PRACTICE CDR EXAM
incorporated into the Federal Food, Drug and Cosmetic Act by the Food Additives Amendment of 1958, requires the FDA to ban food additives which are found to cause cancer in humans or animals as indicated by testing.
Delaney clause
Which level of employee may be asked to temporarily assume duties concerning nutrition education, food service management, or diet counseling?
Dietetic Technician—This position is tasked with helping with menus, understanding dietary requirements, prepping food, giving advice about eating habits and meals, charting nutritional habits, and working with the dietitian to implement programs, menus, etc. Because of this, they will be the most fit to temporarily assume these duties.
When unexplained food costs occur, the RD manager should first
Evaluate departmental security—This is to help isolate the reason for the food costs.
When considering the purchase of a possible new tray delivery system, the RD manager should
Evaluate different tray delivery systems—This will allow you to choose the most effective system for your setup.
Generally, a straight line layout for dishwashing is the most efficient because it is in accord with the design principle of
Flow—We want the sanitation process to be as smooth as possible. By using a straight line layout, we can ensure that we can wash, rinse, and sanitize with ease.
A government agency can take action against a processor for food adulteration, based on the provisions of the:
Food, Drug, and Cosmetic Act
Ingredients are added to this when they have undergone safety evaluations by experts and has been proven not to cause harm when used as intended
Generally Recognized as Safe (GRAS) List
Which of the following is the least useful in evaluating recent overnutrition or undernutrition?
Height for age—Because height for age will be an indicator of long-term overnutrition, malnutrition or stunting. Weight is a more accurate predictor of recent malnutrition or overnutrition.
A foodservice is being converted from a conventional system to a ready-prepared system. The dietitian should first consider the adequacy of the:
Low-temperature storage capacity—Ready-prepared foods will take up more walk-in space
Which of the following are not added to foods to prevent oxidation?
MSG and nitrites—MSG is added as a flavor enhancer and nitrites are added as a preservative, anti-bacterial, and color enhancer. Nitrites can also be a result of pesticides and fertilizers used in agriculture.
A system which minimizes inventory on hand is known as
Minimum/maximum- "A system to control supplies so that quantities in stock generally fall within an established range"
A 50-bed hospital has limited kitchen space for refrigeration, dry storage, and food production. The most appropriate type of menu for the hospital is:
Nonselective—This will eliminate extra work for the kitchen.
A lactose-intolerant individual is most likely to tolerate:
Parmesan cheese-has a long aging process
A patient who is receiving thiazide diuretics may benefit from increased consumption of
Potatoes and Cantaloupe—The use of thiazide diuretics cause a decrease in serum potassium. Potatoes and cantaloupe are examples of foods high in potassium.
Extreme hyperphagia with abnormal, bizarre eating habits is a concern in
Prader-Willi syndrome---a genetic disorder caused by a loss of function of specific genes on chromosome 15. In newborns, symptoms include weak muscles, poor feeding, and slow development. Beginning in childhood, those affected become constantly hungry, which often leads to obesity and type 2 diabetes.
Process objectives
Process objectives describe what will be changed or implemented to achieve the outcome objectives
Botulinum
Produced by bacteria, this is the most potent neurotoxin known. When introduced into the body, this neurotoxin affects the nervous system's ability to function and causes botulism
Which is not a role of liquids in baking?
Promoting a soft crumb in bread and cakes—liquids will not help to make something more crumby.
In setting up a new WIC program in a large, rural, and economically depressed county, what is probably the most crucial aspect to making sure eligible clients use your program?
Providing adequate transportation to and from the WIC site—Because the community is large and rural, there is a good chance that many people cannot access it if they need it.
requires that all meat sold commercially be inspected and passed to ensure that it is safe, wholesome, and properly labeled.
The Federal Meat Inspection Act (FMIA)
Statistical Quality Control (SQC)
The application of statistical techniques to quality control.
Your foodservice operation begins the month with $9250 in food inventories, and orders an additional $56,000 in food during the month. Your cafeteria and catering sales amount to $22,575. Your closing inventory for the month is $6225. How much were your food costs for the month?
$59,025---The sales had nothing to do with the cost of food in this case
Campylobacteria
-Campylobacter is 1 of 4 key global causes of diarrheal diseases. -Considered to be the most common bacterial cause of human gastroenteritis in the world. -Campylobacter infections are generally mild, but can be fatal among very young children, elderly, and immunosuppressed individuals. -Campylobacter species can be killed by heat and thoroughly cooking food. -To prevent Campylobacter infections, make sure to follow basic food hygiene practices when preparing food.
Giardiasis
-Diarrheal disease caused by the microscopic parasite Giardia duodenalis -Once a person or animal has been infected, the parasite lives in the intestines and is passed in stool. -Once outside the body, Giardia can sometimes survive for weeks or even months. -Spread by: Swallowing unsafe food or water contaminated with Giardia germs, Having close contact with someone who has giardiasis, particularly in childcare settings, Traveling within areas that have poor sanitation, Exposure to poop through sexual contact from someone who is sick or recently sick with Giardia, Transferring Giardia germs picked up from contaminated surfaces (such as bathroom handles, changing tables, diaper pails, or toys) into your mouth, Having contact with infected animals or animal environments contaminated with poop
Salmonella (Salmonellosis)
-bacteria - sources: GI tract of birds and mammals (sewage) - foods: poultry, beef, pork, eggs, cakes, custards, diary products - onset: 8-48 hours - duration: 2-5 days - 10-20% of victims are carriers for 4-8 weeks - symptoms: low-grade fever, nausea, diarrhea, and cramps
For a diabetic diet, a croissant containing 17 grams of carbohydrate and 30 grams of fat should be counted as
1 bread and 6 fats---FOOD EXCHANGE: 5g of Fat=1 fat, 15g CHO=1 Bread
The purchase of expensive equipment in a facility falls under the ______ budget.
Capital—capital budgeting is used when a business wants to evaluate large projects, expenses, and investments.
Choose the appropriate formula for a baby with galactosemia:
Casein hydrolysate, glucose, corn oil—This is because babies with galactosemia cannot consume lactose or galactose. Although Casein should be avoided, casein hydrolysate is casein that goes through hydrolysis and is broken down into peptides. When hydrolysed, the casein is pre-digested and is able to get past the immune system without causing a reaction.
Decreasing calorie levels by 1100 per day in a weight-stable patient will result in the loss of how many kg per week?
1.0 kg---1kg=7716kcals, 1lb=3500kcals
Fluid needs for parenteral/enteral feedings can be estimated by
1.0ml/kcal ingested
The rate of weight gain during pregnancy should optimally be
2-4 lb in the 1st trimester and 1 lb per week thereafter
A clinic that serves approximately 140 patients per week has a staffing standard of one dietitian for every 200 patients per month. The number of dietitian full-time equivalents (FTE) needed for the clinic is:
2.8—140patients/week x 4weeks/month = 560patients/month, 560patients/month / 200patients/RD = 2.8 FTE
A level teaspoon of salt contains about how much sodium?
2000 mg
A study showed that 60 out of 2200 children were hungry in a rural community. This is:
2727/100,000—60 is 2.727% of 2200. This is the same as 2727/100,000 because 2727 is 2.727% of 100,000.
The physician has ordered a 2200 kcal, 80 gram protein, 35% fat diet instruction for Rob. How many grams of carbohydrate will you plan for in his daily meal pattern?
275---80gP x 4kcal/gP = 320kcalP, 35%Fat = 35/100 x 2200kcal = 770kcalFat, so 1090kcals come from fat & protein, 2200-1090=1110kcalCHO, 1110kcalCHO/4kcal/gCHO = 275 (rounding difference)
A patient is prescribed 1000 ml of a 10% dextrose solution. How many calories will he receive?
340---10gdex / 100ml = 0.1, 0.1 x 1000ml = 100, 100 x 3.4 = 340kcalsDex
A facility establishes a productivity standard of 3.75 labor minutes per meal for 4500 meals. The normal work schedule of each full-time employee is 8 hours per day. The minimum daily staffing needs of the facility, stated as full-time equivalents (FTEs), would be approximately:
35—4500meals x 3.75 mins per meal =16875min, 16875/60min/hr = 281.25hr / 8 hours =35.2FTEs
Sheila is receiving a PN solution containing 1000 cc 8.5% amino acids and 500 cc of D40W with no lipids. What percent carbohydrate is her solution?
67% —First, we figure out how many grams of amino acids and grams of dextrose in the solution. 8.5% amino acids mean that there are 8.5g of amino acids in 100ml of solution. 8.5gaa / 1000ml = 85gaa. We know that protein provides 4 kcals per gram so... 85gAA x 4kcals/g = 340. For dextrose: 49gdex / 500ml =200. We know that carbohydrates provide 3.4 kcals per gram so... 200gCHO x 3.4kcals/g = 680. 680 +340 = 1020... Since we want to find what percent CHO is in her solution, we find the percent of 680 out of 1020 which is 66.67% or 67%.
How many hours is equivalent to 1.75 FTE's?
70hours—standard hours per week / 40 = 1.75FTE=SHPW = 40 x 1.75 = 70SHPW
Listeriosis
A disease of the nervous system of humans that can cause fever, meningitis, miscarriage, or premature birth and is spread by eating food contaminated with listeria
Identify the false statement about objective testing measurement
A viscometer can measure the clarity of honey—Objective testing measurement must result in a numeric or measurable value. The clarity of honey is not something that can be objectively measured.
Glucose and amino acids are pumped across membranes during absorption through
Active Transport—Glucose and amino acids are pumped through the membrane by membrane proteins using energy.
Which of the following values best represents somatic protein?
Creatinine height index
The one symptom of vitamin E deficiency that has been demonstrated in human beings is
Breakage of red blood cell membranes—(hemolytic anemia) premature infants are more at risk.
Which of the following guidelines should be employed in counseling patients?
Build on current practices and reinforce positive practices—It is best to meet the patient where they are at. Instead of overwhelming them by changing their whole lifestyle, we should encourage the good practices and slowly build up to other healthy practices.
A grievance procedure is best described as a process through which:
employees register problems with the employer, investigations are conducted, and objective conclusions are reached.
To calculate the benefit in a cost-benefit analysis of a nutrition program, it is necessary to
establish and quantify the relationship between the change in nutrition services and any change in health status
A reason for iron deficiency anemia in children would be
excess milk consumption---cow's milk makes it harder to absorb iron
There are too many write-ins on the select menu at the hospital. Which of the following provides the best strategy for resolving the problem?
expand the menu to provide more choices
An appropriate meal for a patient with chronic celiac sprue is
hamburger steak, rice, and green beans
Which of the following is known to impede iron absorption?
high calcium foods
A commercial muffin mix is described as a "rich formula," which means that it contains:
high proportions of sugar and shortening
Phosphorus in foods is associated with
high protein foods
Characteristics of refeeding syndrome include
hypophosphatemia
A nutrition surveillance program is designed primarily to:
identify the nutritional needs of the population.
The purpose of Healthy People 2000 initiatives is
to help prevent chronic disease
For a vegan, soy milk is best fortified with
vitamin B12, calcium, and vitamin D---these typically come from animal products
What is the best behavioral approach to weight management?
keep food and activity records
Good dietary sources of folate include all except
milk
Antioxidant substances that are believed to help protect against cancer include all of the following except
molybdenum
You are assigned to count the items in the storage room on the first day of the month. This type of inventory is called
physical
Potatoes, tomatoes, dried fruits, nuts, and legumes are all rich sources of
potassium
A dietitian is asked to develop quality control guidelines for receiving purchased foods. The most important guideline would define:
proper temperatures of the foods received.
What is the difference between regular flour and cake flour?
protein content---Cake flour comes from soft wheat. This flour type has lower protein content and less gluten than all purpose flour
A patient who has been treated for chronic renal failure during the past year must now begin hemodialysis. The patient's diet should be modified to include more:
protein-this is lost in large amounts during dialysis and prevents malnutrition
The dietitian at an outpatient clinic is planning a training program to improve the skills of clinic aides in weighing and measuring infants and children. An appropriate outcome objective for the program would be to
provide accurate measures of heights and weights---established to define in measurable terms what is to be achieved through the interventions regarding health status of participants; and changes in knowledge, attitudes, beliefs, behaviors and conditions related to health and nutrition status.
With the TB drug Isoniazid (INH), which of the following would be need to be supplemented?
pyridoxine
In management theory, power accruing to an individual in authority as a result of being liked or identified with by others is known as what kind of power?
referent
Fluid is typically not restricted in
renal insufficiency---dialysis is usually suggested after a PT has a GFR of >15, when kidneys cannot filter much, including fluid.
The single most effective way to teach nutrition to children is by
setting an example
A hospital cafeteria that currently serves 500 meals at noon must increase service to 800 without adding food production staff. The most appropriate action would be to:
simplify the menu.
Carlos has end stage liver disease and is being managed nutritionally. Which of the following best represents key components of the diet for Carlos (and his health care team) to monitor?
sodium, protein, and fluid
Carla is receiving Trophocal ¾ strength at 50 cc q h, which provides 55 g protein/L full strength and consists of 79% water. The tube feeding was turned off for 4 ½ hours on Tuesday. How much protein did Carla receive?
you know that it is 50 ml/hr, but was turned off for 4.5 hours, so it was running for 19.5 hours So 50 ml/hr x 19.5 hours provides = 975 ml per day. So it has 55 gm /liter (1000ml) .975 x 55= 54 gm protein/day it is at 3/4 strength - no one does this, but take the amount and multiple by 75% 54 gm x .75= 40 gm protein The water does not play into calculating the answer
Characteristics that are desired in a food product are outlined in the
specifications
Which of the following is the least important to consider when planning menus?
staff food preferences
The foundation of quality assurance is
standards of performance and care
A pan of au gratin potatoes has been cooked to an endpoint temperature of 140°F. Serving is scheduled to begin in 10 minutes. The dietitian should:
substitute instant mashed potatoes until the au gratin potatoes are done.
Which of the following has the greatest effect on the basal metabolic rate?
Thyroxine—The thyroid gland controls BMR and thyroxine is the main hormone produced by the thyroid gland. Too much thyroxine can cause dangerously high BMR which can lead to Grave's disease.
The ATP III dietary guidelines for the prevention and treatment of coronary heart disease include
Total fat 25-35% of kcal, saturated fat <7% of kcal, and cholesterol < 200 mg/day
responsible for ensuring the safety, wholesomeness, and accurate labeling of meat, poultry, and processed egg products.
USDA Inspection Service guidelines
Failure to thrive (FTT) in infants is measured by
Weight for length—WHO growth charts are recommended to assess infants up to 2 years old.
Which of the following nutrients is generally not found on a standard food label?
Zinc—The FDA doesn't require food labels to list zinc unless it is added to the food and is not naturally occurring.
Botulism
a rare but serious illness caused by a toxin that attacks the body's nerves and causes difficulty breathing, muscle paralysis, and even death. Caused by Clostridium botulinum and sometimes Clostridium butyricum and Clostridium baratii bacteria.
Total parenteral nutrition may be indicated in all but which of the following?
advanced inoperable cancer
An elderly woman has rheumatoid arthritis. Lab values show normocytic anemia. This is probably due to:
anemia secondary to chronic disease
For quality assurance, the RD would consider which of the following regarding food deliveries received at the loading dock the most important?
appropriate temperature
What is the first step in preparing for a training session?
assess needs
A young boy is brought into the ER at supper time with breathing, swallowing, and speaking difficulties. His mother mentions that he ate some home-canned vegetables at lunch. Food contamination is suspected with the most likely toxin being
botulinum
Which of the following ingredients listed on food labels would be acceptable to a person who is highly intolerant to lactose in the diet?
casein---present in milk, but it's not a milk sugar like lactose
Which of the following foods contain high levels of tyramine?
chicken livers
A person who has atrophic gastritis might be at risk for what nutrient?
cobalamin(any cobalt-containing substance incl. vit. B-12)---Autoimmune chronic atrophic gastritis is a rare etiology of vitamin B12 deficiency, which results in a destruction of the parietal cells, leading to a reduction in intrinsic factor, which is essential to the absorption of vitamin B12.
Negotiations between representatives of both management and employees regarding employment and working conditions is called
collective bargaining
Mr. Brown's wife recently died. He is very lonely and has financial problems as well. Which program is probably the single best one for him to be referred to by the community nutritionist?
congregate meal program---provides nutritious meals to people in a group setting. Most congregate meal programs are for people 60 and above. Most programs are free of charge but give people the opportunity to make a small donation. Most programs ask for a small donation of under $3 per meal. The typical congregate meal program offers activities during the meal such as games, light exercise, and informative guest speakers.
A dietitian who wants to ensure patient acceptance of a menu adapted from a multi-institution menu should first consider:
cultural and ethnic differences among patients.
When the diet contains an adequate amount of protein, what amino acid can be used by the body to synthesize niacin?
tryptophan
What is the major factor that determines metabolic rate?
Amount of lean tissue—Unlike fat, muscle is an active tissue. Maintaining muscle requires expending energy, which will raise metabolic rate.
What part of management is MOST associated with the financial aspects of the work environment?
controlling
The quality of a standardized recipe varies each time it is prepared. The RD supervisor should
supervise the preparation of the recipe
A study which provides ongoing information about nutrition status is called a
surveillance project
Which of the following is a possible fate of acetyl CoA?
synthesis to fatty acids
