Nutrition Assessment Final

Which 5 aspects are evaluated in the NFPE? Select one or more: Micronutrient deficiency Edema Fat loss Muscle loss Grip strength Kidney function Blood pressure

Micronutrient deficiency Edema Fat loss Muscle loss Grip strength

Increases in temperature are associated with decreases in energy expenditure, therefore energy needs are reduced.

false

Most macronutrients are broken down to be small enough for absorption by the time they exit the stomach.

false

Question text Malnutrition is associated with gains in lean tissue (e.g. muscle).

false

A BMI calculated for a 10 year old that falls within the 57th percentile would classify that child as:

normal

Which of the following would be the most appropriate immediate inpatient (hospital setting) intervention for a dx of "inadequate protein intake" for a patient with poor appetite and oral consumption after surgery?

order and provide a high protein nutrition supplement for additional source of protein

Which of the following would least likely impact interpretation of a lab value within the acute care setting? Select one: Overall physical activity Hydration status Medications Medical conditions Inflammation

overall physical activity

During dietary assessments, individuals tend to _______ healthy foods and _____________ unhealthy foods eaten.

overestimate; underestimate

niacin (B3) deficiency is related to

pellegra (resulting in the 4 d's dermatitis dementia diarrhea and death)

which equation should be used for a patient on a ventilator

penn state

Biochemical/physiological effects drug

pharmacodynamics

time course of a drug

pharmacokinetics

Which of the three electrolytes of main concern is the most dangerous when low? Hint= If low, Its a "hallmark" symptom of re-feeding syndrome Select one: phosphorus sodium magnesium potassium

phosphorus

hypo/hyperphosphatemia

phosphorus

primary intracellular ion

phosphorus

Which of the following is NOT a biomarker (lab value) for inflammation? Select one: White blood cell count C-reactive protein Albumin Plasma carotenoid

plasma carotenoid

4+ medications

polypharmacy

The following description is of what type of dietary fat? ______________________________ " has more than one double bond in the structure, usually liquid at room temperature, and includes many plant based oils"

polyunsaturated fat

condition related to zinc deficiency

poor DNA repair, hair loss, poor wound healing

Which of the following was described as a cause of malnutrition in class and within the article? Select all that apply. Select one or more: poor nutrient transport and utilization malabsorption fluid overload increased metabolic needs associated with trauma, disease etc. reduced intake

poor nutrient transport and utilization, malabsorption, increased metabolic needs associated with trauma, disease, etc, reduced inake

Which of the following tests are NOT related in some way to kidney function? Select one: GFR BUN BUN/Creatinine ratio Vitamin D Serum thiamin

serum thiamine

For infants we usually measure recumbent length vs. height because they are not standing yet, and those measurements are made to the nearest 0.1 cm.

true

Which of the following is NOT a primary function of the GI tract? digestion circulation absorption immunological barrier signaling to the nervous system

circulation

3 labs to identify iron deficiency anemia

complete blood count low MCH low MCV

which equation should be used for a patient with burns

curreri

The DRI recommendations begin for individuals at age _______ and begin to vary by sex at age ______ . Differences in DRIs also occur during _______________ .

0-6 months; 9; pregnancy/lactation

List at least 5 examples of assessment data categories (e.g. ABCDE's) and then list at least ONE data collected for that category. This question is worth 20 points.

1. Anthropometric - height, weight 2. Biochemical - blood work and lab values 3. Clinical - medical history 4. Diet - current intake, excesses, deficiencies 5. Energy - how much energy does the patient require? What breakdown of macronutrients do they require

How many of the ABOVE metabolic syndrome indicators must be identified to dx MetSyn?

3 or more

3 things stool might be examined foor

blood in the stool; steatorrhea; pathogens such as C. diff

Which of the following is NOT true of whole grains? They contain all 3 layers of a seed (germ, endosperm, bran) They are good sources of fiber and micronutrients (vitamins/minerals) 100% whole wheat bread would be an example of a whole grain They are good sources of insoluble fiber (Regular) Saltine crackers would be a common example of a whole grain

(Regular) Saltine crackers would be a common example of a whole grain

6 indicators of malnutrition

- weight loss - loss of adipose tissue - loss of lean tissue - loss of grip strength - reduced intake - inflammation

Amount of glucose stored (as glycogen) in the liver (g)

100

Minimum amount CHO needed to spare protein (g)

130

How many malnutrition indicators must be identified to formally diagnose malnutrition using best/evidenced based practices? 1 2 3 4

2

Total number of AAs

20

According to the Joint Commission, every patient should be screened within __________ hours of admission.

24

Screening for nutritional risk (malnutrition) must be done for every patient within __________ hours of admission, per the Joint Commission requirements.

24

Recommended amount of fiber to consume daily (18-50 years old) (g)

25-38

Amount of protein broken down/recycled/utilized daily (g)

250

what is normal serum mOsm? 280-300 mOsm/L 1400 mOsm/L 100 mOsm/L None of these

280-300

Quantity of CHO suggested for lowest mortality (% range)

50-55

Number of kcal/g in fat (lipid)

9

CHO limit (g) associated with ketosis and recommended in keto diets

<50

Which of the following is NOT true regarding pressure ulcers? Select one: They are damage to the skin or underlying tissue They are scored from 1-4 A score of 1 is the worst level Pressure ulcers occur where weight is deposited (low spots) and or near bony prominences (bony edges of body, ie. tail bone)

A score of 1 is the worst level

Which of the following is true concerning the USDA Automated Multiple-Pass Method? Can be completed in person or by telephone guided by a trained interviewer Must be conducted with a food model booklet This is a research based approach None of these. A , B, and C are correct.

ABC are correct

which are the fat soluble vitamins

ADEK

meets daily needs for healthy groups of people when RDA hasn't been established

AI

Which of the following are criteria of Metabolic Syndrome? (Select ALL THAT APPLY-there should be 5) Select one or more: Abdominal obesity Blood pressure Triglyceride profile Blood glucose BMI Total cholesterol HDL cholesterol

Abdominal obesity Blood pressure Triglyceride profile Blood glucose HDL cholesterol

Which vitamin deficiency may occur if the parietal cells had reduced function or were damaged?

B12

A person has macrocytic RBCs, increased MCV, low B12, and high Ferritin. What type of anemia would you expect this to be? Select one: iron deficiency anemia anemia of chronic disease B12 deficiency pernicious anemia

B12 deficiency pernicious anemia

You are evaluating body composition for the elderly during a community health fair in a local assisted living facility. What body composition analysis method would be the MOST appropriate?

BMI

Elevated serum electrolytes are most likely indicative of which of the following? Select one: a. Increased fluid consumption b. Increased food intake c. Dehydration d. Kidney complications e. C and D are most likely

C and D are most likely

Which of the following is NOT included in a BMP? Select one: Glucose Sodium Potassium CRP Creatinine

CRP

designed for healthcare providers

DGA

most current version is from 2015

DGA

published by the USDA and DHHS

DGA

updated every 5 years

DGA

meets daily needs of 50% of a healthy population

EAR

Which of the following labs/indicators would be related to kidney (renal) function? Select one: hematocrit glomerular filtration rate (GFR) ferritin HDL cholesterol

GFR

Which of the following is NOT included in a CMP? Select one: Albumin Total cholesterol Bilirubin AST HCO3

HCO3

Which of the following is NOT true regarding HbA1c? Select one: 6.5% is used w/ diabetes diagnostic criteria 4-7% HbA1c suggests good diabetic control HbA1c is an excellent short term lab in the acute/hospital setting to identify if initiation of insulin is working to keep glucose within a controlled range

HbA1c is an excellent short term lab in the acute/hospital setting to identify if initiation of insulin is working to keep glucose within a controlled range

Which of these are a barrier to obtaining an accurate weight?

Leaving clothes and shoes on Fluctuations in weight throughout the day Recent food and fluid intake Edema

Which of the following are common nutrition screening tools used in hospital settings?

MAST MNA NRS

malnutrition screening tool

MST

depicts the composition of a healthy meal

MyPlate

designed for general public

MyPlate

published by the USDA

MyPlate

meets daily needs for 97-98% of a healthy population

RDA

What is bioavailability? Select one: The speed at which a nutrient is absorbed in the body The availability of a certain nutrient in grocery/food stores The proportion of a drug/nutrient that enters circulation after being consumed and is able to have an active effect The amount of a nutrient that gets excreted after being used by the body

The proportion of a drug/nutrient that enters circulation after being consumed and is able to have an active effect

level that my introduce risk of adverse/toxic effect of over consumption

UL

Which was developed off of a population with optimal growth and development focusing on ages 0-2?

WHO

Which of the following is NOT a benefit to minimizing a drug-food/nutrient interaction? Select one: Reduced need for additional meds Health care costs reduced Adverse side effects are increased Less professional liability (risk of being sued) Nutrition status is optimized, fewer supplements are needed, reduced long term med use and nutrition deficiencies

adverse effects increased

3 things that could impact a persons RMR

age, body composition, climate in whic they live

List at least one hepatic protein that decreases during a state of acute inflammation?

albumin

How are fluids lost/eliminated from the body? Kidneys Feces Respiration Sweat All of the above

all of the above

Which of the following are clinical markers of inflammation that we look at? Select one: elevated CRP elevated blood glucose elevated WBC Fever Abnormal albumin/prealbumin All of the above

all of the above

Which of the following are indicators a clinician may use to monitor fluid status? Electrolyte status Blood pressure I's/O's Edema All of the above

all of the above

Which of the following are ways that drugs could affect nutrition status? Select one: Taste & smell GI effects (diarrhea, constipation, malabsorption) Appetite Organ system toxicity Glucose metabolism All of the above

all of the above

what is an ADIME note

an ADIME not is a standardized documentation of the assessment portion of the nutrition care process

Which of the following is NOT a common cause of metabolic acidosis? Select one: Chronic kidney disease diarrhea an acidic diet excessive production of acid

an acidic diet

Nutrition screening is completed for all patients to determine which individuals should be further ____________.

assessed

condition related to B1 or thiamin deficiency

beriberi

___________ is secreted into the duodenum by the pancreas to neutralize the acidic chyme entering from the stomach.

bicarbonate

Which of the following utilizes electrical current to measure the proportions of adipose vs. lean tissue?

bioelectrical impedence

metabolism of a drug/nutrient

biotransformation

melena involves ______ in the stools

blood

How might the use of biochemical tests affect the nutrition care process? Select one: a. They will affect what nutrition diagnosis should be prioritized for a pt b. They will be essential in monitoring and evaluation of the intervention's success c. They will help the RD to assess a patient and diagnose them with specific medical issues d. both A and B

both A and B

Which of the following recommended intake values are used when no RDA has been established? A. EAR- estimated average requirement B. DRV- daily reference value C. AI- adequate intake D. RDI- reference daily intake E. both C and D

both c and D

measures pressure sore risk

braden scale

99% stored in the bone; 20-60% absorbed in the ileum

calcium

hypo/hypercalcemia

calcium

cracking, fissuring at corners of mouth and sometimes eyes related to riboflavin deficiency

cheilosis

non-nutrient cause of anemia

chronic disease

limitation of predictive equation

developed for populations but used for individuals

Which of the following would be utilized to measure bone density?

dexa

_______ calorimetry measures body heat among other things to get metabolic rate_____________ calorimetry measures CO2 output and O2 consumption to estimate metabolic rate. ____________ is most likely to be used in the clinical setting and is considered the clinical gold standard for identifying metabolic rate.

direct, indirect, indirect

Specific changes in the function of a drug by a nutrient or of the kinetics of a nutrient caused by a drug

drug-nutrient interactions

In a nutrition diagnosis, what does E stand for?

etiology

Albumin has a shorter half life than pre-albumin which means it responds to changes in the body much slower.

false

During kidney failure you would expect to see levels of RBP decrease.

false

The Recommended Dietary Allowances (RDAs) are meant to focus on health promotion and disease prevention. The Dietary Reference Intakes (DRIs) are meant to focus on preventing deficiencies.

false

The cause of refeeding syndrome is the shift from increased BMR and electrolytes in starvation to decreased BMR and cellular uptake of any available electrolytes when re-feeding resumes

false

The nutrition focused physical exam is an in-person physical exam conducted before examining the patient's medical record.

false

True or False: Bicarbonate is a lab that primarily indicates hydration status.

false

True or False: Only carbohydrates can produce products which enter the citric acid/Krebs cycle for energy production.

false

True or False: The NCPT is a diagram showing the steps of assessment.

false

gynoid body shape is the most risky for health

false

Bile's main function is to emulsify ________________ so that an enzyme can further break it down for absorption.

fats

For which of the following methods is memory not a limitation? food diary FFQ 24 hr recall

food diary

Which of the following is prospective rather than retrospective? food frequency questionnaire food diary/log 24 hour food recall

food diary/log

Broader term; impact drugs have on nutritional status

food-drug interaction

smooth, red tongue sometimes cracked and sore tongue related to b vitamin deficiency

glossitis

2 nutrient related tests in urine

glucose, protein

condition related to iodine deficiency

goiter

Which of the following is NOT a physical sign of dehydration? Darkened urine Dry mouth Sunken eyes Goosebumps

goosebumps

What four patient descriptives are needed to use HB or Mifflin St. Jeor? (what is needed to plug in to the equation?). To assess REE/RMR only.

height, weight, age, gender

A patient has a Total Cholesterol lab value of 231mg/dL. Is this low, normal, or high total cholesterol? Select one: Low Normal High

high

Which of the following is NOT a patient population at risk for a food-drug interaction? Select one: Individuals who take 2+ medications Individuals with a high quality diet Excessive alcohol consumption and/or smokers Patients with long term medication use or who don't comply with medications Individuals with serious health problems

high quality diet

Sodium, BUN, serum osmolality, urine specific gravity These labs are associated with... Select one: anemia hydration status infection inflammation

hydration status

Which of the following is NOT a symptom of dehydration? Select one: decreased body temp hypertension weak and rapid pulse dry tongue

hypertension

___________fiber adds bulk to the stool to reduce risk of constipation and related hemorrhoids and diverticulitis ____________fiber creates a gel in the stomach and is also fermentable in the large intestines which promotes good bacteria growth

insoluble; soluble

electrolytes

ions dissolved in water

Which of the following is NOT true about albumin? It correlates poorly with weight loss and nitrogen balance It correlates poorly with inflammation It doesn't respond to nutrition interventions (e.g. repletion) It is a serum protein

it correlates poorly with inflammation

which of the following is true regarding the 24 hour recall? It is usually used in the acute care setting It provides a very general overview of dietary patterns and trends (ie food groups) and is retrospective The FFQ is better at looking a general overview of diet patterns and food group intake- the 24 hour recall gets a detailed picture of intake in the previous 24 hours It rarely demonstrates bias It is relatively quick with generally low participant/patient/client burden

it is relatively quick with generally low participant burden

which of the following is true regarding a FFQ It is normally prospective It is relatively quick and has low participant/patient/client burden It provides a more extensive assessment of an individual's dietary habits and trends It is often done in the acute care setting

it provides a more extensive assessment of an individual's dietary habits and trends

Which of the following is NOT a limitation of the 24 hour recall? social desirability bias literacy data entry is labor intensive one recall isn't representative of diet

literacy

Acid-base balance is managed by two main organs, what are they? Lungs and kidneys Heart and lungs Stomach and kidneys Liver and stomach None of the above

lungs and kidneys

hypo/hypermagnesemia

magnesium

when low, potassium excretion increased; functions as a cofactor enzyme

magnesium

condition associated with B12 and folate deficiency

megaloblastic anemia

condition related to iron deficiency

microcytic anemia

which equation is most accurate for an obese patient

mifflin st. jeor

an imbalance of this electrolyte can cause hyper/hypokalemia

potassium

hypo/hyperkalemia

potassium

Select the THREE electrolytes (dissociated ions) of concern with re-feeding. Select one or more: potassium magnesium glucose phosphorus

potassium, magnesium, phosphorus

In a nutrition diagnosis, what does the letter P stand for?

problem

Which of the following are recommendations for treatment of refeeding? Select all that apply. Select one or more: refeed slowly discontinue all feedings rehydrate slowly decrease protein

rehydrate slowly and refeed slowly

malnutrition screening identifies _________

risk

In a nutrition diagnosis, what does S stand for?

signs and symptoms

Which of the following is a physical symptom of fatty acid deficiency? Select one: Skin rashes Respiratory changes Dizziness Fatigue

skin rashes

After bile is used, where is it reabsorbed?

small intestine

hypo/hypernatremia

sodium

regulates extracellular(plasma) volume, neuromuscular function, acid/base balance

sodium

Where are the parietal cells located? Which vitamin deficiency would occur if they were damaged?

stomach;B12

The Healthy Eating Index (HEI) compares american's diets to the DGA and evaluates 12 components: whole fruit, total fruit, whole grains, dairy, total protein foods, seafood and plant proteins, greens and beans, total vegetables, fatty acids, refined grains, sodium, and empty calories Which of the following HEI scores would be considered "healthiest"?

the highest score is the best

Which of the following MST scores would be most concerning (i.e. demonstrates the greatest risk) for a patient?

the highest score listed

What B vitamin should be supplemented to reduce re-feeding risk?

thiamine

When assessing weight, it is important not only to obtain an accurate current weight but also to consider any changes and within what ______ those changes have occurred as these can demonstrate overall nutritional risk (e.g. excess or deficiency).

time

Insufficient intake of carbohydrates may result in brain fog, headaches, and hypoglycemia.

true

Obtaining a patient or client's dietary intake would be included in the assessment portion of the NCP (Nutrition Care Process)?

true

Pre-albumin levels may be impacted by zinc deficiency.

true

RBP helps to transport vitamin A/retinol and it forms a complex with pre-albumin.

true

True or False: A discussed benefit of the NCP is to standardize the approach to nutrition care, to better evaluate outcomes from nutrition interventions, and to ensure quality and consistency of care across providers.

true

True or False: Evidence based practice is the concept that care and service providers will utilize the best and most current research to support objective, successful provision of patient or client or community care/services

true

True or False: Lactic acid dehydrogenase is associated with tissue damage

true

True or False: The enzymes Alanine and Aspartate Transaminase convert amino acids in the liver for use as energy, protein production, release to blood , or storage of excess in adipose (fat tissue).

true

True or False: hs-CRP is a high sensitivity measure of inflammation that can indicate low levels of inflammation in chronic disease like CVD.

true

True or false: Ascites are the abnormal accumulation of fluid in third spaces.

true

True or false: Fluid imbalance is common in hospitalized patients and if not treated could result in death.

true

True or false: Oral rehydration solutions must contain sodium and glucose to enhance absorption of fluids in severely dehydrated patients.

true

USDA's Automated Multiple-Pass Method (AMPM) is a standardized method for 24 hour recalls.

true

Vegetables and fruits can also be sources of carbohydrates.

true

When assessing clinical indicators of malnutrition: At least two types of data are needed- anthropometric (weight) and recent dietary intake history.

true

morbidity is a risk associated with nutritional deficiency

true

true or false a food diary requires the participant to record their intake as it occurs

true

A predictive RMR equation would likely ___________________ the calorie needs of a body builder with high percentages of lean body mass.

underestimate

Which of the following is NOT true regarding vitamins A, E and K? Select one: Deficiencies are most commonly associated with some type of fat malabsorption Deficiencies in the developed world are uncommon Vitamin K is directly measured for concentration of vit K in the serum Vitamin A deficiency is associated with malnutrition Vitamin E is associated with bleeding disorders when taken in excess

vitamin K is directly measured for concentration of vitamin K in the serum