 100 grams of concentrated juice).

54. The correct nutritional management for a kidney disease (CKD) patient receiving hemodialysis is: A. 30 kcal /kg, 0.8 to 1/kg protein; 2 to 4 g sodium; 2 g potassium, 800 to 1200 mg phosphorus restrict fluid to 1500 ml per day. B. 30 to 35 kcal/kg, 1 to 1.3/kg protein; 3 to 4 g sodium,; unrestricted potassium; restrict phosphorus by limiting dairy to one 8oz serving or the equivalent per day; unrestricted fluid. C. Minimum 30 to 35 kcal/kg, 1.2 g/kg of protein; 2 to4 sodium; 2 to 3 g potassium; restrict phosphorus by limiting dairy to one 8oz serving or the equivalent per day; fluid intake of 1000 ml plus the amount of daily urinary output. D. 25 to 30 kcal/kg, 1.5 g/of protein; 4g sodium, 2 g potassium; restrict phosphorus by limiting to one 8 oz serving or the equivalent per day; fluid intake of 1500 ml plus the amount of daily urinary output.

C. Minimum 30 to 35 kcal/kg, 1.2 g/kg of protein ; 2 to 4 g sodium; 2 to 3 g potassium; restrict phosphorus by limiting dairy to one 8oz serving or the equivalent per day; fluid intake of 1000 ml plus the amount of daily urinary output. An ESRD patient receiving hemodialysis treatments does require nutritional management. Energy intake should be 30 to 35 kcal/kg but can vary, based on the patient's overall clinical condition. Protein requirements are 1.2 g/kg or higher depending on protein status. Sodium restriction is required for blood pressure management and fluid status. When the patient's kidney function has deteriorated enough to require hemodialysis, a potassium restriction of 2 to 3 grams per day is usually sufficient to maintain serum potassium in the normal range, but adjust potassium as needed. Phosphorus restriction of 800 to 1200 mg per day is usually required, even if the patient already uses phosphorus binders. Limit fluids to the amount of unitary output plus 1000 ml. Monitor weight gain between treatments. Weight gain from dry weight should be less than 3kg.

82. If a patient in a long term care facility requests a write in or substitution on the menu, the RD's response should be: A. Immediately disregard the request because it increases food costs B. Inform the patient you considered the request but the policy is no substitutions C. Provide the request or offer another option D. Inform the patient you need at least 48 hrs to plan for special requests

C. Provide the request or offer another option. Many institutions, especially long term care facilities, try to provide increased choices for patients or may liberalize diet modifications. Still patients may have special requests known as substitution one write ins. The Centers for Medical and Medical Services (CMS) require that substitutions should be honored in long term carefacilities. Other types of institutions should either provide the request or find another option that is amenable to the patient. Exotic request may be difficult or impossible to provide. Most are reasonable, do not take much effort to provide, and increase patient satisfaction. Keep a list of potential write in requests available in the kitchen o ease the process.

4. Body fat performs all of the following functions except ? A. Provides a concentrated source of energy? B. Protects bones and. Internal organs by cushioning them and regulating their temperature. C. Provides a source of eicosapentaenoic (EPA) and docosahexaenoic (DHA) essential fatty acids. D. Aids absorption of the fat soluble vitaminsA, D, E and K

C. Provides a source of eicosapentaenoic (EPA) and docosahexaenoic (DHA) essential fatty acids. Fat plays a very important role in the body. It provides a concentrated energy, at 9 kcal per g, whereas protein and carbohydrate only provides 4 kcal per g. Structural fat pads cushion and protect the body from injury, especially bones and internal organs. Fat provides a source of essential fatty acids, which the body does not manufacture, but must obtain form seeds, oils, cold water fish, or supplements. Three essential fatty acids (EFAs) are arachnoid if, linoleic and linolenic. EFAs are important for blood clotting and brain development. Eicosapentaenoic (EPA) and docosahexaenoic (DHA) derive form a-linolenic acis, but are not themselves essential fatty acids. Fats are also required for the absorption of the fat soluble vitamina A, D, E and K

74. What kind of research design does the Dietary Approaches to Stop Hypertension Trial (DASH) follow? A. Randomized controlled double blind study B. Meta analysis C. Randomized epidemiological study D. Cohort study

C. Randomized epidemiological study. The DASH trial was a multi centered, randomized controlled feeding study that examined three different meal patterns. Over an 8 week period: Control group who ate diet low in fruits and vegetables A test group with a diet high in fruits and vegetables A test group with a diet high in fruits and vegetables and low in saturated sand total body fat DASH used a large study sample and four collection centers to gather research information. Study participants were given the food they were to consume, and were randomly assigned into one of the groups. A randomized, controlled, double blind study means neither the study participants nor the researcher knows who receives the test substance and who does not, so the results are more accurate.a meta -analysis is a statistical approach to reviewing similar literature. The researcher combines the data to determine statically significant results. A cohort study observes a particular group (similar in age, race, or another significant indicator) over a long period. A cohort study is relevant for one group, not able to be extrapolated to the general population.

9. Which description of marasmus is the most accurate ? A. Starvation from good deprivation , with a decrease in somatic and visceral protein stores, but subcutaneous fat stores are preserved. B. Protein deprivation, with adequate calories from carbohydrates and depletion of visceral protein stores,but preservation of somatic stores. C. Severe malnutrition, with loss of subcutaneous fat and depletion of muscle mass, followed by breakdown in lean body mass. D. A form of malnutrition mainly seen in the US, due to limited access to food.

C. Severe malnutrition with loss of subcutaneous fat and depletion of muscle mass, followed by a breakdown in lean body mass. Marasmus is severe lack of calories. It usually affects infants 6 to 18 months old when their mothers' milk fails and they contract chronic diarrhea from polluted water. It can also affect children with metabolic disorders or malabsorption. Marasmus is characterized by: Decreased in somatic and subcutaneous stores; perseveration of visceral protein stores; depletion of lean body mass; loose skin; intellectual disability; (emanciation) to 20%of normal for. Given height;large head;loose skin; intellectual disability; depression; and failure to thrive. By contrast kwashiorkor affects children 1 to 3 years old with depleted visceral protein stores, but somatic and subcutaneous fat stores are preserved. Mixed malnutrition (maras mic kwashiorkor ) means both calories and protein are deficient and features of both conditions are present.

22.All of the following statements about Healthy People 2020 are true except: A.the two top goals are to increase the quality of life and the number of years spent in good health, and to eliminate disparities in health. B. There are 12 Leading Health Indicators C. The program originated the the 1960's through the Surgeon Generals' Report on Health Promotion and Disease Prevention. D.there are 42 topic areas and hundreds of specific objectives.

C. The program originated in1960s through the Surgeon general's Report on Health Promotion and Disease Prevention. Healthy People 2020 is an extent in of a health prevention program that originated in 1979 through the Surgeon General's Report on Health Promotion and Disease Prevention. the program's two goals are: To increase the overall quality of life and the number of years spent in good health, and to eliminate disparities in health between different parts of population. There are 42 topic areas and. Hundreds of specific objectives that can be used by states, local communities and various organizations and institutions. Some of the focus areas include cancer, obesity, diabetes, health communication, oral health and food safety.

14. Physiological changes in an older person may include all the following except: A. Loss of lean body mass and an increase in adipose tissue. B. Loss of kidney function from age 30, due to gradual loss of nephrons and reduced blood flow. C. Up to 40% reduction in resting metabolic rate, due to reduced lean body mass , since muscle is the most metabolically active tissue. D. Achlorhydria, resulting in a vitamin B12 deficiency, because stomach acid is required to absorb Vitamin B12.

C. Up to 40% reduction in resting metabolic rate, due to reduced lean muscle mass , since muscle is the most metabolically active tissue. The aging process essentially begins after the age of 30. The body has reached physiological maturity and the rate of catabolism is greater than the rate of anabolism. The aging process is influenced by genetics, socioeconomic status, overall health, activity level and lifestyle. Lean body mass is lost at a rate of 2% to 3% per decade and it is often replaced with fat. Lean body mass is the most metabolically active tissue, so it's loss reduces the resting metabolic rate by 15% to 20% over the course of a lifetime. Other physiological changes include nephrons loss in the kidneys and achlorhydria, which is reduced stomach acid affecting the absorption of B12 and subsequent pernicious anemia.

52. The food intake of a patient with chronic obstructive pulmonary disease (COPD) is adversely affected by all of the following except: A. Shortness of breath B. Problems with food preparation due to increased fatigue C. Increased oxygen saturated while eating D. Fluid restriction

C.increased oxygen saturation while eating. A COPD patient has difficulty consuming enough food, due to shortness of breath. Dyne a decreases oxygen saturAtion. Advise your COPD patient to use oxygen while eating to help alleviate dyspena. Often, liquids are easier for COPD patients to consume, rather than chewing and swallowing foods. Consider this before you decide to restrict fluids from COPD patient. Many individuals with COPD have difficulty preparing meals, due to fatigue from oxygen deprivation. Anorexia or poor appetite is related to many chronic diseases, including COPD. The COPD patient's metabolism changes and energy requirements are often increase, due to the increased work of breathing and the type of treatments required(eg. Physiotherapy and steroid medications).

10. Which of the following statements about Vitamin D is false? A. Vitamin D activated by two hydroxylation; the first hydroxylation occurs in the liver and the second hydroxylation occurs in the kidneys. B. The. Most active form of vitamin D occurs after hydroxylation in the kidneys to 1, 25 dehydroxyvitamin D, also know as calcitriol. C. The most active form of vitamin D is 25 hydroxycholecalciferol and occurs after hydrolysis in the liver. D. The main function of Vitamin D is calcium and phosphorus homeostasis.

C.the most Clive form of Vitamin D is 25 hydroxycholecalciferol and occurs after hydroxylation in the liver. Vitamin D is obtained through fortified dietary sources and sunlight exposure. Vitamin D is activated by two hydroxylation: The first occurs in the liver and produces 25- hydroxycholecalciferol, the main circulating form of vitamin. The second hydroxylation occurs in the kidney where 1-25-dihyydroxyvitamin D is produced, the most active form on vitamin D (also called calcitriol. Vitamin D has many functions but mainly it promotes calcium and phosphorus homeostasis. Vitamin D also plays a role in skin, muscle and nerve function, cell differentiation, and immune function.

99. You are serving a 4 ounce option of mashed potatoes on the serving line. What size of a dish is appropriate? A. 16 B. 12 C. 10 D. 8

D. 8. A dishes is also known as a scoop size. A dishes helps with portions control. Portion control is very important, both controlling food costs and for promotion customer satisfaction. Food service managers and employees must understand the need to control portions and must remember the quality each disher, ladle and pan will yield. A number 8 dishes is approximately 8 tablespoons or 1/2 c and has approximate weight of 4 to 5 ounces. Dishes are typically even numbered ranging from 6 down to 1000. A size 6 measures 2/3 c. A size woo measures 2 teaspoons

113. All of the. Following violate the Dietetics Code of Ethics except: A. The RD in private practice actively promotes specialized vitamins and minerals and benefits financially from sales, but does not tell the client of her personal involvement with the products B. The RD food service manager in a hospital kitchen depends on painkillers to control pain from a running injury and takes them on the job. C. The clinical RD exhibits symptoms of bi polar disorder while at work and various coworkers complain. The RD receives psychiatric treatment but later refuses medication due to its side effects D. A Clinical RD dates another RD who is the assistant manager in the food production area.

D. A Clinical RD dates another RD who is the assistant manager in the food production area. The ADA developed a voluntary Code of Ethics for RD's . The CODE OF ethics a outlines the values and morals that guide the profession, maintain its credibility and protect the consumer. In the examples cited any dietetics professional who tries to sell a product to clients for financial gain without disclosure, violated the Code of Ethics. Any type of substance abuse on the job, including prescription painkillers, is a violation because it could lead the RD to miscalculate sensitive ingredients, such as sugar levels for diabetic. A bipolar RD who refuses treatment and continued to practice could endanger herself or others and thereby violates the Code of Ethics. However, two RD's with different jobs in the same organization who date are not necessary violating the Code, unless one is in a position of authority over the other or sexual harassment is involved.

21. The National Health and Nutrition Examination Survey (NHANES) is: A. A general screening program that interviews 10,000 Americans each year to determine their medical and dental histories. B. A state program that examines people over the age of 18 to gather their health-related information (demographic, socioeconomic, and nutritional) C. A state program that obtains information from participants to improve health promotion and epidemiological research. D. A federal program that combines in interview with a physical exam to assess the general health and nutritional status of participants of any age living in the US.

D. A federal program that combines an interview with a physical exam to assess the general health and nutritional status of participants of any age living in the US. The National Health and Nutritional examination Survey (NHANES) is a federal program that surveys the health and nutrition status of both children and adults in the US. The program information through that the interview process. The interviewer gathers data about the participants', demographic, socioeconomic status, diet and health- related questions. The interview is followed by a physical examination that includes laboratory tests and medical, dental, and anthropometric measurements. The HANNES survey helps to establish national standards for health issues, such as blood pressure and extremes of weight. The data obtained is available for epidemiological research through out the. World. Past surveys produced data that helped researches develop growth charts for infants and children, policies benchmarking lead levels and increase public awareness about diseases such as diabetes.

107. A food service manager is often responsible for scheduling the: A. Production schedule B. Master schedule C. Shift schedule D. All of the above

D. All of the above. The three types of schedules that a food service manager is responsible for writing are the master schedule, shift schedule and production schedule. The master schedule is written on a set rotation, such as every two weeks or every three weeks. The master schedule indicates employees days off and vacation time. Include the weekend rotation on the master schedule; do not separate weekdays from weekends. Ensure kitchen work gets done in the most cost effective way. For example, do not allow all cooks to take the same week off as vacation, so that you do not pay for overtime coverage unnecessarily. Base the shift schedule on the master schedule. The shift schedule lets the employee's know the hours they will work. The production schedule lets the employee's know their daily and the period for completion.

28. Your referral patient is a 52 year old female with elevated glucose levels, diagnosed with diabetes mellitus. Her fasting blood glucose level is 132mg/dl. Her BMI is 28, which has increased from 25 over the past several months. She performs physical exercise two or three times per week for approx 15 minutes. Select a nutrition diagnosis based on the above information: A.excessive carbohydrate intake, physical inactivity, or diabetes mellitus. B. Inappropriate carbohydrate intake, inadequate physical activity or excessive energy intake. C. Excessive carbohydrate intake, impaired nutrient utilization or diabetes mellitus. D. Altered nutrition related lab values, physical inactivity, or over eight obesity.

D. Altered nutrition related lab values, physical inactivity or overweight/obesity. The nutrition diagnosis is a problem the RD lable, addresses, improves and resolves. Diabetes mellitus is a. Medical diagnosis but not a nutritional diagnosis. Instead of using diabetes mellitus, it would be appropriate to use the nutrition diagnosis of altered nutrition related lab values. In this case,fasting blood glucose falls under behavioral -environmental. From the information provided, we do not know what this woman's diet history is. We are unable to assign a nutritional diagnosis related to her carbohydrate intake or energy intake, until we obtain the information. We do know that her physical activity is inadequate, which also falls under behavioral environmental. We do know from her BMI of 28 that she is overweight and this is a clinical finding.

17. The Nutrition Screening Initiative is a joint project between all of the following groups except the: A. American Dietetic Association B. American Academy of Family Physician C. Nutrition Council on Aging D. American Medical Association

D. American Medical Association. The nutrition screening initiative of 1990 was a partnership between the American Academy of Family Physicians, American Dietetic Association and the National Council on Aging. The partners wanted to develop a tool to improve nutritional care forthe elderly. They developed a simple checklist screening tool and two levels for further evaluation which the patient can complete independently, or a medical professional can administer. Many community agencies administer the screen to populations they serve.

11. All of the following foods are good sources of niacin except: A. Chicken B. Tuna C. Mushrooms D. Baked potato

D. Baked potato. Niacin is found in many foods, Including chicken, turkey, lean meats and fish. Niacin is one of the four vitamins added to enrich grain products ( flour, cereals, and breads). Beans ,seeds, legumes ( peanuts and lentils) are good sources of. Niacin. Milk, coffee and tea provide some niacin. Vegetables are not a significant source of niacin, except for mushrooms. Most people get plenty of niacin from their diets and do not require a supplement. Large doses of niacin are sometimes used to treat hyper cholesterolemia under medical supervision. Significant side effects may occur such as severe flushing or itching skin and liver damage.

30. Which of the following dietary methodology may you use when conducting a dietary history? A. Retrospective data collection, such as food frequency or 24 hr call. B. Prospective data collection, such as a 24hr recall. C. Retrospective data collection, such calorie count or 24hr recall D. Both retrospective data collection, such as food frequency or 24hr recall, and prospective data collection, such as food record or food diary.

D. Both retrospective data collection, such as food frequency or 24 hr recall, and prospective data collection, such as food record or food diary. To obtain information for a dietary history, the RD collects retrospective data, prospective data or a combination of both. Retrospective data is information recalled from the patient or client memory. Retrospective data includes food frequency questionnaires or 24 hr recall. The concern about retrospective data collection include its validity, reliability, memory issues and inaccurate reporting. Prospective data collection is information recored around the time the food is eaten. Examples of prospective data collection are calorie count or nutrient intake records, food records and food diaries.

95. Identify the food service system that partially cooks food, quickly chills it, stores it and reheats it before client service. A. Centralized B. Decentralized C. Commissary D. Cook chill

D. Cook chill. A cook chill system is part of a ready prepared food service system. A cook chill system means the food s partially cooked, then quickly chilled and stored until it is needed. Food is the reheated and served immediately. Hospitals frequently use the cook chill method using microwaves, convection ovens or specially made rethermalization carts. Commissary service is a centralized facility that ships food to several distant facilities, where preparation is finished and food is served. Centralized service means patient trays are prepared in the main kitchen and production area, then delivered and served to patients. Decentralized service means food is sent to galley kitchen for heating and tray assembly, and the food is served to the patients in designated areas, rather the a dining hall.

61. The name of the program that provides nutrition education regarding food choices, food safety, budgeting and gardening to adults and children in many venues is: A. Nutrition programs and minority servicing institutions B. Eat better move more C. SAP-Ed D. EFNEP

D. EFNEP The Expanded Food and Nutrition Education Program(EFNEP) was designed to help individuals and families of limited resources learn about nutrition based behaviors that can improve their diets and overall wellbeing. EFNEP instructors teach adults about shopping and budgeting strategies, cooking techniques, food safety and sanitation. EFNEP is a very hands on program to enhance, kin esthetic learning. For children and adolescence the program maybe part of community centers. 4 H groups, after school programs, or daycare centers. Children may learn about gardening, food preparation, food safety and how nutrition and health are related.

71. The RD documents all of the following nutrition education items except: A. Reason for visit and current diagnosis B. Short term and long term goals, meal planning and topics covered during education C. RD's thoughts on the client's progress,expected compliance level, and. What changes the client has already succeeded in making. D. Fee schedule, erasing any charting errors, and client's perception of medical care he or she is receiving.

D. Fee scheduling , erasing and charting errors and client's perception of medical care he or she is receiving. Do not include the client's fee schedule when documenting patient education, as this is not pertinent information. Remember that the patient's chart is a subpoenable document that a judge may review. It is illegal to erase or paint correction fluid or chart error.draw a single line through the error in dark blue or black ink. Write the correction above the error, initial and date it. You must document the reason for the patient's visit, his or her current diagnosis, any relevant lab results, medications and the name of the physician who referred the patient to you. Briefly outline the history, the nutrition problem list and the care provided by the physician, including goals set and expected level of compliance. Documental topics you address during ht eyes ion, dietary changes successfully implemented and a follow up plan.

65. Monitor the patient with an enteral jejunostomy tube for all the following except: A. Weight monitoring at least 3 x per week. B. Serum electrolytes and renal function C. Intake and output records, including bowel movements D. Gastric residuals check every 4 to 6 hrs

D. Gastric residuals check every 4 to 6 hours. Any patient receiving enteral nutrition must have a planned monitoring schedule, including a patient with a nasogastric tube, gastric tube or jejunostomy tube. The doctors orders lab tests according to the institution's specific protocols. Monitor the patient's laboratory results for the serum electrolytes, renal function, glucose, calcium, phosphorus, magnesium, albumin, and nitrogen balance. The nurse weighs the patient at least 3 x per week and the RD should check the results. Work with the nurse to monitor the patient's intake and output (urine & stool) and ensure the patient receives adequate nutrition and hydration. For nasogastric and gastric tube patients, monitor gastric residuals as a precaution. The validity of monitoring residuals remains unclear, as they may be 150 ml or more in the stomach at any given time, due to gastric juices. Do not check feeding tubes in the jejunum because there is no reservoir, as in gastric feedings.

78. To encourage a client in the contemplative stage of change, the RD SHOULD: A. Assist the client to make appropriate goals to facilitate change. B. Help the client adjust the changes already made, to further progress C. Prevent the client from feeling discouraged to help change continue forward D. Help the client see the advantages and disadvantages of making change

D. Help the client see the advantages and disadvantages of making changes. A client in the contemplative stage of change remains indifferent or uncertain about making dietary changes. The contemplative client thinks about a change but may find a reason to opt out of it. The RD's job in the Contemplative stage is to help the client see why making changes would benefit him/her. Do not begin goal setting, as the client will likely tune out. Help your client to adjust before proceeding to the action stage. Prevent your client from feeling discouraged. Move forward by making positive changes until the maintenance stage.

29. Your patient is a 46 yr old man, who is 6 ft tall and. Weights 160 lbs. he presents with difficulty swallowing and weight loss of 20 lbs. he states he is usually 180 lbs. he is a long history of cigarette smoking but no other medical issues. The doctor admits your patient to a hospital to evaluate him for possible esophageal cancer. Admission blood work reveals a serum albumin of 2.8g/dl. During the nutrition interview, his diet history shows your patient consumes approx 1500 cal/day, and has altered his diet to soft/semi sift consistency to accommodate his dysphasia. Based on the above information, all of the following are possible nutrition diagnosis except: A. Inadequate energy intake B. Excessive smoking C. Swallowing difficulty (dysphasia ) D. Involuntary weight loss

D. Involuntary weight loss. There are many potential nutrition diagnosis for the patient. The best choices are: inadequate energy intake because of the weight loss; swallowing difficulty causing the patient to alter the consistency of his diet; involuntary weight loss. Excessive smoking is not a nutritional diagnosis, but it likely does influence his medical diagnosis. Another potential nutrition diagnosis would be altered nutrition related lab value because his serum albumin was low there are no right or wrong nutrition diagnosis but they must be well thought out and prioritize in order of importance. The primary nutrition diagnosis must be something the RD can influence and potentially resolve.

15. A very young child is at highest risk for a deficiency in: A. Protein B. Vitamin C C. Calcium D. Iron

D. Iron. A child grows rapidly from age 1 to 3 years. Some children are at risk for malnutrition because they are very fussy eaters, or are not offered appropriate foods to meet nutritional needs, or have reduced appetite. The need for more protein decreases as a child gets older. Most children consume more protein than is needed by the body. It is easy to meet the requirements for vitamin C with a daily serving of juice. Calcium deficiency occurs if a child does not consume any sources of calcium. Iron deficiency is the most likely to occur following the rapid growth of infancy, as there is an increase of hemoglobin. Many children's diets lack iron and it's absorption rate can be decreased by many factors.

100. Include all of the following items in a job description except: A. Job title B. Job duties C. Job specifications D. Job benefits

D. Job benefits. A job description is a document that describes the various taske, requirements, working conditions, necessary tools and equipment and equipment and responsibilities involved in a certain job. A job description has three main sections: job title, job identification and job duties. Job title is important because it allows the employee to know exactly where he/she fits into the organization (org chart). Job identification identifies to whom the employee will report. Job duties list the job functions and responsibilities in order of their importance. Some job descriptions include an additional job specifications section, which lists the necessary education, registration, skills and training, required to preform the job legally.

81. All of the following characterize restaurant style except: A. Clear, concise, easy to understand menu selections B. Short explanations about modified doers C. Room service, where meals ordered by telephone are delivered at the patient's request D. Less interaction between the patient and food service personnel

D. Less interaction between the patient and food service personnel. A restaurant style menu in a hospitalizncreasespatient satisfaction and menu variety. A room service option may be available, where the patient phones the kitchen to order a meal at Willa d has it delivered in a timely manner. A restaurant style menu should be clear, concise and easy to read and understand. Remember that patients are incapacitated and medicated and may have difficulty focusing their eyes. Offer explanations about diet modifications and basic nutrition advice on the menu. Restaurant style menus are not designed for less interaction with food service personnel. Frequent, positive interaction with food service personnel improves patient satisfaction.

50. Identify the contents of the Therapeutic Lifestyle Change (TLC) diet. A. Less than 35% of total calories from fat, with less than 10% saturated fat, up to 10% polyunsaturated fat, up to 20%, mono saturated fat, and cholesterol intake less than 300 mg per day: 50% to 60% of total calories from carbohydrates; and 30 to 35 grams of fiber per day. B. Less than 35% of total calories from fat, with less than 10% saturated fat up to 15% polyunsaturated fat, up to 15% monounsaturated fat, and cholesterol intake less than 200mg per day; 45% to 50% of total calories from carbohydrates;and 30 to 35 grams of fiber per day. C. Less than 30% of total calories from fat, with less than 7% saturated fat , less that 10% polyunsaturated fat, 10% monounsaturated fat, and cholesterol intake less than 300mg/day, 45% to 550% of total calories from carbohydrates and 25 to 30 gm fiber /day. D. Less than 35% of total calories from fat, with less than 7% saturated fat, up to 10% polyunsaturated fat, up to 20% monounsaturated fat, and cholesterol intKe less than 200 mg/day; 50% to 60% of total calories from carbohydrates and 25gm of fiber/day.

D. Less than .35% of total calories from fat, with less than 7% saturated fat, up to 10% polyunsaturated fat, up to 20% mono saturated fat, and cholesterol intake less than 200 mg/day; 50 to 60% of total calories from carbohydrates and 25 grams of fiber per day. The Therapeutic Lifestyle Change (TLC) diet is part of the National Cholesterol Education Program (NCEP). The TLC DIET replaces the former American Heart Association step 1 & 2 diets. The recommendations for the TLC diet are as follows:less than 7% total calories from saturated fat; 25 to 35% of total calories from fat; less than 200mg per day of cholesterol; up to 10% of total calories form polyunsaturated fat; up to 20% of total calories from monounsaturated fat; 50% to 60% of total calories from carbohydrates; 25 gm of fiber per day; 15% of total calories from protein. Weight loss or maintenance is important,as is regular and consistent physical activity.

42. All of the following goals are appropriate medical nutrition therapy for diabetes except: A. Maintain blood glucose levels as close to the normal range as possible to help prevent or delay complications of diabetes B. Adjust nutrient intake to help address possible complications resulting from obesity, heart disease and nephropathy. C. Learn to make healthier food choices and improve physical activity level to help improve overall health status. D. Modify fat intake to help prevent the development of cardiovascular disease and improve lipid panel; modify protein intake to help prevent the development of nephropathy and other kidney related complications

D. Modify fat intake to help prevent the development of cardiovascular disease and improve lipid panel; modify protein intake to help development of nephropathy and other kidney related complications. The main goals of medical nutrition therapy for diabetes are essentially the same for all patients, regardless of age. Keep blood glucose, lipid levels, and blood pressure within recommended ranges to prevent or delay potential complications of diabetes Encourage weight loss for patients who are overweight or obese Adjust nutrient intake as needed, if complications are present, but otherwise encourage healthy dietary choices and exercise Do not modify the protein intake of diabetics who have normal kidney function. Some diabetics may have protein requirements slightly above the RDA. There is no evidence to prove that higher protein intake causes diabetic related nephropathy.

83. Your first task when planning a cycle menu is: A.plan salads, side dishes and appetizers B. Plan breakfast services C. Plan starch items and sauces D. Plan dinner entrees for the whole cycle

D. Plan dinner entrees for the whole cycle. The RD must plan the dinner entrees first when preparing a cycle menu because dinner is the most expensive meal of the day. All entrees must balance, varied and within budget. Consider alternatives for vegetarian clients or those with cultural restrictions(eg. Kosher for Jews and Halal for Muslims). Secondly, plan the lunch entrees. Thirdly, plan the starch choices, followed by salads, side dishes and appetizers. Plan desserts after the balanced dinners and lunches. Finally, plan the breakfast meal. Preform a final review to ensure the overall menu is balanced and meets any required government regulations and accreditation standards. Review the results of the last accreditation so survey for your departments to pinpoint the weak areas in your kitchen.

121. A customer evaluating a meal's quality is least likely to consider: A taste, appearance and portion size B. Service and preparation method C. Quality of ingredients D. Popularity of the item in the cafeteria

D. Popularity of the item in the cafeteria. Generally, when a customer evaluates a meal's quality, the popularity of one item with other customers is not a primary factor. However, the. Customer may initially select the food item based on what other customers are ordering in his/her presence. The customer assesses the meals quality according to: how the meal taste; acceptability of portion size; hoe the food was prepared and overall service. A food service operation cannot hide the use of low quality foo.d. Food specifications spell out exactly the quality that is expected, including food grade, form, pack and price. If miserable cashier is the last food service employee the customer sees, the it negatively influenced the customer's opinions of the meal, even if the food was of good quality.

19. Which of the following programs do not incorporate nutrition screening as part of the enrollment process? A. The Head Start Program B. Special Supplemental Nutrition Program for Women, Infants and Children (WIC) C, Farmer's Market Nutrition Program D. Supplemental Nutrition Assistance Program

D. Supplemental Nutrition Assistance Program.The Head Start Program requires that a child's medical needs are up to date and his/her nutritional need are addresses within 90 days of enrollment. The Special Supplemental Nutrition Program for Women, infants and Children (WIC) documents nutritional risk when participant is certified. The Farmer's Market Nutrition Program is part of the Special Supplement Nutrition Program for Women,Infants and Children program in 45 states. Participants currently enrolled in the WIC program are eligible for the Farmer's Market by using separate coupons issued along with the participants regular WIC BENEFITS. The Supplemental Nutrition Assistance Program (SNAP formerly known as food stamp program) is based on mainly income level. Nutrition screening is not part of the SNAP process.

104. Orientation familiarized new employees with organization and teaches them hoe to preform their new job functions. Select the best orientation process: A. The new employee tours the department and reads the policy and procedures manual B. The preceptor gives the new employee tour, explains the job requirements, and directs the initial assignment C. The departmental director welcomes welcomes the new employee, gives a tour, completes the paperwork, and tells the new employee to observe another employee who performs the same job. D. The RD: meets the new employee; explains the purpose or Orientation; completes the paperwork; discuss the department's purpose and objective; introduces other employees; gives a tour of the department and overall facility; reviews Policy and Procedured; explains and demonstrates job duties; additional observation and training with a preceptor.

D. The RD: meets the new employee; explains the purpose or Orientation; completes the paperwork; discuss the department's purpose and objective; introduces other employees; gives a tour of the department and overall facility; reviews Policy and Procedured; explains and demonstrates job duties; additional observation and training with a preceptor. A proper orientation reduces employee turnover and improves job performance. The orientation process prepares the new employee to preform his/her new job to an acceptable standard and to integrate smoothly with new coworkers. Orientate the new employee to the organization as a whole and then the Dietary Department. Welcome the new employee warmly. Complete the paperwork first. Explain the organizational chart; show the employee where his/her new job fits into it, and the supervisor to whom the employee will report. Review the organization's missions and departmental objectives. Take the employee on a comprehensive tour of the facility, especially restrooms, notice boards, change rooms and cafeteria. Point out restrictive areas. Get the employee photographed for identification. Sign out necessary keys. Show the new employee the Policies and Procedures manual and give him/her a copy of necessary forms. Demonstrate his/her job duties. Allow sufficient time for observation and training, so employee can preform job duties safely and effectively.

44. Which of the following statements about intermediate acting insulin is true? A. The onset action is 30 minutes to 1 hour, peak action is 6 to 10 hours, and the duration is 10 to 16hours. B. The onset of action is 15 to 30 minutes, peak action is 2 to 3 hours, and the duration is 6 to 8 hours. C. The onset action is 4 to 6 hours, peak action is 10 to 12 hours, and the duration is 16 to 20 hours D. The onset is 2 to 4 hours, peak action is 6 to 10 hours and the duration is 10to 16 hours.

D. The. Onset action is 2 to 4 hours, peak action is 6 to 10 hours and the duration is 10 to 16 hours. The different types of insulin is currently available are injections and pumps of rapid and short acting, intermediate acting, long acting and per mixed. Oral sprays and skin patches are now in development. NPH and Lente are examples of intermediate acting insulin. Give intermediate acting insulin twice per day, once before breakfast and the other at dinner or bedtime. The duration of intermediate insulin is between 10 to 16 hours. Check the effects of intermediate insulin within 8 to 12 hours, to ensure the patient's blood glucose is in the proper range. Short acting begins to work within 6 hours. It's peak is within 2 to 3 hours. It's duration is 3 to 6 hours. Long acting insulin

5. Which of the following are not essential amino acids? A. Lysine, leucine, valine B. Isoleucine, tryptophan, phenylalanine C. Methionine,threonine, lysine D. Tyrosine, glycine, alanine

D. Tyrosine, glycine, alanine. Amino acids are the building blocks of protein. There are 20amino acids in total. Nine amino acids are essential and cannot be manufactured by the body: Isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine and histidine. Often, adults can synthesize enough histidine, but infants and children cannot. Essential amino acids must be obtained from food. The best sources of essential acids are animal products, such as meat, poultry, fish, dairy and eggs. A diet containing 10% to 12% of calories from protein should meet essential amino acid requirements.the non essential amino acids are arginine, alanine, asparagine, aspartic acid, cystine, glutamic acid, glycine, proline, serine and tyrosine.

108. All of the following are reasons for an employee to join a union except A. Dissatisfaction with management rules and policies B. Compensation and benefit packages C. Worries about job security D. Unions require all employees to join if the workplace is an open shop

D. Unions acquire all employees to join if the workplace is an open shop. Junior dietitians may be union members. Senior dietitians are usually management. Kitchen staff are often union members. The usual reasons for employees to join a union and dissatisfaction with management rules and policies, low compensation and lack of job satisfaction. Membership in a union protects worker from unfair management practices or management decisions made

55. The vitamin is least likely to be deficient in patients with chronic kidney disease receiving hemodialysis ? A. Vitamin D B. Vitamin C C. Vitamin B6 D. Vitamin A

D. Vitamin A. Vitamin A deficiency is a concern for patients with chronic kidney disease because their diets are restricted for fruits, vegetables and dairy products. Adding dialysis to the equation increases their risk for Vitamin C and B deficiencies, as these vitamins are lost through dialysis . Rarely do patient's with ESRD develop Vitamin A deficiency. The amount of retinal binding protein is usually elevated in the blood of patients with CKD, indicating potential toxicity. Supplements of Vitamin A is not recommended. Vitamin D is converted to its active form in the kidney. With kidney failure, this process does not occur. Provide the active form of Vitamin D as calcitriol to prevent kidney disease.

84. The School Meals Initiative for Healthy Children (SMI) requires schools to do all of the following except: A. Decrease the amount of salt and sugar in reimbursed meals B. Use one of four menu planning options, such NuMenu or Enhanced food based menus C. Provide meals consistent with Dietary Guidelines for Americans D. Limit total fat to 40% of total calories for reimbursed meals over the course of a week

D.Limit total fat to 40% of total calories for reimbursed meals over the course of a week. The School Meals Initiatives for Healthy Children (SMI) requires school to implement guidelines within their food services operations to help improve the health of our children through improved nutrition. Meal planning must be consistent with the Dietary Guidelines for Americans. Four choices are available for assistance with menu planning: NuMenus, Assisted NuMenus, Enhanced Food Based and Traditional Food Based. Some of these require computer resources, which may not be an option for all schools. Other guidelines include reducing the amount of salt and sugar found in meals, and limit fat to 30% of total calories and saturated fat to 10% of total calories for meals that are reimbursable. Increase the fruit and vegetables choices for your students. Provide 1/3of the RDA for protein, calcium, iron and vitaminA and C for lunch and 1/4 of these for breakfast.