Nutrition Final

35) Do patients with recession and exposed cementum have a higher or lower caries rate?

"Recession of gingival tissues exposes root surfaces of teeth to the oral environment... the lack of a protective enamel layer on the root, surface roughness of the roots and demineralization related to a lower pH, make the area highly susceptible to dental caries"

33) What is the impact of multiple medications consumed by older adults on their risk for xerostomia? Reduced renal or liver function?

(Ch 15 slide 3) Xerostomia may lead to avoidance of crunchy, dry, and sticky foods May choose hard candies to stimulate saliva, increasing caries risk (pg 351) "Salivary flow does not significantly decrease as a result of aging. Adults most frequently experience xerostomia in relation to taking multiple medications."

31) What are some healthy snacks that you can recommend to toddlers and preschoolers? (first 4 are from test bank, last are book page 698)

(first 4 are from test bank, last are book page 698) Low fat milk or yogurt Whole grain cereals Raw vegetable sticks Cheese cubes Air popped popcorn with sprinkle of parmesan cheese Fresh fruit Frozen fruit (grapes, bananas) Low fat cottage cheese Peanut butter on apple slices or celery sticks Pretzels Baked chips Hard boiled eggs Animal crackers Graham crackers Sliced turkey or chicken Rice cakes Low fat pudding Sugar free gelatin with fruit Mini bagels Pickles Frozen juice bars

46) If you have an adolescent patient who eats a lot of fast food, what recommendations can you make to them to improve their diet?

-wise choices are possible when an individual's nutritional needs and nutrient content of menu items are known -Go for grilled over fried, veggies are a great option, high fat and sugar coffees→ get regular and add a little flavor on your own instead (just look at box 16.5 if you want their word for word list but this is pretty obvious)

49) Differentiate and define the federal meal programs we discussed in class.

?????

-Human breast milk provides distinct advantages over commercially produced formulas because the infant's system is not fully developed.

A. Both the statement and the reason are correct and related.

3)What is antidiuretic hormone? What is its role in the body?

ADH is a hormone released by the pituitary gland to act on the kidneys to control urine output

48) Does juicing help with weight loss? Are there advantages to juicing? Disadvantages?

Advantages: Juicing is the extraction of juice from fresh fruits or vegetables. This juice contains most of the vitamins, minerals, and phytonutrients found in the whole fruit; however, whole fruits and vegetables contain fiber lost in juicing. Whether juicing actually reduces risk of cancer, boosts the immune system, helps remove toxins, aids digestion, and helps with weight loss is unproven. Disadvantages: Freshly squeezed juice can develop harmful bacteria unless consumed soon, and juices contain significant amounts of sugar that can lead to weight gain.

54) What medications are most likely to influence or cause xerostomia?

Although medications such as antidepressants, antihistamines, antihypertensives, and diuretics can cause xerostomia, more than one third of older adults experience xerostomia primarily as a result of anticholinergic medications. These medications block impulses through the parasympathetic nerve. Xerostomia can affect nutritional status in numerous ways and is a risk factor for dental caries and periodontal disease.

Each is a complication of neutropenia, except one. Which is the exception?

Atrophic glossitis

Which is correct and advisable for patients with gastrointestinal problems? (Select all that apply.)

Avoid foods that increase the likelihood of reflux. Limit caffeine, chocolate, alcohol, and carbonated beverages. Nitrous oxide during dental treatment decreases the likelihood of an episode.

An organic cracker made with wheat flour is consistent with the Dietary Guidelines for Americans if whole grain is listed as one of the top five ingredients. A dental hygienist would be wise to recommend selection of organic beverages, crackers, and candy bars as appropriate after-school snacks.

Both statements are false

Neurologic deficits can cause patients to be unaware of the presence of food in the mouth. Pocketed foods remain in the mouth, especially the vestibule, after meals in patients.

Both statements are true.

Human breast milk provides distinct advantages over commercially produced formulas because the infant's system is not fully developed.

Both the statement and the reason are correct and related.

Nonorganic animals do not contain antibiotic residues because FDA regulations prohibit farmers from giving feed with antibiotics to conventionally raised animals for a period of time before slaughter.

Both the statement and the reason are correct and related.

The dental hygienist should have three or four glucose tablets available because some oral diabetes medications are often combined with an oral agent that causes hypoglycemia.

Both the statement and the reason are correct and related.

Each is true of human breast milk, except one. Which is the exception?

C it is low in cholesterol.

Human breast milk contains omega-3 (docosahexaenoic) and omega-6 (arachidonic) fatty acids. Compared with cow's milk, human milk is low

C the first statement is true; the second is false

Which describe oral conditions diabetic patients and dental hygienists should watch for? (Select all that apply.)

Changes in the fit of partial denture or bridges Pain when chewing

45) Why do consumers choose organic foods?

Consumers perception that organic products are healthier, tastier and contain fewer calories Organic farming tends to build topsoil Environmental reasons/less fertilizer Fresher More humane treatment of animals, less antibiotic resistant bacteria Grown withought synthetic pesticides, growth hormones, antibiotics or genetic engineering. Note* organic can still use a type of pesticide that is natural and approved by national organic standards board.

44) If you are storing foods in your pantry, how would you store them? Containers? Environment? Temperature?

Containers? Environment? Temperature? Digital book p.807 -Products stored at room temperature should be kept in cool, dry areas in airtight containers

59) What chronic diseases can impact nutrient absorption?

Crohn disease Ulcerative colitis Cystic fibrosis Gluten-sensitive enteropathy (sprue or celiac disease) Acquired immunodeficiency syndrome (AIDS)

Infants who are given artificial infant milk tend to weigh less than breast-fed infants. No artificial infant milk can match the benefits of breast milk.

D. The first statement is false; the second is true.

Fluoride supplementation is recommended for all infants older than 6 weeks because this mineral increases the strength and acid resistance of developing tooth enamel.

D. The statement is not correct, but the reason is correct.

Consumers state each of the following reasons for choosing organic foods except one. Which one is the exception?

Decomposition of topsoil

42) What is dietary acculturation?

Dietary acculturation: dietary changes that occur as a result of adapting to food resources of a new location. "Dietary professionals should learn about ethnic foods for immigrants in the area so they can assist in suggesting alternatives or similar types of foods. Gradually, the diet conforms to food resources of the new location, a process called dietary acculturation. Ex: Second generation Americans are raised without that direct native connection, and their parents, often struggling with new foods themselves may not have the knowledge to educate their children about healthy American foods." p. 782

Oral manifestations of renal (kidney) disease include each, except one. Which is the exception?

Dysphagia

While discussing food budgets with a patient a dental hygienist would wisely convey each of the following except one. Which one is the exception?

Families at the poverty level may spend 20 to 25% of household income on food.

Each is true of retinoic acid, except one. Which is the exception?

Formation of odontoblasts in enamel requires retinoic acid.

25) Does the mother's diet impact a child's tooth development in utero?

From book (page 616 & 662) Critical periods for various stages of tooth development occur at different times. Nutrients supplied by the mother must be available when needed for development of pre-eruptive teeth and soft tissues. All primary teeth and many permanent teeth are at various stages of development at birth. Breast milk provides approximately 0.01 mg per day of fluoride, regardless of drinking water and maternal plasma levels. Despite the low fluoride levels, infants who are breastfed up to 12 months are not at risk of dental caries

26) At what age should fluoride supplementation begin? Do all children need fluoride supplementation?

From book (page 662) As shown in Table 14.2, the American Dental Association and American Academy of Pediatric Dentistry (AAPD) recommend delaying fluoride supplements for all infants until 6 months of age.

23) What recommendations have been made about what age a child should stop drinking human breast milk or artificial infant milk? At what age should milk be introduced? Is there a point when a child should no longer receive whole milk?

From the book (page 660 & 663) Infant formulas should be discontinued by 12 to 14 months of age, and vitamin D-fortified whole milk should be provided until age 2. Low-fat milk is not recommended for children before the age of 2. Exclusive breastfeeding for at least 4 months is strongly recommended by numerous organizations in the United States and worldwide to reduce the incidence of gastrointestinal and respiratory infections, ear infections, and eczema; and to reduce long-term incidence of obesity and other chronic health conditions

58) Identify the names of GI problems.

Gastroesophageal Reflux Disease Lower esophageal sphincter allows gastric contents to enter the esophagus Crohn disease Ulcerative colitis Cystic fibrosis Gluten-sensitive enteropathy (sprue or celiac disease) Acquired immunodeficiency syndrome (AIDS)

47) What can a hair analysis tell about a person's diet or nutritional status?

Hair Analysis is used to recommend vitamin and mineral supplements. Hair analysis can indicate exposure to toxic heavy metals, but vitamins are not present in hair except in roots below the skin. Hair grows very slowly and does not reflect current body status. Hair mineral content can be affected by shampoos, bleach, dye, and many other factors, including environmental and geographical factors.

Each is a gastrointestinal problem, except one. Which is the exception?

Hirsutism

56) When there is pain of the tongue, what is the proper term to describe this?

I didn't find much about this because it is just a term definition so I added the descriptive that was on the test bank: Pain in the tongue is technically called glossodynia. Glossopharyngeal is a term describing anatomic features occurring in the junction of the tongue and pharynx. Although glossitis may be painful, the term refers to the more general condition of inflammation of the tongue. Macroglossia is an enlarged tongue

A dental hygienist could correctly convey each of the following statements to a patient considering the value of organic food except one. Which one is the exception?

Imported produce is grown under the same regulations as those enforced by the USDA.

57) What are complications that can occur with neutropenia?

Invasive dental treatment contraindicated until white blood cell counts rise Palliative care (such as, non alcoholic chlorhexidine rinse) may help reduce bacterial load until patient can perform more thorough oral self-care Stress importance of frequent oral prophylaxis and meticulous oral hygiene care once mucositis pain subsides Refer to a registered dietitian

Each is a chronic disease or condition associated with poor nutrient absorption, except one. Which is the exception?

Ischemia

Each of the following correctly state reasons for the higher cost of organic food except one. Which one is the exception?

Labor costs are lower.

52) How does the loss of smell impact an individual's dietary choices?

Loss of smell (anosmia) causes people to eat and drink fewer sweet food and beverages. The foods people choose to eat are modulated by taste, smell, and oral textural perception. Taste and smell dramatically affect appetite and food intake.

40) What conditions can increase an individual's risk for foodborne illness?

Many older adults are more susceptible to foodborne illness because of a compromised immune system (placing them at risk for infections), decreased secretion of gastric hydrochloric acid, and reduced smell and taste. Food poisoning is caused by food contaminated with pathogenic bacteria, toxins, viruses, or parasites.

50) Define the following terms: meta-analysis, systematic reviews, evidence- based, observational studies.

Meta-analysis: systematic analysis that is applied to separate experiments on a related topic involving pooling the data to provide larger study samples that generate information about statistically significant results from the cumulative research on a topic. systematic reviews:reliable information based on all relevant published and unpublished evidence, selecting studies for inclusion, assessing the quality of each study, then compiling the findings and interpreting them to present a balanced and impartial summary while defining limitations of the evidence. evidence- based:medical practices that have been thoroughly evaluated using scientific methods. observational studies: epidemiologic research studies with no type of intervention or experiment.

Based on the information in the Food Record, which contains lactose, galactose, and glucose? Food Record Breakfast 1 cup oatmeal 1 slice whole-grain toast cup grapefruit juice 1 cup milk Lunch 2 slices white bread Lettuce leaf and carrot 2 oz slices turkey breast cup corn 1 orange Dinner 1 whole blueberry muffin 3 oz grilled chicken cup baked beans cup cooked cabbage 2 plums

Milk

51) What factors influence the development of disease?

No single parameter is responsible for formation of a carious lesion (Fig. 18.2) A combination of factors is involved, including a susceptible host or tooth surface, a sufficient quantity of cariogenic microorganisms in the mouth, the presence of fermentable carbohydrates, and a particular composition or flow of saliva. All of these must be present simultaneously for an adequate time to allow decay to occur.

36) Which dental conditions increase the risk of malnutrition in older adults?

Oral health issues including chewing, swallowing, and mouth pain are indicators of risk for malnutrition Changes in taste and smell may increase cariogenic food choices Xerostomia may lead to avoidance of crunchy, dry, and sticky foods • May choose hard candies to stimulate saliva, increasing caries risk

Each is true of iron requirements, except one. Which is the exception?

Preterm infants should receive iron supplements after 6 months

60) What recommendations would you make to a patient with

Recommendations Avoid foods causing gastroesophageal reflux disease (e.g., fatty foods) Eat small meals Keep patient in semisupine position Assist with tobacco cessation gastroesophageal reflux?

Renin:

Renin is a hormone that leads to increased release of the hormone aldosterone by the adrenal cortex.

Each should be recommended for patients with cardiovascular disease, except one. Which is the exception?

Salt substitutes

Comparing the cost of 20 g of protein from the following sources, which is the least economical source?

Sliced bacon

When counseling a teenager about fast food, a dental hygienist could correctly cite the following facts except one. Which one is the exception?

Studies reveal that protein is lacking in most menu items.

8)When is an infant considered to be born prematurely?

Test bank question above in #20

37) What is the most likely cause of mental confusion in older, hospitalized patients?

Textbook Dehydration is the primary cause of confusion in older patients and can occur because of the kidney's inability to concentrate urine, changes in thirst sensation, changes in functional status, side effects of medications, and lack of mobility. (pg. 288) Homeostatic mechanisms: body's ability to correct imbalances, such as decreased nutrient intake accompanied by an increase in nutrient absorption or efficiency of use.

Because of increasing cases of fluorosis, low levels of fluoride are added to commercial infant formula. Breast milk provides low levels of fluoride.

The first statement is false; the second is true

Food deserts are yet another nutritional constraint frequently encountered by people with limited financial resources. Small, independent stores provide the best opportunity for people in inner city and rural areas to purchase reasonably priced fruits and vegetables.

The first statement is false; the second is true.

Infants who are given artificial infant milk tend to weigh less than breast-fed infants. No artificial infant milk can match the benefits of breast milk.

The first statement is false; the second is true.

E. coli contamination does not differ between organic and conventional produce. Standards for composting of animal manure are more strict than for conventional farming.

The first statement is true; the second is false.

Few dental and periodontal changes and no oral mucosal changes are observed in well-controlled diabetes. The fruity-smelling breath characteristic of diabetes is more common in type 2 diabetes.

The first statement is true; the second is false.

In both organic and conventional farming, bacterial contamination of chicken and pork is common. Bacteria resistant to seven or more antibiotics was higher in conventional than in organic chicken and pork.

The first statement is true; the second is false.

16)What is fetal alcohol syndrome (FAS)? What are the clinical signs/manifestations of FAS? When is a fetus most vulnerable to a mother's consumption of alcohol during pregnancy?

The first trimester, especially the first month, is the most vulnerable time for the fetus because the woman may not even be aware of the pregnancy. Signs: Small head and brain size, small eyelids, eyes close together, sunken nasal bridge, small teeth with faulty enamel ears poorly formed, heart defects, deformities of joints, limbs and fingers, weak skeletal muscles, slow physical growth before and after birth, vision difficulties, intellectual disabilities

41) What is the impact of income on the health status of an individual? The impact of race or ethnicity?

The impact of race or ethnicity Patients who speak, understand, or read only a language other than English, have different levels of acculturation and socioeconomic status, understand illness uniquely, or have a different perspective on health care are challenging to health care workers educated in the American mainstream system. Impact of income on the health status The average american family spends approximately 10%-15% of it/s income on food, poverty level may spend 33% Consumers believe that healthy food must be more expensive than less expensive foods and that higher-priced food is healthier.

14)What is the impact of the hormones progestin and estrogen in oral contraceptive agents on appetite and carbohydrate metabolism?

The question for 13 also answers this??

Each of the following accurately describes aspects of dietary acculturation except one. Which one is the exception?

This is the immediate adjustment of dietary patterns to a new location.

12)What are the side effects associated with taking iron supplements?

This is the only one I found.. The explanation of the answer goes more into detail of what we might need to know Even though iron can be considered toxic because of the body's inability to excrete excess amounts, supplementation is a safe and effective treatment for iron-deficiency anemia.

39) What are Vitamin D requirements for older adults, hospitalized or homebound patients? Why?

Vitamin D: should be limited to less than 4000 IU each day. This should be taken in conjunction with calcium to increase calcium absorption. This amount should not be increased without a recommendation from the health care provider. (pg. 296) Why?: They are taken to prevent a disease/medical problem because they know their eating patterns are not ideal or because a healthcare professional recommended them. (pg. 296)

43) What food choices could you make when trying to eat healthy on a limited budget?

Week 13 slide 11, list from book box 16.1 on p. 785 -Evidence of poor or fair health status and malnutrition ↑ as income level ↓ -Foods supplying the most nutrients relative to cost include beef, fresh potatoes, brown rice, wheat germ, milk, eggs, and peanut butter -Basic principles for economic food purchases: -Take inventory before shopping -Plan weekly menus/MyPlate/make list and stick to it -Plan around weekly specials/seasonal foods -Never shop when hungry -Purchase least expensive items in a food group you'd eat -Rely on minimal servings of meats/use meat substitutes (legumes, nuts, PB, cheese several times a week) -Grains, cereal, pasta, be aware of portion sizes -small quantity whole grains over large quantity refined grains -prepare from scratch instead of buying frozen -Fruits and veggies instead of $$ high processed foods -List goes on but essentially compare unit prices, don't let food go bad, shop perimeter, dont shop hungry, and quantity is more financially feasible

15)What nutrient and diet recommendations should be made to post- menopausal women?

Weight gain is a major health concern of postmenopausal women. Weight loss becomes more difficult because body metabolism is lower and physical activity may be reduced. Weight loss during this stage of life requires greater focus on dietary monitoring, home-prepared meals, and increasing physical activity

Taste perception declines with age. Individuals taking three or more medications are likely to have less taste sensitivity and require greater amounts of sodium and sugar to perceive these tastes.

a. Both statements are true.

Weight loss therapies that rely on juicing typically provide increased fiber, vitamins, and minerals. An added incentive is that juices contain a lower concentration of sugar than the whole fruit.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: B Freshly squeezed juices contain most of the vitamins, mineral, and phytonutrients found in the whole fruit; however, much of the fiber can be lost in the juicing procedure. A drawback is that fresh juice contains significant amounts of sugar that can actually lead to weight gain. Also pertinent, harmful bacteria can develop in fresh juice if it is not consumed in a short period of time. REF: p. 326

The body's hydration status depends on an electrolyte balance of equal concentrations of solutes to kilocalories. Electrolytes are an important in water balance and acid-base (pH) balance.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: D : The body's hydration status depends on an electrolyte balance of equal concentrations of cations to anions. Sodium and potassium are the major cations while chloride and phosphate are the major anions. Solutes are substances that create a solution when dissolved in a solvent such as sugar dissolved in water. Note that solvents are involved in hydration via osmosis and cellular permeability.

Vitamin B6 reserves are affected by oral contraceptive agents (OCAs). Progestins within OCAs can cause weight gain related to increased appetite and altered carbohydrate metabolism.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: A

The health status of the underprivileged and many racial and ethnic minority groups is poor. Evidence of poor health status and malnutrition increases as income level increases.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: C The first statement is true; the second is false. Although health care disparities are a serious problem in the United States for the underprivileged and not all ethnic minorities are disadvantaged, different cultural backgrounds and language barriers can predispose individuals to nutritional deficiencies. Regardless, the consensus is that the health status of the underprivileged and many racial and ethnic minority groups is poor. Evidence of poor health status and malnutrition decreases as income levels increase.

Human breast milk contains omega-3 (docosahexaenoic) and omega-6 (arachidonic) fatty acids. Compared with cow's milk, human milk is low in lactose and relatively high in protein.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: C The first statement is true; the second is false. Docosahexaenoic acid and arachidonic acid are omega-3 and omega-6 fatty acids, respectively. Compared with cow's milk, human milk is high in lactose and relatively low in protein. Note that lipase, an enzyme present in breast milk, breaks down the disaccharide sugar, lactose.

The most powerful predictor for how much children eat is how much food is put on their plate. The MyPlate sections for kids are different from those of adults.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: C The first statement is true; the second is false. The MyPlate sections for kids are the same as for adults, but serving sizes differ, so smaller sized plates are encouraged. Large portion sizes of snacks and fast foods parallel dramatic increases in childhood obesity

Infants who are given artificial infant milk tend to weigh less than breast-fed infants. No artificial infant milk can match the benefits of breast milk.

a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true. ANS: D The first statement is false; the second is true. Infants who are fed artificial infant milk tend to weight more than breast-fed infants. It is thought this puts them at risk for obesity later in life, but more research is needed to confirm this association. Although artificial formulas are constantly being modified to duplicate components of human milk more closely, no formula can match the benefits of breast milk.

The RDA is higher for premenopausal women than for men or postmenopausal women because of the blood loss during menstruation.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: A: The Institute of Medicine (IOM) recommends 18 mg of iron per day for women 19 to 50 years old, 8 mg per day for women 51 years old and older and men 19 years old and older. Note that during the reproductive phase of a woman's life, iron loss is at least twice that of a man or of a postmenopausal woman: REF: p. 230

Hair analysis can indicate exposure to toxic heavy metals content because hair reflects current body status.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: C Although hair analysis can indicate exposure to toxic heavy metals, an important caveat for consumers is that hair grows slowly and does not reflect current body status. Although many products and procedures claim to provide current nutritional status based on hair analysis, vitamins are not present in hair except in roots below the skin. Also significant, hair mineral content can be affected by shampoos, bleach, dye, and many other factors, including environmental and geographic factors. A staggering statistic for dental hygienists to convey, Americans spend more than $10 billion annually for cures that are deemed quackery by scientists. REF: p. 326

Patients with xerostomia benefit from lemon glycerin swabs to moisten mucosa because the glycerin contains an alcohol and the swab is flavored with lemon.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: D The statement is not correct, but the reason is correct. Dental hygienists should evaluate salivary substitutes that patients with xerostomia may be using. Lemon glycerin swabs, often recommended by health care professionals to moisten mucosal tissues, contain lemon, which is acidic

Human breast milk provides distinct advantages over commercially produced formulas because the infant's system is not fully developed.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: A Both the statement and the reason are correct and related. The American Academy of Allergy, Asthma and Immunology (AAAAI) strongly recommends exclusive breastfeeding for at least 4 months to reduce potential for long-term health consequences. Specific protein fractions synthesized in breast tissue promote colonies of healthy bacteria in the gastrointestinal tract that aid nutrient absorption and help to protect infants from infections and illness.

Excess water is eliminated by the kidneys because antidiuretic hormone (ADH) secretion is increased when osmoreceptors detect excess water.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: C Excess water is eliminated by the kidneys because ADH secretion is decreased when osmoreceptors detect excess water. ADH originates in the pituitary gland and is involved in the regulation of fluid levels. As in this question, during times of excess water, ADH is decreased causing increased urinary output. Conversely, if osmoreceptors detect a water deficit, ADH stimulation is increased. This causes the body to retain fluid by decreasing urinary output.REF: p. 215

Fluoride supplementation is recommended for all infants older than 6 weeks because this mineral increases the strength and acid resistance of developing tooth enamel.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: D The statement is not correct, but the reason is correct. Fluoride supplementation is recommended for all infants older than 6 months, not weeks, and children; however, before fluoride supplementation is prescribed, the American Association of Pediatric Dentistry (AAPD) recommends a caries risk assessment and an evaluation of dietary sources of fluoride, including fluoridated water. Vitamin supplements containing fluoride can be prescribed by a health care provider or dentist. The reason correctly states that fluoride increases strength and acid resistance of developing enamel.

A mother's food choices during pregnancy will affect her child's health, but have little bearing on later preferences because flavors from the mother's diet rarely transmit through amniotic fluid.

a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct. ANS: E Neither the statement nor the reason is correct. Flavors from the mother's diet are transmitted through amniotic fluid and mother's milk. A mother's food choices, particularly for fruits and vegetables, influence later preferences and food behaviors.

20. Each of the following interferes with zinc absorption except one. Which one is the exception?

a. Calcium b. Fiber c. Higher quality protein d. Phytate e. Phosphate salts ANS: C Bioavailability of zinc varies widely. Absorption can be inhibited by calcium, fiber, phosphate salts and phytate (a plant fiber). Higher-quality protein improves zinc absorption. In developing countries, severe zinc deprivation has been related to excessive consumption of inhibitors, which adversely affect zinc absorption, rather than inadequate zinc intake. REF:p. 233

Each increases the susceptibility for foodborne illness, except one. Which is the exception?

a. Compromised immune system b. Increased secretion of gastric hydrochloric acid c. Reduced sense of smell d. Reduced sense of taste ANS: B Decreased, not increased, secretions of gastric hydrochloric acid improves susceptibility of foodborne illness. Older adults are more susceptible to foodborne illness because they stand a higher chance of exhibiting a compromised immune system, decreased secessions of gastric hydrochloric acid, a reduced sense of smell, and a reduced sense of taste.

Which are sound nutritional directives for older adults? (Select all that apply.)

a. Daily multivitamin-mineral supplementation provides immune protection. b. Calcium supplements should not be more than 1000 mg/day. c. Vitamin D supplements should be limited to less than 4000 IU/day. d. Vitamin B12 supplementation may improve cognitive function. ANS: A, C, D Calcium supplements should not be more than 2500 mg/day. Omega fatty acids, obtained through consumption of certain fish, are thought to decrease dangerous triglyceride levels. People who do not eat much fish may benefit from a fish oil supplement. Note that for all older adults, daily multivitamin-mineral supplementation at 100% of recommended daily intake level provides immune protection. However, an important consideration is that 27% of older adults who take supplements exceed the upper limit for a nutrient. Also pertinent, in addition to improving cognitive function, vitamin B12 can relieve symptoms of depression and prevent pernicious anemia.

Each is commonly deficient in the diet of adolescents, except one. Which is the exception?

a. Fiber b. Protein c. Riboflavin d. Calcium e. Vitamin D ANS: B Average protein in adolescents is well above average. If overall intake becomes insufficient for any reason, dietary protein can be used for energy and would not be available for needed growth and repair. Note that while the need for calcium, vitamin D, and iron is of particular concern throughout childhood, the need for these nutrients is critical during adolescence because of extensive bone development

The best way to prevent osteoporosis is through building bone mass during what stage of life?

a. Infancy b. Early childhood c. Adolescence d. Young adulthood ANS: C It is thought that adolescence is the best time to build sufficient bone mass to prevent osteoporosis later in life. During this period, 45% of adult skeletal mass is formed. Calcium needs are greater at this period than at any other time. Additionally, vitamin D deficiency in adolescents can place them at greater risk

Each is true, except one. Which is the exception?

a. Infant formulas should be discontinued at approximately 1 year of age. b. Vitamin D-fortified whole milk should not be provided until 2 years. c. Low-fat milk is not recommended for children younger than 2 years. d. Special toddler formulas are available but are unnecessary. ANS: B After discontinuing breast feeding or infant formulas, vitamin D-fortified whole milk should be provided until age 2. The remaining selections are true. Note also that lactose-free and reduced lactose-containing cow's milk formulas are available and could be used for circumstances in which elimination or a reduction in lactose is required.

When counseling a parent regarding early childhood caries (ECC), advice from the dental hygienist should include which of the following? (Select all that apply.)

a. Limit the child's access to a sippy cup containing milk or juice. b. If natural fluoride is low, install a home filtration system to add fluoride. c. During the first year, food that requires chewing should be added based on the number of erupted teeth. d. Wean the infant from the bottle soon after the first birthday. e. To encourage more consumption of fluids, add fruit juice to bottle and sippy cup. ANS: A, C, D Home filtration systems can remove fluoride; therefore, tests conducted by state health departments to measure fluoride content of filtered and treated water should be performed. Fruit juice adds unnecessary carbohydrates that are cariogenic. With both the sippy cup and bottle, fluids linger in the mouth enhancing the action of cariogenic bacteria. Juice should be offered in a cup.

Each of the follow is a classic sign of fluid volume deficit (FVD) except one. Which one is the exception?

a. Longitudinal fissures in dry tongue b. Sunken eyes c. Orthostatic hypotension d. Hypotension e. Pale urine ANS: E Pale yellow or almost colorless urine indicates adequate hydration. Dark yellow urine with strong odor, advancing to painful urination, are advancing signs of inadequate water intake and dehydration. A diminished salivary flow is also associated with inadequate fluid intake. Treatment of FVD involves replacing lost fluid. For mild FVD, oral fluids are likely sufficient. Intravenous solutions are needed with significant FVD. REF: p. 221

Which term is used to describe medical practices that have been thoroughly evaluated using scientific methods?

a. Meta-analysis b. Systematic reviews c. Evidence based d. Observational studies ANS: C The gold standard for research studies is evidence based, a term used to describe practice that has been thoroughly evaluated using scientific methods. Evidence-based studies involve evaluation of interventions based on risks and benefits revealed during randomized and placebo-controlled clinical trials. Meta-analysis combines all relevant studies from independent sources using a statistical technique. Systematic reviews also provide reliable information and present an impartial summary. Observational studies are epidemiologic research studies with no type of intervention or experiment. REF: p. 328

Each is true of vitamin D requirements, except one. Which is the exception?

a. Prevalence of vitamin D deficiency is high in homebound or institutional patients. b. Aging skin may not synthesize vitamin D efficiently. c. As many as half of older adults could be deficient in vitamin D. d. Older patients do not synthesize vitamin D. e. Adequate calcium in addition to vitamin D is important. ANS: D Note that although older patients synthesize and use vitamin D less efficiently than their younger counterparts, they continue to synthesize this vitamin. Nevertheless, supplementation reduces bones loss and reduces risk of falling and fracture. It is important to ensure that patients receive adequate calcium in addition to vitamin D

Sarcopenia, protein, and osteoporosis have important links that dental hygienists should understand. Which of the following are accurate? (Select all that apply.)

a. Sarcopenia is inevitable with aging. b. Impaired protein use can be overcome by consuming high-quality protein at each meal. c. High-protein foods stimulate carbohydrate synthesis. d. Resistance exercise combined with complete protein consumption elicits anabolism. (states reduces risk of osteoporosis on page 70 of book) ANS: B, D Sarcopenia, the reduction of skeletal muscle mass with its replacement by fat, is not inevitable with aging. High-protein foods stimulate muscle protein synthesis, even in older adults. Consumption of high-quality protein and resistance training elicits the greatest anabolic (cellular and tissue building) response. Note that decreases in vital proteins result in an inability to respond to a physiologic injury or insult and declining function of many organ systems. Maintaining appropriate blood levels of vitamin D can also aid in retaining muscle strength and physical performance.

Which is NOT a prudent recommendation for a menopausal patient?

a. Supplement calcium and vitamin D slightly beyond upper intake (UI) level because of increased metabolic needs.

Which is the least significant factor influencing development of dental caries?

a. Susceptibility of the host or tooth b. A sufficient quantity of cariogenic microorganisms in the mouth c. An adequate supply of saliva d. The presence of fermentable carbohydrates ANS: C An adequate supply of saliva provides protection against dental caries in numerous ways. Particularly important to the prevention of dental caries is the flow of saliva. An adequate flow enables rapid transport of foods from the mouth. Saliva also acts as a buffer by neutralizing oral acids. REF: p. 366

The mother of a toddler is concerned because her son is not eating well. Each, except one, is a sound tip the dental hygienist can provide. Which is the exception?

a. Until age 6, a good rule of thumb is 1 Tbsp of vegetables, fruit, or meat per year of life. b. Eating at the same time everyday helps control appetite. c. Food jags should be discouraged with the parent taking charge of food intake. d. If sufficient amounts are not eaten at meals, snacks should be limited to nutrient-dense selections. e. If a child has been active, a short rest before a meal improves intake. ANS: C Food jags, refusing to eat anything except one food for several days, are common and are one way that toddlers and children assert independence. This typical developmental stage is temporary. Parents should refrain from forcing children to eat when they are not hungry. Instead, if sufficient amounts are not eaten at a meal, parents should limit snacking or provide nutrient-dense snacks. Note also that tired children eat poorly; before a meal, a short rest following activity is beneficial.

Which are reflective of food patterns? (Select all that apply.)

a. When adjusting to a new country, problems with food patterns are almost always cultural. b. Foods sometimes become symbolic because of religious connotations. c. Food patterns are generally deeply ingrained. d. Dental hygienists who do not address individual patient needs are typically ineffective. e. Religious beliefs and food patterns infrequently coincide. ANS: B, C, D When individuals immigrate to a new country, problems with adjusting to new food patterns are usually economic. Foods from the country of origin, which were cheapest at "home," may be expensive or unavailable in the new location. Religious beliefs, cultural beliefs, and food patterns coincide significantly in all cultures. Dental hygienists should learn about ethnic foods for immigrants so that they can assist in suggesting alternatives or similar foods.

The ideal time to begin taking folate to prevent neural tube defects is:

a. before conception. b. once pregnancy begins. c. at 6 weeks. d. upon completion of the first trimester.

While assessing oral tissues, signs of fluid volume deficit (FVD) that a dental hygienist should look for include: (Select all that apply.)

a. dry tongue with longitudinal fissures. b. xerostomia. c. edema of oral mucous membranes. d. increased salivary flow. e. use of ma-huang. ANS: A, B, E Mucous membranes in a patient with FVD will not appear edematous, because edema indicates fluid is present in the intracellular spaces. Instead, tissues will appear shrunken and skin will have decreased turgor. Salivary flow will be diminished. Ma-huang is another name for the ephedra, an herb that can cause xerostomia (dry mouth). Many patients use ma-huang as an appetite suppressant. REF: p. 221

The primary cause of confusion in older hospitalized patients is thought to be:

a. malnutrition. b. atrophic gastritis. c. dehydration. d. sarcopenia. ANS: C Dehydration is probably the primary cause of confusion in older hospitalized patients and can occur because of the kidney's inability to concentrate urine, altered thirst sensations, and side effects of medications. Dehydration frequently results in hospitalization as a result of fecal impaction, cognitive impairment, and overall functional decline. Atropic gastritis is chronic stomach inflammation with mucous membrane atrophy. Sarcopenia is the reduction of skeletal muscle mass and its replacement by fat.

Iron supplements are NOT typically associated with:

a. nausea. b. constipation. c. high hemoglobin levels. d. congenital hypothyroidism. ANS: D An excessive intake of iodine supplements may produce congenital hypothyroidism, whereas nausea, constipation, and high hemoglobin levels are associated with iron supplementation.

To help prevent early childhood caries (ECC), the dental hygienist should recommend the infant:

a. not be given nighttime bottles. b. drink pasteurized skim milk. c. eat iron-rich foods. d. drink fruit juice. ANS: A ll expectant parents should be educated about techniques for avoiding early childhood caries, including avoidance of using a bottle or sippy cup as a pacifier at bedtime, naptime, or throughout the day. Fruit juice provides no nutritional benefit for infants younger than 6 months and is highly cariogenic. To decrease the risk of dental caries, fruit juice should not be given in bottles or sippy cups. After weaning from breast or bottle feeding, babies should be given whole vitamin D-fortified milk. All children require iron, with the need increasing after 6 months.

Dissolved substances that freely cross cellular membranes are:

a. osmoreceptors. b. solutes. c. renin. d. cations. ANS: B Dissolved substances called solutes freely cross cellular membranes. Glucose, amino acids, and oxygen are examples of solutions. Osmoreceptors are neurons in the hypothalamus that register thirst when stimulated and increase the release of antidiuretic hormone (ADH) from the pituitary gland. Renin is a hormone that leads to increased release of the hormone aldosterone by the adrenal cortex. This release of aldosterone ultimately results in an increase in blood pressure. Cations are positively charged ions related to electrolytes and the body's hydration status:REF: p. 214

The dental hygienist should encourage a patient who has gastroesophageal reflux to:

avoid eating for 2 hours prior to the appointment.

Cardiovascular disease (CVD) produces numerous oral effects. A causative relationship has been established between periodontal disease and CVD.

b. Both statements are false.

Each is a sign of vitamin B12 deficient megaloblastic anemia, except one. Which is the exception?

b. Dark red oral mucosa

Which provides the most fructose?

b. Fruits

Which are associated with malnutrition in older adults? (Select all that apply.)

b. Impaired immune response c. Delayed wound healing e. Greater length of hospital stays ANS: B, C, E

Each is true of fetal alcohol syndrome (FAS) and fetal alcohol syndrome disorder, except one. Which is the exception?

c. At birth, an infant with FAS has a head circumference that is larger than normal.

The mother of a toddler is concerned because her son is not eating well. Each, except one, is a sound tip the dental hygienist can provide. Which is the exception?

c. Food jags should be discouraged with the parent taking charge of food intake.

Which animal-derived food contains the most significant level of carbohydrates?

c. Milk

Approximately 36% of older adults take five or more prescription drugs and multiple dietary supplements. Mature renal and liver function in older adults facilitates clearance of medications from the body.

c. The first statement is true; the second is false.

Individuals with loss of smell are NOT inclined to:

c. eat and drink more sweets.

Pain in the tongue is called:

c. glossodynia.

Which type of medication is most likely to induce xerostomia?

d. Anticholinergic

The most common nutritional disorder in older adults is cardiovascular disease. Dietary quality and obesity are two modifiable

d. The first statement is false; the second is true.

Gingival recession predisposes teeth to root caries because the enamel covering the root becomes roughed as it is exposed to the oral environment.

d. The statement is not correct, but the reason is correct.

Most patients with xerostomia eat significant portions of vegetables because crunchy foods stimulate salivary flow.

d. The statement is not correct, but the reason is correct.

Which dental condition does NOT increase the risk of malnutrition in older adults?

e. Homeostatic mechanisms

Cations:

ion carrying positive charge as a result of a deficiency of electrons; sodium and potassium major cations

A generalized malignant disease characterized by distorted proliferation and development of white blood cells (WBCs) is called:

leukemia.

Osmoreceptors:

neurons in the hypothalamus stimulated by increased osmolality, enhancing the release of AD