Clinical (664)

What is the optimal waist circumference recommendation for men and women?

Male = <40" Female = <35"

IBW equation

Males: 106 lbs (for 5') + 6*(every inch after) +/-10% for frame size Females: 100 lbs (for 5') + 5*(every inch after) +/-10% for frame size

Which three-step, validated nutrition screening tool would be used to quickly identify patients at risk of malnutrition in an acute care setting?

Malnutrition Screening Tool

One of the biggest challenges to the RD in providing nutrition therapy for HIV-infected patients is which of the following?

Management of complications associated with opportunistic infections

vitamin B3

Niacin

M0

No distant metastasis

T0

No evidence of primary tumor

N0

No regional lymph node metastasis

silver sulfadiazine cream

a sulfa medication used to prevent and treat bacterial or fungal infections

fundoplication

a surgical technique used to suture the fundus of the stomach around the esophagus to prevent reflux

For a patient who has undergone major surgery, had complications, and is now in complete recovery, you would expect a gradual rise in which laboratory value?

albumin

Dehydration causes which of the following lab test values to be elevated?

albumin AND creatinine AND sodium AND BUN

What affects the integrity of the gastric mucosa the most?

alcohol

Which of the following favors central obesity?

alcohol (?)

The most common cause of cirrhosis is:

alcohol abuse

Foods not allowed on the bland diet include:

alcohol, coffee, cocoa maybe fruit juice?

Pancreatitis most often develops as a complication of all of the following

alcoholism and gallstones

Which hormone is responsible for reabsorption of Na by the kidneys, thereby controlling blood pressuer?

aldosterone

A pH of 7.5 is defined as:

alkalosis

full liquid diet

all beverages from clear liquid diet but also milk, ice cream yogurt, liquid supp

Vitamin D is one of the vitamins most likely to cause overt toxicity when ingested in chronic, large amounts. Which of the following is not a symptom of vitamin D toxicity?

alopecia (hair loss, result of vit D DEF)

As insulin deficiency persists, production of which of the following hormones increases, leading to lipolysis

catecholamines, cortisol and growth hormone

arteriovenous graft

connection of an artery and vein to provide circulatory access for HD

The body responds to simple starvation by:

conserving protein stores

Which of the following is not a potential complication of bariatric surgery?

constipation (IS: malabs, steatorrhea)

High-fiber diets are of particular benefit to people with:

constipation AND the need to lose wt AND diverticulosis

All of the following are characteristics of hydrolyzed formulas

contain broken-down molecules of protein; require only minimal digestion; often low in fat to ease digestion and abs

Clinical complications associated with cirrhosis that can impact nutrition include which of the following:

ascites AND esophageal varices AND hepatorenal syndrome

nPNA

assessment of PRO catabolism rate

Which of the following concerning irritable bowel syndrome is true?

associated w/ alternating episodes of diarrhea and constipation

To prevent episodes of reactive hypoglycemia person should:

avoid concentrated sweets AND eat protein and fat along with carbohydrate for meals and snacks

The nutrition care plan for a patient with GERD would include:

avoid eating w/in 3 hrs of going to bed

Mr. John is a 56 year old male, who was recently diagnosed with hypertension. You notice in the medical record that his doctor prescribed Altace. What is a drug-nutrient interaction you would want to educate Mr. John on?

avoid foods high in K+, especially salt substitutes

The diet for stomatitis is:

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

learned food aversion

avoidance of certain foods due to association with unpleasant GI symptoms

Residue includes all of the following except:

bacteria (?)

Human insulin used to treat diabetes is made from

bacteria or yeast using recombinant DNA techniques

A patient on home TPN for the past month develops an elevated temperature with possible sepsis. This could indicate:

bacterial translocation

nephron

basic functioning unit of the normal kidney; each has 2 main parts: glomerulus and the tubule

Which of the following is a source of soluble fiber?

beans, apples, flaxseed, pectin

Which food would cause delayed gastric emptying?

beef brisket (?) b/c fat??

Which of the following statements is true about a critically ill patient who is post stress injury?

benefit from tight glycemic control to reduce catabolism (?)

Advantages of continuous feedings include all of the following:

benefit people who have received no food through GI for a long time; benefit people who are hypermetabolic

Which of the carotenoid pigments had the greatest pro-vitamin A activity?

beta carotene

The process of breaking down fatty acids 2 carbons at a time to provide compounds that can produce ATP is:

beta-oxidation

Gallstones may consist of all of the following

bilirubin, cholesterol, bile pigments

Which of the following is NOT a function of HCl in the stomach?

binding of vitamin B12 to facilitat abs (cleaves it from protein to bind w/intrinsic factor)

Epiglottis

blade-shaped flap of tissue, reinforced by cartilage that is attached to the dorsal and superior surface of the thyroid cartilage; folds over entrance of the larynx during swallowing

appendix

blind tube connected to the cecum of colon; produces intestinal flora and helps w/infection

Diets containing 30 grams of dietary fiber may improve:

blood glucose control the frequency of hypoglycemia blood lipid profiles

BP

blood pressure

Determination of a person's fluid needs during stress is based on all of the following

blood pressure, heart rate, urinary output

All of the following foods are high in oxalate

blueberries celery sweet potatoes

renal threshold

body holds too much of a substance so that it spills into the urine

Delivering 300 to 400 milliliters of formula in 15 minutes or less is referred to as

bolus

Conditions associated with dysphagia include

brain tumors AND aging AND cancers of head and neck

Patients diagnosed with maple syrup urine disease must limit foods containing:

branch-chain AA

In patients with acute hepatic/liver failure, ________ plasma levels are decreased and ________ accumulate in the brain.

branched chain AA; aromatic AA

The purpose of glycolysis is

break down of glucose into pyruvate

lactic acidosis

buildup of lactic acid in body

lipohypertrophy

bulging area of the skin that forms when a person continuously injects insulin the the same spot

CABG

coronary artery bypass graft: surgery that creates new routes around narrowed and blocked arteries, allowing sufficient blood flow to deliver oxygen and nutrients to the heart muscle

CHD

coronary heart disease

Which of the following is the least acceptable way to administer medication through feeding tubes?

crush and mix w/water (?)

Water can be a source of food-borne illnesses such as:

cryptosporidiosis

Which of the following factors appears to play a role in the wasting associated with cancer?

cytokines and inflammatory response

The first step in the oxidation of an amino acid for energy involves the removal of the amino group. This is referred to as

deamination

During hyperventilation, the levels of CO2 in the blood:

decrease

In the metabolic phases ebb and flow that occur after a severe injury, what is the body's typical initial response?

decrease metabolic rate

The primary purpose of a low-fiber diet is to:

decrease risk of obstruction

A tube fed patient receiving bolus feedings develops a distended abdomen. What should you recommend?

decrease the rate

In kidney disease, calcium absorption is decreased because of

decreased active vit D formation

The following effects are cardioprotective effects of EPA and DHA

decreased blood platelet reactivity, reduced LDL, reduced TG and VLDL

Immune suppression in AIDS is related to

decreased lymphocyte count

ileus

decreased or absent motility of the bowel and forward movement of bowel contents; obstruction of intestine

Which of the following may result in metabolic acidosis?

decreased retention of bicarbonate

Protein deficiency is a potential indicator of what condition?

decreased retinol binding protein and decreased transferrin

Symptoms of hyperglycemia include all of the following except:

decreased urination

Which of the following is NOT a physical sign of diabetic ketoacidosis?

decreased urine flow

What effect does monounsaturated fatty acid intake have on serum lipid levels?

decreases LDL OR decreases LDL and increases HDL

As CO2 levels in the blood increase, blood pH _______ as H+ ions accumulate _____.

decreases; more

A male patient is in the ER with oliguria, 95% UBW, and lightheaded. What is the probable diagnosis?

dehydration

Sue often feels full after eating only a small amount of food and frequently experiences nausea, vomiting, abdominal pain and bloating. She also has lost some weight. She is most likely experiencing symptoms of:

delayed gastric emptying

Alpha-glucosidase inhibitors (AGIs) work to control blood glucose levels for those with Type 2 Diabetes by

delaying intestinal absorption of glucose

Which of the following statements concerning eicosanoids is correct?

derived from omega-3 FA anti-inflam, regulate blood pressue, involved in blood clotting

What is the correct order of steps in making an ABG analysis?

determine oxygenation status, determine acid-base balance, determine cause of acid-base imbalance

Which of the following is not a health risk associated with being underweight?

diabetes

All of the following may interfere with chewing and swallowing except

diabetes (MAY: Parkinson's, strokes, AIDS)

fusion inhibitors

A class of antiretroviral drugs that work on the outside of the host CD4 cell to prevent HIV from fusing with and infecting it.

What are the stages of hypertension?

1) normal: <120/80 2) pre- : 120-139/80-89 3) Stage 1: 140-159/90-99 4) Stage 2: >160/>100

Protein needs for the client with cirrhosis who does not show signs of impending coma are calculated based on:

1-1.5 g/kg

Jill currently weighs 160 pounds and has asked to be placed on a weight-loss diet to allow her to lose two pounds a week. You tell Jill that she must cut _____ kcalories/day in order to achieve this goal.

1000

Mr. Singer is working with a client who was admitted to the hospital with a myocardial infarction. Several hours have passed and the client's shock has resolved. What would be the appropriate diet for this client?

1000-1200 kcalorie diet that progresses from liquids to low-sodium soft foods of moderate temperature in frequent small feedings. (?)

How many g CHO in milk and veg

12 g and 5 g

Hyperglycemia would characterized by a blood glucose range of what?

120+ mg/dL

Nutritional adequacy is difficult to achieve on fewer than _______ kcalories a day.

1200

Symptoms of diabetes usually occur when the blood glucose level remains above what number for an extended amount of time?

126 mg/dL (?)

A female has a total cholesterol level of 243, an HDL of 51, and a TG level of 288. What is her LDL cholesterol?

134 mg/dL; borderline high

Of the total kcalories in a diabetic diet, _____ percent should come from protein.

15-20

What is a normal range for total lympohocyte count?

15-39% (?)

To treat fluid overload in heart failure patients, a fluid restriction of ______ is recommended.

1500-2000

A TPN prescription consists of the following: 500 ml 50% dextrose, 500 ml 8.5% a.a., 500 ml 10% lipids. How many kcal and g of protein will it provide?

1570 total kcal and 42.5 g protein

If your 5'11" male patient has a current weight of 165#, what is his ideal body weight (IBW) as calculated by the Hamwi formula, and is his current weight above or below that IBW?

172; below

What daily caloric intake will result in a 2# weight loss per month if the client is currently consuming 2000 kcal/day?

1750

correction factor

1800(or 1500) ÷Total Daily Insulin Dose = 1 unit of insulin will reduce the blood sugar so many mg/dl

Jake, a 34-year-old male certified public accountant, has struggled with being overweight since early childhood. Jake's current anthropometric measurements are: 6'1" , 427#. What is Jake's ideal body weight?

184 lbs

If an individual needs 1500 calories, how many grams of carbohydrate do they need and how many carbohydrate choices does this equal?

188; 12

What is the normal value range for a pre-albumin lab test?

19-43 g/dL

A male has an HDL level of 39, LDL of 118, and TG level of 178. What is his total cholesterol and how would it be classified?

193; normal

You count a one cup serving of a combination food such as spaghetti and meatballs, macaroni and cheese, or tuna noodle casserole as having ______ carbohydrate choice(s).

2

Mr. Jones has heart failure but no CAD or increased CHD risk. His diet should be:

2 g Na

How many kcals in 20% lipid solution?

2 kcals/mL

combo therapy

2 or more antineoplastic agents to achieve max kill malignant cells

What is the recommended serum creatinine range for the CKD population as compared to a normal population?

2-15 mg/dL

People with severe burns may need as much as _______ grams protein per kilogram of body weight per day.

2-2.5

1 kilogram = ___ pounds

2.2 lbs

1 inch = ___ cm

2.54 cm

A woman of normal weight may have, on average, ______ percent of her body weight as fat.

20-30

A TPN prescription consists of the following: 500 ml 50% dextrose, 500 ml 8.5% a.a., 500 ml 10% lipids. What is the non-protein calorie to nitrogen ratio?

206:1

A patient is receiving an intermittent tube feeding of 300 ml formula 4x/day. The formula provides 1.5 kcal/ml and 795 ml water/L. The patient's estimated daily fluid requirement is 1800 ml/24 hours. How much additional water will be required per feeding?

212 ml/feeding

What range constitutes a normal HCO3 level when making an ABG analysis?

22-26

Normal HCO3

22-26 mEq/L

1 mEq Na+ =

23 mg

A continuous drip tube feeding of a 1.2 kcal/ml formula is being infused at 90 ml/hr. The formula is 53% cho, 18% pro, and 29% fat. How many calories and grams of protein are delivered in a 24 hour period?

2592 kcal and 116.6 g prot

Use the mL/kg method (a.k.a. Holliday-Seger method) to estimate the fluid needs of a 62 year old adult male that is 5'9" tall and weights 212#.

2640

Recommended energy needs for an adult with paraplegia are

28 kcal/kg

Use the Chronological age method (a.k.a. body weight (kg) method) to estimate the fluid needs for the 62 year old male who is 5'9" and weighs 212#.

2891 mL

1 fl oz = ___ mL

29.57 mL

How many kcalories would a client receive from an IV solution containing 1500 ml of 50 percent dextrose and 1500 ml of 7 percent amino acid solution?

2970

How many kcals in dextrose?

3.4 kcals/g

What is the total daily insulin amount if 1 unit of insulin covers 15 g of carbohydrates?

30-33.3

An isotonic enteral feeding solution has a known osmolality of

300 mOsm/L

Hemodialysis diet recommendations

35 or more kcal/kg 1.2 g/kg protein 1 L + output 2000-4000 mg/d Na 2000-3000 mg K 800-1000 mg P <2000 mg Ca

Peritoneal dialysis diet recommendations

35 or more kcal/kg 1.2-1.3 g/kg protein maintain fluids 2000-3000 mg/d Na 2000-4000 mg/d K 800-1000 mg/d P <2000 mg Ca

An HIV patient has a consistent temperature of 104o F. What % increase would there be in kcal level to maintain body weight?

35%

What range constitutes a normal PCO2 level when making an ABG analysis?

35-45

Normal PaCo2

35-45 mmHg

How many grams of carbohydrates are covered by a total daily insulin amount of 12 units?

37.5-41.67 g of carb

1 mEq K+ =

39 mg

1 large bagel (4 oz.) is equal to _________ carbohydrate choices

4

1 mEq Ca++ =

40 mg (Ca+ = 20 mg)

Symptoms of hypoglycemia usually manifest when blood glucose levels fall below what number?

40 mg/dL

Oliguria is defined as a urine output of less than ________ ml/day

400

How many grams of carbohydrates are covered by a total daily insulin amount of 10 units?

45-50 g of carb

The diet for diabetes should provide approximately _______ percent kcalories from carbohydrate.

45-60

Which of the following hemoglobin A1C values is normal?

5

You should subtract fiber from the total carbohydrate if a food has more than _______ grams of insoluble fiber per serving.

5

A 5% dextrose solution contains

5 g dextrose per 100 ml

Which of the following could a person expect to experience after a gastric resection for cancer?

B12 malabs and hyperglycemia

A patient with T1DM has a hemoglobin A1c of 9.0%; the patient should

Be assessed by a DM educator to determine where changes can be made in insulin, diet, and/or exercise patterns

Three years after bariatric surgery Todd has lost a total of 250# and he has been able to maintain his weight within a 5# range for two months. In order for his surgery to be considered successful, what is the amount of weight loss he will need to maintain for a five-year period?

50-80% starting wt and keep it off for 5 yrs (?)

To estimate daily fluid needs of a renal client, add ______ milliliters to the daily urine output.

500-750

ICR (insulin-carb ratio)

500/TDD

What is the 500 rule?

500/TDD (total daily insulin) = carb coverage

Jake, a 34-year-old male certified public accountant, has struggled with being overweight since early childhood. Jake's current anthropometric measurements are: 6'1" , 427#. What is Jake's current BMI?

56

What is the total daily insulin amount if 1 unit of insulin covers 8 grams of carbohydrate?

56.25-62.5

Physicians generally order all foods and fluids withheld for at least ____ hours before surgery.

6

high fiber diet

6-10 g above usual recommendation of 20-35 g/day

The brain uses what percent of the glucose we consume on any given day?

60-70

What are DASH recommendations (2000 kcal diet)

7-8 grains 4-5 fruits 4-5 veg 2-3 low/nonfat dairy 2 or less lean meat/fish/poultry 4-5 nuts, seeds, legumes limited fat

Arterial pH

7.35-7.45

Parenteral nutrition can be discontinued when at least _____ percent of estimated energy needs are being met by oral intake, tube feeding, or a combination of the two

70

The normal range for blood glucose levels is what?

70-120 mg/dL

The kidneys can lose about _______ percent of their function before symptoms of renal failure appear.

75% (?)

_________________ is a progressive condition associated with weight loss, significant lean body mass depletion, early satiety, increased basal metabolic rate, weakness, and malnutrition. This syndrome is seen in some clients with chronic disorders like cancer, AIDS, congestive heart failure, and COPD.

cachexia

Lack of _______________ is related to renal osteodystrophy

calcitriol

In patients with gastric cancer, ________ and iron absorption will be reduced due to a reduction in the secretion of hydrochloric acid, which is produced by the parietal cells of the gastric mucosa.

calcium

Which of the following is a long-acting insulin?

Detemir/Levemir Lantus/Glargine

The most common type of kidney stone is composed of:

calcium oxalate

A resident of a long term care facility is receiving a nocturnal tube feeding from 7 p.m. to 9 a.m. The formula has a concentration of 1.5 kcal/ml. what rate is required to provide 1650 kcal per 24 hours?

79 ml/hr

Karen's father and mother are both obese. What are Karen's chances of also becoming obese?

80%

What are the protein needs for a 160# male with an albumin level of 2.1 g/dl?

85-90 g (?)

60 gm Protein = ___________ gm Nitrogen

9.6 g

Normal GFR

90-120

MX

Distant metastasis cannot be assessed

You are conducting a nutritional assessment on a patient who has a below-the-knee amputation. When estimating his adjusted weight in order to calculate BMI, you would divide his current weight by:

92.9

At what value should a CKD patient with a depleted serum creatinine be assessed for malnutrition and skeletal muscle wasting?

<10 mg/dL

Which of the following levels is normal for whole blood glucose levels before meals?

<100 mg/dL

A patient experiences severe pain, abdominal distention and vomiting. The expelled material consists of gastric fluids and bile. This patient is suffering from:

? acute diverticulitis/adynamic ileus/irritable bowel syndrome

CA

cancer

Central TPN is indicated for each of the following

cannot be fed through GI, long-term PN needed, nutrient reqs are high

What is the site of chylomicron fat absorption by tissues of the body?

capillary beds

Hyperkalemia may cause

cardiac arrest

CVD

cardiovascular disease

Which of the following does contribute to AIDS wasting syndrome?

cariogenecity (dental caries), inactivity, malabs

efferent arteriole

carries blood away from the glomerulus

afferent arteriole

carries blood to designated site

A client has been diagnosed with hypochromic, microcytic anemia. She should be advised to

Increase absorbable iron in her diet, include Vitamin C at every meal, and take an iron supplement

Muscle wasting during cancer cachexia may be a result of which of the following:

increased protein catabolism, decreased protein synthesis, AA not spared

Overfeeding of malnourished clients can result in:

increased work of the heart and lungs

The immediate post-stress release of glucagon:

increases glucose release into the bloodstream

Serum Osmolality

increases with hypovolemia and decreases with hypervolemia

As CO2 levels in the blood decrease, blood pH _______ as H+ ions accumulate _____.

increases; less

Diverticulosis disease often occurs with:

increasing age (?)

All of the following are modifiable risk factors for CHD except:

increasing age (ARE modifiable: blood cholesterol, hypertension, tobacco)

The kidneys respond to respiratory acidosis by:

increasing the retention of bicarbonate

Total Lymphocyte Count

indicates immune function reflective of B and T cells

Which of the following provides the most reliable measure of energy needs in severe stress?

indirect calorimetry

retrovirus

infectious particles consisting of RNA genome packaged in protein capsid, surrounded by lipid envelope that contains polypeptide chains including receptor binding proteins which link to membrane receptors of host cell, initiating infection

rectum

inferior portion of digestive tract; functions as temporary storage for fecal matter

Which of the following is a limitation of using a pre-albumin lab test?

inflammation and certain drugs can interfere with the readings and cause a false diagnosis. (?)

necrotizing fasciitis

inflammation of the connective tissue leading to necrosis of the tissue; may be caused by infection, injury, or an autoimmune reaction

cholecystitis

inflammation of the gallbladder, usually due to a gallstone

gastritis

inflammation of the gastric mucosa

pancreatitis

inflammation of the pancreas; autodigestion of pancreatic tissue by its own enzymes

As blood pH becomes more basic, the respiratory centers in the brainstem will become ________ which will cause the respiration rate to ______.

inhibited; decrease

ultrafiltrate

initial filtration of metabolic byproducts from the filtered blood within the tubule

refractory CD

initial or subsequent failure of a strict GF diet to restore normal intestinal architecture and function in pts who have celiac-like enteropathy

aspiration

inspiration of foreign matter into lungs

aspiration

inspiration of foreign matter into the lung; causes are dysphagia and EN

Lipoprotein lipase is activated by:

insulin

____ promotes protein synthesis.

insulin

Which hormones act on the brain to signal feelings of satiety and hunger?

insulin AND leptin AND ghrelin

What is the cause of type 2 diabetes?

insulin resistance AND progressive decrease in insulin secretory capacity

IGF

insulin-like growth factor

Types of formulas that contain complete proteins are called ________ formulas.

intact

IFN-

interferon-gamma

IL

interleukin

IDL

intermediate lipoprotein particles that contains as much TG as chol

Delivering 250-400 milliliters of formula over a 30 minute or more period by an infusion pump is referred to as

intermittent

If a patient has peripheral edema, he can still be dehydrated because of

intravascular depletion

A patient with a complete intestinal obstruction should be fed by:

intravenous nutrition (?)

When a dialysis patient is receiving erythropoietin, which mineral may need to be supplemented?

iron

A transferrin lab value of 450g/dl is indicative of what condition?

iron deficiency

A typical peripheral parenteral nutrition solution:

is designed for those who need only short-term nutrition support

Once dialysis is initiated, protein intake:

is less restrictive

All of the following are correct about fasting hypoglycemia except

it can result from tumors to pancreas AND it is more serious than reactive hypoglycemia (?)

Which of the following is true about GLP-1?

it enhances pancreas sensitivity to glucose and is deactivated by DPP-4

A patient with hepatitis needs a high protein intake. Besides helping the liver to regenerate, what other purpose is served?

it helps prevent a fatty liver

All of the following are true about the exchange system except

it is easy to read and understand for people with low literacy

All of the following are correct about type 1 diabetes except

it is the most common type of diabetes

All of the following are a result of cigarette smoking except:

it lowers LDL levels (IS a result: it damages platelets, it leads to inflammation of blood vessels, it deprives the heart of oxygen

Which of the following results when bilirubin accumulates in the inflamed liver and spills into the blood?

jaundice

A patient has anemia and a low RBC count. This may be due to

kidney disease

Respiratory acidosis/alkalosis is compensated by altering the activity of the _______ which is known as ______ compensation.

kidneys; renal

A post surgery patient has been NPO for 10 days due to an ileus. He has been receiving 2L of D5 per day. His weight increased from 75 to 78 kg and his albumin is 1.9 g/dL. The patient has developed

kwashiorkor

achlorhydria

lack of gastric HCl secretions

What might a patient after a gastrectomy have trouble absorbing?

lactose

When serum NH3 is high, which of the following medications is used to assist in lowering the level?

lactulose

parotid gland

large salivary glands that secrete saliva that contain high concentration of salivary amylase

chylomicrons

largest lipoproteins, most enriched in TG, least dense, transport dietary TG and chol, mostly TG

Mary has been overweight for many years. She tends to eat when she is not really hungry and eats more food when she is angry or depressed. Which of the following theories could explain Mary's problem of overweight?

learned behavior

The normal value for respiratory quotient (RQ) is:

less than or equal to 0.85

The branched chain amino acids are:

leucine, isoleucine, valine

Which of the following is an example of a systemic type of tumor?

leukemia

Which of the following is a limitation of using an albumin lab test?

levels decrease in a protein-free diet alone, but are preserved in general starvation. AND levels increase slowly in healing people due to long half life.

Which of the following is a limitation of using a transferrin lab test?

levels respond slowly even though it has a shorter half-life than albumin

Which of the following is/are essential fatty acid(s)

linoleic AND linolenic

Leptin is associated with:

lipids

Which of the following processes leads to long-term storage of glucose in the form of fat in adipose tissue?

lipogenesis

LDL

lipoproteins rich in chol and represent about 70% of total chol in body

clear liquid diet

liquids that contribute minimal residue to GI; fruit juices (no pulp), sodas, broth, tea, coffee, water, popsicles, jell-o, liquid supp

Following a cholecystectomy, bile is produced by the:

liver

VLDL is formed where in the body?

liver

bile is produced in the

liver

A transferrin lab value of 180g/dl is indicative of what condition?

liver disease

Left untreated for year, a blocked bile duct may lead to:

liver failure

The conversion of lactic acid to glucose takes place in the ___ and is referred to as the _____.

liver; Cori cycle

A 6' 2" male, large frame, 230 lbs. with Type II diabetes should:

lose 20 lbs. slowly following balanced diet

Treatment of an altered immune response with corticosteroids is associated with which one of the following adverse side effects

loss of bone mineral

lipoatrophy

loss of fat beneath the skin mostly in the face, arms, legs, and buttocks

local anesthesia

loss of sensation only in the area where an anesthetic drug is placed

After review of his lab work, a patient was informed that his renal failure had progressed to the point where he now needed dialysis treatment. Which lab results would have indicated this?

low GFR

All of the following favor plaque development except:

low LDL levels (DO favor: low HDL, diabetes, metabolic syndrome)

neutropenia

low WBC count

Drugs may be slow to reach their sites of action in individuals with PEM due to

low blood albumin levels

hypotension

low blood pressure

You are assessing a 4' 11" female patient who weights 160 lbs. She has hypertension, high cholesterol and diabetes. What do you recommend?

low calories

Successful treatment of diarrhea and malabsorption in individuals with HIV-related GI infections should include:

low fat, low fiber, lactose restricted

Which of the following is not one of the basic components of the nutrition therapy for hypertension?

low potassium intake

A patient with Crohn's Disease needs the following diet:

low residue

Mr. Smith has inflammatory bowel disease and has just had surgery of his GI tract. Which formula would be the least likely to cause gas and abdominal distension?

low residue, hydrolyzed formula

Manifestations of the nephrotic syndrome include:

low serum albumin proteinuria high blood lipids

LDL

low-density lipoprotein

Why are low-fiber foods recommended following a heart attack?

low-fiber foods are less likely to produce gas and abdominal distention

nadir

lowest point; ref to WBC count

In people with multiple organ failure, which organ often fails first?

lungs

What compensatory response would occur due to the following ABG lab values: pH = 7.48; CO2 = 43mm Hg; HCO3 = 33mEq/L

lungs will retain CO2 to lower pH

Metabolic acidosis/alkalosis is compensated by altering the activity of the ________ which is known as ________ compensation.

lungs; respiratory

Joe is in the hospital and was prescribed a clear-liquid diet. Which of the following is he not allowed to drink?

milk

Mary is prescribed a low-residue diet for a 24-hour period. Which of the foods should she avoid on this diet?

milk (b/c of lactose)

The most immediate task for the medical team following severe stress is to:

minimize nutrient loss (?)

Basal Energy Expenditure (BEE)

minimum energy expenditure to sustain life

All of the following statements about heart disease are correct except:

moderate consumption of alcohol may raise blood LDL cholesterol levels (ARE correct: fish oils lower triglyceride levels in the blood, soluble fiber may lower blood LDL cholesterol levels, saturated fatty acids raise blood LDL cholesterol levels

MUFA

monounsaturated fatty acid

A fecal excretion of ___ grams of fat/24 hours is considered fat malabsorption.

more than 7

Prealbumin

most often used to diagnose protein-calorie malnutrition

T4

multicentric tumors occurring simultaneously

Due to a lack of the enzyme glucose-6-phosphatase, which tissue capable of glycogenolysis cannot contribute to blood glucose levels between meals?

muscle

Much of the fat released from adipocytes goes where?

muscle and liver

Common clinical symptoms of the uremic syndrome include all of the following

muscle cramps anorexia skin hemorrhages

stomach

muscular saclike portion of the alimentary tube between esophagus and duodenum that functions as a reservoir that allows digestion to take place gradually; alcohol, water, and fluoride abs

esophagus

muscular tube that connects the pharynx to the stomach

MI

myocardial infarction

Which of the following is used as a feeding tube placement site?

nasoduodenal, gastrostomy, nasogastric

Which of the following feeding tube placement sites would be the most appropriate for a client who is expected to be on a tube feeding for less than 4 weeks?

nasogastric

dawn phenomenon

natural increase in the morning of a person's glucose levels and insulin needs

___________________ chemotherapy is given before surgery or radiation therapy to reduce the size of the tumor.

neoadjuvant

The functional unit of the kidneys is the:

nephron

glomerulus

network of thin walled capillaries surrounded by pear-shaped epithelial membrane know as Bowman's capsule

Common side effects of chemotherapy include

neutropenia and anemia

A patient has been on an enteral feeding for 4 days and develops diarrhea. What would be the most likely cause?

new meds

Which of the following is/are a coenzyme(s) used in the Tricarboxylic Acid cycle?

niacin AND thiamin AND riboflavin

Which vitamin(s) is/are required as co-enzyme(s) in fatty acid synthesis?

niacin and biotin

NPO

nil per os (nothing by mouth)

Which drug is given as a spray to treat angina episodes?

nitroglycerine

Which of the following processes are reversible?

none (?)

What are the total cholesterol levels?

normal: <200 mg/dL borderline high: 200-239 high: >240

Good advice for a patient with hiatal hernia is to:

not eat before bed

Women with gestational diabetes should be encouraged to:

not gain excessive wt during preg

An HIV patient tells you his family brought a homemade lasagna for dinner. They heated it up before heading over to the house, but did not heat it again before eating (nearly 1½ hours later). You suggest the patient not eat it because

not high enough temp

A decreased respiration rate means:

not hypoventilation and acidosis???

Patient admitted with albumin of 3.7 g/dL. After surgery it was 3.1. You should

not worry, it's typical after surgery (?)

osmolarity

number of millimoles of liquid or solid in a liter of solution

osmolality

number of water attracting particles per weight of water in kilograms

In working with clients with disabilities, health care professionals most valuable assessment tool is:

observations of clients during mealtimes

Which of the following is an appropriate suggestion to improve oral intake in cancer clients?

offer cold foods if sensitive to smell

Americans are urged to eat more fish due to its high content of:

omega-3 PUFA

gastrectomy

opening in the stomach

biguanides

oral DM med works by decreasing hepatic glucose output and enhancing insulin sensitivity in muscle. Can be used as a monotherapy of in combo with sulfonylureas

sulfonylureas

oral DM med works by increasing insulin production from the pancreas and by improving peripheral insulin activity

meglitinides

oral DM meds stimulate the beta cells of the pancreas to produce insulin. They can be used as monotherapy or in combo with metformin

OGTT

oral glucose tolerance test

HIV related causes of anorexia include:

oral infections, side effects of meds, resp infections

An AIDS patient should select the following fresh fruit:

orange, banana, pineapple

liver

organ of the digestive system that have varied and vital functions, produces plasma proteins, excretes bile, stores energy reserves, detoxes poisons, interconverts nutrients, repackages fat and sends out or stores

Serum sodium of 119 mg/dL is a sign of

overhydration

Henderson-Hasselback equation

pH = pKa + log [base]/[acid], helps determine pH

If a patient with renal disease is diagnosed with an acid-base disorder, such as metabolic acidosis, this would mean which function of the kidneys is affected?

pH homeostasis

claudication

pain in arms and legs due to inadequate blood flow to those muscles

All of the following are common causes of respiratory alkalosis

pain, emotions, rep overventilation

odynophagia

painful swallowing

A pt receiving radiation therapy to control intracranial swelling in order to alleviate pain is an example of:

palliative therapy

Secretin is released into the:

pancreas AND blood

Enzyme replacements and a fat-restricted diet would be recommended for

pancreatic cancer

vitamin B5

pantothenic acid

Which hormone is responsible for activation of vitamin D in the kidney?

parathyroid hormone

A 10-year old child is >90th %ile for height and >95th %ile for BMI. Which of the following data help to determine the likelihood of obesity as an adult?

parents are obese

pCO2

partial pressure of carbon dioxide

pO2

partial pressure of oxygen

Which of the following is a source of monounsaturated fatty acids?

peanut AND olive oil

Which of the following foods would not be appropriate on a diet for dysphagia?

peanut butter (?)

Simple IV solutions which provide water, dextrose, and electrolytes are appropriate for:

people who are expected to eat w/in a few days

PTC

percutaneous transhepatic cholangiogram; an x-ray of the bile ducts inside and outside the liver; the x-ray is taken after contrast medium if injected directly into the bile ducts

PAD

peripheral artery disease

Which phase of fuel homeostasis is characterized by high plasma insulin levels, low glucagon levels, and triglyceride synthesis in the liver and adipose tissue?

phase 1

Which phase of fuel homeostasis is known as the anabolic/fed state?

phase 1

Which phase of fuel homeostasis occurs 0 to 3.9 hours after eating?

phase 1

Which phase of fuel homeostasis is known as the post-absorptive state?

phase 2

Which phase of homeostasis occurs 4 to 15.9 hours after food consumption?

phase 2

Which phase of fuel homeostasis is known as the early starvation state?

phase 3

Which phase of fuel homeostasis is known as the preliminary prolonged starvation state?

phase 4

Which phase of fuel homeostasis occurs 48 hours to 23.9 days after food consumption?

phase 4

Which phase of fuel homeostasis is known as the secondary prolonged starvation state?

phase 5

Which phase of fuel homeostasis occurs 24 to 40 days after food consumption?

phase 5

A patient diagnosed with PKU would need to restrict which amino acid?

phenylalanine

Patients on PD (peritoneal dialysis) require

phosphate binders

When educating your patients on the amount of Ca to include in their renal diet, it is important to also include:

phosphate binders

Which of the following forms of energy expenditure has the most potential for control?

physical activity energy expenditure

Which of the following is a common cause of respiratory acidosis?

pneumonia, COPD, CNS damage

PUFA

polyunsaturated fatty acid

Esophageal varices may be caused by:

portal hypertension

A patient has undergone a colectomy for colon cancer. The MD has kept the patient NPO for 4 days post op. What is the likely cause of this order?

post-op ileus

The person on peritoneal dialysis does not have to restrict dietary sources of:

potassium

All of the following are appropriate for a client suffering from mouth dryness except

potato chips

Which can be included in a meal for gluten-induced enteropathy (Celiac Disease)?

potatoes and butter

Foods high in potassium

potatoes, raisins, bananas, spinach, avacados, carrots, milk, tomato, lentils, chocolate, dairy, bran, cooked mushrooms, salt substitutes, avocado, pumpkin, seeds, kiwi, nutsmolasses

All of the following foods are rich in omega-3 polyunsaturated fatty acids except:

poultry w/o skin (ARE omega-3 rich: nuts and canola and flaxseed oils

A malnourished patient's response to enteral nutrition support would be best measured with

prealbumin

Which lab test has a half-life of 2-3 days?

prealbumin

You would observe low levels of which protein in a stressed patient?

prealbumin

The gastrocolic reflex:

prepares the colon to make more room by pushing down digested material for excretion

hematuria

presence of blood in the urine

cholelithiasis

presence/formation of gallstones

T

primary tumor

ketoacidosis

process that occurs during fasting state in which fats are broken down in body, yielding ketone bodies and fa; can lead to coma and death

If a patient with renal disease shows depleted vitamin D levels, which function of the kidneys is affected?

production of hormones

Erythropoiesis

production of red blood cells

Controlling intake of which of the following is a primary goal in the treatment of chronic renal failure?

protein

Phosphorus appears in many high- _______ foods.

protein

Urea excretion is related to ____________ while creatinine excretion is related to ________________

protein intake, muscle mass

During a 24-hour study, a hospitalized patient consumes 55 grams of protein and has UUN of 12 g. What conclusion can be drawn?

protein is being broken down faster than being replaced

What would increase the RSL?

protein, Na (?)

Iatrogenic malnutrition is

protein, calorie malnutrition brought on by treatments and/or hospitalization

What dietary constituents are changed with hepatic disease as it progresses?

protein, fluids, sodium

hiatal hernia

protrusion of a part of the stomach through the esophageal opening in the diaphragm

All of the following are true statements concerning IV lipid emulsions

provide essential FA, concentrated source of energy, provided daily or periodically

duodenum

proximal part of the SI that contains short villi and submucosal glands; functions in most digestion and abs; releases hormones to help w/digestion

Diets restricted in _________ are commonly prescribed to prevent uric acid stones.

purine

Cortisol causes which of the following physiological effects on the body?

quick burst of energy; lowered immune sys; high pain threshold; impaired cognition

_____________________ can be given externally or internally, such as by intravenous therapy.

radiation therapy

intravenous pyelogram

radiographic imaging of the kidneys, ureter, and bladder using x-ray and contrast dye that is injected

ventricular tachycardia

rapid heartbeat originating from the ventricle

A basal/bolus insulin regimen is comprised of the use of what type(s) of insulin?

rapid-acting and long-acting (?)

Which of the following foods can be problematic following bariatric surgery?

raw fruits/vegs AND high fat/fried OR high fat/fried foods (?)

glycemic control

recommendations aimed at keeping blood glucose at a safe level

hypoperfusion

red blood flow; occurs during circulatory shock

The primary goal of initial therapy for the client with acute pancreatitis is:

reduce stimulation of pancreatic secretions

leukopenia

reduced WBC in blood

neutropenia

reduced number of mature WBC in blood

ante-emetic

reduces nausea

epigastric

referring to the upper abdominal region

Albumin

reflects general nutrition status, liver function

Tranferrin

reflects iron and protein status; may indicate liver disease

Retinol Binding Protein

reflects protein status

Radiation therapy to the head and neck may cause the following,

reflux, dental caries, lack of smell, odynophagia (painful swallow)

N

regional lymph nodes

Which of the following is a function of amylin?

regulation of food intake inhibition of digestive secretions slowing of gastric emptying

Which if the following is not a form of vitamin A?

reinase (IS: retinal, retinol, retinoic acid)

To prevent the refeeding syndrome in a severely stressed individual you would:

reintroduce nutrients slowly

A retinol binding protein lab value of 7.2g/dl is a potential indicator of what condition?

renal failure

Which of the following is a common cause of metabolic acidosis?

renal failure, diarrhea, diabetes

CRRT

renal replacement therapy used to treat pts in acute renal failure, particularly those w/multiple organ failure; types of pts treated tend to be hemodynamically unstable, have poor cardiac output, and are unable to tolerate HD

Hyperglycemia can result in disease of the:

renal sys, eyes, nervous sys

What condition is indicated by the following ABG lab values: pH = 7.48; CO2 = 33mm Hg; HCO3 = 24mEq/L

respiratory

A PCO2 level of 55 is indicative of which condition?

respiratory acidosis

What condition is indicated by the following ABG lab values: pH = 7.31; CO2 = 50mm Hg; HCO3 = 24mEq/L

respiratory acidosis

A PCO2 level of 25 is indicative of which condition:

respiratory alkalosis

REE

resting energy expenditure; energy expended at rest to keep vital organ systems functioning

People with renal failure frequently develop water-soluble deficiencies due to all of the following

restrictive diets loss of vit during dialysis altered metabolism

A patient with metabolic alkalosis would have

retention of base by the kidneys

A half-life of 12 hours is indicative of which lab test?

retinol binding protein

2.1-6.4 mg/dl is the normal value range for which lab test?

retinol-binding protein

Which of the following is a component of the Electron Transport Chain?

riboflafin (?)

Gliadin, the damaging fraction of wheat gluten with celiac disease, is found in all but which one of the following grains?

rice

ascending colon

right of the abdomen; about a foot in length, between cecum and transverse colon

iso-osmolar

same osmolality as body fluids

SFA

saturated fatty acid

Which of the following is not associated with anorexia nervosa?

schizophrenia (food adversions, distorted body image, constant concern about weight status are associated with anorexia)

The coiling or folding of a polypeptide chain that results from hydrogen bonds between the amino group of one amino acid and the carboxy group of another is referred to as

secondary

Which hormone(s) inhibits the production of acid in the stomach by leading to the release of bicarbonate to act as a buffer?

secretin

Which hormone(s) stimulates the release of pancreatic enzymes?

secretin AND CCK

Which hormone(s) is released from the duodenum when chyme arrives in the duodenum?

secretin and CCK

Patients with decubitus ulcers will likely demonstrate low:

serum albumin

If provided only once or twice a week, IV fat emulsions:

serve primarily as a source of essential FA

The theory that the body tends to maintain a certain weight by means of its own internal controls is referred to as the _________ theory.

set point

fulminant hepatic failure

severe impairment of hepatic functions in the absence of preexisting liver disease

All of the following conditions raise water requirements

severed vomiting, burns, blood loss

A patient has anorexia nervosa. What do you tell her after beginning a high CHO, high PRO diet

she may have water retention

orthopnea

shortness of breath associated with lying in the supine position, can breath normally when standing/sitting upright

A client unable to tolerate solid foods:

should receive a liquid diet formula

The component of amino acids that make each one unique is:

side chain attached to central carbon

Which of the following products of protein digestion can be absorbed into the enterocyte?

single AA, dipeptides, tripeptides

T1

single tumor 5cmor less

T3

single tumor more than 10 cm

T2

single tumor more than 5 cm but less than 10 cm

During negative nitrogen balance which body tissue is sacrificed to supply the glucose and amino acids necessary to respond to stress?

skeletal muscle, connective tissue and gut (?)

Another factor to consider in carbohydrate counting is fat. Fat can

slow gastric emptying

The most important intervention in CKD is:

slowing the progression of the disease

Where are chylomicrons formed?

small intestine mucosal epithelial cells

You have a patient experiencing symptoms of gastroparesis. Which of the following is an appropriate recommendation for treatment of this condition?

small, frequent meals

HDL

smallest lipoprotein, richest in protein, highest density

All of the following are common causes of metabolic alkalosis

sodium bicarb overdose, prolonged vomiting, NG drainage

Which of the following dietary components are restricted in nephrotic syndrome?

sodium, fat

The nephrotic syndrome can occur as a consequence of:

diabetes, HTN, illicit drugs

Which is a common complication of AIDS?

diarrhea

Billy consumed the following foods at lunch: a hamburger with lettuce and ketchup on a bun; potato salad; a carbonated beverage. Later that afternoon, he began to experience gas. Which of the following foods was most likely to be responsible for production of the gas?

diet carbonated beverage

low-residue diet

diet low in fiber and other constitutes that may contribute to bulk in the large intestine

dysphonia

difficulty speaking

dysphagia

difficulty swallowing

pancreas

digestive organ containing exocrine and endocrine tissues; exocrine portion secretes pancreatic juice and endocrine portion secretes hormones, ie insulin and glucagon

Which drug type increases the strength of the pumping action of the heart?

digoxin

The primary reason for the anemia found in patients with ESRD is

diminished erythropoietin production

Benefits of physical activity in a weight-control program include:

directly increasing energy output it speeds up basal metabolism it helps control appetite

After a gastrectomy, the diet order should indicate a decrease in:

disaccharides

diabetes mellitus

disease characterized by high blood glucose due to inadequate insulin secretion, action, or both

Which part of the tubule system of a nephron helps to regulate pH and the concentration of sodium and potassium?

distal convoluted tubule

M

distant metastasis

M1

distant metastasis present

lipodystrophy syndrome

disturbance of lipid metabolism that involves partial or total absence of fat and often abnormal deposition and dist of fat

Low-fiber diets are used in the treatment of all of the following conditions except:

diverticulosis (IS USED: post-surgery, diverticulitis, IBD)

DHA

docosahexaenoic acid

Charlie is trying to change his eating behaviors and start following a high fiber diet. To successfully implement this change, you would tell Charlie to:

drink plenty of fluids AND gradually add high fiber foods to the diet

Nutrient deficiencies are an almost inevitable result of alcohol abuse because:

drinkers obtain few nutrients from food; alcohol interferes w/ingestion, digestion, abs, metabolism and excretion of nutrients

Which of the following drugs contains the principal ingredient in marijuana and works as both an antiemetic and appetite stimulant?

dronabinol

epdural anesthesia

drug placed into epidural space of lumbar or sacral region of spine, causing loss of sensation from abdomen and pelvis to lower limbs

Which of the following is true regarding pharmacologic treatment for AIDS?

drugs are used to inhibit HIV replication

xerostomia

dry mouth, often the result of damage to the salivary glands

After being released from the gallbladder, bile travels first to the

duodenum

small intestine

duodenum, jejunum, ileum; digestive tract between stomach and large int; functions in dig and abs

To minimize the possibility of aspiration of formula in tube-fed clients, the head of the client's bed should be elevated:

during and for 45 min after feeding

One means of glucose absorption into the enterocyte after a meal involves 2 molecules of ___ via the____, which requires ATP and is considered an active transport process.

sodium; sodium-glucose transporter 1

Which of the following is the basic premise of the etiology of obesity?

energy intake > energy expenditure

A high level of serum glucose, amino acids and fatty acids can send a signal to the CNS neurotransmitter that

enhances the feeling of satiety

LV hypertrophy

enlargement of the left ventricle; most commonly related to HTN and/or CHF

When triglycerides accumulate in the liver, the liver:

enlarges

John is an obese deliveryman for a company and drives in his car all day. He sees fast food restaurants on almost every corner and finds he eats at least 2 meals a day at such an establishment. Which of the following theories could explain John's problem of overweight?

environmental stimuli

Treatment for cystic fibrosis includes:

enzyme replacements and high kcal, high prot, balance diet

GERD occurs when:

esophageal sphincter fails to close tightly enough

In what way do changes in the GI tract contribute to multiple organ failure?

exaggerating and prolonging inflam response, slower peristalsis sets the state for overgrowth of bacteria

Overweight

excess body weight when compared to height

steatorrhea

excess fat in the stool (6 g/24 hr); caused by decreased pancreatic lipase, not enough bile, cystic fibrosis, liver disease, malabs, disease of the GI

Obese

excess of body fat or adipose tissue

The most common causes of gastritis include all of the following except:

excessive CHO (ARE causes: alcohol, H pylori, cigarettes)

hypercalciuria

excessive amount of calcium in the urine

All of the following can cause fatty liver except:

excessive protein intake (CAN: excess wt gain, alcohol, diabetes)

polyuria

excessive urination

In metabolic acidosis, which of the following is involved?

excretion of sodium bicarbonate

What is the best therapy for weight loss?

exercise, diet, behavior modification

In ____ reactions, energy is released during the reaction and in ____ reactions, energy is consumed or added to the product during the reaction.

exothermic; endothermic

Parenteral nutrition or tube feedings are not appropriate for individuals:

expected to eat w/in 7-10 days

polydipsia

extreme thirst

A full-liquid diet includes only those foods that are opaque liquids.

false

A normal nitrogen balance lab test value should be below 0.

false

Amino acids are absorbed into the enterocyte by passive diffusion.

false

Angiotensin is a vasodilator.

false

Bradykinin is a vasoconstrictor which inhibits the vasodilation action of ACE inhibitors.

false

Chronic stress triggers the fight or flight response.

false

Chyme is produced in the small intestine.

false

During metabolic acidosis, lungs "blow off" CO2 to lower pH

false

During respiratory alkalosis, the kidneys excrete HCO3 and increase pH.

false

During severe stress, the body lowers its metabolic rate to slow its usage of glucose and amino acids."

false

Fatty acids released from adipocytes during periods of starvation can be used to make glucose.

false

GIP suppresses glucagon secretion.

false

Gastrin production in the stomach is stimulated when the pH in the stomach reaches 3.0.

false

Gluconeogenesis is a reversal of glycolysis.

false

Increased insulin levels promotes the breakdown of fats and proteins for energy use.

false

Insoluble fiber helps to modulate blood cholesterol concentrations.

false

Intravenous solutions supply whole proteins rather than amino acids.

false

It is very difficult for individuals with HIV to transmit the virus to others during phase 1 of the infection.

false

It is well established that antioxidant supplement use act synergistically with anti-cancer medications.

false

Most people with feeding disabilities are usually unable to learn to feed themselves and become independent.

false

Nutrition support is appropriate for most terminal cancer patients or for patients with a poor prognosis for whom all medical anticancer therapies have been exhausted.

false

Once HIV progresses and becomes AIDS, the virus is no long transmittable to others.

false

Protein losses from hemodialysis are slightly higher than from peritoneal dialysis.

false

Stones composed of magnesium ammonium phosphate are frequently associated with gout.

false

The end of phase 2 of HIV is marked by a T-lymphoctye count that outnumbers viral load.

false

The lower the blood CO2 level, the lower the respiration rate.

false

The parasympathetic nervous system helps the body maintain the sympathetic nervous system response to stress.

false

The risk of aspiration is higher with continuous feeding than with intermittent feedings.

false

The serum osmolality appears increased in people with Type 1 Diabetes due to hypervolemia.

false

There are four phases of type 2 diabetes progression.

false

Type 2 diabetes is characterized by hypoglycemia.

false

Type 2 diabetes is insulin dependent diabetes.

false

Vitamins, but not minerals, may be added to IV solutions.

false

When the stomach is empty, ghrelin levels decrease.

false

Seroconversion refers to HIV replicating and invading uninfected cells.

false (making antibodies agains)

Ketone bodies are produced by the incomplete breakdown of ______ when insufficient carbohydrate is available within the cell.

fat

diabetic clients with nephropathy need to further restrict:

fat intake

In acute pancreatitis, the diet progresses from nothing by mouth to a liquid diet and then to a __________ diet.

fat-restricted diet

During diabetic ketoacidosis, ______ is broken down to provide energy in the form of ____

fat; ketones

Which of the following can result from hypoglycemia?

fatigue AND come AND death

Which of the following may be the cause of loose stools in a tube fed patient?

feeding was administered at too rapid a rate, an inadequate amount of intestinal surface area

GFR

filtration ability of the glomerulus; used s an index of kidney fxn; normal value is about 125 mL/min

An abnormal opening or passage between two internal organs or between an internal organ the surface of the body is referred to as a:

fistula

soft palate

fleshy posterior extension of the hard palate; separates the nasopharynx from the oral cavity

Ascites is:

fluid accumulation in the abdomen

Immediately following a severe burn, nutritional therapy should include:

fluid and electrolyte replacement

dialysate

fluid used by the dialysis procedure to assist in removal of metabolic by-products, wastes, and toxins; composition is determined by individual patient requirements; draws negatives out of blood

vitamin B9

folic acid

An elderly patient's lab results show hemoglobin of 10.5 g/dL, MCV of 105 fL, and MCHC of 33 g/dL. His family reports the patient has also recently had fatigue, irritability, and forgetfulness. The likely cause is

folic acid deficiency

Which amino acid is the preferred fuel by the gut during stress?

glutamine

An 8 month old is admitted with steatorrhea and diarrhea with frequent foul-smelling bulk stool. The baby's mother reports she has just introduced wheat cereal in his diet. A probably diagnosis is

gluten enteropathy (celiac)

Glucagon raises blood glucose levels by stimulating which of the following

glycogenolysis AND gluconeogenesis

Which of the following processes produces glucose?

glycogenolysis AND gluconeogenesis

Which of the following processes is associated with glucagon?

glycogenolysis AND gluconeogenesis AND ketogenesis

Which of the following processes are irreversible?

glycolysis

Which of the following processes leads to the production of ATP?

glycolysis

Which of the following processes does glucose undergo as a result of insulin stimulation?

glycolysis AND glycogenesis AND lipogenesis

What are LDL cholesterol levels?

good: <100 mg/dL okay if no other risks: 100-129 borderline high: 130-159 high: 160-189

Hypertension can lead to all of the following except:

gout (CAN lead to heart attack, transient ischemic attack, renal failure)

A formula that approximates the osmolality of normal blood serum

has osmolarity of ~300 mOsm/l; is isotonic

A PEG feeding tube would be useful in a patient with

head or neck cancer who will not be PO for weeks

HF

heart failure

Your patient has been diagnosed with CKD. He consumes very-high-fat foods and has elevated cholesterol. The focus of your nutrition therapy should be:

heart-healthy eating

Which of the following can lead to an inflammatory response?

heat, chemicals, loss of blood flow

Which of the following is a function of the kidneys?

help regulate blood pressure by secreting the enzyme renin, produce hormone erythropoietin, maintain acid-base balance

The primary purpose of simple IV solutions is to:

help restore acid-base balance, help maintain fluid and electrolyte balance

What would benefit a patient with an eating disorder the most?

help the patient set realistic goals and remain flexible

CD4 cell

helper T cell that recognized antigens on surface of virus infected cell and secretes lymphokines that stim B cells and killer T cells

Fibronectin

helps predict the short-term risk of preterm delivery

HDL- cholesterol gets its reputation as the good cholesterol because it:

helps remove cholesterol from the blood

A patient s GFR has decreased to less than 5 ml/min; he would be considered for

hemodialysis

Compare the requirements for CAPD to HD:

hemodialysis more restrictive

What test do you recommend to evaluate iron and protein deficiencies?

hemoglobin (?)

Which of the following viruses is(are) transmitted by feces and bodily fluids?

hep A, B, D (?) E

Which of the following cause cancer?

hereditary genetic anomalies, exposure to some viruses, exposure to toxic agents, unhealthy behaviors

Most often GERD develops as a consequence of:

hiatal hernia (?)

An obese, but otherwise healthy individual, could be expected to have which lipid profile?

high TG OR VLDL and high HDL

A patient is admitted to the hospital after 3 days of n/v and diarrhea and has lost 4% of his body weight. Assessment of lab data would likely show

high albumin and low Na (?)

HBP

high blood pressure

People with diverticulosis require:

high fiber; low fat diet

The one criteria that does NOT determine whether a food is allowed on a clear- liquid diet is:

high in nutrient density (IS criteria: transparent, minimal stimulation to GI, liquid at rm temp)

A child with AIDS needs a high calorie and high _____ intake

high protein

A patient has a stage 2 decubitus and a serum albumin of 2.8. Which of the following would be included in the nutrition care plan?

high protein, multivitamin, zinc, vit C

HDL

high-density lipoprotein

Compared to people with renal failure who are not on dialysis, people on dialysis receive diets:

higher in protein

hyperosmolar

higher osmolality than body fluids (300 mOsm/kg)

azotemia

higher than normal blood level of urea or other N containing compounds in blood

Which enzyme is responsible for breaking down triglycerides in adipocytes to fatty acids and glycerol to be released back into the blood?

hormone-sensitive lipase

amylin

hormoned formed by beta cells in pancreas and regulates timing of glucose release into bloodstream after eating by slowing gastric emptying

Which of the following complications associated with central TPN is when fluids accumulate in the chest?

hydrothorax

Activation of vitamin D involves

hydroxylation in the kidney, hydroxylation in the liver

If a person does not produce sufficient insulin, he is prone to have

hyperglycemia and increased use of proteins for energy

Clinical findings typical of the stress response during the period following injury include all of the following

hyperglycemia, inc excretion of potassium, increased retention of fluid and sodium

Trauma can place the patient in:

hypermetabolic state

Metabolic alterations of Systemic inflammatory Response Syndrome (SIRS) or sepsis include all of the following

hypermetabolism, accelerated lipolysis, protein catabolism

Altered metabolism may raise nutrient needs in cancer patients due to all of the following:

hypermetabolism, secondary infections, nutrient def

tube feeding syndrome

hyperosmolar-non-ketotic dehydration, over short 2-4 period

HTN

hypertension

Sodium and fluids are restricted in later renal disease to prevent:

hypertension, edema, HF

An increased respiration rate means

hyperventilation and alkalosis

Mr. Stone's medical problem which caused the need for IV nutrition has resolved. It is necessary to gradually transition him from an IV feeding to an oral diet to prevent:

hypoglycemia

A severely malnourished patient receives TPN at a rate of 125 m.l/hr. What could result?

hypophosphatemia

Which organ controls feelings of satiety and hunger?

hypothalamus

Which organ is responsible for the release of CRF into the bloodstream?

hypothalamus

Which of the following are true regarding respiratory quotient?

hypoventilation increases the RQ (?)

oxidative stress

imbalance between production of reactove O2 and biological sys ability to detoxify or repair damage

When are rapid-acting insulins taken?

immediately before meals

When should you provide nutrition counseling to an AIDS patient?

immediately upon diagnosis

Which body system is the main target of the HIV virus?

immune

autoantibodies

immune protein directed again body's own proteins

Which of the following statements best describes the appropriate use of alcohol by individuals with diabetes?

in moderation with meals

ATP is synthesized

in the ETC

cardiac cath

test used to check the heart and coronary arteries; it checks blood flow and pressure in the chambers of the heart, abilities of the heart valves, and defects in the way the wall of the heart moves

cardiac cachexia

the CVD-associated malnutrition/wasting syndrome characterized by extreme skeletal muscle wasting, fatigue, and anorexia

You have instructed your patients to look for Light in Sodium on certain food labels. This means:

the food contains 50% less sodium than the regular version

You are weighing a team of football players and according to the ideal weight tables they appear to be obese. Which of the following would you most likely conclude?

their muscle weight is probably responsible for the elevated scale weights AND their bones are likely well mineralized (?)

During hypermetabolic illness, when adequate energy is not being supplied through the diet:

there is a loss of vital protein from the muscles and organs

Which of the following is NOT true concerning pureed diets?

they cannot meet all nutrient needs (IS true: provide near liquid foods, offer a wider variety than full-liquid, monotonous)

Wernicke's encephalopathy is due to a severe deficiency of:

thiamin

vitamin B1

thiamin

A patient with dysphagia waiting for a swallow test may receive:

thick liquids

viscosity

thickness of a liquid

A critical care patient has a serum albumin of 2.0 g/dL, with nursing reporting an increased abdominal girth and edema of the extremities. This patient has

third spacing of fluids

Oral infections and mouth sores in people with HIV infection are usually due to:

thrush, herpes virus

stent

tiny tube placed into an artery, blood vessel, or other duct to hold the structure open

What is the role of insulin in Phase I of fuel homeostasis?

to promote fuel storage in the form of glucagon and triglycerides

polyhydramnios

too much amniotic fluid

In lipodystrophy, where does fat tend to accumulate?

top of the back and abdominal area

24 hr Energy Expenditure

total energy expenditure to 24 hr period; 3 comonents: REE, TEF and PAEE

general anesthesia

total loss of sensation and consciousness as a result of an anesthetic drug

During ___, the amino group from an amino acid it transferred to an ___ carbon skeleton to create a different amino acid.

transamination; alpha-keto acid

200-400 g/dl is a normal value range for which lab test?

transferrin

Which lab test has a half-life of 1 week?

transferrin

Which of the following is believed to be one factor in the development of sepsis and multiple organ failure in severely stressed individuals?

translocation

VLDL

transport endogenous TG from liver

TG

triglycerides

A living will and durable power of attorney are types of advance directives.

true

AIDS is characterized by no functional immune system.

true

Adipocytes are stimulated by glucagon to release fatty acids into the blood.

true

After fat is absorbed in the ileum, bile salts travel back to the liver for reuse.

true

An increased total lymphocyte count is indicative of a patient having a viral or bacterial infection.

true

Bile functions to help with fat digestion and absorption in the small intestine.

true

Both children and adults with chronic renal disease frequently develop wasting and PEM.

true

Compared with peripheral TPN, central TPN presents a greater risk of introducing disease-causing microorganisms into the bloodstream.

true

Competent individuals have a legal right to refuse medical treatment including nourishment and hydration even when medical experts consider the treatment necessary to sustain life.

true

Diabetic ketoacidosis causes dehydration which further exacerbates hyperglycemia

true

Diabetic ketoacidosis is a homeostatic mechanism to feed cells when glucose cannot enter cells.

true

Diabetic ketoacidosis is a result of hyperglycemia

true

During metabolic alkalosis, lungs retain CO2 to lower pH.

true

During phase 1 of HIV infection, viral load increases drastically as T-lymphoctye count decreases drastically.

true

During respiratory acidosis, the kidneys retain HCO3 and increase pH.

true

Fatty acids released from adipocytes travel in or with albumin.

true

Generally the full-liquid diet is deficient in kcalories and most nutrients.

true

Highly concentrated nutrient solutions cannot be infused through a peripheral IV catheter.

true

Insulin decreases blood glucose levels whereas glucagon increases blood glucose levels.

true

It is possible to meet all nutrient needs using a mechanical soft diet.

true

Leptin levels rarely change because it is based on the about of adipose that is stored and not the amount of fat ingested.

true

Many foods on a full-liquid diet contain lactose.

true

Medications designed to dissolve in the mouth should not be given through a feeding tube.

true

Negative nitrogen balance is present in patients with infection or traumatic injury.

true

One method of making the transition from an intravenous feeding to an oral diet is to place the client on a tube feeding.

true

Only when people cannot meet their nutrient needs using the enteral route for extended periods of time should they receive total parenteral or intravenous (IV) nutrition support.

true

Plant sterols and stanols help to reduce blood total cholesterol.

true

Positive nitrogen balance is present in pregnant women because they use ingested protein for themselves and for the growing baby.

true

Prevalence of diabetes increases with age

true

Providing too much dextrose can result in hyperglycemia which is a common metabolic complication associated with TPN.

true

Renin is released by the kidneys and plays a role in the formation of angiotensin.

true

Risk for DKA increases during illness, infection, and emotional stress.

true

Saturated fatty acids increase blood total cholesterol while monounsaturated fatty acids decrease blood total cholesterol.

true

Sodium and potassium levels are affected during diabetic ketoacidosis.

true

Soy protein and soluble fiber help to reduce blood total cholesterol.

true

The Scored Patient Generated-Subjective Global Assessment (PG-SGA) has shown to be quick, accurate, and reliable for distinguishing well-nourished cancer patients from malnourished cancer patients.

true

The fed state represents an anabolic state, and the fasting or starvation state represents a catabolic state.

true

The gastrointestinal system is able to regulate itself using the enteric nervous system.

true

The higher the blood CO2 level, the lower the respiration rate.

true

The sympathetic nervous system prepares the body for action during the fight or flight response to stress.

true

Tumors only become dangerous when cancerous cells start to travel through the blood to other parts of the body and invade noncancerous tissues.

true

Type I diabetes can occur at any age.

true

When the amount of fat stored in adipose decreases, leptin levels increase

true

Enteral nutrition includes

tube feedings

TNF-

tumor necrosis factor-alpha

TNM

tumor, nodes, metastases

When are most common mixed insulins taken?

twice daily, before meal

volvulus

twisting of the bowel on itself, causing obstruction

The number one nutrition problem of people with disabilities is:

inadequate intake

During hypoventilation, the levels of CO2 in the blood:

increase

Which of the following physiological changes is the adrenal gland responsible for?

increased O2 to brain and muscles, inc gluc to brain and muscles, limited non-emergency bodily functions like digestion

All of the following are symptoms of the systemic inflammatory response syndrome

increased WBC count, anorexia, increased body temp

leukocytosis

increased blood leukocyte count

thrombocytosis

increased blood platelet count

Metabolic acidosis may be associated with

increased chloride levels increased metabolic acids decreased bicarbonate

Which of the following physiological changes is caused by activation of the sympathetic nervous system?

increased heart rate, mobilization of fat and glycogen

Your patient has been admitted to the hospital with an exacerbation of Crohn's disease. The physician has prescribed corticosteroids to control the inflammation. Which of the following is not a complication of this medication?

increased lipogenesis (IS: hyperglycemia, osteoporosis, N wasting)

alpha-glucosidase inhibitor

type of DM med that inhibits enzymes int small intestine that digest CHO abs and lowers post-prandial glycemia

macrophage

type of WBC that ingests foreign material

peritoneal dialysis

type of renal replacement therapy during which the peritoneal cavity serves as the reservoir for the diasylate and the peritoneum acts as the semipermeable membrane across which excess body fluid and solutes are removed

hemodialysis

type of renal replacement therapy whereby wastes or uremic toxins are filtered from the blood by a semipermeable membrane and removed by the dialyses fluid

Curling's Ulcer

ulceration of gastric or duodenal tissue as result of burn or trauma

peptic ulcer disease

ulceration of perforation in lining of stomach, duodenum, or esophagus

BMI classifications

underweight: <18.5 normal: 18.5-24.9 overweight: 25-29.9 obese: >30

BMI classifications for children

underweight: <5th normal: 5th-<85th overweight: 85th-95th obese: >95th

TLC diet

up to 35% of calories from fat <7% saturated fat up to 10% PUFA up to 20% MUFA <200mg of cholesterol 25-30g of fiber maintain DBW, prevent weight gain increase physical activity at least 30 mins a day 2 g sodium

In liver disease, blood ammonia levels rise because the liver cannot convert the ammonia to:

urea

The main component of the solute load of the kidney is

urea

To combat bitter or metallic taste perceptions in cancer patients, you would recommend they:

use eggs, fish, poultry in place of meats

Which of the following is the best way to prevent aspiration of formula in a tube-fed client?

use nasoenteric, gastrostomy or jejunostomy feedings

adjuvant chemo

use of drugs additional treatment for ts with cancers thought to have spread

brachytherapy

use of implants of radioactive materials (radium, cesium, iridium, gold) at the tx site; used in radiation therapy

Which of the following should be included in the diet for celiac disease?

use potato and rice flour, IM vitamin B12 and iron

C-reactive protein (CRP)

used as a marker for inflammation

antemetabolites

used in the tx malignancies, especially those involving rapidly proliferating neoplasms

The body responds to severe stress by:

using more energy

The digestive tract transport system for the absorption of fructose after a meal

utilizes facilitated diffusion because the liver can help maintain the appropriate concentration gradient by efficiently removing fructose from portal blood AND utilizes GLUT5 as transporter

Which of the following results in vasoconstriction, fluid retention, and increased blood pressure:

vasopressin AND angiotensin II

Acute diarrhea that occurs abruptly in a healthy person frequently results from:

viral or bacterial infection AND a side effect of meds

The client on a renal diet will usually need supplements in:

vit B6, folate, Ca

While reviewing a patient's chart, the dietitian notices that the patient is taking Levadopa. What nutrient should the dietitian be concerned about?

vitamin C (?)

Patients receiving warfarin should avoid taking ____ supplements above the RDA amount.

vitamin E

The primary function of ___ is as an antioxidant in cellular and organelle membranes.

vitamin E

A patient taking warfarin needs to maintain a consistent, but not high intake of

vitamin K

Newborn infants may have low stores of ___ and thus an injection of the vitamin shortly after birth may be given.

vitamin K

hydrophillic

water loving, attracted to water

Which of the following receives a high priority in the treatment of type 2 diabetes, because of its beneficial effects in reversing insulin resistance, improving blood lipids, and reducing blood pressure?

weight loss

These signs or symptoms are usually associated with heart failure, except

weight loss (IS associated with liver tenderness, nocturia, increased heart rate, shortness of breath

Mr. M is a 45-year-old man. He has type 2 DM that is controlled by diet alone. He is 5' 9" and weighs 210 lbs. Which of the following will help to improve insulin resistance?

weight reduction

Foods useful in increasing dietary fiber are:

whole-grain bread, dried beans, and fruits

stylet

wire guide within the enteral tube that assists with insertion

A patient with chronic pancreatitis should consume oral pancreatic enzymes:

with all meals and snacks

What is your greatest nutrition concern in this AIDS patient? Ht: 5'10" Wt: 115# Hct: 34% Alb: 2.8 MCV 101 BUN 11

wt loss

Which of the following is a source of insoluble fiber?

(not soybean) oat, wheat, banana, nuts

The vitamin deficiency that could develop in post or total gastrectomy patients is

B12

Hypoglycemia can result from all of the following except:

taking too little insulin

Nitrogen Balance

tells you the rate/amount of protein being broken down

Which needs to decrease to prevent a fatty liver?

100 ml of 20% lipid (fat concentration)

An elderly woman who is usually 120% IBW is now malnourished. The best way to evaluate her is

%UBW

Which of the following is the correct formula for calculating total lymphocyte count?

(% lymphocyte x WBC count) / 100

When estimating IBW for a 30 year old with tetraplegia (quadriplegia), you would use the Metropolitan Life Insurance tables and adjust the weight given for his height

(not by 10-15% reduction)

These sources of dietary fiber help to reduce elevated blood cholesterol concentrations, except

(not guar) oat, wheat, pectin, psillium

Treatment of hypoglycemia with the "15 Rule" consists of eating or drinking 15 grams of what type of carbohydrate?

(not immediate-acting)

Which phase of fuel homeostasis is characterized by suppressed insulin secretion and stimulated counterregulatory hormone secretion?

(not phase 2)

Which phase of fuel homeostasis is characterized by the breakdown of protein as effective fat stores are depleted?

(not phase 3)

What percentage is considered a significant weight loss at one week, one month, and six months?

1 week: 1% 1 month: 5% 6 months: 10%

Phase 2 of HIV can last for up to:

10 yrs

The progression from a single cancer cell to the development of a tumor can take how many years?

10-30

What is a typical daily dose of insulin for adults diagnosed with diabetes?

0.4 - 1.0 units per kg

What is a typical daily dose of insulin for children diagnosed with diabetes?

0.5 - 1.0 units per kg

Standard commercially available formulas provide approximately:

1 kcal/ml

How many kg would be lost in one week if a man decreased his caloric level from 2700 to 1600 kcal/day?

1 kg

1 cc = ___ mL

1 mL

10 steps for calculating diabetic diet

1. Calculate % and g macronutrients 2. Determine milk, veg, fruit 3: Find remaining CHO g 4. Calculate exchanges 5. Subtract protein from carbs, milk, veg 6. Divide by 7 to get protein exchanges 7. Subtract fat from meat and milk 8. Divide by 5 to get fat exchanges 9. Divide food into meals and snacks 10. Fit in real food

Dietary progression for post-bariatric surger patient

1. clear liquid (3 days) 2. full liquid (2 wks) 3. pureed (2 wks) 4. soft (2 wks) 5. regular (1 wk)

How many kcals in 10% lipid solution?

1.1 kcals/mL

The dietitian has been asked to calculate the protein needs of a 57 YO woman with PKD who just started PD. What calculations would the dietitian use?

1.2-1.5 g/kg IBW

pH

A measure of the acidity or alkalinity of a solution

paracentesis

A procedure in which fluid is withdrawn from the abdominal cavity via a trocar and cannula, needle, or other hallow instrument

BCAA

AAS that has a branch; leucine, isoleucine, valine

AAA

AAs containing aromatic side chain (phenylalanine, tyrosine, tryptophan)

You have a patient who is taking a medication to control hypertension. He mentioned that his doctor described this medicine as blocking the enzyme that converts angiotensin. Which medication is he taking?

ACE inhibitor

anion gap

AG = Na - (Cl + HCO3)

Integrase inhibitors

AIDS med that works by blocking integration of HIV's viral DNA

What is the Holliday-Segar method for determining fluid needs?

Adults over age ?: 100 ml/kg for the 1st 10 kg of wt. 50 ml/kg for the 2nd 10 kg of wt. 15 ml/kg for the remaining wt. Children: 100 ml/kg for the 1st 10 kg of wt. 50 ml/kg for the 2nd 10 kg of wt. 20 ml/kg for the remaining wt.

As HIV progresses and immunity continues to be impaired, low levels of _____ are associated with neurologic changes.

B12

Which of the following nutrition education sessions does the Academy of Nutrition and Dietetics recommend due to its effectiveness in achieving improved dietary patterns, lipid profiles, and weight status?

An initial planned visit with an RD lasting 45-90 minutes and at least 2-6 follow up visits (30-60 minutes each) with the RD

High energy and protein intakes are associated with the need for increased amounts of

B vitamins

HCO3

Bicarbonate

Which of the following nutrients are absorbed in the ileum?

Bile salts and acids, Thi, Biot, vit C, folate, B12, vit D, vit K, Mg, Se, Mn

vitamin B7

Biotin

The presence of fat in chyme stimulates the release of what hormone(s) in the duodenum?

CCK

Which hormone stimulates the release of bile into the GI tract?

CCK

Which hormone(s) causes the gallbladder to contract and release bile into the duodenum?

CCK

Which hormone(s) inhibits stomach motility?

CCK and secretin

Which type of cell is the HIV virus's main target?

CD4+ T-cell

Which of the following statements is false in regards to digestion in the stomach?

CHO digestion is unlimited in stomach (TRUE: pepsin is primary enzyme responsible for chem digestion in stomach; of macronutrients, proteins are subected to the most active chem digestion; salivary amylase is inactivated by HCL

Complete oxidation of the macronutrients yields

CO2, H2O, ATP

_____ causes the ______ gland to release ______, which stimulates the ______ gland to release cortisol.

CRF; pituitary; ACTH; adrenal

Which of the following are positively correlated with reduction of blood pressure and treatment of hypertension?

Ca, K, Mg

Which of the following nutrients are absorbed in the duodenum?

Ca, P, Mg, Iron, Cu, Se, Mn, Thiamin, Rioflavin, Niacin, Biotin, Folate, Vit C, ADEK

Foods high in sodium

Canned vegetables, carrots, tomatoes, tomato catsup, tomato juice, bouillon cubes, mustard, pickled olives, pickles, cucumber, dill, salad dressing, soy sauce, bacon, cheeses, ready to eat breakfast cereals, peanut butter, soups, corned beef, sauerkraut

biliary cirrhosis

Cirrhosis develops from chronic biliary obstruction, bile stasis, and inflammation, resulting in severe obstructive jaundice.

What foods count as fluid for dialysis patients?

Coffee and tea Gelatin Ice chips or cubes Ice cream Juice Milk and milk substitutes Popsicles Sherbet Soup Sorbet

Renal failure risk factors

DM, HTN, male, African American, FHx of CKD

Which digestive hormone(s) comprise the incretin effect?

GIP AND GLP-1

The patient with Short Bowel Syndrome (SBS) would initially benefit most from which form of nutrition support?

Elemental enteral feedings (?)

The main cause of LBM depletion in the HIV-infected person is which of the following?

Elevated protein turnover rates

What is your justification to a physician that your patient with an admit BMI of 40.2 needs to be fed after 7 days NPO?

Energy is being produced from somatic protein sources

EER

Estimated energy requirement - average dietary energy intake defined by age, gender, ht, wt and PA to maintain energy balance; not used much now

How does fever affect BMR?

Fever increases BMR by 7% for every 1 degree above normal.

An athlete is above the normal BMI. You should recommend

Further testing to determine body composition

GTT: 200 mg/dL; fasting glucose: 175 mg/dL at 20th week gestation

GDM

One of the first body organs that is affected by the stress response is the:

GI

After receiving a new kidney, adverse effects of immunosupressive medications to prevent tissue rejection include the following

GI bleeding, muscular weakness, protein catabolism

The postoperative client is ready to begin a progressive diet when:

GI tract resumes (?)

___ is required for glucose uptake and is regulated by insulin in cells of the muscle, heart, and adipose tissue.

GLUT4

Which type of hepatitis is usually transmitted by the fecal-oral route?

HAV

Which of the following viruses is(are) transmitted by contaminated water?

Hep A AND E

Coinfection with ________, which often leads to chronic hepatitis, is common in people with HIV infections.

Hep C

Which of the following viruses is(are) transmitted by HBV?

Hep D (?)

The diet for hepatic coma is low in protein due to:

High ammonia levels

A 25-year-old man with Type 1 diabetes eats 2 meals a day between 9 a.m. and 5 p.m. (He skips lunch.) He takes regular and NPH insulin twice daily at 7 a.m. and 4 p.m. Which best indicates how he will feel?

Hypoglycemic before 9 a.m. and hypoglycemic in mid-afternoon

Fasting glucose: 120 mg/dL and 117 mg/dL, respectively, on 2 different occasions

IFG (impaired fasting gluc)

What compensatory response would occur due to the following ABG lab values: pH = 7.16; CO2 = 57mm Hg; HCO3 = 25mEq/L

Kidneys will retain increased amounts of HCO3 to increase pH

The primary blood cholesterol most clearly linked to atherosclerosis is:

LDL

How do you calculate total cholesterol?

LDL + HDL + TG/5

Which of the following nutrients are absorbed in the jejunum?

LIPIDS, MONOSACCHARIDES, AA, Small peptides, Thiamin, Ribo, Niacin, Pantothenate, Biotin, Folate, B6, vit C, ADEK, Ca, P, Mg, Iron, Zinc, Chromium, Mg, Mb, Se

The medical nutrition therapy protocol for dumping syndrome is

Liquids between meals, avoid simple CHO, increase soluble fiber

Which of the following is a rapid-acting insulin?

Lispro/Humalog

Which part of the tubule system of a nephron helps control the concentration of urine by reabsorbing water and ions from the filtrate?

Loop of Henle

You have a patient who has been diagnosed with diverticulitis and is beginning to feel better after beginning antibiotic treatment. Which type of solid food diet would be the most appropriate for this patient initially?

Low intake of fiber

Your patient has been experiencing diarrhea for a few days. The best possible nutrition therapy for this patient is to re-introduce foods with which type of diet?

Low residue diet

What compensatory response would occur due to the following ABG lab values: pH = 7.18; CO2 = 41mm Hg; HCO3 = 14mEq/L

Lungs will ""blow off"" CO2 to raise pH.

If the client with cirrhosis develops fat malabsorption, the diet should include:

MCT

Which of the following has the most profound impact on nutritional status in a burn patient?

Major protein loss at injury

Which predictive energy equation is suggested for use in adults who are not injured or critically ill?

Mifflin-St Jeor

Which validated nutrition screening tool would be used to assess undernutrition in older adults or in a long-term care setting?

Mini Nutrition Assessment

The following are produced in the TCA and can be used in other metabolic processes

NADH + H+, FADH2, CO2

An 18 YO trauma victim with no known previous health problems has an albumin of 2.1 g/dL. The likely cause is

Negative acute-phase response of albumin to the trauma

What is the onset, peak, and duration of long-acting insulin?

Onset: 1-2 hours Peak: no peak Duration: 24+hrs

What is the onset and peak of NPH insulin?

Onset: 1-2 hrs Peak: 4-6 hrs Duration: >12 hrs

What is the onset, peak, and duration of regular insulin?

Onset: 1/2-1 hr Peak: 2-4 hrs Duration: 6-8

What is the onset, peak, and duration of rapid acting insulin?

Onset: 15 min Peak: 60-90 min Duration: 3-4 hours

Mrs. Jones is severely malnourished and may need nutrition support for several weeks. The nurse recognizes that Mrs. Jones should be placed on:

PN or TPN???

In which of the following disorders is it detrimental to the patient to have unrestricted access to food?

Prader-Willi Syndrome (?)

Systolic blood pressure

Pressure exerted against the walls of the artery when the left ventricle contracts

ACE Inhibitors work to control blood pressure by

Preventing the conversion of angiotensin I to angiotensin II

TX

Primary tumor cannot be assessed

vitamin B6

Pyridoxine

Which of the following is a short-acting insulin?

R (Regular)

Respiratory Quotient (RQ)

RQ = VCO2/VO2 Normal: 0.8 Range: 0.67-1.3

N1

Regional lymph node metastasis

NX

Regional lymph nodes cannot be assessed

vitamin B2

Riboflavin

Foods high in phosphorus

Scallops, cheese, milk, nuts, beans, lentils, fish, bran cereal, bologna, cola, PB, liver, eggs, beer

Which of the following nutrients are absorbed in the colon?

Short chain FA, Water, vit K, Biotin, Sodium, Cl, K

GTT: 290 mg/dL; fasting glucose: 182 mg/dL; polydipsia, polyuria, weight loss, +islet cell antibodies

T1DM

GTT: 350 mg/dL; fasting glucose: 175 mg/dL; polydipsia, polyuria, no weight loss

T2DM

The metabolic pathway that is the final catabolic pathway for the macronutrients is:

TCA (?)

Insulin dose

TDD = (g CHO in meal/carb ratio) + (diff btwn actual blood gluc and target/correction factor)

Carbohydrate/Insulin Ratios are designed for people who

Take insulin with intensive management Use multiple daily injections Use an insulin pump

A plateau is reached in weight loss because

The basal metabolic rate (BMR) adapts to weight loss

debride

To remove dead or damaged tissue

oliguria

Urine output less than 400mL /day, which is the min amount of normal urine that can carry away daily load of metabolic waste products

You have a camper whose BG is 65 mg/dL prior to going swimming. You should

Use the rule of 15 s to treat the hypoglycemia and not allow the camper to go swimming (below 70 is DANGEROUS)

Vitamin E is transported from the liver to extra-hepatic tissues via

VLDLs then LDLs

Alcohol increases the excretion of which of the following vitamins?

Vitamin B6

What is the chronological age method for estimated fluid needs?

Weight (kilogram [kg]) x 25-35 milliliter (mL)=mL fluid required daily: 25 mL/kg for congestive heart failure or renal disease 30 mL/kg for average adults 35 mL/kg for patients with infection or draining wounds

A man with a peptic ulcer should consume:

a balanced diet he can tolerate

Barrett's esophagus

a complication of severe chronic GERD involving changes in the cells of the tissue that line the bottom of the esophagus

dumping syndrome

a group of symptoms that occurs with rapid passage of large amounts of food into the small intestine; symptoms include dizziness, sweating, decreased blood pressure, and diarrhea

BMI (body mass index)

a person's weight in kilograms divided by the square of height in meters; correlates well with body comp estimates from skinfold and underwater test

Female athlete triad

a potentially fatal triad of medical problems AND a combination of disordered eating, amenorrhea, and osteoporosis

ileostomy

a procedure in which the colon and rectum are surgically removed, and the end of the ileum is attached to the stoma

colostomy

a procedure to remove only rectum and end of colon is attached to the stoma; reversible, unless colon removed

toxic megacolon

a very inflated colon with abdominal distention, and sometimes fever, abdominal pain, or shock

fistula

abnormal opening between two organs or from organ to surface of body

macrosomia

abnormally large babies usually born to women with DM

When given in excess of energy and essential fatty acids requirements, omega-6 fatty acids:

accelerate inflammatory response

Which compound plays a central role in energy production, lipogenesis, cholesterolgenesis, and ketogenesis?

acetyl CoA

Acute HIV syndrome symptoms result from what?

activation of immune cells and death of immune cells

Heart attack, shock, or severe blood loss from trauma or during surgery all can cause:

acute renal failure

During prolonged fast, the brain

adapts to using 20-30 mg of glucose per minute relies mostly on ketone bodies is less reliant on glucose to function

All of the following statements describe modular feedings

add energy to diet, serve as source of single nutrient, can be combined to individualize

Which of the following would you suggest to a cancer patient experiencing xerostomia?

add gravy or sauce to meats, potatoes and dry foods

For clients on fluid-restricted diets who experience extreme thirst, you should suggest:

adding lemon juice to water to make it more refreshing

Lilly is experiencing a sudden bout of diarrhea. Which of the following should be temporarily avoided by Lily?

adding salt to foods (?)

salvage

additional tx used in hope of a cure or to prolong life in pt with recurrence of malignancy after initial tx

The primary nutrition intervention in ARF is:

adequate calories and protein

For achieving desirable body weight, adults have control over all of the following except

adipocyte number

According to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative, which of the following should be used to calculate energy and protein needs of underweight or obese CKD patients?

adjusted edema-free body wt using NHANES II standard wt tables

When a client is first placed on a tube feeding, the formula should be:

administered slowly at first

ulcerative colitis

affects the colon and begins in rectum

Crohn's disease

affects the terminal ileum

A half-life of 3 weeks is indicative of which lab test?

albumin

dysgeusia

altered taste

Which of the following is used as the precursor material for producing glucose in gluconeogenesis?

amino acids (?)

Which of the following are pancreatic hormones?

amylin AND glucagon AND insulin

Which of the following hormones is produced by pancreatic beta cells?

amylin AND insulin

When a starved patient begins to eat, they might expect:

an increased workload on the heart

peritonitis

an inflammation of the peritoneal cavity

Which of the following is an example of secondary cancer prevention?

annual mammogram

Cancer cachexia is characterized by:

anorexia

A pediatric dietitian suspects that a 13 YO girl has marasmus related to anorexia nervosa. The most effective method to validate this suspicion would be to obtain

anthropometric measurments (?)

Which of the following should not be used to assess malnutrition in an iron-deficient patient

anthropometrics (?)

Which of the following may be useful in treating irritable bowel syndrome?

antidepressants AND stress management (?)

Vitamin K is involved in all of the following except:

antioxidant AND visual cycle

reverse transcriptase inhibitors

antiretroviral drug that inhibits activity of revers transcriptase, a viral DNA polymerase enzyme that HIV needs to reproduce

Apo-B

apolipoprotein B

The protein components of lipoproteins that provide stability in the aqueous environment of the blood and confer specificity to the lipoproteins allowing them to be recognized by specific receptors on cell surfaces are:

apolipoproteins

The psychological desire to eat is referred to as:

appetite

Hypertonic formulas

are well tolerated in most cases, but can cause diarrhea when delivered directly into the intestine

Which amino acid is conditionally essential during stress?

arginine

The glomerulus consists of what?

arterioles Bowman's capsule Bowman's space

acidosis

conditions that produce excess acid in the blood

alkalosis

conditions that produce excess base in the blood

emetogenic

causing vomiting

CVA

cerebrovascular accident (stroke)

angina

chest pain caused by oxygen deficit to the heart

Which of the following would not be an appropriate source of carbohydrate for a diabetic experiencing an insulin reaction?

chocolate candy bar

Chol

cholesterol

Chylomicrons are composed of what?

cholesterol AND FA AND protein

James wants to gain weight. Which of the following would you suggest to help James with his goal?

choose energy dense foods such as milk shakes instead of milk begin a weight training program snack frequently

Individuals with cystic fibrosis often have these complications with nutrition implications:

chronic lung disease, malabs, loss of electrolytes in sweat

GERD

chronic or recurrent gastric pain due to reflux of gastric secretions into lower esophagus

Vitamin A and carotenoids are transported out of the enterocyte primarily as part of:

chylomicrons

These are carcinogens

cigarette smoke, chewing tobacco, polycyclic aromatic hydrocarbon, betel nuts

protease inhibitors

class of med to treat or prevent infection by viruses (HIV); prevent viral rep by inhibiting protease, enzyme used to cleave growing proteins for final assembly of new virons

Candidates for peripheral parenteral nutrition include all of the following

clients on oral feedings who need extra, need short-term support, inserting central line would be difficult

Which part of the tubule system of a nephron joins with the tubule systems of other nephrons to collect filtrate?

collecting tubule

thiazolidinediones

collective name for pioglitazone and rosiflitazone, which lower blood glucose by decreasing insuling resistance/improving sensitivity to insulin in muscle, liver, and adipose. They can be used as monotherapy or concomitantly w/ sulfonylurea, insulin, metformin

silver nitrite

colloidal silver used as an antibacterial treatment in burns

Untreated severe hyperglycemia can lead to:

coma (?)

The fatty acids found in VLDL:

come from chylomicron remnants and are produced from gluc in liver

Bile travels from the gallbladder to the duodenum through which duct(s)?

common bile duct AND cystic duct

Bile travels from the liver to the gallbladder through which duct(s)?

common hepatic duct AND cystic duct

ESWL

common procedure used to treat kidney stones whereby shockwaves are used to break down the stones into smaller pieces

Which of the following statements is true regarding carbohydrate in the diabetic diet?

complex should be emphasized (?)

Intravenous lipid emulsions provided daily serve primarily as a source of

concentrated energy

Acute Coronary Syndrome

condition characterized by an episode of acute unstable angina

acidemia

condition of excess acid in the blood consistent with a pH <7.35

alkalemia

condition of excess base in the blood consistent with a pH >7.45

Repeated bouts of pneumonia may be associated with:

dysphagia

What is rule of nines?

each upper limb = 9% each lower limb = 18% anterior and posterior trunk = 18% each head and neck = 9% perineum and genitalia = 1%

Tis

early cancer than has not spread to other tissues

Which of the following are nutrition implications resulting from cirrhosis?

early satiety AND impaired nutrient digestion and abs

A patient has lung cancer with liver and bone metastases. His albumin is 2.4 g/dL and his serum calcium is 10.6 mg. His spouse reports that his appetite has been poor, but that he eats a pint of strawberry ice cream every night. The dietitian should encourage the patient to:

eat a variety of nutrient-dense foods as toelrated and not be concerned about the high-calcium content of the ice cream (?)

A 16 year old girl runs 10 miles/day; she has missed her menstrual period over the past few months. What should she do to get her menstrual cycle back?

eat more food to gain weight (?)

Clients with GERD should be instructed to:

eat small, frequent meals

Which of the following is an example of primary cancer prevention?

eating healthy and exercising

All of the following can cause ulcers except:

eating spicy foods

Which of the following is not a sign of marasmus?

edema

Weight loss in people with chronic heart failure may go unnoticed until it has progressed considerably because:

edema masks underweight condition

Dialysis reduces all of the following symptoms

edema, uremia, hypertension; most people anemic and need erythropoietin

For a patient on hemodialysis who has a low albumin, poor appetite, and weight loss, what is the most appropriate snack?

egg and slice of toast

EPA

eicosapentaenoic acid

What is the most important factor to monitor if a patient is admitted with dehydration?

electrolytes

Hodgkin's disease is a potential indicator of what condition?

elevated albumin

The client who has pancreatitis will also have:

elevated serum amylase and lipase

Pregnancy in all women _____ blood insulin but later in pregnancy, hormones act ______ to insulin's rise.

elevates; antagonistically

A traveling blood clot is also called a(n):

embolus

palliative

end of life care

pancreatic polypeptide

endocrine GI reg peptide that inhibits pancreatic bicarb and enzyme secretion

secretin

endocrine GI regulatory peptide that stimulates biliary and pancreatic bicarbonate secretion in response to acid in the duodenum

Cholecystokinin (CCK)

endocrine GI regulatory peptide that stimulates gallbladder contraction and pancreatic secretions in response to peptides, amino acids, and fatty acids in stomach

Thermic Effict of Food

energy expended by the body to digest, absorb and metabolize food. ~10% EE

Adaptive Thermogenesis

energy expenditure above and beyond the thermic effect of food and resting energy expenditure that is seen in response to overfeeding, traumatic injury, changes in hormonal status, and exposure to a cold environment

Latent Autoimmune Diabetes in Adults (LADA)

form of autoimmune T1DM which is diagnosed in individuals who are older than the usual age of onset of T1DM (>30)

common bile duct

formed by the union of the cystic duct from gallbladder and bile duct from liver; terminates as the the duodenal ampulla, where it meets the pancreatic duct

Where is bile stores?

gallbladder

Consequences of cirrhosis include all of the following except:

gallstones (?)

choledocholithiasis

gallstones that are present in the common bile duct but are usually formed in the gallbladder

The client with a colostomy or ileostomy is usually concerned about foods that cause:

gas and odor

Which hormone(s) stimulates the secretion of digestive juices in the stomach when food is present there?

gastrin

Which hormone(s) is released into the blood?

gastrin AND secretin AND CCK

hematopoiesis

generation of blood cells

A nephron consists of what?

glomerulus and tubule

When glucose levels fall, the liver also produces additional glucose through the conversion of amino acids to glucose, which is called _____

gluco

What is the primary source of fuel in a patient that has not been fed for 3 days?

gluconeogenesis

The glycerol resulting from lipolysis during DKA can be converted to ____.

glucose (?)

What is sucrose made of?

glucose + fructose

What is lactose made of?

glucose + galactose

What is maltose made of?

glucose + glucose

As concentration of ketone bodies increases during diabetic ketoacidosis, the kidneys excrete _______ and ________

glucose and ketones (?)

The percentage of glycated hemoglobin reflects

glucose control over past 2-3 months

glycosuria

glucose in urine

Possible nutrition problems associated with the presence of neoplastic disease are likely to include

glucose intolerance, taste changes, organ hyperfunction and bowel obstruction

What happens to chylomicron remnants?

taken up by liver AND incorporated into VLDL

The primary nutrition-related concern for the client in the immediate post-operative period is:

maintenance of fluid and electrolyte balance

acid-base balance

maintenance of homeostasis between acidity and alkalinity within body systems

Radiation to the small intestine can cause radiation enteritis, which can lead to:

malabs, chronic blood clots, fluid and electrolyte imbalance

bacterial overgrowth syndrome

malabsorption and malnutrition that result from cross-contamination of bacteria from the colon to the small intestine; blind loop syndrome

Which of the following persons is at highest risk for developing CKD?

male diabetic w/diagnosed proteinuria

Changes in body composition during AIDS-related wasting syndrome appear to fit the profile of:

marasmus

Function of teeth

mastication

serum osmolality

measure of the amount of solute (particles) in one kg of blood

IGF-1 (insulin-like growth factor 1)

measured to help diagnose the cause of growth abnormalities

All of the following are criteria for the selection of candidates for home parenteral and enteral nutrition

medical considerations; client's financial resources, psychological profile

A HCO3 level of 18 is indicative of which condition?

metabolic acidosis

Acid-base abnormalities in an uncontrolled diabetic are likely due to:

metabolic acidosis

What condition is indicated by the following ABG lab values: pH = 7.31; CO2 = 44mm Hg; HCO3 = 20mEq/L

metabolic acidosis

A HCO3 level of 34 is indicative of which condition?

metabolic alkalosis

Hypokalemia is often associated with which of the following conditions?

metabolic alkalosis

refeeding syndrome

metabolic alterations that may occur during nutritional repletion of starved patients

Mets

metastases

Legumes are limited in the sulfur-containing amino acid ____. What food group is considered complementary because it supplies this amino acid?

methionine; grains

The products of lipid digestion combined with bile salts to form molecules that can be moved through the unstirred water layer and allow absorption into the enterocyte are called:

micelles

During fat digestion, which of the following can be absorbed directly into the enterocyte and then into the circulation?

micelles (?)

Who is the most appropriate candidate for TPN?

middle aged woman beginning chemo

What characteristics of fiber may protect against developing colon cancer?

some fibers adsorb primary bile acids to promote their excretion before they can be converted to secondary bile acids AND some fibers increase fecal bulk and dilute carcinogen concentrations AND some fibers can be fermented to butyric acid, which may slow proliferation of cancer cells

Which of the following people has the highest risk for developing heart disease?

someone who is diabetic

When an RD suspects bulimia, she should look for

sore throat, tooth decay, rectal bleeding

Which of the following professionals most often trains the client to use lips, tongue, and throat for eating?

speech-language pathologist

GRF stages

stage 1: GFR >90 mL/min stage 2: mild CKD, GFR 60-89 stage 3: mod CKD, GFR 30-45 stage 4: severe CKD, GFR 15-29 stage 5: end stage, GFR <15

t Mr. Jones's annual examination, his blood pressure was 165/80. What category would this put him in?

stage 2 hypertension

pre-diabetes mellitus

stage before DM where erson's blood glucose levels are between 140-200 in GTT

A patient experiencing ____ could have increased need for vitamin A.

steatorrhea

Calcium deficiencies can develop from cirrhosis due to:

steatorrhea, low serum albumin, impaired vitamin D abs

As blood pH becomes more acidic, the respiratory centers in the brainstem will become _______ which will cause the respiration rate to _______.

stimulated; increase

Parathyroid hormone

stimulates resorption of calcium and phosphorus from bone, stimulates kidney to activate vit D, is released in response to low blood Ca

The drugs to treat people with type 2 diabetes work by:

stimulating the release of insulin from the beta cells lessening peripheral insulin resistance blocking the digestion of starches and slowing the digestion of disaccharides

If a patient has had a gastrectomy, what has been removed?

stomach

Which type of cancer has been associated with a diet high in smoked, salted and pickled foods?

stomach

The gastrocolic reflex involves which organ(s)?

stomach and colon

All of the following are ways to reduce the likelihood of formula contamination when open feeding systems are in use

store opened cans in fridge, clean can opener and lid before opening, discard unlabeled containers, discard open containers after 48 hrs

Unresolved gastritis can lead to all the following except:

stronger stomach lining (CAN lead: ulcers, gastric cancer, B12 def)

If your patient reports that he/she has nausea after eating and vomits one time per day, this type of data is considered to be

subjective

electroneutrality

sum of the charges of the anions equals the charges of the cations

Which of the following cancer treatment methods target(s) only cancerous tissue?

surgery

Who is more at risk for Kwashiorkor?

surgery patient on D5W for 2 weeks

All of the following are examples of pathological stresses

surgery, burns, uncontrolled infections

anastomosis

surgical connection of body parts, especially hollow tubular parts like those of the GI

percutaneous nephrolithotomy

surgical procedure where a surgeon makes an incision the back and creates a tunnel to the kidney to remove a kidney stone

cholesystectomy

surgical removal of the gallbladder

All of the following are true about Hyperglycemic Hyperosmolar Nonketotic Syndrome

symptoms are comparable to mod hyperglycemia, blood gluc >700 mg/dL, absence of significant ketoacidosis

hepatic encephalopathy

syndrome characterized by CNS dysfunction in association with liver failure; impaired mentation

viral load

the measure of the severity of a viral infection calculated by estimating the amount of virus in body fluid; given in RNA copies/ml blood plasma

gallbladder

the pear-shaped reservoir for bile, behind the liver; stores and concentrates bile

Ejection Fraction (EF)

the percentage of the LVEDV that is ejected in the systolic phase; in normal, healthy adults, typical ejection fraction is 50-60%; defined mathematically as stroke volume divided by LVEDV

If a client is on peritoneal dialysis, his energy needs decrease because:

the person obtains glucose from fluids used to remove waste products (?)

proteinuria

the presence of too much protein in the urine

Diastolic Blood Pressure

the pressure in the arteries when the left ventricle is refilling

esophagectomy

the surgical removal of all or part of the esophagus

A patient suspected of having pancreatic lipase insufficiency has a fecal fat test that shows he had 15 g of fat remaining in the feces. What conclusion can be drawn?

the test shows an abnormally high amount of fat in the feces, but more disease-specific tests are needed before a diagnosis can be made

What is the 1800 rule?

• Rapid acting insulin • 1800 ÷ TDD = mg/dL drop in glucose per unit of rapid acting insulin

What is the 1500 rule?

• Regular insulin • Estimates insulin sensitivity • 1500 ÷ TDD = mg/dL drop in glucose per unit of regular insulin