PocketPrep Domain 2 topic C

John is complaining of constipation. What foods would you recommend to help relieve his constipation? A Bran cereal and milk B White rice and applesauce C Cheese and crackers D Banana and toast

Bran cereal and milk Constipation can be treated with a high-fluid and high-fiber diet with exercise. Foods highest in fiber include dried fruit and bran cereal. The best of the options to relieve constipation is a bowl of bran cereal with milk because this provides both fiber and fluid. Diarrhea can be treated with a BRAT diet (Banana, Rice, Applesauce, Toast) and/or probiotics (cheese, yogurt).

What item would you not recommend to a client experiencing diarrhea? A Caffeine B Sports drinks C Probiotics D Prebiotics

Caffeine The recommended nutrition therapy for diarrhea is to remove the cause, let the bowel rest, and replace lost fluids and electrolytes. It is recommended that caffeine be avoided or limited, due to its ability to irritate the digestive system and worsen diarrhea. Foods that are recommended for diarrhea include prebiotics (oats, bran), probiotics (yogurt), and fluids high in electrolytes (sports drinks).

Which of the following is not a part of the dietitian's discharge documentation? A Failed interventions B Nutrition therapy outcome C Lab orders D Patient's weight

Lab orders Lab results would be provided, but lab orders are for in-facility use. Any information that may be helpful to create a positive outcome for the patient can be included in discharge documentation. That includes failed interventions, which may help prevent a repeat failure or provide insight into where the patient was at the time of discharge (eg., not ready for that intervention at that time).

A skin condition characterized by dark, velvety patches in body folds and creases is known as: A Gout B Goiter C Microcytic hypochromic anemia D Acanthosis nigricans

Acanthosis nigricans Acanthosis nigricans is a skin condition characterized by dark, velvety patches in body folds and creases. This condition is a risk factor for diabetes. Goiter is the enlargement of the thyroid gland due to insufficient thyroid hormone. Gout is a disorder of purine metabolism characterized by pain and swelling in the joints. Microcytic hypochromic anemia is an iron deficiency characterized by small, pale cells

Which of the following is an example of an endocrine gland? A Adrenal B Gastric C Salivary D Sweat

Adrenal Endocrine glands release substances directly into the bloodstream or tissues. Examples of these glands include the thyroid, pituitary, and adrenal glands. Exocrine glands release substances through ducts to the outside of the body. Examples of these glands include the sweat, gastric, and salivary glands.

Which of the following is not a step in the pathophysiology of the allergic response to a food? A Sensitization to the allergen B Anaphylaxis C Breakdown of oral tolerance D Reaction to the allergen

Anaphylaxis The 3 steps in the development of a food allergy are: Breakdown of oral tolerance Sensitization to the allergen Reaction to the allergen Anaphylaxis is the acute immune response to an allergen, after the allergy has developed.

Which of the following can be used as a clinical indicator of endogenous insulin production? A C-peptide B Insulin C HgbA1C D Fasting plasma glucose

C-peptide Insulin is secreted as 2 polypeptide chains joined by disulfide bonds and C-peptide is released as the 2 chains separate. Since insulin and C-peptide are secreted in the bloodstream in equal amounts, C-peptide can be used as a clinical indicator of endogenous insulin production. HgbA1C measures the percentage of hemoglobin that glucose has attached, which measures long-term blood glucose control (2-3 months). Fasting plasma glucose indicates glycemic control is <126 mg/dL in non-diabetic individuals.

A non-diabetic patient is 39 years old with an LDL of 180 mg/dL. What recommendations would you provide to improve his cholesterol levels? A Prescribe a statin due to the high LDL level B Eat more plant stanols and sterols to lower LDL C Avoid soluble fiber to inhibit cholesterol absorption D Consume 40% of calories from unsaturated fat to reduce dietary cholesterol levels

Eat more plant stanols and sterols to lower LDL Therapeutic lifestyle changes (TLC) recommends 2-3 grams/day of plant stanols and sterols to inhibit cholesterol absorption and lower LDL levels. Soluble fiber decreases serum cholesterol by binding bile ACIDS (not bile salts), which helps convert more cholesterol into bile. According to the ACC/ADD guidelines, a statin should be prescribed if the following conditions apply: 1) LDL >190 mg/dL, 2) 40-65 years old with diabetes and LDL 70-189 mg/dL, or 3) diagnosis of atherosclerotic CVD (ASCVD).

What is not a risk factor for impaired wound healing? A Excessive exercise B Significant weight loss C Inadequate protein intake D Morbid obesity

Excessive exercise Risk factors for impaired wound healing: Significant weight loss Inadequate protein and nutrient intake Extreme BMI (high or low)

Which type of food can cause an allergic reaction in latex-food syndrome? A Gluten-containing foods B Starches C Fruits D Vegetables

Fruits An allergic reaction to foods can occur when an individual has a latex allergy. This occurs because many people with a latex allergy have IgE antibodies that can react to antigens from foods. This is most likely to occur with fruits, especially avocado, banana, chestnut, kiwi, and mango.

Which of the following is not a symptom of overhydration? A Hyponatremia B Hyperalbuminemia C Weight gain D Shortness of breath

Hyperalbuminemia Overhydration, known as hypervolemia or fluid overload, is a condition in which the volume of the liquid portion of the blood (plasma) is too high. The signs and symptoms include shortness of breath, weight gain (>3 kg), hyponatremia, and decreased albumin (hypoalbuminemia). This can be caused by excess fluid or salt intake and/or failure of the heart, kidney, or liver.

Which type of activity would you be the least concerned about the athlete's carbohydrate intake? A Competitive swimming B Cycling C Tennis D Basketball

Cycling Of the examples given, cycling is more mixed in relying on carbohydrate and fat. Cycling involves least movement d/t sitting compared to others. Basketball, tennis, and competitive swimming have higher glucose use, because they have higher bursts of activity, which relies more heavily on carbohydrate (glucose)

What would be best of the following, to discuss with a teenager to discourage a fad diet? A Research studies B Long-term issues C Parental concerns D Short-term consequences

Short-term consequences Teenagers have difficulty associating current actions with future consequences. Therefore, it would be best to discuss short-term consequences instead of long-term issues. Teens are also generally more concerned with fitting in with their peers than with parental influence. Research studies don't fit into most teenagers reasons for making food choices, which include taste preference, peers, cost, schedules, and family support. These areas would be more beneficial to discuss than research studies.

Consuming up to 35% of calories from fat may help reduce dietary cholesterol levels, based on the TLC recommendations. Which of the following is not a goal of obesity treatment? A Lose 5% of weight if over 65 B Stop weight gain C Improve health parameters D Lose 5 to 10% of initial weight

Lose 5% of weight if over age 65 Weight loss for individuals over age 65 is not recommended. It may cause harm and not provide any benefit. Obesity treatment should aim to improve health parameters, such as blood glucose, blood pressure, or cholesterol levels. A general guideline is to aim for 5 to 10% weight loss from initial weight, as this is typically enough to start to see improvement in health parameters. Even halting weight gain can be a goal, as it stops further weight gain.

Where would you send a client to find credible information on dietary supplements? A DSHEA B GMP C ODSHide Explanation D GRAS

ODS The National Institute of Health started the ODS (Office of Dietary Supplements) to fund research and provide credible information on dietary supplements to consumers. The ODS has a website for this purpose, and also produces Supplement Fact Sheets. GMPs (Good Manufacturing Procedures) do not contain information about the supplements themselves. GRAS (Generally Recognized As Safe) is a distractor. DSHEA (Dietary Supplement Health and Education Act) is a piece of legislation, not a source of information.

A change in the epigenetic pattern results in a change in what? A RNA B Phenotype C Genotype D DNA

Phenotype An epigenetic pattern change results in a change in phenotype, or how a gene is expressed. It does not actually change the genotype. Changes in epigenetic marks occur because of outside influences, such as environment and nutrition. DNA and RNA are distractors.

For which of the following conditions would TPN be indicated? A Postoperative ileus B IBS C Gastric bypass surgery D PKU

Postoperative ileus TPN is indicated when a patient has unavailability of the GI tract (short bowel syndrome, short bowel obstruction, ileus, malabsorption), minimized GI function (acute irritable bowel disease, fistula, acute pancreatitis), or is unable to meet >60% of their needs by the enteral route alone (as soon as possible in severely malnourished patients or 7-10 days in previously nourished patients). TPN is not indicated in gastric bypass surgery, IBS, or PKU unless one of the above situations is present.

which of the following nutrient deficiencies is associated with delayed or poor wound healing? A Folic acid B Vitamin B-12 C Zinc D Iron

Zinc Delayed or poor wound healing is associated with nutrient deficiencies of protein, zinc, vitamin C, and vitamin A. Deficiencies of folic acid, iron, and vitamin B-12 are associated with pallor, or paleness of the skin.

Which symptom and recommended diet is associated with Addison's disease? A Hypertension; low-sodium diet B Weight gain; low-sodium diet C Weight loss; high-protein diet D Hyperglycemia; consistent carbohydrate intake

Weight loss; high-protein diet Addison's disease is a disorder in which the adrenal glands do not produce enough hormones. The atrophy of the adrenal cortex leads to decreased cortisol (glycogen depletion, hypoglycemia), decreased aldosterone (sodium loss, potassium retention, dehydration), and decreased androgens (tissue wasting, weight loss). The recommended diet for Addison's disease is a high protein, a high salt diet with frequent meals to prevent weight loss, hypoglycemia, and dehydration. The other choices do not reflect signs/symptoms or appropriate diets for an individual with Addison's disease.

Which of the following nutrients is a gastric bypass patient most likely to become deficient in, and why? A Vitamin E due to decreased intake B Zinc due to decreased intrinsic factor C Vitamin B-12 due to decreased absorption D Vitamin C due to decreased gastric acid

vitamin B-12 due to decreased absorption 30% of gastric bypass patients become deficient in vitamin B-12 due to decreased mechanical digestion and absorption of iron, B-12, and other nutrients. The etiology of the deficiency is due to inadequate contact with intrinsic factor, decreased gastric acid, and low intake of foods rich in vitamin B-12. Other common nutrient deficiencies include iron, protein, calcium, folate, and vitamin D. Vitamin C, vitamin E, and zinc are not common deficiencies for gastric bypass patients.

What is a potential long-term consequence of chronic hyperphosphatemia? A Soft-tissue calcification B Respiratory paralysis C Muscle weakness D Cardiac arrhythmia

Soft-tissue calcification Serum phosphorous generally ranges (in adults) from 3 to 4.5 mg/dL. Hyperphosphatemia is abnormally high serum phosphate levels, which can result from increased phosphate intake, decreased phosphate excretion, or disorders that shift intracellular phosphate to extracellular spaces. Acutely, this is not a severe clinical issue; however, a potential long-term consequence of hyperphosphatemia is soft-tissue calcification. Hyperkalemia is abnormally high serum potassium levels, which include acute symptoms of nausea, vomiting, muscle weakness, and tingling and may lead to more serious symptoms of slow heartbeat, cardiac arrhythmia, and respiratory paralysis

What is a potential effect of following a high-fiber diet? A Increased HDL and postprandial blood glucose levels B Decreased intestinal function C Increased risk of constipation D Decreased LDL and postprandial blood glucose levels

Decreased LDL and postprandial blood glucose levels Fiber provides indigestible bulk and promotes intestinal function. A high-fiber diet helps decrease LDL and postprandial blood glucose levels, which provides benefits for gastrointestinal health and weight control and protects against cardiovascular disease and diabetes. A low-fiber diet may lead to constipation.

What does the term "anuria" mean? A Failure to produce urine B Less than 500mL of urine production C Increased urea in blood D Burning with urination

Failure to produce urine Anuria is the failure to produce urine. Oliguria is a small urine output, which is defined as less than 500mL of urine production. Azotemia is increased urea in the blood. Dysuria is burning with urination.

A patient with an ileostomy has an increased need for which of the following nutrients? I. Water II. Water-soluble vitamins III. Salt IV. Protein A III, IV B I, II, IV C I, III D I, II

I, III A patient with an ileostomy has an increased need for water and electrolytes (eg. sodium) to compensate for excessive losses in their stools. The jejunum remains intact; therefore, water-soluble vitamins and protein needs are not affected.

Which of the following foods would you recommend to a celiac disease patient? A Rye B Barley C Bran D Quinoa

Quinoa Celiac disease is gluten-induced enteropathy, and medical nutrition therapy recommends the need for a gluten-restricted diet. Gluten is found in wheat, rye, barley, triticale, bran, graham, malt, bulgur, couscous, durum, orzo, and thickening agents. Gluten-free: corn, potato, rice, soybean tapioca, arrowroot, carob bean, guar gum, flax, amaranth, quinoa, millet, teff, and buckwheat.

The normal limits for sodium are 135-145 mEq/dL. Your patient has a sodium level of 128 mEq/dL. What could this value indicate in your patient? A Ascites B Refeeding syndrome C Dehydration D Trauma

Ascites A decreased sodium value, or hyponatremia, is associated with fluid overload (especially congestive heart failure or dialysis), SIADH, and/or ascites. An increased sodium value, or hypernatremia, is associated with dehydration, excessive diuresis, and/or recent trauma, surgery, or shock.

Which of the following is a characteristic of Non-IgE-mediated allergic reactions? A Delayed or chronic reaction B Commonly caused by shellfish C Instant and acute reaction D Treated with epinephrine

Delayed or chronic reactions Non-IgE-mediated allergic reactions cause delayed or chronic reactions instead of the acute reactions that occur in IgE-mediated allergic reactions. IgE-mediated food allergies are commonly caused by cow's milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, and soy. An acute reaction, anaphylaxis, is treat with epinephrine (EpiPen).

After a gastrectomy, a patient is on a clear liquid diet. The patient drinks 12 ounces of organic apple juice at 4 pm. Which of the following symptoms is the patient most likely to experience? A Hyperglycemia and constipation B Hypoglycemia and diarrhea C Increased blood pressure and weakness D Decreased heart rate and decreased insulin production

Hypoglycemia and diarrhea The patient will most likely experience dumping syndrome. Dumping syndrome may occur after a gastrectomy when a patient digests too much simple or concentrated carbohydrate, resulting in hypoglycemia and diarrhea. After a gastrectomy, the holding capacity of the stomach is decreased, and when too much food or liquid enters the stomach it is dumped into the intestines, causing cramps, rapid pulse, weakness, perspiration, and dizziness. This dumping leads to an overproduction of insulin, causing a drop in blood sugar, and water to be drawn into the intestines, causing diarrhea.

A patient claims she was billed for medical services she did not receive. What type of claim is the patient reporting and what is the corresponding agency to handle this claim? A Insurance; USDA B Insurance identity theft; FDA C Medical identity theft; FTC D Financial identity theft; FTC

Medical identity theft; FTC Medical identity theft occurs when someone uses another person's name or insurance information to get medical treatment, prescription drugs, or surgery (FTC). Complaints are filed with the federal trade commission (FTC) for all issues regarding identity theft. Other forms of identity theft include child, medical, social security, criminal, financial, employment, driver's license, and insurance.

Which menu item would be appropriate for a patient on a "level 2 dysphagia" diet according to the NDD system? A Apple with smooth peanut butter B Ice cream sundae with peanuts and syrup C Peanut butter and jelly on white bread D Pancakes with syrup

Pancakes with syrup A level 2 dysphagia diet in the NDD system (National Dysphagia Diet) includes only moist and soft foods. Regular foods should be modified to make them easier to chew and swallow by blending, chopping, grinding, mashing, shredding, or cooking the food. Examples of foods appropriate for this level include soft pancakes with syrup, ground meat with soft cooked vegetables, and canned fruits. Foods that are not appropriate include peanut butter and jelly on white bread (no bread), ice cream sundae with peanuts and syrup (no nuts), and apple with smooth peanut butter (no raw fruit or sticky foods). The NDD system is being phased out in favor of the IDDSI (International Dysphagia Diet Standardisation Initiative). However, since not all facilities have transitioned to the IDDSI, providers should be aware of both systems.

Jason is a 33-year-old male with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following lab values would you expect to be decreased? A Triglycerides B Sodium C Carbon dioxide D Magnesium

Sodium Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). ADH helps the kidneys control the amount of water your body excretes through the urine. SIADH causes the body to retain too much water. As a result, individuals with SIADH are likely to develop hyponatremia (or decreased sodium levels) in the setting of fluid retention.

Which of the following can cause a reversible decrease in cognitive ability in an older adult? A Urinary tract infection B Renal failure C Dementia D Cardiovascular disease (CVD)

Urinary tract infection A UTI in an older adult can cause changes in cognition that present like dementia, but clear up once the UTI is treated and cured. Decreases in cognitive ability that occur with dementia and that may occur with renal failure aren't reversible. CVD (cardiovascular disease) is a distractor.

What type of obesity is associated with metabolic syndrome? A Visceral B Subcutaneous C Metabolically Healthy D Morbid

Visceral Visceral obesity, or central fat, is associated with metabolic syndrome and refers to fat stored in the abdomen, around the organs. Metabolic syndrome is a cluster of conditions (including hyperglycemia, hypertension, and hyperlipidemia) that increase the risk of heart disease, stroke, and diabetes. Subcutaneous obesity refers to fat located under the skin, which is not necessarily hazardous to your health. Metabolically Healthy Obesity (MHO) is when an individual with a BMI greater than 30 and has normal insulin sensitivity and no diabetes, hypertension, or dyslipidemia. Morbid obesity is when an individual has a BMI greater than 40. BMI does not define/identify where fat storage is located, which is an important factor in metabolic syndrome.

What nutrient would you recommend to a leukemia patient and why? A Vitamin C to support immune function B Vitamin K to synthesize bacteria C Vitamin E to ward off tumors D Calcium to inhibit bone resorption

Vitamin C to support immune function Leukemia is a cancer of blood-forming tissues that hinders the body's ability to fight infection. The potential role of vitamin C to help protect the immune system may be beneficial to patients with leukemia. Patients should be encouraged to increase vitamin C through diet rather than supplementation. Foods high in vitamin C include citrus fruits, Brussels sprouts, orange juice and potatoes. Vitamin E is an antioxidant important for red blood cell formation. Vitamin K is an antioxidant and is important for blood clotting. Calcium is a mineral and is important for blood clotting, cardiac function, nerve transmission, smooth muscle contractility, and functions to inhibit bone resorption.

Which of the following populations is at increased risk for iron-deficiency anemia? A Women with heavy menstrual periodS B Individuals consuming a vegetarian diet with mineral supplementation C Individuals following the Atkins diet D Individuals consuming too little fiber

Women with heavy menstrual periods The following populations are at increased risk for iron-deficiency anemia: Individuals consuming a vegetarian meal plan without vitamin/mineral supplementation Individuals following low-energy diets/skipping meals Individuals consuming too much dietary fiber, coffee, and/or tea Women with heavy menstrual periods Women who are pregnant and/or lactating Recent loss of blood (surgery, ulcers, hemorrhoids) Endurance athletes, who may have increased red blood cell breakdown Individuals taking certain medications that decrease absorption and/or utilization *Information cited from Nutrition Care Manual The Atkins diet is a low-carbohydrate high fat meal plan for weight loss that is not a risk for iron deficiency since it contains animal-based proteins.

Which of the following is the most common risk factor for developing COPD? A Being overweight B Sedentary lifestyle C Stressful work environment D Cigarette smoking

cigarette smoking Chronic obstructive pulmonary disease (COPD) is a term used to describe progressive lung diseases, including emphysema, chronic bronchitis, refractory asthma, and some forms of bronchiectasis. Cigarette smoking is the most common cause of COPD; however, other causes include secondhand cigarette smoke, air pollutants/chemical fumes in the home or work-place, dust, and genetic factors.

Which of the following should not be decreased to treat peptic ulcers? A Alcohol B Coffee C Spices D Fermented foods

fermented foods Nutrition treatment of peptic ulcers includes decreasing alcohol, spices, and caffeine (which includes coffee). Fermented foods, omega-3 and -6 fatty acids, and easy-to-digest foods should be increased.

Which nutrition prescription would be most appropriate for a stressed patient with cirrhosis and ascites? A 15-20 kcals/kg, 0.8 g protein/kg B 30-35 kcals/kg, 2.0 g protein/kg, 1.5 L fluid restrictionC 30-35 kcals/kg, 2.0 g fat/kg, 3.0 L fluid restriction D 25 kcals/kg, 0.8-1.0 g protein/kg

30-35 kcals/kg, 2.0 g protein/kg, 1.5 L fluid restriction The most appropriate nutrition prescription for a stressed patient with cirrhosis and ascites is a high-calorie, high-protein, fluid-restricted diet. A stressed patient requires more calories (30-35 kcals/kg) to provide energy for the hypermetabolic state, cirrhosis requires high protein (2.0 g protein/kg) to help prevent fatty liver and spare protein, and fluid restriction (1.5 L) to help reduce edema and fluid retention. The other answer choices do not provide the appropriate high-calorie, high-protein, and fluid-restricted nutrition prescription

A lunch includes the following: sandwich (2 slices of whole wheat bread, 3 ounces of low-sodium turkey, 1/8 avocado, 1 ounce of reduced-fat cheese), side salad (1 cup lettuce, 1/2 cup cooked asparagus, 1 tbsp olive oil), and 1 small apple with 2 tbsp natural peanut butter. Using the carbohydrate exchange, how many grams of carbohydrates does this meal provide? A 22 g CHO B 35 g CHO C 45 g CHO D 55 g CHO

55 g CHO Using the carbohydrate exchange, the lunch includes: 2, 1 oz servings of starch/bread = 2 slices of bread = 30 g CHO 2 servings of vegetables = 1 cup lettuce and 1/2 cup cooked asparagus = 10 g CHO 1 serving of fruit = 1 small apple = 15 g CHO Note: 1 cup of raw lettuce counts as a "free vegetable" because there is fewer than 10 calories per serving. 30 + 10 + 15 = 55 g CHO total for lunch

A patient weighs 64 kg and requires a tube feeding initiation. His estimated needs are 30 kcals/kg and 1.5-2.0 grams protein/kg. If the tube feed runs continuously, what is the tube feeding goal rate? The chosen enteral formula nutrition facts are 1,000 kcal, 64 g protein, and 840 mL H2O per 1,000 mL of formula. A 90 mL/hr B 80 mL/hr C 60 mL/hr D 64 mL/hr

80mL/hr To determine his estimated calorie needs: Multiply weight by estimated calorie needs: 64 kg x 30 kcals/kg = 1,920 kcals To determine his estimated protein needs: Multiply weight by estimated protein needs: 64 kg x 1.5-2.0 g protein/kg = 96 - 128 g protein To determine the rate: Multiply volume by kcals per mL and divide by hours the feeding will run: 1,920 mL x 1 kcal/mL = 1,920 kcal / 24 hours = 80 mL/hr To check if the rate meets the estimated protein needs: Multiply volume by protein per L: 1.920 L x 64 g protein = 122.88 g protein

Which of the following clinical characteristics would be categorized as chronic, moderate malnutrition? A <60% of energy intake for 1 month B 3% weight loss in 1 week C <80% of energy intake for 3 months D <70% of energy intake for 8 days

<60% of energy intake for 1 month < 60% of energy intake for 1 month is less than 75% which is even worse. Based on the ADA/A.S.P.E.N. chart of clinical characteristics to support the diagnosis of malnutrition, chronic moderate malnutrition is categorized as <75% of energy intake for ≥1 month, 5% weight loss in 1 month, 7.5% weight loss in 3 months, 10% weight loss in 6 months, and 20% weight loss in 1 year. <80% of energy intake for 3 months would be categorized as chronic, severe malnutrition. <70% of energy intake for 8 days would be categorized as acute, moderate malnutrition. 3% weight loss in 1 week would be categorized as acute, severe malnutrition.

Which by-product of alcohol metabolism causes the most significant damage to the liver? A Acetate B Excess water C Acetaldehyde D Carbon dioxide

Acetaldehyde During the 1st step of ETOH metabolism, ADH metabolizes ETOH to acetaldehyde, a highly toxic substance, and a known carcinogen. Acetaldehyde is a significant cause of liver damage function that disrupts mitochondrial function in alcoholic liver diseases such as hepatic steatosis, alcoholic hepatitis, and cirrhosis. In the second step of alcohol metabolism, acetaldehyde is further metabolized down to a less active by-product called acetate. Acetate is further broken down into water and carbon dioxide for elimination.

Which of the following diseases and recommendations would be most likely related to a 78-year-old nursing home patient? A Bezoar formation; large meals B Atrophic gastritis; high-fiber meals C Gastroparesis; high-fat meals D Achlorhydria; small, frequent meals

Achlorhydria; small, frequent meals Gastric function decreases with age; therefore, elderly patients commonly experience decreased gastric emptying and HCl in the stomach. As a result, common gastric problems for the elderly include achlorhydria, atrophic gastritis, gastroparesis, and bezoar formation. The treatment of these gastric problems includes small frequent meals, pureed foods, and avoidance of high-fiber or high-fat foods. The only correct recommendation is small, frequent meals to treat achlorhydria; the other answers provide incorrect recommendations

Rachel has heart failure and her doctor has prescribed Lasix (furosemide). Which of the following foods would you recommend for her to include in her diet? A Hummus B Applesauce C Avocado D Watermelon

Avocado avocados are high in potassium. lasix is a diuretic that depletes potassium.

What advice would you give to a person complaining of symptoms of gastroesophageal reflux disease? A Chew spearmint gum B Use pepper instead of salt for seasoning C Eat small meals with high-fat snacks D Avoid eating before bed

Avoid eating before bed Gastroesophageal reflux disease (GERD) is a digestive disease where stomach acid or bile irritates the food pipeline, causing a feeling of heartburn and pain. The nutrition intervention for GERD involves avoidance of the following: eating 2-3 hours before lying down, large and high-fat meals, caffeine, chocolate, alcohol, mint, tomatoes/tomato products, and highly spiced and acidic foods.

Which of the following disorders or procedures would most likely result in steatorrhea? A Histal hernia B H. Pylori bacterial infection C Billroth I D Billroth II

Billroth II A Billroth II (gastrojejunostomy) is a procedure that attaches the stomach to the jejunum. Since food then bypasses the duodenum, there is less duodenal hormonal secretion and in turn less pancreatic secretion. As a result, steatorrhea is likely to occur after this procedure due to the lack of pancreatic enzymes to break down fat. Steatorrhea is the presence of fat in the feces. A Billroth I (gastroduodenostomy) is a procedure that attaches the stomach to the duodenum. The disorder most likely to occur after this procedure is dumping syndrome. A histal hernia is a disorder where a portion of the stomach protrudes into the diaphragm. The most likely symptom to occur is heartburn. H. Pylori bacteria causes stomach ulcers and can be treated with antacids and antibiotics. The most likely symptom to occur is increased stomach acidity with pain.

Esophageal varices occur when: A Blood cannot enter the liver B Connective tissue overgrowth blocks blood flow into the vena cava C The liver expands and pressure causes fluid to enter the peritoneal cavity D Blood cannot leave the live

Blood cannot enter the liver Esophageal varices occur when blood CANT ENTER the liver because connective tissue overgrowth causes resistance to blood from the portal vein. This pressure forces blood back into the collateral veins, enlarging the esophageal, abdominal, and collateral veins. This occurs in people with advanced liver disease. Ascites occurs when blood CANT LEAVE the liver because connective tissue overgrowth blocks blood flow from the liver to the vena cava. As a result, the liver expands and pressure forces fluid into the peritoneal cavity, and more protein-containing fluid is drawn in, causing sodium and water retention. This occurs in many disorders but is usually found in cirrhosis.

During diabetic ketoacidosis, what is the relationship between blood pH and respiration? A Blood pH decreases, respiration decreases B Blood pH increases, respiration decreases C No change in pH or respiration D Blood pH decreases, respiration increases

Blood pH decreases, respiration increases During DKA, blood pH decreases as a result of ketone bodies. As pH decreases, respiration is stimulated (hyperpnea) to excrete CO2 to try and compensate. Excreting CO2 would help increase pH to neutral. This increased rate of breathing labors the individual, leading to dyspnea, and eventually deep, gasping breaths (Kussmaul respirations).

Which of the following foods should not be recommended to patients with AIDS? A Unpasteurized scrambled eggs B Mashed potatoes with brown gravy C Brie cheese D Whole milk

Brie cheese Soft cheeses, such as Brie, should be avoided by individuals with compromised immune systems, including patients with HIV, AIDS, and/or cancer, pregnant, due to the live mold in the cheese. Neutropenic diets are low in bacteria and should be followed for this patient population. Milk should be pasteurized, eggs should be pasteurized when eaten undercooked or raw, but eggs may be unpasteurized when fully cooked.

Which type of food would you recommend to prevent dental caries and why? A Nuts because they decrease salivary pH B Chicken because it is a weak buffer C Cheddar cheese because it is a low cariogenic food D Lemon because it metabolizes bacteria

Cheddar cheese because it is a low cariogenic food Dental caries is the scientific term for tooth decay or cavities. To prevent dental caries, non-cariogenic foods are recommended. Non-cariogenic foods do not promote tooth decay because they are not metabolized by bacteria in plaque and do not decrease salivary pH. Some characteristics of these foods are high protein, moderate fat, low concentration of fermentable carbohydrates, strong buffers, high mineral content (Ca, P), pH >6, and stimulation of saliva production. Examples include cheddar cheese, eggs, fish, poultry, nuts, meat, and sugarless gum.

Fluid restriction is indicated in all of the following disease states except: A Congestive heart failure B Cholecystitis C Liver disease with ascites D Chronic renal failure

Cholecystitis Fluid restriction is indicated for liver disease with ascites, chronic renal failure, and congestive heart failure, due to the abnormal levels of sodium and potassium, to help reduce edema and fluid retention. Fluid restriction is not indicated in cholecystitis. Cholecystitis is inflammation of the gallbladder that causes excess water to be absorbed, which leads to the precipitin of cholesterol and the formation of gallstones. The appropriate nutrition therapy includes a low-fat diet.

Which dietary recommendation is appropriate for an individual with Crohn's disease? A Take vitamin E and omega-3 supplements B Take anti-constipation medication regularly C Consume a high-fat diet when steatorrhea is present D Consume a high-calorie and high-protein diet

Consume a high-calorie and high-protein diet Crohn's disease is a chronic inflammatory bowel disease that affects the lining of the digestive tract, typically the distal ileum and colon but may effect any part of GI tract. Nutrition therapy for Crohn's disease include a high-calorie and high-protein diet, supplement B12, folate, vit A, vit D, vit E, vit K, iron, calcium, magnesium, zinc, and eating a low-fat diet when steatorrhea is present. Since diarrhea and steatorrhea are more common side effects, anti-diarrhea medication is more likely to be recommended.

For which of the following disease states would you recommend pancreatic enzyme replacement therapy (PERT)? A Cystic fibrosis B Gastroduodenostomy C Lactose intolerance D Hepatic failure

Cystic fibrosis Pancreatic enzyme replacement therapy (PERT) involves taking digestive enzymes in the form of a tablet to assist in the digestion of fat, carbohydrates, and proteins. PERT is used with meals and snacks to prevent fat malabsorption due to the lack of pancreatic lipase. PERT therapy may help treat the disease states of pancreatitis, cystic fibrosis, gastrojejunostomy, Crohn's disease, and other diseases with pancreatic insufficiencies.

A patient is diagnosed with congestive heart failure. What diet would most likely benefit the patient? A Mediterranean B DASH C TLC D Gluten-free

DASH The DASH (Dietary Approaches to Stop Hypertension) diet would most likely benefit the cardiac patient with congestive heart failure (CHF) because it provides a low-sodium diet. CHF dietary treatment includes low sodium (2-3 g/day restriction) and fluid restriction if needed. The DASH diet emphasizes low sodium, whole grains, fruits, vegetables, low-fat dairy, poultry, and fish; and it limits alcohol and sweets. The Mediterranean and TLC (Therapeutic Lifestyle Changes) diets would be more helpful for the treatment of hypertension, atherosclerosis, metabolic syndrome, or hyperlipidemia. These diets focus on healthy fats with omega-3s (Mediterranean) and/or low fat with soluble fiber (TLC). Gluten-free diets are helpful for gluten intolerances, such as Crohn's disease

A clinical dietitian is planning to start PN on a patient. Which of the following lab values would indicate the appropriate time to initiate feeding the patient? A Decreased albumin, decreased pre-albumin B Increased CRP, decreased pre-albumin C Decreased CRP, increased pre-albumin D Increased CRP, increased creatinine

Decreased CRP, increased pre-albumin C-reactive protein (CRP) is a marker of acute inflammatory stress, and pre-albumin is a marker of nutritional status. When CRP decreases and pre-albumin increases, nutrition therapy is indicated. Nutrition therapy would be contraindicated by increased CRP and decreased pre-albumin because the inflammatory stress is causing a decrease in pre-albumin. So in this case, the decreased pre-albumin is not a reliable indicator of nutritional status. Malnutrition might be indicated by decreased albumin and decreased pre-albumin; however, CRP would have to be evaluated to determine the patient's stress. Inflammatory stress and muscle wasting or renal disease might be indicated by increased CRP and increased creatinine.

A patient has hyperalbuminemia and hypernatremia. What would you infer about his nutritional intake? A Increased saturated fat intake B Decreased medium-chain triglyceride intake C Decreased fluid intake D Increased protein and salt intake

Decreased fluid intake Albumin and sodium are lab values that typically indicate fluid status. If a patient has high albumin (hyperalbuminemia) and high sodium (hypernatremia), the patient is typically hypovolemic (volume-depleted). Therefore, you could infer that the patient has had a decreased fluid intake leading to his current nutritional and medical status.

Which of the following reactions occurs during the "ebb" phase of injury response? A Oxygen return B Fluid resuscitation C Decreased metabolic rate D Hypervolemia

Decreased metabolic rate The "ebb and flow" response to injury is the body's reaction to physiological trauma, such as critical illness, injury, and/or sepsis. This is associated with a hypermetabolic and catabolic response following the trauma. Immediately following the injury is the "ebb" phase, characterized by hypovolemia, shock, tissue hypoxia, and decreased metabolic rate. Body in shock, everything low. During the "flow" phase there is fluid resuscitation (correction), and oxygen transport returns.

A complication of uncontrolled diabetes, caused by overeating of carbohydrates and omission of an insulin regimen, may result in: A Reactive hypoglycemia B Acute hypoglycemia C Dawn phenomenon D Diabetic ketoacidosis

Diabetic ketoacidosis DKA is hyperglycemia caused by overeating of carbohydrates, decreased use or omission of the insulin regimen, and/or infection. The signs and symptoms include polyuria, polydipsia, hyperventilation, dehydration, fatigue, and a fruity urine odor. Dawn phenomenon is a natural early-morning (around 2 a.m. to 8 a.m.) increase in blood sugar relevant to people with diabetes. This is associated with hyperglycemia and leads to an increased need for insulin in the evening. Acute hypoglycemia is caused by an excess of insulin and/or lack of food (carbohydrates) leading to low blood sugar. Reactive hypoglycemia occurs 2 to 5 hours after eating and is caused by the overstimulation of the pancreas or increased insulin sensitivity, leading to low blood sugar.

A high-fiber diet is contraindicated for which of the following disease states? A Obesity B Constipation C Diverticulosis D Diverticulitis

Diverticulitis A high-fiber diet may be helpful for the treatment of diverticulosis, constipation, or obesity. A high-fiber diet would be contraindicated for the treatment of diverticulitis, which is the inflammation of diverticula and is initially treated with a clear-liquid, low-fiber diet. Diverticulosis is the presence of diverticula and is treated with a high-fiber diet. Constipation may be related to an atonic colon or a weakened colon muscle and can be treated with a high-fiber and high-fluid diet. A high-fiber diet is related to decreased LDL and decreased postprandial blood glucose levels. It can benefit individuals with CVD, obesity, and diabetes.

A client with T1DM tells her RD she is sick with the flu. All of the following sick day guidelines for diabetes are appropriate, except: A Encourage fluids B Do not take insulin C Check urine for ketones D Test blood glucose every 4 hours

Do not take insulin The sick day guidelines for diabetes recommends taking usual doses of insulin, testing urine for ketones, consuming ample amounts of liquid, testing blood glucose every 4 hours, and selecting liquid or soft carbohydrate foods. For a person with TIDM (insulin-dependent), not taking insulin can lead to serious consequences, like diabetic ketoacidosis.

A severely burned patient's estimated nutrition needs are 1,800-2,100 calories and 120-150 grams of protein. A tube feeding formula rate at 75 mL provides 1,800 calories and 115.2 grams of protein. What adjustments do you recommend to reach the estimated needs? I. Keep the tube feeding rate at 75 mL and add one packet of a protein supplement to the tube feeding (e.g., Beneprotein provides 25 kcals, 6 gm protein each). II. Increase the rate to 85 mL/hr. A Either I or II B Neither I nor II C Only I D Only II

Either I or II A severely burned patient's (>20% TBSA) estimated nutrition needs are increased 30-35 kcals/kg and 1.5-2.0 g protein/kg due to the hypermetabolic state and for wound healing Yes. This rate will provide 1,825 calories and 121.2 grams of protein. Yes. 85 mL x 24 hr = 2,040 mL/hr 2.040 L x 1,000 kcals = 2,040 kcals 2.040 x 64 g protein = 130.56 grams protein

Iron deficiency may be a result of a vegetarian diet, but vitamin D deficiency is not common. Which of the following is not a long-term consequence of uncontrolled diabetes? A Retinopathy B Neuropathy C Elevated fasting glucose D Nephropathy

Elevated fasting glucose Long-term consequences of uncontrolled diabetes include neuropathy (peripheral and autonomic damage, such as gastroparesis), retinopathy (leading to blindness), and nephropathy (decreased renal function). Short-term consequences of uncontrolled diabetes include elevated fasting glucose, elevated 2-hour postprandial glucose, and ≥6.5% HgbA1C.

A patient is diagnosed with severe acute pancreatitis and is not able to tolerate solid foods. The medical team is planning to start feeding the patient enterally. What type of diet is most appropriate for this patient? A Enteral nutrition with a standard polymeric formula B No oral diet for the first 72 hours of admission C Enteral nutrition with an elemental formula D Total parenteral nutrition

Enteral nutrition with a standard polymeric formula A standard polymeric formula is appropriate for initiating early enteral nutrition (EN) for patients with moderate to severe acute pancreatitis, if patient does not tolerant then an elemental formula may need to be trialed. Elemental formulas are easier to digest, making them better suited for patients with malabsorption problems, such as short bowel syndrome or inflammatory bowel disease. The use of EN is recommended over total parenteral nutrition (TPN) in patients with severe acute pancreatitis who require nutrition therapy since EN has less risk of complications. TPN may be used if the patient is unable to tolerate EN or unable to obtain distal feeding access. Failure to initiate EN therapy for > 72-96 hours following admission in a patient with moderate to severe acute pancreatitis runs the risk of rapid deterioration of nutrition status and its inherent complications.

Which patient's diet should be liberalized? APatient is morbidly obese and complains of hunger after finishing meals. B Patient is on a low-sodium diet with CHF and complains of bland taste C Patient is on a diabetic diet and complains of small portion sizes D Patient has intake <50% for 72 hours and complains of poor appetite

Patient has intake <50% for 72 hours and complains of poor appetite Overly restrictive diets may limit food choices or provide unfamiliar/unpalatable food items for patients with a poor appetite. These practices may result in inadequate food and nutrient intake. By liberalizing this patient's diet (i.e., removing dietary restrictions), this patient may eat more food as a result of increased food selections. The other patients do not require a liberalized diet due to their disease state (CHF, diabetes, obesity) and chief complaint (not related to poor intake or appetite).

An individual suffering from bulimia might have all of the following symptoms except: A Dental caries B Sore throat C Rectal bleeding D Extreme weight loss

Extreme weight loss The Nutrition Care Manual (NCM) characteristics for bulimia include uncontrolled binge episodes that sometimes alternate with restrictive episodes; abuse of laxatives, diuretics, or syrup of ipecac; compulsive exercise; knuckle bruising (Russell's sign); poor body image; and history of engaging in risky behaviors

this is not a category of a standard of nutrition care. Breatharianism, or the ability to exist only on prana (vital life force) without taking in food or water, is an example of what? A Excipient B Fad diet C Homeopathy D Ayurveda

Fad diet A fad diet does not have a set definition, but its characteristics include that it eliminates foods necessary for good nutrition, is not based on scientific evidence, and has the real potential to cause harm or nutrient deficiency. Breatharianism prescribes the elimination of all food (and, in most cases, also water), is not based on scientific evidence (despite attempts at scientific study), and may lead to death. Homeopathy is medical therapy based on diluted tinctures. Excipients are "extra" ingredients added to dietary supplements to increase bulk. Ayurveda is a system of natural healing that began in India. Breatharianism is not part of that system.

What nutrient is most impaired in cystic fibrosis? A Fat B Protein C Carbohydrate D Fluid

Fat CF is a genetic disease of the exocrine glands characterized by pancreatic enzyme deficiency, high electrolyte perspiration levels, thick mucus secretions, and malabsorption. Fat is the most impaired nutrient due to pancreatic enzyme deficiency. As a result, pancreatic enzyme replacement therapy (PERT) is recommended with all meals and snacks to aid in fat absorption to prevent steatorrhea and promote normal growth. CHO not as impacted in CF bc amylase is secreted in other organs (stomach, where they get broken down to mono and disaccharides, acted upon by enzymes sucrase, maltase, and lactase synthesized in SI) PRO not as impacted in CF bc protease is secreted in other organs (stomach and SI)

The functions of the liver include all of the following except: A Store and release blood B Filter red blood cells C Metabolize nutrients D Filter toxic elements

Filter red blood cells The functions of the liver include storing and releasing blood, filtering toxic elements, metabolizing and storing nutrients, and regulating fluid and electrolyte balance. The filtration of red blood cells is a function of the kidneys.

Education about sources of dietary gluten peptides is the cornerstone of education for what disease? A Crohn's disease B Gluten-sensitive enteropathy C IBS D IBD

Gluten-sensitive enteropathy Gluten-sensitive enteropathy, or celiac disease, is treated by eliminating dietary sources of gluten peptides. Individuals with IBS (irritable bowel syndrome) and IBD (irritable bowel disease) may be sensitive to gluten (gluten peptides), but it is not the only component of the diet to be considered. Crohn's is a type of IBD.

Which of the following nutrition interventions would be most effective for a client with anorexia nervosa? A Have regular meal times B Reach calorie goal as soon as possible C Focus on increasing high protein foods D Work solely with a registered dietitian

Have regular meal times Anorexia nervosa is an eating disorder that causes people to become preoccupied with their weight and what they eat, which results in a disordered body image and severe weight loss. Nutrition intervention should be multidisciplinary (including an RD, doctor, psychologist, etc.) and the RD should facilitate the planning of regular meal times, gradual re-introduction of feared foods, a healthy relationship with food, and slow progression to the calorie goal to prevent refeeding syndrome.

What type of dietary modification would be appropriate for a client with elevated T3 and T4? A Weight reduction B High-caloric foods C Low-purine foods D Goitrogen-free foods

High-caloric foods Hyperthyroidism is the excess secretion of thyroid hormones with elevated levels of T3 and T4. As a result, BMR is increased and weight loss is common. An appropriate dietary modification would be to increase the calories in the diet. Hypothyroidism is a deficiency of thyroid hormones associated with decreased BMR and weight gain. An appropriate dietary modification is weight reduction. Goiter is the enlargement of the thyroid gland due to insufficient thyroid hormones. A diet free of goitrogens is recommended. Goitrogens are substances that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland. An example is Brussels sprouts. Gout is a disorder of purine metabolism associated with increased levels of serum uric acid, leading to deposits in the joint that cause pain and swelling. High-purine foods should be avoided.

An individual has the athetoid form of cerebral palsy. What dietary modification would be most beneficial? A High-calorie, high-protein diet B Low-calorie diet, finger foods C High-fluid, high-fiber diet D High-fat, very-low-carbohydrate diet

High-calorie, high-protein diet Cerebral palsy is a congenital disorder of movement, muscle tone, or posture. There are spastic / stiff and non-spastic (athetoid) forms. The non-spastic (athetoid) form is characterized by involuntary wormlike movements with constant irregular motions that lead to increased energy expenditure and weight loss. The most beneficial dietary modifications include high-calorie, high-protein finger foods that don't require utensils (A). The spastic form is characterized by difficult, stiff movements that lead to decreased activity and weight gain. The most beneficial dietary modification is a low-calorie, high-fluid, and high-fiber diet (B, C). Epilepsy and seizures can be treated with a ketogenic diet, which is characterized as high in fat and very low in carbohydrates (D).

A 93-year-old female patient has dysphagia and uses a PEG tube to receive enteral nutrition. After she was admitted to the hospital due to an infection around the PEG site, the family decided to discontinue the PEG to improve her quality of life in her remaining time (estimated at less than six months). What type of care are the patient and family now pursuing? A Hospice care B Medical care C Curative care D Palliative care

Hospice care In end-of-life care, the RD's assessment requires practitioners to consider not only the clinical nutritional needs of the person but their medical goals (hospice vs. palliative vs. curative). Hospice care focuses on caring for people who are estimated to be within 6 months or less of life expectancy. Its purpose is to make people as comfortable as possible at the end of their life. Palliative care focuses on reducing symptoms and helping the patient deal with negative impacts the illness is having on their day-to-day life. While hospice care occurs at the end of the lifespan continuum, palliative care can be provided at any time and can occur at the same time as curative care. Curative care is the active medical care and treatment for a medical condition where a cure is considered achievable.

Which of the following is an indicator associated with increased risk for wound healing problems in the lower extremity amputation population? A Values for weight following fluid resuscitation may not be accurate B Anthropometric measurements are not sensitive because of acute changes C Plasma protein concentrations affected by stress and the inflammatory response D Hyperglycemia

Hyperglycemia The following indicators (alone or in conjunction) have been associated with increased risk for wound healing problems in the lower extremity amputation population: Serum albumin <3.5 g/dL Total lymphocyte count (TLC) <1,500 cells/mL Hyperglycemia (fasting glucose >126 mg/dL) Patients who are having problems with prosthesis fit Any weight gain or loss >5 lbs The other choices are indicators for burn patients, not amputation patients.

Metabolic syndrome is diagnosed when a patient has at least three of five conditions. Which of the following conditions is not included in the determination? A Hypertriglyceridemia B Hypertension C Hyperinsulinemia D Hyperglycemia

Hyperinsulinemia Metabolic syndrome is comprised of a combination of risk factors linked to increased risk for coronary heart disease, diabetes, fatty liver, and several cancers. Metabolic syndrome is diagnosed when a patient has at least three of the following five conditions: Fasting glucose ≥100 mg/dL (hyperglycemia) Blood pressure 135/85 mm Hg or higher (hypertension) Triglycerides ≥150 mg/dL (hypertriglyceridemia) HDL-C <40 mg/dL in men or <50 mg/dL in women Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women

The following medical conditions are risk factors for the development of kidney stones, except: A Gout B UTIs C Colitis D Hypotension

Hypotension Renal calculi is the presence of calculi within the urinary tract. Risk factors that increase the risk for developing kidney stones include inadequate fluid intake, reduced urine output, increased sodium/oxalate/protein intake, sedentary lifestyle, and obesity. The following medical conditions are risk factors for developing kidney stones: Arthritis Colitis: inflammation of the colon that causes chronic diarrhea, dehydration, and chemical imbalances Crohn's disease Gout: caused by excessive uric acid in the blood, which leads to high urinary uric acid levels High blood pressure, or hypertension Hyperparathyroidism Medullary sponge kidney Renal tubular acidosis Urinary tract infections Inherited condition in which the kidneys are unable to excrete acid

Which of the following scenarios may cause hyponatremia? A Increased sweating B Increased ADH secretion C Decreased H2O intake D Decreased vasopressin excretion

Increased ADH secretion The normal range for Na+ is 136-145 mEq/L. Hyponatremia (Na < 135 MEq/L) can be caused by increased use of thiazide diuretics or by antidepressants, burns, kidney or liver problems, severe diarrhea or vomiting, heart failure, increased H2O intake, ketonuria, and/or increased anti-diuretic hormone (ADH) excretion. Hypernatremia (Na > 146 mEq/L) can be caused by decreased H2O intake, increased NaCl intake, increased sweating, decreased vasopressin excretion, and/or glycosuria.

Which of the following signs might indicate intolerance to a tube feeding advancement? A Increased abdominal distension B Increased complaints of fatigue C Patient's complaints of hunger D Upgrading a patient from mild to moderately malnourished

Increased abdominal distension Enteral nutrition (EN) should be started early (within 24 to 48 hours) and advanced as tolerated. The following indicators should be used to monitor tolerance: Intake/output: Identify negative or positive balances Bowel movements: Constipation or diarrhea Tube placements: Ensure feeding tube is correctly placed Abdominal distension: Abdomen should be soft and non-distended, not hard and distended Weight: Desire stable weight; fluctuation may signify fluid intolerance Lab values: Look at electrolytes, glucose, and other nutrition-related lab values Complaints of hunger, increased fatigue, and changing of a patient's nutrition status are not indicators of intolerance. Upgrading a patient from mild to moderately malnourished is a sign of decline, not improvement.

How do nutrition needs change when a stage I pressure ulcer becomes a stage IV? A Increased fluid requirements B Increased calories and protein C Decreased zinc D Decreased calories and increased protein

Increased calories and protein A pressure ulcer is an injury to the skin and underlying tissue resulting from prolonged pressure. Pressure ulcers are common in the elderly, in those with gunshot wounds and spinal cord injuries, and in patients with immobilization. Pressure ulcers are indicated by stages I, II, III, and IV (increasing in severity) and require increased calorie and protein needs. The nutrition recommendations are as follows: Stage I/II: 30-40 kcal/kg, 1.2-1.5 g protein/kg Stage III/IV: 30-40 kcal/kg, 1.5-2.0 g protein/kg

Marcy is a 47-year-old female with metabolic syndrome, and over the past two years, she has worked with a registered dietitian. She reports significant weight loss, a healthy eating style, and a better quality of life. What is a potential direct nutrition outcome of medical nutrition therapy? A Increased hemoglobin A1c by 0.33% B Increased triglycerides by 21 mg/dL to 35 mg/dL C Increased low-density lipoprotein cholesterol by 2.4 mg/dL D Increased high-density lipoprotein cholesterol by 2.4 mg/dL

Increased high-density lipoprotein cholesterol by 2.4 mg/dL A direct nutrition outcome helps to evaluate the efficacy of a nutrition intervention. In adults with metabolic syndrome, research regarding the impact of medical nutrition therapy reported significant outcome improvements (NCM): Decreased fasting blood glucose by 2.5 mg/dL to 9 mg/dL (0.1 mmol/L to 0.5 mmol/L) Decreased hemoglobin A1c by 0.12% to 0.23% Decreased triglycerides by 21 mg/dL to 35 mg/dL (0.2 mmol/L to 0.4 mmol/L) Increased high-density lipoprotein cholesterol by 2.4 mg/dL (0.06 mmol/L) Decreased body weight by 2.5 kg to 4.1 kg Decreased waist circumference by 1.9 cm to 4.8 cm Decreased systolic blood pressure by 4.9 mm Hg

Education about the low FODMAP diet should be discussed with a client who has which of the following conditions? A Irritable bowel disease B Irritable bowel syndrome C Diverticulosis D Short-bowel syndrome

Irritable bowel syndrome The FODMAP diet is low in fermentable, oligo, di and monosaccharides and polyols. It has been shown to be effective in treating irritable bowel syndrome (IBS). Diverticulosis, short-bowel syndrome, and irritable bowel disease all impact the lower GI tract (like IBS), but they are not treated with a low FODMAP diet.

A child has a starved appearance and a distended belly. What type of malnutrition does the child most likely have? A atrogenic B Kwashiorkor C Cachexia D Marasmus

Kwashiorkor Kwashiorkor is a protein-energy malnutrition produced by a severely inadequate amount of protein in the diet but sufficient calories. It is characterized by edema, distended belly, irritability, and an enlarged liver with fatty infiltrates. This form of malnutrition is most commonly found in children in developing countries. Marasmus is a protein-energy malnutrition characterized by severe fat and muscle wasting with a starved appearance. Unlike in Kwashiorkor, there is no edema and the individual is at a reduced ideal body weight percentage. Iatrogenic malnutrition is brought on by medical treatment, hospitalization, and medications. Cachexia is associated with cancer and is characterized by general wasting due to the hypermetabolic disease state and decreased appetite.

Which of the following would not be part of the nutrition plan for a client with an eating disorder? A Calorie prescription B Limit variety in the diet C Macronutrient breakdown D Micronutrients

Limit variety in the diet Plans for ED (eating disorder) clients should include calorie prescription, macronutrient breakdown (how much carb/pro/fat), micronutrients (specific foods or supplements), and a varied diet. Often ED clients have a very narrow group of foods they will eat, so increasing/encouraging variety in the diet is important in all types of ED.

Jake feels that it is important that the outcome of his treatment results in the best possible aesthetic outcome, regardless of cost. What type of outcome is this example? A Treatment B Cost C Patient-centered D Traditional

Patient-centered Patient-centered outcomes focus on what is important to the patient in the final result of the treatment. Traditional outcome measures are more focused on quantifiable measurements of the success of treatment instead of patient's feelings, beliefs, and preferences. Cost and Treatment are distractors.

A 55-year-old male patient has a past medical history of type 2 diabetes mellitus, hyperlipidemia, and hypertension. He presents to the hospital complaining of shortness of breath and is admitted for new onset of congestive heart failure. His labs are as follows: Albumin 3.0 g/dL, Na 130 mEq/L, HgbA1C 9.8% What nutrition intervention should take priority? A Low sodium, low fluid diet education B Diabetes diet education C High protein diet education D Low fat diet education

Low sodium, low fluid diet education In this scenario, the priority diagnosis is the NEW onset congestive heart failure (CHF). Therefore, the intervention is to educate the patient on the CHF diet (low sodium, low fluid). Since the patient has CHF, his lab values for sodium and albumin are abnormally low due to fluid overload. After the primary CHF nutrition problem is addressed/resolved, the NEXT pertinent nutrition problem to address is his uncontrolled diabetes (as evidenced by HgbA1C 9.8%).

Which of the following individuals would you avoid recommending a low-sodium diet to? A Frank, a 64-year-old man with pre-hypertension B Martha, a 55-year-old woman on megestrol acetate C Marcy, a 35-year-old female taking a lithium carbonate D Jake, a 21-year-old obese male

Marcy, a 35-year-old female taking a lithium carbonate Lithium carbonate is an antidepressant medication, and consistent sodium and caffeine intake are required to stabilize lithium levels. If sodium or caffeine is restricted, lithium excretion decreases and may lead to toxicity. Therefore, it is recommended to keep daily sodium intake consistent. Obese and pre-hypertensive individuals may benefit from a low-sodium diet. Megestrol acetate is an appetite stimulant, and a low-sodium diet would not be contraindicated.

Would you recommend the Feingold diet to a patient with hyperkinesis? Why or why not? A Yes, because sugar causes hyperactivity B No, because consistent carbohydrate intake is important to control blood sugar C Yes, because artificial colors decrease attention span D No, because the efficacy of the diet is not proven

No, because the efficacy of the diet is not proven Attention-deficit/hyperactivity disorder is a chronic condition of attention difficulty, hyperactivity, and impulsiveness. The Feingold diet efficacy was not proven because positive results may be due to the placebo effect. Recent research (Lange et al, 2017) Sugar does not directly cause hyperactivity, and artificial colors do not directly decrease attention span. Consistent carbohydrate intake is important to control blood sugar for patients with diabetes.

A tube feeding is running continuously at 80mL/hr and provides 1,000 calories, 64 grams of protein, and 840 mL of water per 1,000 mL of formula. The patient requires 2,000 calories and 135 grams of protein. Does the current rate meet his estimated needs? A Yes, but the feed should be changed to a 12-hour cyclic rate B No, the rate should be changed to 85 mL/hr to meet his estimated needs C Yes, the current rate meets his needs D No, the rate should be changed to 90 mL/hr to meet his estimated needs

No, the rate should be changed to 90 mL/hr to meet his estimated needs mL per 24hr: 80mL x 24hr = 1,920 mL Calories Delivered: 1,920 mL x 1 Cal/mL = 1,920 Cal Protein Delivered: 1,920 mL x .064 g/mL = 122.88 g of protein 90 mL/hour provides adequate calories and protein and therefore is the correct rate: Calories per mL: 1,000 Calories / 1,000 mL = 1 Cal/mL Protein per mL: 64g protein / 1,000 mL = .064 g/mL mL per 24hr: 90mL x 24hr = 2160 mL Calories Delivered: 2,160 mL x 1 Cal/mL = 2,160 Cal Protein Delivered: 2,160 mL x .064 g/mL = 138.24 g of protein

An athlete's coach has consulted with you to provide education to the athlete about changing their diet during the off-season. What type of diet approach is this? A Cutting B Food timing C Intermittent fasting D Nutrition periodization

Nutrition periodization Nutrition periodization modifies the diet to match the athlete's training pattern during different times. Those times include on-and off-season, pre- and post-competition. These times are distinct from each other, because they have different nutrient needs. Food/nutrient timing is a part of education for athletes, but this is not a description of a diet approach. Cutting is a term used for reducing calories pre-competition for aesthetic-based athletes. Intermittent fasting is a distractor.

Matt is a 64-year-old male with a BMI of 34.8. What is his BMI classification? A Obesity class I B Obesity class III C Obesity class II D Morbid obesity

Obesity class I The body mass index (BMI) is used as a criterion to assign nutritional risk. Individuals are considered at nutritional risk if they are underweight, overweight, or obese. The BMI classifications are listed below: <18.5: Underweight 18.6-24.9: Normal weight 25-29.9: Overweight 30-34.9: Obesity class I 35-39.9: Obesity class II >40: Obesity class III or morbid obesity

Which of the following nutrients may severely decrease during refeeding syndrome? A Phosphorous B Fluid C Protein D Sodium

Phosphorous Refeeding syndrome is the body's adverse response that may occur with the initiation of nutrition after a period of poor intake or starvation, such as in the already malnourished patient. Signs and symptoms include low serum electrolyte abnormalities (specifically phosphate, potassium, and magnesium), vitamin deficiencies, and sodium and fluid retention. The main complications are due to hypophosphatemia, hypokalemia and hypomagnesemia, which may lead to cardiac arrhythmia, seizures, heart failure, or death.

A 65-year-old male patient has chronic obstructive pulmonary disease and hypertension; he requires enteral nutrition (EN) initiation. What type of EN formula is best for this patient? A Polymeric B Glucerna C Elemental D Nepro

Polymeric A standard polymeric enteral nutrition formula is the best formula to use when a patient has a functioning GI tract and does not have a disease state requiring a specialized formula. An example of a standard formula is Jevity. Elemental formulas are used for patients with malabsorption problems and contain hydrolyzed proteins in the form of amino acids. An example of an elemental standard formula is Impact Peptide. Specialized formulas are used for patients with specific disease states that require specialized nutrition, such as Nepro for renal patients and Glucerna for diabetic patients.

A 55-year-old patient weighs 55 kg and is 63 inches tall. He has a past medical history significant for chronic kidney disease stage III, type 2 diabetes mellitus, gastroparesis, and hypertension. His diet order is 2,000 calories with consistent carbohydrates, 60-80 grams protein, 1.5-liter fluid restriction, high fiber with Boost Glucose Control twice per day. What changes would you make to his current diet order, if any? A The current diet order is appropriate B Decrease to 1,500 calories with consistent carbohydrates C Remove the high-fiber diet order D Increase protein to 125-145 grams

Remove the high-fiber diet order Gastroparesis is delayed gastric emptying and is characterized by abnormally delayed emptying of foods from the stomach (NCM). A common cause of gastroparesis is diabetes. Nutrition therapy for gastroparesis includes low fiber, low fat, and 5-6 small meals per day. Therefore, the high-fiber diet order is contraindicated for this patient. The remaining diet orders are appropriate for the patient based on his estimated needs and associated past medical history, thus no additional changes are indicated.

What breakfast meal would you recommend for a patient with gestational diabetes? A Whole-grain bagel with reduced-fat cream cheese and a banana B Slice of toast with peanut butter and hard-boiled eggs C Strawberry-banana smoothie with almond milk D Scrambled eggs with toast and orange juice

Slice of toast with peanut butter and hard-boiled eggs During gestational diabetes (GDM), carbohydrates are less tolerated at breakfast meals due to more insulin resistance in the morning. Therefore, lower carbohydrate meals are recommended in the morning (15-30 grams carbohydrates). AVOID liquid carbohydrate calories (e.g. juices, smoothies made with fruit or sweetened beverages) spike blood sugar and should be avoided. The slice of toast with peanut butter and hard-boiled eggs is the only meal that follows the GDM breakfast guidelines. (15g CHO) The smoothie and juice should be avoided. A bagel (any size) will be more than 30 grams of carbohydrate by itself, plus at least 30 grams from the banana.

Severe and prolonged vomiting can cause all of the following side effects except: A Metabolic alkalosis B Mallory-Weiss tear C Tooth decay D Small bowel obstruction

Small bowel obstruction Severe and prolonged vomiting can cause a Mallory-Weiss tear, metabolic alkalosis, and tooth decay. A small bowel obstruction (SBO) may cause vomiting, but vomiting does not cause SBO. A Mallory-Weiss tear is a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach resulting from excessive, prolonged, and/or forceful vomiting. Metabolic alkalosis occurs from excessive loss of stomach acid from emesis. Tooth decay results from repeated purging, exposing the teeth to stomach acid.

What type of kitchen equipment would you recommend for individuals with developmental delays? A Food dehydrator B Toaster C Spoons and forks with larger handles D Toaster oven

Spoons and forks with larger handles An individual with developmental delays may require special equipment to make preparing, serving, and eating meals easier. Some suggestions are a blender/food processor, juicer, cappuccino maker, pastry cutter/potato masher, dishes with sides, sports cups, spoons and forks with larger handles, rubber sleeves, and a heated baby dish. A toaster oven, toaster, and food dehydrator may be okay kitchen equipment for an individual with developmental delay to have, but they would not be specifically recommended for any particular reason.

A fecal fat test determines a stool has 8 grams of fat. What can this result imply? A Steatorrhea B B-12 deficiency C Lactose intolerance D Diarrhea

Steatorrhea Steatorrhea is a consequence of malabsorption, in which fat is not absorbed and lost in the stool. A fecal fat test can determine steatorrhea by testing the amount of fat in the stool. Normal stool fat is 2-5 grams, and more than 7 grams of fat is indicative of malabsorption. Diarrhea is indicated by three or more loose stools in a day. Lactose intolerance is indicated by the lactose tolerance test, or the inability to break lactase into glucose and galactose. B-12 deficiency is indicated by a blood test to show vitamin deficiencies.

Which of the following is a HIPAA violation? A Paging a patient's room number and MRN to the responsible medical team B Submitting a late copy and documenting the time it should have been recorded C Writing a nutritional assessment in black ink D Texting patient information to the responsible medical team

Texting patient information to the responsible medical team The Health Insurance Portability and Accountability Act (HIPAA) is the United States legislation that provides data privacy and security provisions for safeguarding medical information, such as protected health information (PHI). Texting patient information is a HIPAA violation because texting is not safeguarded and therefore PHI could be exposed to cyberspace. In order to discuss patient information within HIPAA guidelines, the communication sources must be encrypted. The other options are all in accordance with HIPAA guidelines.

How does the diet of a child with PKU differ from that of a child without PKU? A The child with PKU must restrict PHE and supplement TYR B The child with PKU has increased protein needs C Aspartame should be used instead of raw sugar for the child with PKU D The child with PKU has increased need for exogenous glucose

The child with PKU must restrict PHE and supplement TYR Phenylketonuria (PKU) is a genetic disorder and birth defect that causes an amino acid called phenylalanine (PHE) to build up in the body due to the missing enzyme phenylalanine hydroxylase. This missing enzyme would have converted PHE into tyrosine (TYR) and as a result, PHE can build up in the blood, leading to poor intellectual function. The PKU diet has energy needs similar to those of a healthy child. The only diet differences include the restriction of PHE, supplementation of TYR, and avoidance of aspartame. Glycogen liver storage disease is the deficiency of glucose-6-phosphate in the liver, which impairs gluconeogenesis and glycogenolysis, and increases the dietary needs for exogenous glucose (in the form of raw cornstarch with a high-CHO, low-fat diet).

An individual drinks a glass of cow's milk and their blood sugar rises less than 25 mg/dL above fasting. What can be inferred from this result? A The individual has celiac disease B The individual is post-gastrectomy C The individual is lactose intolerant D The individual is gluten-intolerant

The individual is lactose intolerant Normally, lactase is broken down into glucose and galactose to be more easily absorbed in the body. However, when an individual has a lactase deficiency (lactose intolerance) lactase is not split into glucose and galactose. The lactose tolerance test determines if an individual is tolerant by providing an oral dose of lactose after a fast. Tolerance of lactose is indicated by blood glucose rising above 25 mg/dL. Intolerance of lactose is indicated when blood glucose does not rise above 25 mg/dL due to lactase not being split into glucose and galactose molecules.

A patient is medically diagnosed with gestational diabetes and is admitted to the hospital for the remainder of her pregnancy (20 weeks). Which of the following is most likely to change as the patient's response changes? A Neither the nutrition diagnosis nor the medical diagnosis B The nutrition diagnosis C The medical diagnosis D Both the nutrition diagnosis and the medical diagnosis

The nutrition diagnosis A nutrition diagnosis is often a temporary label; ideally, with intervention, the nutrition diagnosis resolves. It changes as the patient's response changes. For example, the nutrition diagnosis "excessive carbohydrate intake" may change as you educate a gestational diabetes patient on the diabetic diet. A medical diagnosis is the identification of a disease or pathology of a specific body/organ/system and does not change as long as the condition exists. For example, gestational diabetes is a medical diagnosis; after the woman gives birth it may change to "diabetes" or "resolved."

Which of the following is not true about order writing privileges for dietitians? A They require a review of the RD's qualifications B They include only the diet prescription C They are not legal in every state D They do not take the place of communicating diet orders to the team

They include only the diet prescription All other answer choices are true. Dietitians may not be able to write orders if a state's licensure laws prohibit it. If order writing by RDs is not excluded by law, then they can be obtained by the facility's medical staff granting the privilege, which includes a review of credentials and qualifications. Even if the RD writes the diet order, that does not mean the RD doesn't also have to communicate that with the patient's care team. Order writing privileges for dietitians can include things beyond the diet prescription, such as ordering labs or formulating TPN orders

What vitamins would you recommend for an alcoholic and why? A Folate to prevent tetany B Fiber to decrease esophageal varices C Thiamin to prevent Wernicke's encephalopathy D Sodium to reduce ascites

Thiamin to prevent Wernicke's encephalopathy An alcoholic may experience decreased absorption of vitamins from food and increased excretion from the body; therefore, B-complex vitamins, vitamins C, D, E, and K, zinc, and magnesium should be recommended. Thiamin may help prevent Wernicke's encephalopathy and folic acid may help prevent macrocytic anemia. Low fiber is recommended when esophageal varices are present. Low sodium and fluid restriction are recommended when ascites are present. Tetany is a result of a calcium deficiency, not folate deficiency.

A lifetime of healthy eating helps to prevent all of the following chronic diseases except which? A High blood pressure B Heart disease C Type 1 diabetes D Obesity

Type 1 diabetes According to the 2015-2020 Dietary Guidelines for America, a lifetime of healthy eating helps to prevent chronic diseases like obesity, heart disease, high blood pressure, and type 2 diabetes. Type 1 diabetes (T1DM), also known as juvenile diabetes or insulin-dependent diabetes, is an autoimmune disease and chronic condition where the pancreas produces little or no insulin. T1DM is primarily managed through exogenous use of insulin. Healthy eating does not prevent this disease but can help manage it.

Liver enzymes are increased in all of the following diseases states except: A Alcoholism B Hepatitis C Uncontrolled diabetes D Fatty liver

Uncontrolled diabetes Liver function tests include the enzymes alkaline phosphatase (ALP), lactic acid dehydrogenase (LDH), aspartate aminotransferase (AST, SGOT), and alanine aminotransferase (ALT, SGPT). Abnormal liver tests are detected when tissue damage causes the liver enzymes to leak into blood circulation. Increased liver enzymes are present in liver disease, bone disease, hepatitis, myocardial infarction, muscle malignancies, hepatitis, acute or chronic alcohol use, and fatty liver. Liver enzymes are decreased in scurvy, malnutrition, and uncontrolled diabetes.

What treatment is advised when a patient has refractory celiac disease? A Vitamin A supplementation B Gluten free diet C Immunosuppressive medications D Intensive gluten free lifestyle

immunosuppressive medications A patient who has refractory celiac disease does not respond to a gluten free diet. Celiac disease has an autoimmune response characterization. Once all potential sources of gluten have been ruled out, the patient is classified as having refractory celiac disease, and immunosuppressive medications become the option for treatment. Anti-inflammatory medications may also be used. A gluten free diet and elimination of all gluten sources in the diet, medication, cosmetics, etc. all happen before diagnosis with refractory celiac disease. Vitamin A supplementation is a distractor.

Nick is offered two different treatments for his prostate cancer. The first has a higher documented cure rate and can result in several side effects that are important to Nick to avoid. The second option has a lower documented cure rate and avoids the side effects that are important to Nick to avoid. Nick and his physician discuss the options. In patient-centered care, which option is most likely to be the one that is chosen and why? A The second option, because it is likely less invasive B The second option, because it takes into account the outcomes that are important to Nick C The first option, because it has a higher documented cure rate D The first option, because Nick's doctor will likely recommend that treatment

the second option, because it takes into account the outcomes that are important to Nick Patient-centered care focuses on the treatment outcomes that are important to the patient.

Which of the following is not a symptom of celiac disease? A Malabsorption B Macrocytic anemia C Diarrhea D Weight gain

weight gain Celiac disease is an autoimmune disorder characterized by a genetic sensitivity to gluten (found in wheat, barley, and rye). When these grains are consumed, an autoimmune response is triggered that damages the small intestine's mucosa. This damage reduces the small intestine's absorptive surface, leading to malabsorption of macro- and micronutrients. A lifelong gluten-free nutrition prescription is recommended to treat this disease. The signs and symptoms include malabsorption, macrocytic anemia, iron-deficiency anemia, weight loss, diarrhea, and steatorrhea. Weight gain is not a symptom of celiac disease.