Dietetic Technician Registered Exam: Book Exam

reasons that the general population is told to "eat your colors" when referring to fruits and vegetables include all the following except: a. the different colors contain different phytochemicals b. selecting from all 5 colors ensures adequate protein intake c. Doing so ensures adequate fiber intake, which may protect against certain types of cancers d. Eating the colors helps lower Type 2 diabetes mellitus and heart diesase risks.

B: "Eat your Colors" is a mnemonic phrase used to remind the general population to select a variety of fruits and vegetables based on colors. The color groups are red, yellow/orange, green, purple/blue, and tan/white. Eating a variety of colors ensures consumption of a wide range of vitamins and minerals. Fruits and vegetables are excellent sources of phytochemicals, which fight disease. Increasing fruit and vegetable consumption may reduce the risk of cancer, Type 2 diabetes mellitus, and heart disease. Fruits and vegetables are naturally low in fat but may not necessarily supply enough protein in the diet. They are excellent sources of fiber as well.

which of the following statements are not true about a dietary history? a. information for a dietary history can be obtained using a food diary recorded by the individual for a period of 3-7 days b. a 24 hour recall is the most accurate way to obtain information about an individual's dietary history c. a food frequency questionnaire can be a tool used to obtain information about an individual's dietary history as it determines how often a person eats a certain foods d. a nutrient intake analysis is a way to obtain information regarding a person's dietary history when they are hospitalized or are living in another in a situation where an observations can be made about the type and amount of food consumed

B: A dietary history involves obtaining information about the type of food a person eats, food patterns, and quantities of food. There are many ways to obtain this information. A 24-hour recall is helpful, but it may not always be the most accurate as the person may not eat his/her typical diet and/or may struggle to accurately recall all food consumed. A food diary is often used to record what a person eats and generally can be kept for a period of 3-7 days. It may incorporate a weekend day as well. A food frequency questionnaire can also be used to help determine a person's eating habits, such as the most frequently consumed food and beverage groups. A nutrient intake analysis is also referred to as a calorie count and is often used in a hospital setting but may not always be accurate.

the main, long-term nutritional priorities for post-cardiac transplant patients long-term likely include all of the following, except: a. monitoring and managing glucose intolerance b. instituting a high protein diet to prevent catabolism due to steroids c. weight management d. cholesterol management

B: A high protein diet is more appropriate in the immediate post transplant period due to stress of surgery, catabolism due to high dose steroids, and the need for wound healing. As the patient recovers and the steroids are weaned, the need for a high protein diet is not usually warranted. The main nutritional concerns post-transplant address side effects of the immunosuppressive medication. Glucose intolerance is a common side effect of many medications. Many of the medications also cause weight gain or increased appetite. Cholesterol management is also extremely important as many long-term transplant survivors will experience atherosclerosis of the graft, which may ultimately lead to death. Other potential long-term complications of transplants include hypertension and osteopenia.

as a DTR, part of your job is to complete the initial nutrition screening on all admissions. Next, you collaborate with the RD to decide how the department tasks will be completed...You have a good working relationship with the RD. The Clinical Nutrition Manager asks the RD for input on your performance over the past year. A reason for this may be: a. she is getting ready to perform corrective discipline b. she is getting ready to complete your performance appraisal c. she is trying to keep tabs on the inpatient staff d. she is trying to write a job description

B: A performance appraisal is an evaluation of an employee's job performance. A yearly performance appraisal is required by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) for DTRs. Performance appraisals are not only an evaluation but also an opportunity for the employee to discuss job expectations, review strengths and weakness, and examine areas for improvement. It is also a way to indicate the desire for growth within the organization and to develop a plan to achieve this. Training issues should also be reviewed. Any negative feedback discussed in the performance appraisal should not be news to the employee as performance issues should be addressed as soon as they become concerning. Performance appraisals may coincide with salary adjustments.

which of the following choices indicates nutritional risk? a. a nursing home patient stable on a tube feeding regimen b. diarrhea for 1 week with a 10 pound weight loss c. a 3 year-old girl with a sore throat and poor appetite for 2 days d. a 21 year-old male who is drinking protein shakes in an attempt to build muscle

B: A person experiencing diarrhea for a period of 1 week and who has had a 10 pound weight loss is at a nutritional risk requires immediate attention. A patient who is stable on tube feeding is not at nutritional risk, however, if the patient was losing weight, had poor skin integrity, or was not receiving the full tube feeding prescription regularly, that individual would then be at risk. . A 3 year-old with a poor appetite and a sore throat is not necessarily a nutritional risk unless the difficulty with swallowing persisted and was unrelated to a minor viral or bacterial illness. A 21 year-old who is drinking protein shakes to build muscle would not be considered at nutritional risk unless the amount of protein he is taking in is adversely affecting kidney or liver function or has other risk factors.

the concept encouraging a more personalized presentation of menus to hospitalized patients is called: a. printed menu b. spoken menu c. menu board d. master menu

B: A spoken menu is used in many healthcare facilities due to the shorter lengths of stays. A spoken menu enables more personalized service and this usually equates with improved customer satisfaction. Because the lengths of stay are now shorter, an extensive menu is not usually required because most patients do not stay long enough to feel bored with the menu. A spoken menu also allows costs to be reduced because paper and printing costs are eliminated. The process of planning the menu is simpler because it takes less time to process the menu and it can be easily adapted to food that is in season.

a body mass index of 28 is considered to be: a. underweight b. overweight c. obese d. normal weight

B: Body mass index (BMI) is a validated tool to help determine nutritional status. A BMI requires a height and a weight value, which when inputted in a formula, can determine a person's weight status. The metric formula is: BMI = weight (kg) ÷ height (m)2. It is an inexpensive tool that is easily used by clinicians as well as the average person. BMI is classification is as follows: underweight if less than 18.5 kg/m2, overweight between 25-29.9 kg/m2, and obese greater than 30 kg/m2. BMI values tend to rise as a person ages due to changes in overall body composition as well as changes in weight. Normal weight is considered to be 18.5-24.9.

the hospital cafeteria has added Pizza Hut pizza and Boar's Head deli meats to its employee menu. This is an example of: a. marketing b. branding c. promotion planning d. mark-up merchandising

B: Branding is a marketing method that utilizes certain brands to increase sales. The brands can be nationally known or local brands. Retail item branding is a form of branding where the name of the product is strategically placed on the menu such that the menu reads Kellogg's Corn Flakes instead of just corn flakes. Restaurant branding is where nationally known restaurant chains are operating within a food service operation, such as in a hospital cafeteria or a school food service. In- house signature branding are special items created by the food service operation. These may be high quality sandwiches, salads, or other products. An entire marketing scheme, including logo and slogan development is then focused on the branding. Branding helps increase sales and revenue, and adds interest for the consumer.

as the cafeteria manager, you notice that the hamburgers are not cooked to the proper temperature and are very rare on the inside. what are you most concerned about? a. salmonella b. e.coli 0157:H7 c. bacillus cereus d. shigella

B: E. coli is a microorganism that lives within the intestines and is beneficial to health. Other types of E.coli such as E. coli 0157:H7 are very dangerous and can cause severe illness. This type of E.coli can be found in undercooked beef but especially in ground beef, raw fruits and vegetables, soft cheeses, unpasteurized dairy products, and contaminated water. The onset of this type of infection is between 1-8 days and can last as long as 10 days. The main symptom of E. coli infection is severe diarrhea that is often accompanied by blood. Vomiting and abdominal pain are also likely, however, fever is not usually present. This can also lead to hemolytic uremic syndrome, which leads to acute kidney failure. E. coli poisoning can be prevented by washing all foods including meats, fruits and vegetables thoroughly and cooking to the appropriate temperature.

which of the following scenarios would not raise red flags to a food service manager? a. a food service worker has a broken washing machine and has not had time to go to the laundromat to clean his uniforms b. a food service worker comes to work without a fever but complains of allergies and congestion c. a food service employee making sandwiches in the deli is sneezing frequently and often forgets to sneeze into her elbow d. a cafeteria line server absentmindedly touches her head and face when no customers are being served

B: Employees can inadvertently be a cause of food borne illness. As a manager, there are a few situations to be aware of in terms of preventing potential food borne illness. These include employees who are touching the scalp or hair; wiping the nose or mouth; or coughing and sneezing into the hand. Other situations to be aware of include touching the skin where there may be a blemish or open wound that could be potentially infected, touching inside the ear, or spitting in the area where food is handled. Dirty uniforms are also a danger. Employee illness is sometimes difficult to gauge, but if fever is present at any time, the employee should be considered contagious and avoid coming to work. Proper hand washing, keeping oneself appropriately cleaned and groomed, and dressing in clean clothes are all training concerns.

folic acid requirements during pregnancy are increased because folic acid: a. deficiency causes glossitis b. helps prevent neural tube defects c. prevents pernicious anemia d. deficiency causes poor appetite

B: Folic acid is an extremely important vitamin for women of childbearing years. Adequate intake of folic acid reduces the incidence of neural tube defects (NTD), such as spina bifida. The requirements for folic acid increase during pregnancy from 400 μg to 600 μg. The neural tube closes by the 28th day of pregnancy. Many women do not even realize they are pregnant by this time; therefore, it is recommended that all women of childbearing age increase their folic acid intake to help prevent NTD. Other reasons for the increase in folic acid requirements are because of the expanding blood volume as well as growth of the fetus and the placenta.

an individual has become ill 6 hours after eating a salad bar buffet containing various cooked meats, cottage cheese, and potato salad. The symptoms are nausea, vomiting, diarrhea, and severe abdominal cramping. the microorganism most likely responsible for the outbreak is: a. clostridium botulinum b. staphylococcus aureus c. e.coli 0157:H7 d. campylobacter jejuni

B: Food poisoning caused by staphylococcus aureus (staph aureus) is typically caused when the person serving food cross contaminates from other products. It can also be caused by equipment that has not been properly cleaned. Foods that are likely to cause this type of infection include egg products; salads, such as potato or tuna salad; and cream-type dessert foods, such as custard or cream puffs. Chicken and cooked meats can also cause this. The onset of symptoms is usually 1-6 hours and will last approximately 2 days. The symptoms include vomiting, diarrhea, nausea, lack of appetite, abdominal pain, and distention. This type of microorganism can be verified through a stool culture. It can live in the nasal passages and throats as well as on the hair and skin.

which of the following terms means predicting the amount of food needed for a specific event? a. production b. forecasting c. purchasing d. food scheduling

B: Forecasting is the term used for predicting how much food is needed for specific period, such as a day or an event. Forecasting helps the purchasing area know what type of food to buy and how much is required. The production area needs this information to determine how much of an item is needed and where it will be served, such as tray line or cafeteria. Accurate forecasting can be difficult, but it is important to make the best possible prediction in order to prevent waste or loss of money. In smaller facilities, menu items for patients are often tallied, but in larger operations, different methods are used that involve information on historical data, census or number of students enrolled, other staff purchasing meals, and other information. Computers can also be utilized for this process. The weather also needs to be taken into account when making a forecast.

you are working at the local health department initiating health promotion programs. which of the following departments of the Department of Health and Human Services may provide guidance for program development? a. Dietary Reference Intake (DRI) b. Healthy People 2020 c. NHANES d. Dietary Guidelines for Americans

B: Healthy People 2020 is a program administered through the Department of Health and Human Services that aims to address health issues within our nation and help reduce the impact of these issues. The overall goals are to help individuals live longer and to have a better quality of life. Another goal is to try to eradicate differences in health between different population groups. There are a number of leading health indicators that are utilized to determine if the overall health of the nation is improving. These indicators include physical activity, weight, and access to health care. It also includes 28 focus areas, such as diabetes, cancer, food safety, heart disease, and health education to help organizations determine what areas to target.

the best initial nutrition intervention for a person with metabolic syndrome is: a. encouraging a 20% weight loss and at least 60 minutes per day of exercise b. implementing the TLC diet and increasing physical activity to a minimum of 30 minutes per day c. encouraging a 5-10% weight loss and implementing the Dean Ornish diet d. smoking cessation and adding medications to reduce lipids

B: Initial treatment for metabolic syndrome includes lifestyle changes, such as diet and exercise habits, weight loss, and smoking cessation. A 5-10% initial weight loss is recommended with a longer term goal of lowering BMI to less than 25 kg/m2. Increasing physical activity to at least 30 min/day of moderate intensity most days of the week is also a goal. The TLC (Therapeutic Lifestyle Changes) diet should be implemented as a way to improve eating habits. This aims for reducing saturated fat intake to less than 7% of total calories, total fat intake to 35% or less of total calories, and increasing the amount of soluble fiber in the diet. The DASH diet is another possibility. Smoking cessation is also highly recommended. Medications may need to be added to lower lipid levels but may not be the initial therapy.

an employee attempts to provide input to his food service manager with regard to the workflow surrounding the prep area. The manager tells the employee that the necessary changes have already been instituted and there is no room for discussion on the matter. This is an example of what type of leadership style? a. democratic b. autocratic c. bureaucratic d. participative

B: Kurt Lewin identified three styles of leadership in 1939. An autocratic leader is one who makes all the decisions without input from employees. This type of leadership style tends to produce the most dissatisfied employees. A decision made without the input of employees may set the employees up to fail if the decision is not a sound one. In a democratic style of leadership, the manager involves the employees in the decisions but reserves the right to make the final decision after reviewing input. This is usually a successful type of leadership unless opinions vary widely on all decisions. A laissez-faire style of leadership is one where the manager allows the employees to make the decisions but also makes the employees responsible for the consequences of that decision. This type of leadership style can work well with extremely motivated and knowledgeable employees. .

as a DTR, you serve as the evening shift supervisor at the hospital. the food service director asks you to join a collaborative training to learn how the kitchen functions over a period of several months. The training objectives is for you to gain familiarity with and competence in the key kitchen positions so that you may better supervise and assist employees. What type of training is this? a. adult b. on-the-job c. group d. self-directed

B: On-the-job training is a type of training that is usually completed on-site and typically has good results. It helps develop good working relationships with other employees and supervisors, helps people feel a sense of accomplishment that they have learned the appropriate skills required to do the job, and helps reduce costs by protecting equipment from accidental breakage due to knowledge deficit. Generally the one who is training tries to make the employee comfortable in order to learn. The trainer shows the employee how to complete each task and emphasizes key issues. The employee should then be able to demonstrate tasks and be able to verbally explain them as well. Follow up is important to ensure complete and adequate training as well as to answer remaining questions.

protein digestion begins in the: a. jejunum b. stomach c. small intestines d. brush border

B: Protein digestion initially starts in the stomach; however, the duodenum is the major site of protein digestion. Enzymes such as pancreatic trypsin or chymotrypsin work to break intact protein down into smaller polypeptides and amino acids. Enzymes, such as proteolytic peptidases, located on the brush border also help digest protein. Small peptides can be absorbed as is but dipeptides need to be further reduced to amino acids. It is here on the brush border that the final phase of protein digestion occurs. The majority of protein absorption occurs before it gets to the jejunum so minimal protein is wasted and excreted.

how much protein is recommended for a patient with cirrhosis but without evidence of encephalopathy to maintain positive nitrogen balance?

B: Protein remains a very controversial nutrient for individuals with liver disease. For a patient with cirrhosis but without encephalopathy, the recommended protein intake is 0.8-1 g/kg to maintain positive nitrogen balance. The patient's estimated dry weight should be used for calculations. For a patient who is in negative nitrogen balance with cirrhosis without encephalopathy, this patient may need 1.2-1.3 g/kg. If this same patient is stressed, they may need as much as 1.5 g of protein per kg. The decision to restrict protein during acute encephalopathy is still unresolved. It is also imperative that adequate caloric intake be maintained.

which of the following strategies is most likely to have the best nutrition counseling outcomes? a. cognitive restructuring b. self-monitoring c. structured meals d. social support

B: Self monitoring is a technique used in nutrition counseling that has had evidence of improved outcomes. This technique utilizes record keeping of any behavior that may negatively or positively impact food choices or weight. An example of recorded data includes the amount of food, time, and place food was eaten. Specific nutrients may be recorded, such as carbohydrates or fat. Another example is recording any type of emotion that is felt when eating or any negativism in terms of body image or success. Clinical data includes weight, blood pressure, or blood glucose. Successes should be enjoyed and celebrated. Feedback should be provided to help the client fine tune what he or she is recording.

which of the following are examples of omega-3 polyunsaturated fatty acids? a. palmitic acid and lauric acid b. eicosapentaenoic acid and docosahexaenoic acid c. linoleic acid and linolenic acid d. arachidonic acid and oleic acid

B: The 2 main omega-3-fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are found primarily in fish sources, such as fish oil and fish from the ocean. Omega3- fatty acids along with omega-6-fatty acids are essential fatty acids. These fatty acids cannot be made by the body and therefore must be supplied through diet. Omega-3-fatty acids can help lower triglyceride levels and are thought to reduce overall CVD risk. Omega-3-fatty acids also help reduce the rate of atherosclerotic plaque that accumulates in the arteries. . To ensure adequate intake of essential fatty acids, it is recommended that fatty fish be consumed at least twice per week or other sources of fatty acids, such as flaxseed, canola, and soybean oils as well as walnuts and flaxseed be included in the diet.

the American Dietetic Association and the Commission on Dietetic Registration (CDR) have written a Code of Ethics. which of the following is an example of an ethics violation? a. the hospital food service receives holiday cards from food vendors b. the inpatient RD accepts monetary gifts from a holistic physicians' group and in return, is advising patients to purchase the products offered by this group c. the DTR is taking diet histories on all new admissions d. the DTR in a long-term care setting was recently in a car accident. while on a medical leave of absence, he became addicted to pain killers but has since received treatment for this addiction and is in recovery.

B: The Code of Ethics was implemented to provide direction to dietetic professionals for issues surrounding practice and conduct. The code applies to any member of the American Dietetic Association (ADA). . Even RDs and DTRs who are not ADA members, must comply with the code, except for the points relating to membership. The Code of Ethics is built on the foundation that all dietetic professionals should always be honest, fair, and display integrity. The code states that a practitioner should not practice if he is struggling with an active addiction, is mentally incompetent, or has impaired judgment. The code addresses the relationship with clients, to the overall profession, and to other dietetic professionals. A committee reviews reported ethical violations. In the above example, an RD who is accepting money from a physician group to promote the use of their products is likely committing an ethical violation.

a women and man both interview for a cashier position in a hospital cafeteria. both are hired for the job but the women is paid $1.00 less per hour than the man. identify the law that may be violated. a. Fair Labor Standard Act b. Equal Pay Act c. Minimum Wage Act d. Fair Pay Act

B: The Fair Labor Standards Act of 1938 was established to help prevent poverty. This law established minimum wage and was expanded in 1966 to include food service employees. The Equal Pay Act was an amendment to the Fair Labor Standards Act written in 1963. This law makes it illegal to discriminate on the basis of gender. Men and women must be paid the same wage for the same jobs if the jobs require similar skills and responsibilities. . A wage difference can occur if it is based on seniority, merit, or other reasons besides gender.

which of the following is not addressed in the FDA Food Code? a. food service establishment flooring material characteristics b. specific dress code policies for food service personnel working in kitchens c. guideline for using ice to keep foods cool d. guidelines for sinks used for hand washing

B: The Food and Drug Administration (FDA) is responsible for publishing the Food Code. This code is update every 4 years, but interim reports are published if new information needs to be addressed. The Food Code is scientifically-based and applies to all public establishments where food is involved, including restaurants, grocery stores, and institutional food services. It provides useful and realistic information on preventing food borne illness. Topics addressed by the Food Code are food, equipment, utensils, lines, physical facilities, and plumbing and water issues. It also addresses personnel in terms of cleanliness, proper hygiene, and the use of clean clothing. It does not directly establish specify uniforms or clothing criteria. The Food Code also addresses supervisory issues to help prevent illness from spreading. It is a comprehensive report full of important information.

the type of federal regulation that defines bittersweet chocolate must contain at least 35% cocoa butter with a 30-35% fat content is called: a. standards of fill b. standards of identity c. standards of quality d. standards of labeling

B: The Food and Drug Association manages many of the laws and regulations pertaining to food. The Food and Drug Cosmetic Act, 1938, is responsible for establishing standards of identity that specify ingredient requirements for food classification. There are standards of identity for many food products, including chocolate, ice cream, milk, and others. Other standards include the standard of quality, which specifies both quality of ingredients and acceptable defects; and standards of fill, which specifies the ingredient amount in a product (designed to prevent consumer deception). For example, a can of vegetables must contain a standard amount of vegetable and water dependent upon can size.

how much protein does the National Kidney Foundation recommend that a patient with end stage renal disease (ESRD) who has yet started to receive dialysis treatments consume daily? a. 0.5g/kg b. 0.6g/kg c. 1gram/kg d. 1.2g/kg

B: The National Kidney Foundation's Kidney Dialysis Outcome Quality Initiative (KDOQI) developed nutritional recommendations for individuals with ESRD. For those with a glomerular function less than 25 ml/min and who have not started any form of dialysis, a limit of 0.6 g/kg of protein is suggested. It is very important to adjust caloric intake such that protein is spared from being used as calories. Thus, for the aforementioned patients, 35 kcal/kg, daily, is recommended. About half of the protein intake should come from high biological value. The amount of protein being consumed should be adjusted based on renal function, nutritional status, and ability to consume adequate calories.

all of the following statements are true about the Supplemental Nutrition Assistance Program (SNAP), except: a. to qualify, one's gross monthly income must fall at or below 130% of poverty levels or 100% if the poverty level for net monthly income b. applications must have no discernable assets or money in bank accounts c. children automatically qualify for free school breakfast and lunch programs if they are receiving benefits from SNAP d. this program was formerly called the Food Stamp program and includes nutrition education services

B: The Supplemental Nutrition Assistance Program (SNAP) was formerly called the Food Stamp program. It is a federally funded program administered by the United States Department of Agriculture's Food and Nutrition Service. Congress passed the last law in 2008, called the Food, Conservation and Energy Act of 2008 as part of the Farm Bill. Income eligibility is no more than 130% of the poverty level for gross monthly income or 100% of the poverty level for net monthly income. Adjustments have been made to the law to enable consumers to have a certain amount of money in the bank and other assets, such as a car or a house worth a certain amount. Retirement and education accounts are not counted. Children who receive SNAP benefits are automatically eligible for free school breakfast and lunch programs. There are also employment requirements as well as rules for the elderly and disabled.

you enter the dry storage area and make a few observations. which of the following would be the most concerning to you? a. the temperature is 68F b. new orders are being placed on top of existing inventory c. bags of rice are stored on shelves 8in. above the floor d. an open sack of flour is found in a covered and labeled plastic container

B: The dry storage area must be dry and well ventilated. The appropriate temperature for a dry storage area is between 50-70 degrees with humidity between 50-70% to prevent the growth of mold. Food placed 8 inches off the ground is appropriate. Flour or other types of food products should be stored in air tight containers once they have been opened. Inventory should be stored using the FIFO (first in, first out) approach. This ensures that older inventory is used before the newer products. New inventory should always be placed at the back. Paper products can be stored in the dry storage area but most health codes require that chemicals and cleaning supplies be stored in a different location for safety reasons.

all of the following are true about nutritional diagnosis except: a. nutrition diagnosis is when a nutritional issue is identified and labeled b. a physician must make a nutrition diagnosis in order for the individual to receive nutritional care c. a nutrition diagnosis is documented as problem-etiology-signs/symptoms d. standardized terminology is used to delineate nutrition dianoses

B: The nutrition diagnosis is part of the nutrition care process. This is the step where the nutritional issue is identified and labeled using standardized language. A nutrition diagnosis is not made by a physician but rather an RD or a DTR depending upon the scope of practice. The nutrition diagnosis is organized and documented using a format of problem followed by etiology then signs and symptoms (PES). A standardized list is available for labeling the nutritional problem. An example of a PES is: Increased fat intake related to excessive consumption of fast food as evidenced by fasting serum cholesterol of 340 mg/dL. This statement leads the way for the nutrition intervention to be determined and implemented.

which of the following is the term that means comparing one's performance with the performance of another? a. outcomes management b. benchmarking c. performance outcome d. resource measurement

B: The process of benchmarking is an aspect of quality improvement initiatives. Benchmarking is the process where the performance of one group is measured against a comparable group. Sometimes performance is measured against national standards. The most useful type of benchmarking is comparing oneself against the best possible group, who have set and maintained high goals and standards. The process by which they have achieved the standards is closely examined. The process helps organizations identify their strengths and weaknesses. The Leapfrog Group and Press Ganey are two groups that collect this type of data. The Leapfrog Group looks at patient safety issues, whereas Press Ganey looks at patient satisfaction, safety, the flow of patients, food service, and other areas. Food service operations can use this information to improve their operations.

two men are the same age and both weigh, but one man is 5'7" and the other is 6' tall. What can be determined about their resting metabolic rate? a. their resting metabolic rate is about the same b. the resting metabolic rate is higher for the taller man c. the resting metabolic rare is higher for the shorter man d. It is difficult to draw conclusions based on the information available

B: The resting metabolic rate (RMR) is the amount of calories required to maintain bodily functions, such as breathing and maintenance of temperature. The RMR is usually 10-20% higher than the basal metabolic rate, which allows for the thermic effect of food (TEF). RMR is affected by many factors such as age, sex, body size, and composition. Typically, if two men weigh the same but have different heights, the taller man will have a higher RMR because his surface area is greater. In terms of body composition, a higher percentage of lean body mass will produce a higher metabolic rate. Women tend to have lower metabolic rates than men. As one ages, the metabolic rate decreases. Hormonal status and fever also affect the RMR.

intervention aimed to modify which of the following risk factors will reduce cardiovascular risk? a. age, cigarette smoking, obesity b. high fat diet, hypertension, cigarette smoking c. diabetes, homocysteine, alcohol consumption d. family history, LDL cholesterol, physical inactivity

B: There are a number of risk factors for developing cardiovascular disease (CVD). Category I risk factors are risk factors that have been definitively proven to reduce overall risk through intervention. These risk factors include smoking cessation, lowering LDL cholesterol, reducing blood pressure, treating thrombogenic issues, and diet modification for fat and cholesterol. Conversely, there are risk factors that will never be able to be modified, such as age, male gender, and family history of early CVD. Low socioeconomic status is another risk factor that is difficult to modify. These are considered Category IV risk factors. Category II risk factors, such as diabetes, lack of physical activity, HDL level, and obesity, will likely improve CVD risk if these risk factors are addressed. Category III risk factors may possibly lower CVD risk if intervention is provided. These risk factors include improving homocysteine level, reducing alcohol intake, and improving psychosocial situation.

what lifestyle change is most beneficial to a person with hypertension? a. limiting alcohol to 1oz/day for men or 1/2oz/day for women b. lose weight if overweight c. lower sodium intake to less than 2400mg/day d. increase intake of calcium, magnesium, and potassium

B: There are many lifestyle changes that can be made to promote lower hypertension, but the most beneficial change is weight loss. Research shows that the risk for developing hypertension is up to 6 times higher in people who are overweight. As much as a third of all cases of hypertension are due to being overweight. The Framingham Heart Study has shown that a 10% gain in weight can lead to an increase of 7 mm Hg in blood pressure. The dangers of hypertension include damage to kidney function, changes in insulin resistance, and hyperinsulinemia. Losing weight leads to a lower vascular resistance, reduces total blood volume thus reducing the amount of effort needed to pump blood, and lower cardiac output as well as improvement in insulin resistance. Even a 5% reduction in weight provides almost immediate benefits.

during inventory of a community hospital kitchen, a DTR notes that there are 2 cases of canned peaches. He decides to order 1 case of canned peaches. Which of the following is the most likely inventory scenario? a. according to the par stock system of inventory, the par level for canned peaches must be 2 cases b. according to the par stock system of inventory, the par level must be 3 cases c. according to the mini-max system of inventory, the safety stock level must be 2 and the maximum inventory level must be 5 d. the DTR is basing the decision to purchase another case solely on instinct

B: There are several different types of inventory systems in food service. One system is the par stock system. This system establishes a required minimum number for each product stock. For example, if the DTR in this case was using the par stock system and chose to order 1 case of peaches, the par level must be 2 because that would be the number on-hand after delivery. The min-max system of inventory set a maximum amount of product in stock at any one time. It also determines a minimum amount of product in stock, and when the inventory reaches this specific level, the product is replenished to the maximum level. In this example, the numbers do not add up to a maximum level. Although inventory does involve some degree of instinct and experience to order correctly, it is most often done in a systematic manner.

egg yolks used in lemon meringue pie primarily serves as which of the following agents? a. emulsifying agent b. coloring agent c. thickening agent d. textural agent

B: Typically egg yolks serve as a coloring agent in lemon meringue pie (lemon does not provide the same rich yellow color). As a whole, eggs also act as emulsifying agents (the lecithin forms a protective layer around lipid particles); thickening agents (the egg yolks act as a binding agent when heated); and textural agents. As the protein in eggs is denatured, it becomes rigid, yet it also has a rubbery, elastic quality to it as well. Egg whites can be beaten until foamy, which will then add texture to products such as soufflés, omelets, and angel food cake.

as the evening supervisor in the kitchen of a small nursing home, it is your job to verify the dish machine is operating correctly. which of the following would concern you? a. wash temperature of 140F b. rinse temperature of 165F c. dishes drying on racks to allow for air drying d. prewash water temperature of 120F

B: When using a dishwasher, prewash is required to remove food particles from plates, silverware, and other items. The proper temperature for prewash is 110-140°F. The proper wash temperature is 140-160°F, and the proper rinse temperature is 170°F to ensure all dishes are properly sanitized. Correct placement of table wares is essential to proper cleaning in the dish machine. Some machines are equipped with hot air bow dry feature but many food service operations use air drying. This saves considerable energy. It is also important to have a service plan in place for the dish machine. This should include regular maintenance to ensure proper operation.

a patient you are working with reads various magazines, many of which focus on health and nutrition. She has many questions regarding what she is reading as the advice seems conflicting. All of the following would be appropriate responses, except: a. asking her to determine whether the article is reporting information and advocating change based on information from only one study b. asking her if you may look at the article in order to determine how the diet was evaluated c. telling her that if it is published in most magazines, the information must be correct d. asking her if the article was reporting on a study done on animals or people. Also, ask her how large the sample size was.

C: A DTR has the responsibility to help clients decipher available nutrition information. Many factors must be considered when interpreting literature, whether it is publicized via a peer- reviewed journal or a media outlet. Media will often sensationalize a story. Literature may present information that is not statistically significant or has study design flaws. Moreover, studies may not have examined endpoints, such as the development of a disease. Instead, they may measure certain markers that do not always translate into the development of a disease. It is also important to note that some studies are done on animals, and the data may not be relevant to human nutrition.

food that is prepared in a hospital kitchen; cooked, portioned, and assembled on the tray line; and served to patients is an example of what type of food service? a. cook/freeze b. cook/chill c. cook/hot hold d. heat/serve

C: A cook/hot-hold type of food service is one where food is prepared and heated to the desired final temperature then held hot on the tray line. Food is then portioned, and the trays are assembled. Trays are transported to the patient unit and delivered to the patient immediately. This is an example of a centralized system. . A cook/freeze or cook/chill system involves an initial heating of the food product followed by either freezing or chilling then storage until needed. At that time, the products are heated to a final desired temperature. In a heat/serve system, commercially prepared foods are used and no initial heating is done.

which of the following is not an advantage of standardized recipes? a. customers or patients can be assured that the menu item will not change each time it is served. b. standardized recipes help to facilitate the forecasting, purchasing, and production processes. c. the recipes can easily be extended by the chef if additional food is required d. standardized recipes are necessary when using computerized systems because the reports use that format to communicate to various areas such as centralized ingredient area or purchasing

C: A standardized recipe is one that has been extensively tested in the facility where the recipe will be utilized to ensure it meets the needs of the facility. These needs may include factors such as customer satisfaction, use of equipment, or financial. It is considered a control tool. Standardized recipes help ensure the product is consistent in flavor and composition each time it is served Standardized recipes facilitate other areas of food service, such as production, purchasing, and centralized ingredient area. Food service systems that are computerized require standardized recipes to work as a trigger point of many different functions, such as developing the production schedule. It should include the title of the recipe, the yield and portion size, list of ingredients and amounts needed as well as how cooking time and temperature. If the chef is planning on extending the recipe, it should be adjusted ahead of time.

which of the following is not essential information to consider during vendor selection? a. vender's ability to reliably meet contract specifications b. vender's emergency/disaster delivery policy c. attractiveness of the vender's website d. vender's credit/refund policies delivered products that do not meet specifications (i.e. spoiled or damaged goods)

C: Although a Web site is a very important tool for any company, it is not necessarily one of the most important points in vendor selection. The relationship between a vendor and a food service operation is very important and merits careful consideration. The vendor is important to the overall functioning of the business or operation. A vendor should have acceptable policies regarding deliveries during emergencies and disasters; refunding and/or crediting the buyer if products are not satisfactory, and others. Recommendations from other food service providers are also helpful when evaluating a vendor's ability to meet contract specifications and deadlines. Value added services, such as service programs and provision of specialized equipment, are also important factors to consider when selecting a vendor.

Anthropometric measurements for children should include: a. weight for age, height or length for age and head circumference up to the age of 2 b. weight for age, skin-fold thickness and length or height for age c. weight for age, height or length for age and head circumference up to the age of 3 d. weight for age, skin-fold thickness, height or length for age and head circumference up to the age of 3

C: Anthropometric measurements in children are extremely important as a way to monitor adequacy of growth. For infants up to the age of 3, weight for age, length for age and head circumference should be measured and recorded on a growth chart. Height can be measured once a child is able to stand. Weight for length can then be plotted. For children older than 3, weight for age and height for age can be measured and plotted. Body mass index can then be calculated and plotted. Skin folds may be helpful but are not often routinely done as part of well child visits to the pediatrician. The National Center for Health Statistics (NCHS) through the Centers for Disease Control (CDC) and the World Health Organization have growth charts available for use.

the best feeding plan for a normal 3 month old infant is: a. (8) 4oz bottles of 20cal/oz formula per day b. (6) 5oz bottles of 20cal/oz formula per day plus rice cereal added to the bottle at night c. breastfeeding on demand d. breastfeeding alternated with 20cal/oz formula throughout the day.

C: Breastfeeding is highly recommended for all infants. If a woman chooses not to breastfeed, standard cow's milk formula at 20 cal/oz constitution can be offered. Breastfeeding infants should be allowed to breastfeed until they are satiated. The same is true for formula-fed infants. Force feeding a set amount of formula may lead to overfeeding and excessive weight gain. Adding rice cereal prior to 4-6 months of age is also not recommended. Adding rice cereal to the bottle at night may lead to excessive calorie intake and has not been definitely demonstrated to help infants sleep better. Weight gain should be carefully monitored to ensure that adequate calories are being consumed, and diapers should be monitored for adequate urine and stool output.

as a DTR in a rehabilitation hospital, you are responsible for determining customer satisfaction with meals. Some of the ways you may accomplish this includes all the following, except: a. comment cards or surveys b. observational surveys c. eavesdropping d. plate waste studies

C: Determining customer satisfaction is a very important part of the menu planning process. It is a subjective process that involves interpreting opinions, perspectives, and perceptions of the menu. There are a few tools that can be used to determine customer satisfaction. Comment cards and surveys may be used and include any number of questions regarding the food. These may include inquires regarding portion sizes, overall taste and appearance, service provided, and tray accuracy. Surveys can be done in house or after discharge. Observational studies and plate waste studies are other ways to gauge customer satisfaction. Eavesdropping is not the best choice but informal comments can be obtained from listening to customers talk. Customer perception is an important element when determining satisfaction.

which of the following strategies is not recommended for imparting nutrition information to a group of individuals with heart disease? a. provide a limited amount of information at one time to avoid overwhelming the group b. present the information in clear, concise, language in the simplest and least complex way possible c. ensure written information is geared to a high school comprehension level d. supplement orally presented information information with visual aids

C: Effective nutrition education encompasses many factors. Educational information should be presented in a clear, concise manner but with repetition to emphasize important points. It is also important to let the audience know in advance what you will be discussing by using words such as first, second, or next. The use of plain language is recommended because it helps to reach a wider range of people with varying literacy levels. Approximately half of the population reads at a reading level somewhere between the 5th and 8th grade. Many of these people will not understand and comprehend information presented to them at a reading level higher than that. Use plain language to simplify and visual aids to clarify presented information.

retaining good employees is challenging. which of the following is least likely to promote employee retention? a. offering an excellent benefits package, including health insurance, life insurance, 401K, etc. b. rewarding employees for good performance with bonuses or consistent raises c. maintaining rigid scheduling because work comes first d. providing opportunities to learn new skills

C: Employee retention can be bolstered by a variety of means. Great benefits packages and competitive compensations, with performance-based raises, are great motivational tools. Employee educational programs promote learning, future career growth, and possible promotions from within. Employees also like flexible work schedules. When this is not possible, manager consideration and accommodation of schedule requests go a long way towards satisfying employees. Moreover, the workplace should be characterized as a positive atmosphere to which employees can look forward to going each day.

which of the following types of fire extinguishers should not be used on a grease fire? a. foam b. sodium bicarbonate c. water d. carbon dioxide

C: Fire safety training is extremely important in food service establishments as there is a high risk of fire as well as potential for injury to employees, patients, and customers. Each food service establishment should have a fire safety policy that is reviewed with each employee at hiring and annually thereafter. The policy should include an evacuation route or plan. All employees should participate in mandatory fire drills to ensure they are prepared. Common causes of fires and types of fire extinguishers should be reviewed. Water-type extinguishers should never be used on a grease fire as this will cause the grease to splatter and increase the size of the fire very quickly. A very small grease fire can be put out by covering the pan with a lid. A class B fire extinguisher is appropriate for flammable liquids, such as grease, gasoline, or paints.

food that is purchased from an instate vendor and shipped intrastate is subject to all of the following regulations except: a. USDA b. FDA c. Food and Nutrition Service d. all local and state regulations if they are at least the equivalent of the federal regulations

C: Food purchased within a state and shipped intrastate is subject to regulations enforced by the US Department of Agriculture, which is responsible for the regulation of meat, poultry, and other types of processed foods. It is also subject to regulation by the Food and Drug Administration, which is responsible for enforcing the production, manufacturing, distribution, and labeling of many food items with the exception of meat, eggs, and poultry. All state and local regulations, which are equal to or greater than federal regulations, must also be followed. In some cases, the regulations are more stringent. The Food and Nutrition Service, as part of the USDA, deals mainly with hunger assistance, not food regulation.

all of the following are potential benefits of genetically engineered food, except: a. a faster growing food supply, thus greater food production b. food that tastes better and is more nutritious c. shorter shelf-life d. reductions in pesticide use

C: Genetically engineered food is a fast growing industry. Scientists alter the genetic makeup of foods to induce a certain trait without having to wait for natural evolution. . Scientists support genetic engineering saying that the potential benefits include more nutritious and flavorful food as well as faster growing periods, which results in faster food production. Increases in food shelf-life may also be a result of genetic engineering. . . Pesticide use is reduced; however, genetic engineering may affect the resistance of plants to certain pests. Foods that have been genetically engineered include potatoes, tomatoes, and soybeans. Animals are also subject to this process. There are still a number of unknowns about genetic engineering, such as the effects of genetically engineered foods on children and the potential risks for allergic reactions, which make people question whether this process is safe for the long-term.

in the quality improvement process, which of the following is a difficult outcome to measure? a. the percentage of patients who had a nutrition screening completed within 24 hours of admission b. the number of patients who had a nutrition consult triggered because of low serum albumin on admission c. the percentage of patients who met 75% of their nutrient goals everyday d. the percentage of patients receiving nutrition support through the most appropriate route

C: In order for the quality improvement process to work, there must be measurable outcomes. Outcomes are the end result of interventions. Outcomes can encompass clinical, functional, or financial issues. The outcome needs to be objective and measurable. Perception also plays a role in outcomes. In the examples above, measuring and tracking the percentage of patients who met 100% of their nutrient needs may be a difficult outcome to measure, especially in a large facility. This would be time consuming and labor intensive. It would also include some degree of uncertainty, due to the estimations that would be made.

a dinner of broiled fish, steamed rice, cauliflower, bread and butter, and tapioca pudding with whipped cream is planned for a Friday evening at the retirement home. What food characteristic is most lacking? a. texture b. flavor c. color d. consistency

C: Menu planning involves thinking about and visualizing how the food will look on the plate when served. In the example, the food is monochrome and not visually pleasing. Color is important in menus and at least two different color items should be offered at a meal. There are so many different types and colors of vegetables that it should never be problematic to find one that is in season and affordable to add to a menu. Other menu characteristics to consider include texture, consistency, and shapes. Varying flavors is also important as too many strong flavors may not go well together. Varying the method of food preparation is also important.

a side effect of chemotherapy is mucositis and xerostomia. this can impact nutritional status because: a. weight loss can occur due to nausea and vomiting b. food intake is reduced due to constipation and abdominal pain c. anorexia, reduced food intake and weight loss can occur due to mouth pain and dryness d. weight loss can occur due to dysphagia

C: Mucositis is defined as inflammation of the mucous membranes usually in the mouth, but it can also occur along the digestive tract. The consistency of a patient's diet can be altered to alleviate some of the pain from mucositis. Examples of diet modification include soft, bland foods void of extremes in temperatures. Avoidance of salty, sour, citrus, and spicy foods and alcohol is generally recommended. Xerostomia is defined as abnormal dryness of the mouth. This side effect can be addressed by avoiding tobacco and alcohol and adequately hydrating. Soft, moist foods are recommended; foods that stick to the roof of the mouth should be limited. Sugarless candies, gum, and lemon may stimulate the flow of saliva.

the purpose of nutrition screening includes all of the following, except: a. identifying risk factors known to be associated with nutritional issues b. identifying individuals who are malnourished c. assessing body mass index d. to more efficiently identify individuals who require a full nutrition assessment

C: One purpose of nutrition screening is to identify risk factors that have been associated with nutritional issues. Nutrition screen also helps to identify malnourished individuals in a timelier manner. The process allows individuals to be more efficiently and quickly identified so nutrition intervention can be initiated. Known risk factors for malnutrition or risk factors that may increase the risk of developing malnutrition are useful in this process. Once an individual is identified in the screening process, a full nutrition assessment can be completed and nutrition care initiated. Body mass index may be utilized in the screening process though this is not generally the purpose of the screen.

outcome measures for nutrition intervention for a patient with chronic obstructive pulmonary disease may include all of the following, except: a. improvement in nutritional status b. improvement in activities of daily living (ADL) c. improvement in renal function d. improvement in weight loss

C: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for malnutrition due to a number of factors. Poor respiratory function can negatively impact appetite, food intake, one's ability to prepare food, and increase caloric requirement with the increased effort to breathe. The prognosis for individuals who develop malnutrition is not as favorable as for those without malnutrition. Nutrition intervention is usually geared towards ensuring adequate caloric, protein, vitamin, and mineral intake as well as providing a balanced diet, which prevents carbon dioxide retention. Overall outcome measures for this population include improvements in weight status and nutritional status. Outcome measures may also include improvements in ADLs, such as meal preparation. Outcomes correlating with renal function are not necessarily measured unless renal dysfunction was preexisting.

which of the following statements about the receiving process is false? a. the receiving area should be close to the delivery docks b. each delivery should be visually checked against the purchase order and the invoice c. frozen items should be placed immediately in the freezer before inspection d. cases or crates should be randomly opened to verify contents

C: Receiving is a very important process. The receiving area should be located close to the delivery dock and near the storage area. This helps reduce the amount of traffic through the production area. The delivery should be checked by a well trained employee to determine if the order matches the delivery as well as to inspect the quality of the deliverables. The delivery should be checked against the purchase order and should also be verified against the invoice as well. When receiving frozen goods, they should be inspected prior to moving into the freezer to ensure the products are still frozen and have not been thawed and refrozen during transport. All food should be checked for quality, and it is a good idea to randomly check cases or crates to verify contents. Security in the receiving area is important to prevent theft.

the main highlights of the 2005 Dietary Guidelines for Americans include all of the following, except: a. achieve and maintain a healthy body weight and incorporate at least 60 minutes of moderate physical activity to help with weight management b. limit fat intake to 20-35% of total calories, with less than 10% of fat intake from saturated sources, and limit the in take of trans fatty acids c. consume plenty of fruits, vegetables, and whole grains to protective against certain chronic diseases d. eat less than 2300mg/day of sodium and consume 3cups/day of low fat or fat-free dairy products.

C: The 2005 Dietary Guidelines for Americans incorporated evidence based recommendations in 9 topic areas. The 2000 guidelines recommended plenty of fruits, vegetables, and whole grains; however the 2005 guidelines provide recommendations to consume vegetables from specific color categories, such as 3 cups/week of dark green and 2 cups/week of orange vegetables. These guidelines also provide specific guidelines for consuming 3 servings/day of breads, cereals, or pasta with the remainder from whole grain products. The guidelines also recommend achieving and maintaining a healthy body weight and engaging in at least 60 minutes of moderate activity most days of the week. Other recommendations include minimizing fat intake to no more than 20-35% of total calories and saturated fat to less than 10% of total calories; consuming 3 servings/day of dairy and less than 2300 mg of sodium per day; and limiting alcohol intake to one drink/day for women and 2 for men. The guidelines also address food safety.

A famous television star is admitted to a hospital due to an injury that occurred during filming. Many employees have legitimate access to his computerized medical record, but some who do not, access his records anyways. Later, information is leaked to tabloids. A review of who has authorized access occurs, and many employees are terminated. What is a possible reason for termination?

C: The Health Insurance Portability and Accountability Act of 1996, is also known as HIPAA. Within HIPAA, there is a privacy rule called Standards for Privacy of Individually Identifiable Health Information. All health insurance plans, health care providers, and organizations that process medical information are bound by this law. Any information entered into the medical record is protected as well as any conversations that occur between health care providers. There must be strict policies in place to safe guard this information and limits are also put in place to restrict access to medical records. For example, in a hospital, many employees have access to computerized records. However, only the employees who are directly responsible for the patient's care are authorized to look at this information. Written permission is required for any information to be shared. Any violation of this law can be met with civil or criminal consequences.

which of the following is not a JCAHO approved medical abbreviation? a. mg for milligram b. ml for milliliter c. Q.D for every day or daily d. IV for intravenous

C: The Joint Commission on the Accreditation of Healthcare Organizations has developed a list of abbreviations that should not be used in the medical record. This list is called the "Do Not Use" list. This list was developed in the interest of patient safety because frequent medical errors have been made using the abbreviations on this list. Some of the abbreviations on this list include: U (units) because it can be confused with a zero; and IU (international units) because it can be mistaken for intravenous. Trailing zeros should be omitted because the decimal point may be missing or illegible. QD and QOD should be written out as daily and every other day, respectively. MS needs to be written out because it can be interpreted to mean morphine sulfate or magnesium sulfate. Additional abbreviations may eventually be added to this list.

which of the following best describes the guidelines for the Therapeutic Lifestyle Changes (TLC) diet? a. limit sodium to 3000mg/day, calories from fat to less than 35% of total calories, with those from saturated fat less than 10%, cholesterol to less than 300mg/per, and sufficient calories to achieve or maintain a healthy body weight b. limit sodium to 3000mg/day, calories from fat to less than 30% of total calories, with those from saturated fat making up less than 5%, cholesterol to less than 200mg/day, and sufficient calories to achieve or maintain a healthy body weight c. limit sodium to 2400mg/day, calories from fat to 25-35% of total calories, with those from saturated fat less than 7%, cholesterol to less than 200mg/day, and sufficient calories to achieve or maintain healthy body weight d. limit sodium to 2400mg/day, calories from fat to less than 30% of total calories, with those from saturated fat less than 10%, cholesterol to less than 200mg/day, and sufficient calories to achieve or maintain a healthy body weight

C: The National Cholesterol Education Program (NCEP) devised a diet called the Therapeutic Lifestyle Changes diet (TLC) as part of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III panel). This diet serves to replace the old Step I and II diet. The diet is geared for people who are at high risk for cardiovascular disease (CVD) or already have CVD. The diet consists of sufficient calories to achieve or maintain a healthy body weight; total fat intake limited to 25-35% of total calories, with less than 7% from saturated sources; cholesterol intake less than 200 mg/day; and 2400 mg or less of sodium per day. Additionally, it is recommended that complex sources of carbohydrates be included as well as 10-25 g soluble fiber and 2 g/day of a plant sterol or stanol.

a 78-year old man is recovering from a stroke. the speech language pathologist has recommended a NDD level 2 diet for him. This diet consists of: a. no restrictions on consistency or texture b. foods that are softer in texture but require more ability to chew c. moist, semisolid foods that require some chewing ability d. puree foods with pudding like consistency and minimal chewing ability is required

C: The National Dysphagia Diet (NDD) was published in 2002 by the American Dietetic Association as a method to streamline the language and definitions used for texture modified diets. The NDD involved a panel of experts including dietitians, speech language pathologists, and a food scientist. There are 4 levels to the diet ranging from Level 1 to regular consistency. Level 1 is a dysphagia pureed diet where food is cohesive and does not need to be formed into a bolus. Minimal chewing ability is required. Level 2 is dysphagia- mechanical altered consistency, which means that the food is moist and semisolid requiring just a little chewing. Level 3 is dysphagia advanced, which is a soft diet that does require some chewing skills. Last is the regular level, in which there are no texture restrictions. The NDD also provides specific terms for liquids including thin, nectar-like, honey-like, and spoon thick.

the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) uses which of the following to assess patient care during a survey? a. tracer methodology b. chart reviews c. audits d. standards interpretation

C: The National Patient Safety Goals were developed by JCAHO in an effort to improve patient safety. It also incorporates Universal Protocol, which involves a 3-step process to ensure the correct body part is treated. There are 16 patient safety goals that include improved communication, such as how verbal orders are treated and the use of the "Do Not Use" list. The goals also involve using two patient identifiers, such as the ID band and asking the patient for their name. Furthermore, the goals target medication labeling, nomenclature, and reconciliation. The goals also encourage the patient to be actively involved in their own care by asking questions or having family members involved as a safety check.

a new dish machine is for the retirement home kitchen. the money to purchase this piece of equipment will come from which part of the budget? a. master b. operating c. capital d. cash

C: The capital budget includes money for purchasing or replacing equipment and should be part of the long-term financial planning for an organization. Items included in the capital budget generally have a minimum dollar amount, such as $10 000. The operating budget serves the day-to- day operations. The cash budget accounts for incoming and outgoing cash. The master budget includes the capital, operating and cash budgets.

how many g of carbohydrate are in the following breakfast: 4oz orange juice, 2 slices of whole wheat toast with 2 teaspoons of margarine and 1 tablespoon jelly, 1/2 cup of oatmeal with 1/2 banana, small cup of black coffee. a. 50g b. 60g c. 90g d. 120g

C: There are approximately 90 g of carbohydrate in the described breakfast. 4 oz of juice and 1⁄2 of a banana contribute approximately 15 g each. One slice of bread and 1⁄2 cup of oatmeal each contribute 15 g. One tablespoon of jelly contributes approximately 15 g as well. Reading food labels is one way to know how many carbohydrates are in certain foods. This method of keeping track of carbohydrate intake is called carbohydrate counting. It is a way for people to know how many grams of carbohydrates they are eating and how this affects blood glucose levels. Fine tuning the total amount of carbohydrates at each meal and snack is important for good control.

all of the following maybe tasks performed by a DTR under the supervision of a RD, except: a. completing nutrition screens in the retirement home b. teaching nutrition education classes at WIC c. providing tube feeding recommendations on the RD's day off d. working at a fitness club assisting with weight loss

C: There are many job opportunities for DTRs. Some jobs require the DTR to work as part of a team under the supervision of the RD. These jobs are often found in settings such as hospitals, nursing homes, long-term care facilities, and research environments. Other jobs enable the DTR to work independently but still with the supervision of an RD. The jobs may be found in business, health clubs, or contract food service companies. DTRs can educate people, such as new moms in the WIC program or clients in a health club, who need help with weight loss. DTRs also work in schools, correctional facilities, and other settings. Moreover, DTRs may also work in a management capacity supervising employees, developing budgets, purchasing, etc.

which of the following statements is not true about soluble fiber? a. as soluble fiber is digested, it becomes gel-like b. soluble fiber works to slow the digestive track c. soluble fiber works to add bulk to the stool helps move food through the digestive track faster. d. soluble fiber may help lower cholesterol levels

C: There are two types of fiber found in foods: soluble and insoluble. Soluble fiber is found in foods such as oat bran, legumes, fruits, and vegetables. The addition of soluble fiber to one's diet has been shown to help lower cholesterol levels. Once it is consumed and comes in contact with water, it forms a gel-like substance. Soluble fiber works to slow the digestive process. Insoluble fiber, on the other hand, works to slow the transit of food through the digestive tract because it adds bulk to the stool. Adding insoluble fiber is helpful when treating constipation. Whole grain breads and cereals as well as fruits and vegetables contain insoluble fiber.

the nutritional priority for a patient with newly diagnosed type 1 diabetes mellitus is: a. weight loss b. determination of a medication regimen then establish of a meal plan c. establishment of a meal plan then coordination of the medication regimen to match the meal plan and exercise habits d. placement of an insulin pump

C: There have been so many advances in the fields of diabetes and insulin regulation that the priority for any newly diagnosed patient should be to establish a meal plan first. The patient's usual eating habits, timing of meals, and food preferences need to be incorporated into the treatment plan. Once this is determined, the insulin regimen can be coordinated accordingly. Unfortunately this does not always happen and patients are left to make drastic changes to their lifestyle to accommodate the insulin schedule. Weight loss is not always indicated for these patients, especially at the time of diagnosis. If weight loss is necessary, it is something that can be explored once the patient is metabolically stable. An insulin pump may indeed be an option for many patients but the meal plan is still first step. .

a client you are working with to reduce her cholesterol frequently interrupts you during the session and makes comments such as, "I am trying to make changes, but I have been under a lot of stress lately," or responds to questions with. "Yes, but..." is displaying what type of behavior: a. ready to change b. unsure about change c. resistance to change d. contemplating change

C: This client is displaying resistant behavior. This type of behavior can be observed in many different ways, such as frequent interruption and offering excuses. Also, a client may try to tell you what is wrong with your suggestions for making change by saying "Yes, but..." Some clients will remain in denial about needing to change or will try to blame another person for being unable to follow nutrition advice. The client may also question the professional's ability to educate or their knowledge on the subject being discussed. A client with resistant behavior may also be very hostile.

while serving as a dietetic technician, you are tasked with visiting patients in a long-term care facility during mealtime in order to long-term observe daily food intake. which of the following observations are you least likely during these meal rounds? a. a patient with dementia consumes less than 50% of breakfast and lunch during a 2 day period b. a patient who is S/P major cardiac surgery is not able to effectively use utensils provided to self-feed c. a patient who is ordered supplemental beverages with meals in order to increase caloric intake does not drink the supplements during the 2 day observation d. a patient recovering from a stroke appears to tolerate a puree diet and may be able to tolerate an advance to a soft diet

D: A DTR can work at a long-term care facility under the direction of an RD. Visiting patients during meals is one function a DTR may perform. The DTR can perform visual observation of a patient's progress with meals. A DTR can visually assess whether an individual is consuming a certain percentage of meals, and this information is helpful in making additional recommendations for nutritional care. The DTR can visually observe whether someone is having difficulty with utensil use and may benefit from the services of an occupational therapist. The DTR can also observe whether the patient is consuming the supplements ordered for them or assist with finding an alternative. Making dietary texture recommendations for and observations of a patient who has had a stroke is difficult as medications may be necessary to accommodate swallowing, not chewing, issues.

a health inspector visits the hospital food service operation where you are a food service supervisor. as the only supervisor on duty at the time, which of the following should you not do during the inspection? a. ask to see the inspector's credentials b. follow the inspector throughout the inspection, make notes of any violations found, and try to fix any small problems while the inspector is there c. sign the copy of the inspection d. refuse the inspection on the grounds that a manager level employee is not present for the inspection

D: A health inspector's visit should never be a complete surprise. Rather, it should be something that is planned and anticipated even if it is not scheduled. The food service operation should do self-assessments and self-inspections. The food service staff should be briefed on any findings so they can be addressed prior to an actual visit. When the health inspector visits, it is appropriate to ask to verify the inspector's credentials as there have been incidents of imposters. The inspection should never be refused because the inspector can then obtain a warrant to inspect the operation. Moreover, the initial refusal may raise a red flag to the inspector. It is appropriate to take notes during the inspection. Upon completion of the inspection, the report should be signed. Signing the report signifies only that you have received a copy; it does not mean you're going to be held responsible for what's on it.

you are completing inventory in the walk in refrigerator. which of the following should be discarded? a. 2-day old leftover beef stew with a temperature of 40F b. hard cooked eggs cooked 5 days ago with a temperature of 39F c. tightly wrapped hard cheese that is 5 months old with a temperature of 40F d. 4-day ground beef with a temperature of 42F

D: A list of suggested maximum storage times and temperatures should be readily available to employees who monitor the inventory. Ground beef should be held at a temperature no higher than 38 degrees for no longer than 2 days. In the interest of food safety, this should be discarded. Hard cooked eggs, if refrigerated at a maximum temperature of 40 degrees, can be held for up to 7 days. Hard cheese that is wrapped tightly and held at a maximum temperature of 40 degrees is good for up to 6 months. Leftover beef stew held at a maximum temperature of 40 degrees is good for up to 4 days. Leafy vegetables that have not been washed can stay good up to 7 days, and root vegetables, such as potatoes and onions can be held for at least a month. Fruits can vary from a week to 2 weeks depending upon the kind of fruit.

a nutrition screen must be completed by which of the following? a. a registered dietitian (RD) b. a registered dietetic technician (DTR) c. a nurse d. a trained health professional (not necessarily an RD or DTR)

D: A nutrition screen can be completed by either a registered dietitian (RD) or a registered dietetic technician (DTR), but in many places, the screening is done by a trained health professional such as a nurse or physician. Nutrition screening is done in a hospital setting; however, it is also done in settings such as clinics, senior centers, or in the individual's home. If the individual is identified as high risk, he or she is then referred to an RD. In many institutions, it is within the DTR's scope of practice to do the nutrition screening.

the type of menu that provides at least two choices in each menu category is called: a. static b. nonselective c. semi-selective d. selective

D: A selective menu is a menu that gives at least two choices in each of the categories listed on the menu, such as appetizers, salads, entrees, vegetables or sides, desserts, and beverages. A semi- selective menu offers at least one choice in a few of the menu categories but not all. For example, at certain health care facilities, a choice of two entrees and two desserts may be offered but soup and vegetable choices are not offered. A static menu is a menu where the same choices are offered each day. Occasionally the choices may include specials to increase variety. A nonselective menu is also referred to as a preselected menu and does not offer choices in any of the categories. Typically a list of alternatives or substitutes is available for those who do not like the choices, and these are written in on the menu.

in Maslow's Hierarchy of needs, which of the following needs must be met first? a. social b. safety c. self esteem d. physiological

D: Abraham Maslow developed a motivational theory based on individuals meeting certain growth needs before being able to advance to the next level. The first level is physiological need. This is the need to satisfy hunger, thirst, clothing, shelter, and breathing. Next, are safety needs, such as freedom from fear and harm. This is followed by social needs, such as the need to belong, be loved, have friends, and overall acceptance. The fourth need is satisfying self-esteem needs, such as status, recognition, or achievement. The last need is self-actualization where one reaches his or her own potential and is fulfilled. Maslow believed that the higher one got in the hierarchy, the more knowledge and wisdom one gained.

which of the following is not an ingredient in baking powder? a. corn starch b. sodium bicarbonate c. cream of tartar d. potassium bicarbonate

D: Baking powder is a leavening agent for baked products. Baking powder consists of 3 ingredients: baking soda, cream of tartar, and corn starch. The baking soda acts as the alkaline salt, the cream of tartar acts as the acidic salt, and the corn starch absorbs moisture. Ultimately, baking powder produces carbon dioxide. Baking powder available in two forms: single and double acting. Single acting baking powder is activated by moisture in the recipe. Recipes using this form need to be baked immediately because the reaction starts right away. Double acting baking powder works in two phases. The first reaction occurs while at room temperature, and the second occurs in the oven. Generally baking powder is used in cake and biscuit recipes while baking soda is used in cookies.

all of the following would be potential interventions for a patient with type 2 diabetes mellitus, except: a. weight loss b. increasing physical activity c. reducing calorie intake d. chromium supplementation

D: Chromium supplementation has not yet been proven an effective means of lowering blood glucose levels for individuals with Type 2 diabetes mellitus. The most effective interventions are weight loss, physical activity, and reducing calorie intake. Weight loss helps improve insulin resistance. Even small amounts of weight loss can be beneficial, especially if weight is lost in the abdominal area. Increasing physical activity helps to lower blood glucose levels by making cells process glucose more effectively. It also helps with weight reduction. Reducing calorie intake has also been shown to be helpful in reducing blood glucose levels. .

which cooking method is recommended for cuts of beef such as stew beef, short ribs, chuck steak or beef round? a. pan frying b. broiling c. roasting d. braising

D: Cuts of meat, such as stew beef, short ribs, chuck steak, beef round, or pot roast are usually less tender cuts and require a moist method of cooking to improve tenderness. Braising typically requires that the meat be browned in a hot frying pan with a little bit of oil to seal in the juices. Liquid, such as water or broth, is then added to the pan. The lid is placed on tightly, and the meat is cooked slowly over a period of time until the meat is tender and done. Roasting, broiling, and pan frying work better for cuts of meat that are already tender and flavorful.

what is the recommend initial nutrition intervention for diverticulitis? a. high fiber diet with adequate fluid and exercise b. high fat diet with moderate fiber c. chemically defined diet d. low fiber diet

D: Diverticulitis is defined as an inflammation of an abnormal pouch-like sac in the wall of the intestine. Diverticulosis is the condition of having the pouch present. When the pouch or sac becomes inflamed, a low fiber (also referred to as low residue) diet should be initiated. This often begins with liquids. A diet high in fat may exacerbate the condition and a low fat diet is usually better tolerated. The diet should be maintained until the inflammation subsides, and then fiber can be gradually added back into the diet. Tolerance should be monitored as fiber is being added. Once the individual is eating a normal diet, fiber intake should be maintained as high as possible with a goal of 30 g/ day. Adequate fluid and exercise is essential to keep the bowels working well and to prevent constipation. Nuts and seeds may be avoided if these foods have caused diverticulitis in the past.

which of the following choices represent acceptable food selections for a mother who is using a WIC EBT for herself and her breastfeeding infant? a. fresh fruits and vegetables, white bread, whole milk, tofu b. yogurt, cheese, peanut butter, orange drink c. white potatoes, rice milk, corn flakes, canned tuna d. oatmeal, chocolate milk, eggs, canned kidney beans

D: Federal requirements mandate that specific foods be available to those participating in the WIC program. All WIC foods must meet the Food and Drug Administration's Standards of Identity to qualify. Breakfast cereals have iron requirements and sucrose limitations. Breads must be whole grain and contain a certain percentage of whole grains. Juice must be 100% juice and not flavored drinks. . Most types of milk are acceptable, including flavored and soy. Cheese is also included as long as is not a processed spread or imported. Yogurt is not an option. Tofu, eggs, peanut butter, most legumes, and canned fish are all available protein choices. Most fruits and vegetables in the fresh, frozen or canned forms are acceptable, however, white potatoes, condiments, salad bar items, and fruit roll up type products are not allowed. There are also many infant products available, such as infant cereal and jarred foods; however, packages for lactating moms will vary if formula is being supplemented.

which of the following is the next step for an individual who does not want to begin medication to lower blood cholesterol but has not had success with the TLC diet? a. consume less than 20% of total calories from fat, with less than 10% coming from saturated sources, and less than 200mg cholesterol per day b. consume less than 15% of total calories from fat, with less than 8% coming from saturated sources, and less than 100mg cholesterol per day c. consume less than 10% of total calories from fat, with less than 5% coming from saturated sources, and less than 50mg cholesterol per day d. consume less than 10% of total calories from fat, with less than 3% coming from saturated sources, and less than 5mg cholesterol per day

D: For individuals who wish to initiate aggressive dietary intervention in an effort to avoid medication or to more aggressively try to achieve blood lipid goals while receiving cholesterol lowering medications, a very low fat diet may be tried. This is not a popular option nor is it an easy plan to follow. This type of diet is basically a vegetarian option although egg whites and nonfat dairy products are allowed. All meat, fish, and poultry are omitted. Other protein sources include soy products and dried beans and legumes. The rest of the diet consists of whole grain products, fruits, and vegetables. Added fats in the form of oils or margarine are not allowed. Foods that contain good types of fat, such as nuts or seeds, are also omitted.

effective communication involves all of the following, except: a. oral b. written c. action or demonstration d. grapevine

D: In order to be an effective leader, good communication skills are essential. Communication can take various forms including oral, written, and action. The grapevine is indeed a form of communication; however, it is an informal method. Some facts may come through the grapevine, but most of the information has been skewed or altered. The grapevine also contains rumors or gossip and may be detrimental if the information is passed along. With effective communication, one is much more likely to remember what is being communicated. It is less likely an employee will remember something that is only verbalized and lacks visual or hands-on supplementation. Reading and understanding body language is also an important facet of good communication.

chronic alcoholics are most likely to be deficient in the following nutrients, except: a. magnesium b. thiamin c. folate d. vitamin c

D: Individuals with chronic alcohol abuse are at risk for many vitamin or mineral deficiencies even if they are well nourished. Chronic alcohol abusers may experience a folate deficiency, which may lead to anemia, because alcohol interferes with the metabolism of folate. Thiamin is another potential deficiency directly related to alcohol abuse. This leads to Wernicke-Korsakoff Syndrome, which is characterized by confusion, memory loss, and problems with coordination. It can lead to permanent brain damage. Other B vitamins may also be affected by alcohol abuse. Magnesium is another nutrient that is commonly deficient in those with excessive alcohol intake. Other nutrients may also be affected depending upon the individual's diet and overall nutritional status.

the food service director of an extended care facility wishes to review changes in the food served to residents with the DTR. All of the following tools are needed to assist with this task except: a. a diet manual b. a master menu c. information regarding the number and types of modified diets served d. the production schedule

D: It is important for food service operations that operate in healthcare facilities to utilize the services of nutrition professionals in order to comply with written physician diet orders. The master menu and diet manual are necessary in order to create modified menu extenders. This collaboration ensures the master menu can also meet the needs of those requiring special diets. For example, if baked chicken is planned for regular diets, the entrée must be evaluated for different texture consistencies, sodium, and/or fat modifications and appropriateness or for individuals with diabetes. This ensures that the meal is in compliance with the written diet order and that appropriate foods are being served to the residents of the facility. It also helps the purchasing process as any special foods will are identified.

which of the following groups are the highest risk if listeriosis is contracted? a. infants b. children, aged 1-5 c. older adults d. pregnant women

D: Listeria is a type of bacteria that can be found in raw foods, processed foods, such as hot dogs and deli meats, as well as dairy products, such as soft cheeses. Listeria is unique in that it can grow in cooler temperatures including the refrigerator. Listeria is especially dangerous to pregnant women as it can lead to stillbirth or delivering prematurely. The symptoms of listeriosis include muscle aches, nausea, and diarrhea. The symptoms can be similar to those of the flu. Other high risk groups include people with compromised immune systems. People older than 60 and infants are also at higher infection risk as they may suffer long-term brain damage from infection.

possible nutrition interventions for a child with cancer who is not eating enough include all of the following except: a. serve small meals and snacks throughout the say capitalizing on the times when the child is feeling hungry and wants to eat b. encourage liquids mostly between meals because drinking a lot of fluid with meals may make the child feel too full c. let the child help make the food they will eat and have friends over to eat with the child d. serve meals on a tight schedule because missing a meal will set the child back too far

D: Many interventions may be employed to encourage a child to eat greater quantities. Small meals and snacks should be offered throughout the day to try to gradually increase the amount of food a child is eating. A variety of foods should be offered. When the child feels hungry, it is important to capitalize on this moment and offer a larger meal. Limiting the amount of fluid the child drinks with meals is important so the child does not feel too full from liquid calories. Presenting the food in an interesting way, such as in different shapes or on fun plates, may encourage the child to eat more. Increasing physical activity may also stimulate the child's appetite.

characteristics of the metabolic the metabolic syndrome include all of the following, except: a. serum triglycerides greater than 150mg/dL b. serum glucose greather than 110mg/dL c. waist circumference greater than 102cm in men and 88cm in women d. blood pressure greater than or equal to 140/90mm Hg

D: Metabolic syndrome is a compilation of multiple disorders, including insulin resistance, elevated glucose levels, hypertension, and elevated lipid levels. These disorders are dangerous alone and when linked together will increase the risk for Type 2diabetes mellitus, heart disease, and stroke. Specific criteria have been developed in order to help diagnose the condition; fat in the abdominal area (known as apple shape) and insulin resistance are the most important indicators. Glucose levels higher than 110 mg/dL, triglycerides higher than 150 mg/dL, and HDL levels lower than 40 mg/dL in men and 50 mg/dL in women are all risk factors. A blood pressure reading greater than or equal to 135/85 mm Hg is a risk factor. Waist circumference measurements greater than 102 cm in men and 88 cm in women are risk factors. It is important to identify metabolic syndrome and to treat accordingly to reduce the chance of developing diabetes.

the motivation interviewing style used during nutrition counseling includes all the following characteristics except: a. empathy b. encouragement c. reflective listening d. rewards and reinforcement

D: Motivations interviewing is a direct and patient-centered method for dietetic practitioners to counsel a patient. The practitioner should express empathy and encouragement while using reflective listening techniques. Reflective listening entails listening to what the patient is saying then making a statement interpreting how the patient feels. The counselor needs to continuously determine the patient's state of readiness for change in order to prevent resistance. The patient is allowed freedom to make his or her own choices assuming that motivation is internal and will be sufficient to provide motivation from within. The counselor does not judge the patient or confront him or her. The patient talks more than the counselor. This style works best if a patient is ambivalent or not ready to change their diet because it helps them to explore the reasons for this.

which of the following laws apply to a hospital cafeteria renovation? a. The Rehabilitation Act b. The Workforce Investment Act c. The Civil Service Reform Act d. The Americans With Disabilities Act

D: The Americans with Disabilities Act (ADA), effective July of 1992, prohibits any discrimination against anyone who has a disability. It also guarantees equal opportunities for people with disabilities in two main areas--employment and public accommodations, such as transportation and facilities. When planning a hospital cafeteria renovation, it is imperative to follow the law exactly. . The law requires reasonable accommodation to make facilities accessible to all people. There are checklists available to help with planning. The list includes items such as widening of doorways to accommodate wheelchairs, addition of ramps, lowering shelves, and adapting other workspaces. This law applies to all employers who have more than 15 employees, has federal contracts worth over $10,000, or receives federal financial assistance.

a 45 year-old women is following the DASH diet. She is consuming 1800cal/day. Which of the following sets of nutritional goals is appropriate for her based on the DASH diet guidelines? a. 60g of total fat with up to 20g saturated fat, 70g of protein, 250g of carbohydrate, 2,300mg sodium, 200mg cholesterol, 20g of fiber b. 50g of total fat with up to 20g saturated fat, 90g protein, 250g of carbohydrate, 1500mg sodium, 100mg cholesterol, 25g of fiber c. 90g of total fat with up to 25g of saturated fat, 90g protein, 270g of carbohydrate, 2300mg sodium, 300mg cholesterol, 30g of fiber d. 55g of total fat with up to 12g saturated fat, 80g of protein, 250g of carbohydrate, 2300mg sodium, 150mg cholesterol, 30g fiber

D: The DASH diet stands for Dietary Approaches to Stop Hypertension. Studies were done by the National Heart, Lung, and Blood Institute (NHLBI) that demonstrated a reduction in blood pressure in response to a diet that was low in total fat and saturated fat, low in cholesterol and sodium, and also included foods that were high in other nutrients, such as magnesium, potassium, and calcium. The general DASH diet nutrient guidelines are: limited total calories from fat to 27%, with up to 6% coming from saturated sources; 150 mg cholesterol; 18% of total calories from protein; and 55% of total calories from carbohydrates. For 1800 calories, this would equal 55 g of fat (495 calories) with 12 g of saturated fat, 80 g of protein (320 calories), and 250 g of carbohydrate (1000 calories). The guidelines also call for 2300 mg of sodium per day with an option of 1500 mg, and 30 g of fiber.

the DTR at the local community hospital is busy with nutritional screening, assessment, documentation, and education. The RD position has been vacant for quite a few months with no immediate prospects. The Director of Nutrition and Food Services feels the DTR is doing a great job. Is there a need to be concerned? a. no, the important point is that the patients are receiving nutritional care b. yes, the DTR should be completing just the nutrition screening c. no, the state regulations do not specify the work must be done by an RD. d. yes, the DTR is working without an RD's supervision and is putting the hospital at risk for consequences, such as fines or loss of license

D: The DTR who is involved with the nutritional care of patients must work under the supervision of an RD. If this is not being done, state agencies may investigate, and it could lead to the loss of an RD's license, fines for the facility, loss of the facility's license, or certification status for reimbursement. For end stage renal disease, the Centers for Medicare and Medicaid Services state that all nutritional care must be provided by an RD who has at least one year of experience post- internship. Much of healthcare is controlled at the state level, thus definitions of certain terms must be verified in the appropriate state. The scope of a DTR's practice varies by state, but may include screening, collecting data, diet histories, or calorie counts.

the Institute of Medicine has identified 6 Quality Aims. These include all of the following, except: a. patient safety and timeliness b. patient-centered and equity c. effectiveness and efficiency d. competency and relevance

D: The Institute of Medicine (IOM) published a report in 2001, called Crossing the Quality Chasm: A New Health System for the 21st Century. In this report, the IOM stated that the US healthcare system needed to undergo significant changes in order to improve the quality of healthcare. It identified 6 aims for improving healthcare. These include patient safety, patient centered, effectiveness, efficiency, timeliness, and equity. An example of patient safety might be avoiding central line placement unless parenteral nutrition is required for more than a week. An example of patient centeredness is ensuring patients who go home on home enteral feeding receive a feeding schedule that works for their situation. An example of effectiveness might be using protocols to address hyperglycemia in hospitalized patients. An example of efficiency might include automatically advancing tube feedings based on tolerance. Timeliness might include completing all nutrition screens within 24 hours.

all of the following are true about the mini nutritional assessment (MNA) except: a.it is a validated tool used for nutrition screening and assessment in the over age of 65 population b. the MNA screens for malnutrition or those who are at risk for malnutrition c. there is a short form to more quickly determine if a person is in good nutritional status and a longer form if a more detailed screening is required d. specialized training is required in order to be certified to administer this screening tool

D: The Mini Nutritional Assessment (MNA) is a nutrition tool that has been validated for use in the over age 65 population. The purpose of this tool is to screen for malnutrition or to identify those that may be at risk for developing malnutrition. The tool offers two different questionnaires. The first is a quick version that can be administered in about 3 minutes. The second is a more detailed questionnaire, which takes about 15 minutes and must be used if the short form indicates risk for malnutrition. Anyone can administer this tool and specialized training is not required. Health care professionals, such as dietitians, nurses, doctors, and others, can utilize this tool in a variety of settings.

as a newly hired DTR in charge of the cafeteria, you are asked to participate in a food safety program sponsored by the National Restaurant Association. the name of this program is: a. Federal Food Safety Program b. Food Safety Certificate Program c. Pura Food Safety d. ServSafe

D: The National Restaurant Association sponsors the ServSafe program. This is a certification program that involves a training course and successful completion. The course may be offered online or at training sites. The certification is valid for 5 years. Concepts that are covered in this certification include dangers of food borne illness and how to prevent it. It also includes a review of personal hygiene. Other concepts include a review of food preparation, cross contamination, storage, serving, and pest management. The program helps managers stay updated with changes to the FDA Food Code. The training provides examples of situations to help participants apply the skills they are learning.

all of the following are true about vitamin C, except: a. the best food sources of vitamin C are fruits, such as citrus, and vegetables, such as broccoli b. cigarette smokers should consume at least 100mg per day of vitamin C c. deficiency of vitamin C can result in issues with wound healing, bleeding gums, tooth loss, and leg pain d. The RDA is 75mg for women and 100mg for men

D: The RDA for vitamin C is 75 mg for women over the age of 19, however, the amount increases if the woman is pregnant or breastfeeding. Pregnancy increases vitamin C requirements to 85 mg/day for ages over 19, and lactating women over age 19 require 120 mg/day. The RDA for men is 90 mg/day. Smokers do need additional vitamin C over and above the RDA because they typically have lower serum levels of the nutrient. . Deficiency of vitamin C is called scurvy, and this may be characterized by swollen and bleeding gums, tooth loss as well as fatigue, skin lesions, and leg pain. Vitamin C deficiency can also negatively impact wound healing. The best sources of vitamin C are citrus fruits, strawberries, and cantaloupe; and vegetables, such as broccoli, peppers, and Brussels sprouts.

which of the following employment advertisement modes is least likely to effectively recruit a new food service director at a large, tertiary-care hospital? a. internet advertising on a Web site, such as Monster.com or creerbuilder.com b. internal sources c. recruitment agency d. advertising in a weekly local newspaper

D: The food service director position for a large, tertiary care hospital is a very specialized position requiring advanced skill, experience, and knowledge. Thus, advertising the position in a small, weekly community newspaper is not likely to result in a pool of qualified applicants. Internal promotion of a current manager, who is familiar with the facility policy and operations, may be possible. That being said, it is wise to advertise the position using resources that reach large audiences, such as internet-based classifieds (Monster.com and others), newspapers, job placement recruiters, trade shows and job fairs, among others.

which of the following is not a true statement about the pancreas? a. the pancreas secretes insulin and glucagon b. pancreatic enzymes are secreted when food reaches the stomach c. the pancreas is one of the organs affected by cystic fibrosis d. tumors in the pancreas are highly resectable and have a favorable cure rate

D: The pancreas is an important organ in the digestive process. It has both exocrine functions (secretion of insulin and glucagon for blood glucose) and exocrine functions (secretion of pancreatic enzymes to help with digestion of fat, protein, and carbohydrate). As food enters the stomach, secretion of pancreatic enzymes occurs. If an individual has either acute or chronic pancreatitis, food is withheld until the condition subsides to prevent this secretion. Some pancreatic tumors may be cured if detected early; however, most cases with this type of tumor are not found early, which negatively impacts prognosis. Tumors that are in the head of the pancreas are most likely to respond to curative treatment.

which of the following grades of beef is the least desirable? a. prime b. choice c. select d. standard

D: There are eight potential grades for beef. Prime is the top of the line beef that is the most flavorful and tender. Choice is the second highest designation, and it has three different grade levels—small, modest, and moderate marbling. Moderate marbling in a choice cut is one step below prime and will yield a tasty and tender product. Select cut is the third designation; select cuts are tender but less tasty (due to less marbling) than higher designations. Prime, Choice and Select beef are available at supermarkets. The other cuts of beef are standard, commercial, utility, cutter, and canner with canner being the lowest quality. These cuts are used in commercially prepared products such as sausages, hot dogs, and other beef products.

potential nutrition diagnoses for an obese male with coronary heart disease may include all the following except: a. food and nutrition related knowledge deficits b. physical inactivity c. excessive fat intake d. excessive hunger

D: There are many, many potential nutrition diagnostic terminologies to select from for an obese male with coronary heart disease. The exact selection of the nutrition diagnosis would depend on the individual's diet history as well as other information. One potential may be related to caloric intake, such as excessive energy intake or imbalance of nutrients. Excessive hunger may be true but it is not considered proper terminology. Another potential nutrition diagnosis could be related to fat intake, such as excessive fat intake or inappropriate intake of food fats. Physical inactivity or inability or lack of desire to manage self care may be potential choices depending upon the individual's exercise habits. Another potential can be in the biochemical category, such as altered nutrition related laboratory values (for example, an elevated serum cholesterol or triglyceride level). No one selection is wrong but rather how the issues are addressed and managed are incorrect.

all of the following are true about trans fatty acids, except: a. trans fats are created through hydrogenation, which is a process that helps to prevent polyunsaturated fats from becoming rancid b. trans fats are found in commercially prepared baked goods, fried foods, processed foods, and some margarines c. the food industry has begun to alter the manufacturing of many products to omit trans fats, and many resturants have stopped using partially hydrogenated oils d. trans fats lower HDL levels and increase total cholesterol but have no effect of LDL cholesterol

D: Trans fatty acids are created through the hydrogenation process that is used to prevent polyunsaturated fats from spoiling. It also helps liquid oil retain a solid form. Trans fats are thought to increase the risk of cardiovascular disease (CVD). They also increase LDL cholesterol levels, lower HDL cholesterol levels, and increase overall cholesterol. Trans fats also cause inflammation of vessels and are linked to obesity and insulin resistance. Trans fats are mostly found in fried foods, baked goods, processed foods, and some margarines. The food industry is taking major steps to eliminate trans fats from many products. Food labeling requirements now mandate that the amount of trans fat be included on all food labels. The restaurant industry is also taking steps to reduce trans fat and hydrogenated oil usage although not all restaurants or fast food chains are presently working toward this goal.

a food service aide has complained to you about frequently finding bloody tissues on one patient's meal tray. how do you correct this? a. tell the employee to remove the tissue and place them in trash can b. the employee should refuse to remove the tray from the room c. tell the employee not to worry and remove the tray from the room d. speak to the nurse about the situation so the tissue can be properly disposed. the employee should wear gloves to remove the tray from the room

D: Universal precautions are methods to manage infection control by assuming all bodily fluids are infectious and could potentially contain HIV, HBV, or other dangerous infections. Bodily fluids include blood, secretions, saliva, etc. The use of gloves, masks, and/or gowns should be used if any contact with bodily fluids is expected. Frequent hand washing is also essential to controlling infections. The frequent use of alcohol-based hand sanitizer is also recommended, especially when moving between patients and from room to room.

which of the following is least likely to occur during a counseling session if a client is ready to make dietary changes? a. mutual identification of potential changes that can be made b. preparing an action plan together c. identification of potential barriers d. telling the client what changes need to be made

D: When an individual is ready to make changes, it is imperative to get the individual involved in making the plan. The job of the RD or DTR is not to tell the client what to do but instead help the individual identify areas where changes can be made. Options can be provided but ultimately it is the individual who must decide what changes to make. The RD or DTR can help the individual set short term goals. Any potential barriers should be identified and discussed. The client should be able to verbalize the plan on his or her own but a written plan should also be given. The main point is for the individual, not the counselor, to be in control of the plan.

which of the following lists the best supports a potassium-rich diet? a. cucumbers, mushrooms, apples, peanuts b. romaine lettuce, pears, walnuts, yogurt c. sweet potatoes, spinach, soybeans, apricots d. green beans, carrots, pineapple, hard candy

c.C: Higher potassium intake has been linked to lower blood pressure readings. Increasing potassium intake has also been linked to a reduced risk for strokes. The DASH diet recommends approximately 90 mEq of potassium each day. Good sources of potassium include vegetables, such as potatoes, sweet potatoes, spinach, tomatoes, and squash; as well as fruits, such as bananas, apricots, oranges, and cantaloupe. Legumes, such as soybeans, lentils, kidney beans, and split peas, are also a rich source of potassium. Nuts, such as almonds and walnuts, can also contribute significant amounts of potassium. Dairy products, such as milk and yogurt, as well as protein choices, such as pork and beef, are also good sources.

potential nutrition diagnoses for a patient with a fasting blood glucose level of 135mg/dL might include: a. alteration in metabolism (type 1 diabetes mellitus) b. alteration in metabolism (hyperglycemia) c. altered nutrition related laboratory values d. gestational diabetes

c.C: There is a distinction between a nutrition diagnosis and a medical diagnosis. Type 1 diabetes mellitus, gestational diabetes, and hyperglycemia are all examples of medical diagnoses. A medical diagnosis will include disorders involving anatomy, physiology, or metabolism that have accompanying symptoms, which can be treated with either medical or surgical interventions. A patient with an elevated fasting blood glucose should also receive a nutrition diagnosis such as altered nutrition related laboratory value, excessive carbohydrate intake, excessive energy intake, or overweight/obesity. The nutrition diagnosis selected is dependent upon the information gathered by the RD or DTR during the assessment piece.

which of the following is not an advantage of a cycle menu? a. a cycle menu increases variety b. cycle menus facilitate staff vacation and leave scheduling c. cycle menus allow greater ease when forecasting and purchasing food d. equipment use can be maximized if the cycle menu is planned appropriately

A: A cycle menu is a menu that is planned to cover a certain number of days or weeks on a rotating schedule. The length of the cycle is determined by the institution utilizing the cycle menu. Many hospitals are now trying shorter cycles because of decreased lengths of stay. Other types of facilities, such as nursing homes, have longer cycles. Cycle menus do facilitate schedules because the menu is known in advance.Equipment use can be maximized with cycle menus because recipes are chosen in advance and with consideration of equipment availability. Variety, however, is not always an advantage of cycle menus because the cycle may be too short or repeated in a very predictable manner, such as on the same day of each week.

a women with type 2 mellitus who is overweight and takes an oral agent but otherwise has good blood glucose control asks you if she can include 1-2 glasses of wine with each night's dinner. the best response is: a. a 5oz glass of wine may be consumed b. alcohol is not recommended for anyone with diabetes c. it is okay to have a glass or two of wine as long as she omits 2 carbohydrates from her dinner d. she should decide for herself if she wants to drink wine, but if she does, she should take it on an empty stomach

A: Alcohol may be permitted if the following conditions are met: diabetes and blood glucose are well controlled, diabetic nerve damage is not present, and the person has a good understanding of how alcohol affects diabetes. Alcohol should be limited to 1 drink per day for women, which is equivalent to 5 oz of wine or 12 oz of beer. For men, the limit is 2 drinks per day. Alcohol should never be taken on an empty stomach as it increases the risk for hypoglycemia. Additionally, alcohol should never be substituted for food. Alcohol is metabolized in the liver, and the liver will temporarily stop blood glucose regulation until the alcohol is cleared. This means that if the blood glucose level is low; it has a good chance of dropping even lower and potentially causing problems.

at the start of a training session, employees are asked to break into small groups and share their 5 favorite musicians or movies. This is an example of: a. an icebreaker b. small talk c. time killer d. team enhancement

A: An icebreaker encourages individuals taking part in a meeting to participate, listen to others, and allows for fun and/or interesting dialog. Typically, icebreakers are used to begin a meeting. Icebreakers are also used to gauge the participants' current level of knowledge regarding the topic at hand. Some icebreakers are also team building exercises. Icebreakers are often useful when they are directly related to the topic of the training session and/or are used to increase interest in future trainings.

which of the following is a false statement about body mass index (BMI)? a. BMI is the best way to measure the amount of body fat on an individual b. men typically have less body fat than women even if the BMI's are the same c. competitive athletes may have a higher BMI because they may have higher muscle mass d. although the BMI is calculated the same way, BMI's for children are interpreted differently than that of adults using age and gender specific percentiles.

A: Body mass index (BMI) is not the best way to determine a person's body mass. . BMI takes into account both fat and muscle mass and is not able to differentiate between these. Women typically have higher amounts of fat than men do even if the BMI is the same. Older adults also typically have more body fat than younger people. Competitive athletes may have a higher BMI because of increased muscle mass. This needs to be taken into account when interpreting the BMI value. BMI is calculated the same way for children, however, the BMI should not be interpreted using adult data. Gender and age specific percentiles have been established and should be utilized.

what type of diet is used to treat celiac disease? a. gluten free b. low fiber c. lactose free d. high fiber

A: Celiac disease is a digestive disease involving the small intestine. The small intestine becomes damaged when any form of gluten is ingested. Symptoms may include diarrhea or constipation, change in appetite, nausea, excessive flatulence, or weight loss. Treatment is the implementation of a gluten-free diet. Some people may experience lactose intolerance prior to the celiac diagnosis but this often resolves once the gut begins to heal. Gluten is found in wheat, barley, rye, and bulgur. Typically oats are also avoided though controversy remains about this. Corn, rice, and soy are acceptable grain products. Label reading is essential as many foods contain grain products. The selection of gluten-free products is growing making this a more manageable way of eating.

all of the following are true about diversity training in the workplace, except: a. diversity training deals only with gender and race b. diversity should be part of an organization's culture so everyone is treated fairly and equally c. interpersonal skills, on the part of both the organization and individual employees, are an important aspect of diversity training d. diversity training is necessary even in an non-diverse environment as each individual is different

A: Diversity training is not limited to race and gender topics; rather it encompasses age, sexual orientation, degree of seniority on the job, different types of jobs, etc. Diversity training is necessary even if the work group appears to be similar in appearance, belief, abilities, etc. Individuals within the group are different and free thinking. Diversity sensitivity should be an integral part of an organization's culture. Communication should always be open and any conflicts should be addressed directly. . Interpersonal skills are also an important part of diversity training. It should be the expectation that each employee treat one another with respect and support. A workplace should never be hostile, and the employees that work there should be thoroughly trained to deal with differences.

labor costs in the hospital cafeteria have been over budget for several months due to overtime. which of the following would not be an immediate solution to the problem? a. dismiss a few employees to control labor costs b. review the operation to see if additional self-serve stations can be implemented c. review the scheduling procedure to see if overtime is justified and see if some of the prep work can be moved to non-peak hours d. determine if employees are being properly supervised and performing tasks appropriately

A: If labor costs are over budget, the manager needs to determine the cause of overspending by reviewing schedules, work flow, and production standards. Periods of down time should be avoided by assigning additional tasks for completion. The manager should also ensure that each employee is properly trained and performing at acceptable standards. The addition of self- serve stations, such as beverage centers or prepackaged sandwiches, may reduce workforce requirements. Another way to minimize labor costs is to review customer usage of services during open hours. If the service is not being utilized, it may be prudent to shorten the availability or discontinue the service.

as a dietetic technician, you are assisting a 78 year-old man with congestive heart failure with meal selections. He has gained 10 pounds over the past week and is starting Lasix. Which of the following lists reasonable goals for this patient in terms of meal selection? a. 2000-3000mg sodium per day, adequate potassium, and mild fluid restriction b. no added salt diet with 2000mg potassium and 500ml of fluid per day c. 1500mg sodium, 4000mg potassium, and 2000ml of fluid per day d. 500mg sodium, 2000mg potassium, 1000ml fluid restriction

A: Individuals with congestive heart failure (CHF) should try to limit their sodium intake to less than 3000 mg/day and ideally2000 mg/day. Too much sodium causes fluid retention, and this extra fluid puts an additional strain on the heart. It can causes cause difficulty breathing (dues to aspiration) as well as swelling of different body parts, =such as the legs or ankles. Furthermore, with Lasix use, adequate potassium is essential because Lasix causes the body to excrete potassium as it works to get rid of excess fluid. Fluids are often restricted for people with CHF. Fluids are typically limited to 500-2000 ml/day while in the hospital. At home, fluid intake is more liberal if the CHF is under good control. Monitoring weight in the morning is recommended.

which of the following would not be an example of good merchandising? a. fruit in a plastic container in the refrigerator b. polished, clean, and unbruised apples, oranges, pears, and bananas in a large wicker basket c. pre-plated fruit plates with interesting garnishes d. weekly-featured fresh fruits with recipes, creative presentation of the fruit, such as ka-bobs, or a special fruit dip

A: Merchandising is also known as marketing, promotions, and selling. Merchandising refers to product placement to help increase sales. In general, merchandising is all about making the product look better. For example, to merchandise a piece of fresh fruit, one might clean and polish the fruit, ensuring it has no bruises, then place the fruit in a an attractive basket for eye-catching placement. Alternatively, fruits may be pre-plated with attractive garnishes. Likewise, weekly promotions, such as incorporating the item into various recipes, offering specialty items, and creatively using the item, may be an effective way of feature that item.

Feeding a preschooler is often challenging due to food jags, pickiness, or the child's attempts to assert independence. which of the following does not describe an effective strategy for managing a preschooler's nutrition? a. The child should be made to sit at the table until the meal or snack is consumed in its entirety b. small servings of a variety of foods should be offered on a fairly regular schedule c. snacks and beverages should not be provided within 90mins of a planned meal d. the parents should not focus too heavily on what is consumed at each meal or snack because over the course of a day, the calorie intake will be fairly consistent if a variety of foods are offered

A: Preschool age is a time of rapid development in many areas including motor, cognitive, and social skills. Growth typically slows down during this period, and children often have a lower appetite. Children are also many times less interested in food because they are too interested in what is going on around them. Many develop picky eating habits, control issues over food, or even a very limited food preference list. Parents or caregivers should not force a child to eat. It won't work. Rather, a variety of foods should be offered on a fairly regular schedule. Preschoolers tend to consume what they need over the course of a day. Portion sizes do not have to be huge. Snacks should not be given less than 90 minutes before a meal. Beverages should also be restricted in the time before meals as this can reduce intake. Excessive juice should also be discouraged.

you are asked to give a presentation at the senior center on new advances in nutrition and heart disease. When reviewing the literature, the best type of studies to review is: a. randomized control trials b. cohort studies c. case controlled studies d. consensus statements

A: Randomized controlled trials (RCT) are considered to be the gold standard in evidenced- based practice. The design of these studies requires subjects to be randomly assigned to groups. When a subjects are divided into groups and neither the subject nor the researcher know what group the individuals are in, the study is double-blind. Double-blind studies are particularly reliable as they eliminate researcher and/or participant bias. Cohort studies examine data collected from a large group over a period of time. Good data can be obtained from these types of studies.Case controlled studies compare one group of people who already have certain symptoms or a specific disease to a similar group without the same trait. These studies cannot analyze past data, such as diet, because the information has not been collected. A consensus statement is a statement made public by a group after reviewing research.

a patient in the hospital recovering from a heart attack wants assistance with his menu selection. he is looking to increase fiber in his diet as he has learned that certain types of fiber more efficiently reduce cholesterol levels. which of the following would be most beneficial? a. oatmeal b. wheat bran c. carrots d. whole wheat bread

A: Soluble fiber has been shown to help lower blood cholesterol levels. Foods that contain soluble fiber include oat bran and oatmeal, dried beans and peas, rice bran, citrus fruit, strawberries, and apples. Commercially prepared products such as oat bran muffins may actually contain very little fiber and may also contain trans fatty acids; therefore, these foods are not recommended. Insoluble fiber does not appear to lower blood cholesterol levels but has other benefits, such as normalizing bowel function. Foods that contain insoluble fiber include whole wheat breads and cereals, wheat bran, carrots, Brussels sprouts, and cauliflower. A total of 25-30 g of fiber should be consumed each day with at least 6-10 g from soluble fiber sources.

the end process of sucrose digestion is: a. glucose and fructose b. glucose and galactose c. glucose and mannose d. 2 glucose molecules

A: Sucrose is an example of a disaccharide. Sucrose is commonly referred to as table sugar and is found in other food products, such as maple syrup and molasses. When sucrose is consumed, it is hydrolyzed by sucrase into glucose and fructose when a water molecule splits in the digestive process. . Both glucose and fructose are monosaccharides. Other disaccharides include maltose, which is broken down by maltase into 2 glucose molecules, and lactose, which is broken down by lactase into glucose and galactose. Glucose is then used for energy by the brain and also provides energy for muscles and tissue. Glucose can be stored for the short-term as glycogen. Insulin and glucagon work to maintain a normal blood glucose level in the absence of diabetes.

which of the following is not a true statement about the American Dietetic Association's Standards of Professional Performance? a. the standards apply only to RDs b. the standards apply to all RDs and DTRs c. the standards were written based on specific training levels of RDs and DTRs as well as the level of responsibility of each d. the standards address 6 areas of professional behavior, including communication and quality of practice

A: The ADA's Standards of Professional Performance (SOPP) were written for RDs and DTRs who work in a variety of settings. The standards reflect the behavior expected of a professional. There is a minimum competency level that must be achieved. There are 6 areas of professional behavior that are applicable, and these areas include: service provision, applying research, applying knowledge and using communication, allocating resources, quality, and competence. SOPP also addresses the supervision of DTRs by RDs. The RD is ultimately accountable for care provided by the DTR. The RD is in charge of the nutrition care process (NCP) but can delegate appropriate tasks to the DTR.

all of the following are true about USDA grades for processed fruit and vegetable products, except: a. the grade standards are mandatory b. the grade standards are voluntary c. standards are defined in terms of attributes such as color, appearance, character, flavor, odor, ect. d. grades may consist of US Grade A, B, C or substandard

A: The Agricultural Marketing Act of 1946 established a grading system for many agricultural products, including fruits and vegetables. The use of the grading system is voluntary. Meat, poultry, fresh fruits, and vegetables are typically labeled with this grading system. Processed fruits and vegetables do not typically utilize the grading process. The standard grades for processed fruits and vegetables are US Grade A, or Fancy; US Grade B, or Extra-Standard; US Grade C, or Standard; and Substandard. One way that manufacturers address quality issues is to develop private labels and build a consumer following. These products may not exactly correspond to the government's grading system, and there may be variations between seasons.

as a dietetic technician, you are planning menus for a nursing home. which of the following tools are you likely to use during this process? a. Dietary Reference Intake (DRI) b. Recommended Dietary Allowances (RDA) c. Tolerable Upper Limits (TUL) d. Estimated Average Requirements

A: The Dietary Reference Intake (DRI) was initiated in 1997 by the Institute of Medicine as part of the US National Academy of Sciences. It is used for many purposes including menu development. The DRIs incorporate the Recommended Dietary Allowances (RDA), Adequate Intake (AI), Tolerable Upper Limits (TUL), and Estimated Average Requirements (EAR). The RDAs were developed from the EAR values. The EAR values are appropriate for most people. The AI values are used for nutrients where no RDA has been determined but the value selected is believed to be safe. The TUL values should be heeded as levels of certain nutrients in amounts higher than the TUL may be harmful All the items listed are important to consider when menu planning.

the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has implemented patient safety goals. All of the following are part of these goals, except: a. the use of 2 patient identifiers b. prevention of decubitus ulcers c. improvement in the safety of all medications d. improvement in the communication between healthcare providers

A: The JCAHO has started using tracer methodology to track a patient throughout their entire hospital experience. A patient is identified and the course of care is followed. The tracer may include observation of patient care, medication dispensing, and care planning. The patient of the family may be interviewed. Medical records are reviewed and old records may be requested. The interaction, training, and development of the staff are reviewed. Policies and procedures may be reviewed. The tracer may involve review of the entire patient stay, to include interdepartmental evaluations. Nutrition care and food service is an integral part of the survey as well.

according to the Stages of Change model, an individual who is trying to lose weight but continues to provide reasons as to why it is difficult for him to make the appropriate change fall in which of the following stages: a. contemplation b. preparation c. action d. relapse

A: The Stages of Change model (also known as the transtheoretical model) describes 6 phases associated with readiness to make a change. It is helpful for nutrition professionals to assess an individual's stage of change when initiating education about diet changes. The individual described in the question is in the contemplative stage. The individual knows that weight loss is necessary but has not yet taken the steps to enter the action phase where successful weight loss should occur. Providing excuses and reasons for not being successful is an indication that the individual is still only thinking about the changes needed to achieve weight loss. It is here that the educator should help the individual look at advantages and disadvantages to help them move towards the preparation and action phases.

which of the following temperature ranges is known as the danger zone? a. 41-140F b. 35-145F c. 50-150F d. 40-120F

A: The danger zone is the temperature range between 41-140°F. This is the range where bacteria can multiply and grow to potentially cause illness. . Freezing foods stops the growth of bacteria but does not necessarily kill the bacteria. Temperatures above 165°F will kill most bacteria. Situations that put food at risk for becoming contaminated include foods that are not properly cooled or heated, foods prepared a day or more in advance before they are served, and mixing contaminated raw ingredients into foods that will not be cooked further. Poor food service employee hygiene and equipment cleaning can increase the risk for infection. Basic prevention includes chilling food quickly to less than 41°F, storing cold foods at a temperature less than 41°F and hot foods at temperatures above 135°F.

a deficiency of vitamin D results in: a. rickets b. night blindness c. scurvy d. beri beri

A: The incidence of vitamin D deficiency is increasing. It may present as rickets in children or osteomalacia in adults. Rickets occurs because bone mineralization is damaged. Rickets can also result from a calcium or phosphorus deficiency. Vitamin D deficiency can occur because there is not sufficient exposure to sunlight or from a lack of dietary sources. Vitamin D deficiency can also occur due to issues with lipid malabsorption or kidney disorders. Individuals who are at the highest risk for developing vitamin D deficiencies include the elderly and infants who are exclusively breastfed. A deficiency can be determined by having a level of 25-hydroxy-vitamin D less than 50 mg/ml. The best food sources of vitamin D include fortified dairy products, fish, eggs, and cod liver oil.

which of the following laboratory data would best indicate nutritional risk? a. fasting blood glucose level of 130mg/dL b. fasting cholesterol level of 199mg/dL c. Serum albumin level of 3.5g/dL d. hematocrit level of 42%

A: There are many different laboratory tests that can be used for nutritional screening purposes. Fasting blood glucose (FBG) level is a useful test as it can identify diabetes or other blood glucose issues. A normal FBG is 70-99 mg/dL. A level between 100-125 mg/dL may indicate prediabetes and over 126 mg/dL indicates diabetes. A level of 126 mg/dL is a significant nutritional risk factor. Fasting serum cholesterol is not technically high at 199 mg/dL but should be evaluated along with other lipid tests such as HDL, LDL, and triglycerides. A serum albumin of 3.5 g/dL is considered normal. A lower level may indicate visceral protein depletion. A hematocrit of 42% is also normal and a lower level may be indicative of anemia and is a nutritional risk factor. Other laboratory values that may be used for nutrition screening include renal labs, such as BUN, and creatinine or electrolyte tests.

documentation developed to facilitate the Nutrition Care Process (NCP) is called: a. ADIME b. SOAP c. PES d. DAR

A: There are many types of documentation styles but the ADIME style is the one that was developed to help facilitate the NCP. ADIME stands for Assessment, Diagnosis, Intervention, Monitoring, and Evaluation. This type of charting format helps to organize the information in the appropriate manner. Nutrition professionals are moving away from the SOAP format because notes tend to be lengthy; physicians do not appear to be as receptive to this type of charting; and it takes away from the evaluation or assessment piece, which is what DTRs and RDs are the most qualified to contribute. The ADIME format incorporates all important information necessary to make the assessment and the PES statement to make the nutrition diagnosis. It also includes the intervention piece, such as change in nutrient intake, nutrition education, counseling, or the coordination of nutrition care. The data to be monitored and evaluated is also charted, such as changes in weight, laboratory values, or improvement in clinical symptoms.

if you are using the factor method to adjust a recipe that serves 8 to serve 50, which factor would you use to make the necessary adjustments? a. 6.25 b. 6 c. 7 d. 0.16

A: There are two methods that are frequently used to adjust the yield of recipes- the factor and percentage methods. The factor method involves dividing the desired yield by the actual yield, in this case 50/8. Next, all the measures are converted to weights then the amount each ingredient needed is multiplied by the factor. Fractions are then rounded off to a usable number. In the percentage method, each ingredient is measured as a percentage of the total weight of the product. The sum of the percentages of all ingredients should add up to 100. The percentage value is then used for further recipe adjustments.

which of the following individuals is likely eligible for unemployment compensation under the Social Security Act of 1935? a. a tray-line worker who has been dismissed due to workforce reduction b. a cook who was using recreational drugs in the restroom during scheduled breaks c. a DTR who voluntarily stopped showing up for work d. a food service supervisor who has accepted a job requiring early morning hours but habitually comes in 1 hour late each day

A: Unemployment compensation is a national system that provides certain individuals with income during transitional times. It was established under the Social Security Act of 1935, and is a joint program between the federal government and the states. Many of the rules for unemployment compensation are subject to individual state guidelines. In general, unemployment compensation may be denied if an employee quit of his own volition and without provocation, or was dismissed due to unauthorized absences or misconduct. Eligibility requirements for unemployment compensation vary by state.

the recommended amount of weight gain for an overweight pregnant women is: a. 15-25lb b. 25-35lb c. 15lb d. 28-40lb

A: During pregnancy, the recommended amount of weight gain for a woman of normal weight is 25-35 pounds. For overweight women, a lower amount of weight gain, 15-25 lbs, is advised. Alternatively, underweight women are advised to gain 25-35 pounds. Typically, for a normal amount of weight gain, less than half of this consists of the fetus, the placenta, and the amniotic fluid. The additional weight is necessary to build-up maternal stores for the last part of the pregnancy and to help support lactation.

as a dietetic technician, you are assisting in a program targeting overweight adolescents at risk for developing hypertension. which of the following best describes appropriate goals for the program? a. address lifestyle modifications such as weight control, reducing sodium intake, and increasing physical activity that are known to control blood pressure. b. weight loss c. blood pressure monitoring d. teach the adolescents appropriate forms of physical activity in order to promote positive exercise habits

A: With overweight and obesity rising in this country, the incidence of hypertension is also rising. It is important for children to have yearly blood pressure checks to monitor for hypertension. Primary hypertension does occur and many times is due to weight. If a child's BMI is above 30, intensive nutrition education is recommended. The overall goal for educating adolescents with hypertension or at risk for developing hypertension is to address lifestyle issues that will impact the child for many, many years. These issues include weight control, reducing sodium intake, and increasing physical activity.

consider the following 24hour recall for a 53 year-old female, who weighs 60kg, has been diagnosed with ESRD, and started peritoneal dialysis (PD): -Breakfast: 4oz skim milk, 1 1/2 cups corn flakes, 1/2 banana, 2 slices whole wheat toast with 2 tablespoons cream cheese -Mid-morning snack: 1 apple - Lunch: tuna fish salad sandwhich with 3oz tuna and lettuce, 1/2cup canned pears, 12oz diet cola - Dinner: 6oz baked chicken, 1/2cup rice with butter, 1/2cup cooked carrots 1/2cup green beans, 8oz milk -Evening snack: 6 graham crackers and a cup of black tea -Lad data: albumin 3.6g/dL., BUN 22mg/dl, creatinine 1.2mg/dl Which of the following statements are true about her protein intake? a. her 24-hour diet recall shows she is consuming approximately 1.8g/kg. it is recommended she decreases protein intake slightly due to good nutritional status to maintain protein intake within recommended guidelines of 1.2-1.5g/kg b. her 24-hour diet recall shows she is consuming approximately 1.8g/kg. it is recommended she decreases protein slightly due to good nutritional status to maintain protein intake within recommended guidelines of 0.8-1g/kg c. her 24-hour diet recall shows she is consuming approximately 1g/kg. increased protein intake is recommended to achieve protein intake within recommended guidelines of 1.2-1.5g/kg and precent malnutrition die to protein losses d. her protein intake is within accepted guidelines for patients receiving peritoneal dialysis

A: Use the American Dietetic Association's Exchange List for Meal Planning as a reference. The diet recall shows the patient consumed approximately 108 g of protein. This provided her with 1.8 g/kg. Protein requirements for continuous ambulatory peritoneal dialysis (CAPD) are approximately 1.2-1.3 g/kg. The laboratory data does not indicate that the woman requires additional protein for repletion of visceral stores. This woman could safely reduce her protein intake to the recommended range by reducing portion sizes of protein containing foods, such as chicken or milk. Care should be taken to ensure she is consuming sufficient calories (30-35 kcal/kg) for weight maintenance.

which of the following physical conditions would not be a considered a nutritional risk factor? a. obesity b. stage IV decubitus ulcer c. cancer d. fractured femur

D: Generally, a fractured femur does not present nutritional risk unless other risk factors are also present. Physical conditions presenting nutritional risk include obesity, severely underweight, or an unplanned weight loss of more than 10 pounds over a 6 month period. Pregnant adolescents, multiple gestation, or women who have had multiple pregnancies in a very short time would also be considered at nutritional risk. Certain diseases, such as diabetes, cardiac and kidney disorders, may increase a person's risk. Individuals with cancer or AIDS are at nutritional risk. Altered skin integrity, such as decubitus ulcers or burns, are nutritional risk factors as well.