Domain II Jean Inman Practice Questions with Explanations

In community surveys, a frequent symptom of malnutrition is:

a. scurvy

b. rickets

c. low serum albumin

d. low hemoglobin

d. low hemoglobin

Low hemoglobin (

Which is the least common symptom in the elderly?

a. osteomalacia

b. osteoporosis

c. obesity

d. hypertension

a. osteomalacia

Osteomalacia is considered "adult rickets". It occurs in response to vitamin D deficiency (lack of sunlight and/or dietary intake). Osteomalacia results in bone density demineralization.

Osteoporosis is common among older, white women who do not engage in weight-bearing activity (typically petite). Obesity and hypertension can occur at any age, and does significantly impact elderly population.

What is included in the study of demographics?

I. age of individuals

II. population statistics

III. sex of individuals

IV. socioeconomic factors

a. I only

b. all of the above

c. II, III

d. I, II, III

d. I, II, III

Demographics include population by age, ethnic groups, sex, birth rates, and deaths.

Socioeconomic factors are a different category, and include census data, housing statistics, etc.

Athletes should receive...

a. salt pills only during the summer months

b. extra protein

c. carbohydrate loading two weeks prior to an event

d. water during an event to replace lost fluids

d. water during an event to replace lost fluids

Hydration/replacing fluid loses during exercise is vital. 16 oz fluid per lb weight lost.

How many grams of protein would you receive on a 1500 calorie diet which is 20% protein?

a. 70

b. 75

c. 64

d. 300

b. 75

1500 x 20% = 300 kcal

300 kcal / 4 kcal/gm = 75 gm protein

A patient is on a high protein, low carbohydrate diet. What advice should you offer?

a. increase fluid intake

b. decrease the intake of complex carbohydrates

c. decrease fluid intake

d. decrease the intake of saturated fats

a. increase fluid intake

High-protein intakes impact renal function via excretion of nitrogenous waste products generated from protein metabolism. A high protein diet might increase renal solute load, thereby increasing fluid necessary for efficient renal handling of solute load. Subsequently, increasing fluid intake is essential for those on high protein diet

Nutritional prescription for a patient with cardiac cachexia includes:

a.

b. low sodium, low saturated fat, low cholesterol, high calorie

Cardiac cachexia is unintended weight loss that occurs when blood backs up into liver and intestines causing nausea and decreased appetite. Since these individuals are experiencing weight loss, high calorie needs are indicated. However, since they are cardiac patients, low sodium (

Which infant is at the greatest risk?

a. 20lb, hemoglobin 10

b. 22lb, hemoglobin 10.5

c. 19lb, hemoglobin 11

d. 30lb, hemoglobin 9

d. 30 lb, hemoglobin 9

Normal hemoglobin for infants is 10 mg/dL. Subsequently, the baby that has a hemoglobin of 9 would be at greatest risk for anemia. Weight does not impact risk given the information provided.

a. 20lb, hemoglobin 10

b. 22lb, hemoglobin 10.5

c. 19lb, hemoglobin 11

d. 30lb, hemoglobin 9

Which of the infants in the above question have a normal hemoglobin?

a. a, b, d

b. b, d

c. c, d

d. a, b, c

d. a, b, c

Normal hemoglobin for infants can vary based on age, but 9.5 to 13 g/dL is the reference range listed for "infants". Subsequently, all other infants aside from the one with a Hg of 9, have a normal hemoglobin.

An alcoholic patient has a low serum albumin, low hemoglobin, high ammonia, abnormal liver function tests and ascites. Why is he on a 500mg sodium diet?

a. secondary renal failure

b. hypoaldosteronism

c. hypoalbuminemia

d. hyperammonemia

d. hypoalbuminemia

Albumin is essential to maintain the oncotic pressure within the vascular compartments, preventing leaking of fluids into the extravascular spaces. It accounts for around 80% of the colloid osmotic pressure. Excessively low albumin levels may cause/exacerbate the abnormal accumulation of fluid in the abdomen (i.e., ascites), which may worsen the impaired blood flow through the patient's already damaged liver.

Subsequently, a low sodium diet is indicated to prevent exacerbation of ascites based on his low serum albumin.

An alcoholic patient has a low serum albumin, low hemoglobin, high ammonia, abnormal liver function tests and ascites. Why is he on a 500mg sodium diet?

Which of the following should the patient in the above question have for lunch?

a. 4 ounces cottage cheese

b. 1 ounce cheddar cheese

c. 1 ounce roast beef

d. 1 ounce cold cuts

c. 1 ounce roast beef

1 oz of roast beef has only ~16mg of sodium. Foods higher in sodium would include processed meats and cheeses. Lower sodium would be unseasoned meats, eggs, etc.

4 oz of cottage cheese has ~411mg of sodium. 1 oz of cheddar cheese has ~176 mg sodium, 1 oz cold cuts has ~376 mg.

Which of the following should be included in the diet for celiac disease?

I. decrease intake of eggs

II. use potato and rice flour

III. MVI vitamin B12 and iron

IV. Low calorie, high fat, high protein

a. II, III

b. II, IV

c. I, II, IV

d. II, IV

a. II, III

Celiac disease (a type of Non-tropical sprue) is a immune reaction to gliadin, which affects the jejunum and ileum. Treatment for Celiac disease includes a gliadin-free, gluten-restricted diet.

Foods okay for Celiac disease include corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax, amaranth, millet, teff, quinoa.

Foods NOT okay for Celiac disease include wheat, rye, oats, barley, bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents.

Who is most at risk for gestational diabetes?

a. BMI

d. BMI >30, history of GDM

Risk factors for GDM include BMI>30, history of GDM

A child is lethargic, irritable with diarrhea. The cause may be:

a. zinc toxicity

b. lead poisoning

c. iron overload

d. vitamin A toxicity

d. lead poisoning

Lead depletes iron, leading to anemia. Iron-deficiency anemia can cause lethargy.

How many calories are in 300ml of a 5% dextrose solution

a. 51

b. 60

c. 15

d. 200

a. 51

5 gm dextrose per 100 mL

5 gm x 3 = 15 gm dextrose per 300mL

15 gm x 3.4 = 51 kcal

A single 19 year old female is 6 months pregnant. She has not gained any weight and has not seen a physician. Hemoglobin is 9. Hematocrit is 30. What is the most important recommendation for her?

a. see a physician immediately

b. apply for WIC immediately

c. join a teenage pregnancy support group

d. begin taking iron supplements

a. see a physician immediately

Normal Hg for females is 12-16 g/dL, and normal Hct for females 36-48%. Subsequently, is is very likely that this patient has anemia and may benefit from iron supplements. However, the RDN would want to first have this patient evaluated by an MD to determine the best course of treatment.

A female, 5'7" tall, weighs 115 lbs. Six months ago she weighed 130 lbs. What is her percent of ideal body weight

a. 85%

b. 83%

c. 81%

d. 87%

a. 85%

IBW= 100 + 5lb for every inch over 5'

IBW = 100 + 5 (7) = 135lbs

Current wt = 115lbs

115lbs/135lbs = 85% of IBW

A vegan is allergic to milk. Which nutrients would you expect might be deficient in her intake?

a. protein, calories

b. vitamin B12, D

c. vitamin C, calcium

d. vitamin A, D

b. vitamin B12, D

Vegans, without supplementation, can become deficient in vitamin B12 as the primary sources come from animal products. Since this individual is also allergic to milk (which she wouldn't drink anyways as a vegan), she could be low in vitamin D, which is fortified in milk. She should drink a plant-based milk fortified with vitamin D and calcium (and B12 if possible).

A patient with Crohn's disease needs the following diet:

I. high fat, high calorie, high protein

II. low fat only with steatorrhea, vitamin C, B12

III. calories according to current BMI, high protein

IV. high residue, low fat, fat soluble vitamins

V. low calorie, low residue, fat soluble vitamins, B12

a. I

b. II, III

c. III, IV

d. V

b. II, III

A Crohn's disease patient will only need to restrict fat if they are experiencing steatorrhea. Vitamin C and vitamin B12 supplementation may be beneficial due to absorption in the small intestine, which is likely affected in Crohn's disease (especially terminal ileum). A Crohn's patient who is not in a flare can have calories according to BMI. A higher protein diet would be indicated.

A high fat, high calorie, high protein diet would not necessarily be indicated in Crohn's. High fat diet may aggravate the patient's GI tract, and high calorie is not necessary if the disease is well controlled. Additionally, a low calorie, low residue diet is not necessary. If a patient is having a flare, they may minimize fiber in the diet until they are in remission, and then increase to higher fiber.

Which of the following diets is appropriate for reactive hypoglycemia

a. reduce intake of concentrated carbohydrates, 5-6 small meals

b. increased complex carbohydrate, low fat, high protein

c. decreased complex carbohydrate, low fat

d. high protein, high fat, high carbohydrate

a. reduce intake of concentrated carbohydrates, 5-6 small meals

Reactive/postprandial hypoglycemia occurs when there is an overstimulation of the pancreas or increased insulin sensitivity, causing BG to fall below normal 2-5 hours after eating. In order to reduce the incidence/severity of blood sugar drops, small frequent meals and reduced intake of simple sugars is recommended.

Which patient has marasmus?

Patient A - Male

Serum albumin 3.5

Transferrin 275

Triceps skinfold 3

MAMC 15

TLC -----

Patient B - female

Serum albumin 2.6

Transferrin 125

Triceps skinfold 16.8

MAMC 24.1

TLC 1000

Patient C - male

Serum albumin 4.0

Transferrin 450

Triceps skinfold 17

MAMC 28.1

TLC 3500

a. A

b. B

c. C

d. A, B

a. A

Patient A is the only one who has marasmus. Serum albumin is not a good indicator of nutritional status so disregard it. **Note, Jean indicates serum albumin normal in marasmus. Transferrin is WNL. Triceps skinfold is 3mm, which is well below the standard for males of 12.5mm. Finally, the AMC is 15cm. Normal arm muscle area (AMA) is 25.3 cm in males, which this patient falls well below. Subsequently, this patient has severe fat depletion and thus marasmus is likely.

Patient B: tricep skinfold WNL, AMC WNL, TLC is low (likely infection as albumin also low)

Patient C: transferrin high, triceps WNL, AMC WNL, TLC WNL

Normal albumin: 3.5-5 g/dL

Normal transferrin: greater than 200 mg/dL (204-360 mg/dl)

Normal triceps skin fold: 12.5mm in males, 16.5 mm in females

Normal arm muscle area (AMA): 25.3 cm in males, 23.2 cm in females

When assessing nutritional status, which would be the most beneficial?

a. 24 hour recall, history of weight changes

b. medical history, diet order, socioeconomic status

c. clinical observation, weight status, cultural habits

d. diet intake info, clinical data, laboratory data

d. diet intake info, clinical data, laboratory data

ABCD's of nutrition assessment- anthropometrics, biochemical data, clinical data, and dietary information. Clinical data would include NFPE, which is an essential component of nutrition assessment. Other answers, including socioeconomic status and cultural habits are very important, but not the most critical.

The first function of the public health nutritionist is:

a. assess the needs of the community

b. counsel patients with special dietary needs

c. write pamphlets for educational purpose

d. expand the role of dietitians

a. assess the needs of the community

The needs assessment is the first step when attempting to implement community-based intervention/project.

The steps include:

-Conducting a community needs assessment

-Developing program goals and objectives

-Developing a program plan

-Identifying funding sources

-Seeking support from stakeholders

What nutrients most affect the renal solute load?

a. protein and carbohydrate

b. sodium and carbohydrate

c. protein and sodium

d. sodium and fat

c. protein and sodium

Renal solute load is the solutes excreted in 1 L of urine; daily fixed load of 600mOsm - mainly measures N (60%) and electrolytes (Na). The two nutrients that most affect RSL are protein and sodium.

The elderly need how many ml per KG?

a. 35 - 40

b. 45

c. 25 - 30

d. 25

c. 25 - 30

The elderly are at an increased risk of dehydration for a variety of reasons, including physiological, psychological, and medication.

According to the Diabetic Exchange Lists, when substituting 2% milk for fat-free milk, you must omit how many fat exchanges?

a. 1/2

b. 1

c. 1 1/2

d. 2

b. 1

2% milk has 12 gm CHO, 8 gm protein, and 5 gm fat. Fat-free milk has 12 gm CHO, 8 gm protein and 0 gm fat. Subsequently, you are omitting 1 fat exchange, which is equal to 5 gm fat.

If a man normally consuming 2600 calories per day reduces his intake to 1500 calories per day, how much weight will he lost in one week

a. 0.5 kg

b. 1.0 kg

c. 1.5 kg

d. 2.0 kg

b. 1.0 kg

2600 kcal - 1500 kcal = 1,100 kcal less per day

1,100 kcal x 7 days per week = 7,700 kcal less per week

7,700 kcal / 3500 kcal per week to lose 1 lb = 2.2lb

2.2 lb /2.2 lbs per kg = 1 kg

For which of the following diseases is diet therapy the primary treatment?

a. peptic ulcer

b. diabetes

c. wilson's disease

d. galactosemia

d. galactosemia

Galactosemia is a genetic disease in which there is a deficiency in converting galactose to glucose. Galactosemia is only treated with diet. Diet followed should be low in galactose, avoiding organ meats, MSG extenders, milk, lactose, galactose, whey, casein, dry milk, calcium or sodium caseinate, dates, bell peppers.

The other conditions have a dietary component, but other factors are involved in treatment (i.e. physical activity, medications, insulin in DM).

Which of the following best reflects protein status?

a. serum albumin

b. serum transferrin

c. retinol-binding protein

d. prealbumin

d. prealbumin

Prealbumin/transthyretin is a hepatic protein and negative acute phase reactant that has a short half-life, meaning it quickly detects changes in protein status.

Serum albumin is also hepatic protein and negative acute phase reactant. However, albumin has a long half life and thus is not a good indicator of nutritional status. RBP is a protein that is necessary to transport vitamin A from the liver to other tissues. RBP circulates with prealbumin, but in itself is not a good indicator of overall nutritional status. Transferrin is a visceral protein that transports iron to bone marrow and is most helpful in identifying anemia.

Following a Billroth II, steatorrhea often results. What is the likely cause?

a. bacterial overgrowth in the remaining loop

b. lack of pancreatic secretion due to less duodenal hormone secretion

c. a diet restricting simple carbohydrates

d. rapid absorption of simple carbohydrates

b. lack of pancreatic secretion due to less duodenal hormone secretion

Billroth II is a gastrojejunostomy, in which the remaining stomach is attached to the jejunum. Subsequently, the duodenum is removed. Typically when chyme enters the duodenum, pancreatic enzymes (such as secretin releasing bicarbonate and pancreatic lipase) are released to help digest foods as well as absorption on the brush border member. However, now that the duodenum is removed, diarrhea may occur as these enzymes are not secreted to help further digest/absorb the chyme.

Meats cured with whey won't be tolerated by someone with:

I. lactose intolerance

II. diabetes

III. post-gastrectomy of 3 months

IV. duodenectomy

a. I, II, III

b. II, III, IV

c. I

d. I, III, IV

c. I

Whey is a protein from milk, which requires further breakdown prior to digestion. If someone is lactose intolerant and thus lacking the lactase enzyme, whey would not be tolerated. Whey isolate, on the other hand, is lactose-free and thus may be tolerated.

Chemically defined formulas are used for:

a. short bowel syndrome

b. post chemotherapy treatment

c. hypermetabolism

d. galactosemia

a. short bowel syndrome

Chemically defined formulas refer to elemental formulas. Subsequently, SBS would be most appropriate to use an elemental formula.

The severity of SBS depends on the length and location of resection, age of patient, health of remaining tract. However, elemental formulas are most commonly utilized for SBS to minimize malabsorption/maldigestion considering a portion of the small intestine is missing/removed.

A PEG feeding would be useful in a patient with:

a. head or neck cancer, who will not be able to eat normally for weeks

b. short bowel syndrome

c. duodenal ulcers

d. pancreatitis

a. head or neck cancer, who will not be able to eat normally for weeks

A PEG tube is used for those requiring NS for at least 3-4 weeks. Head and neck cancer patients notoriously require PEG needs due to the nature of the condition and treatments.

A patient with hepatitis needs a high protein intake. Besides helping the liver to regenerate, what other purpose is served?

a. it helps increase iron absorption

b. it restores glycogen reserves

c. it helps prevent a fatty liver

d. it helps prevent necrosis of the liver

c. it helps prevent a fatty liver

Having a high protein provides lipotropic agents like methionine and choline needed to convert fats to lipoproteins for removal from the liver, thus, preventing fatty infiltration.

The additive influence of foods are constituents which when eaten have a beneficial effect on health refers to:

a. nutraceuticals

b. food synergy

c. positive corollaries

d. medical foods

b. food synergy

Food synergy is the concept that the non-random mixture of food constituents operates in conjunction doe the life of the organism eaten and presumably for the life of the eater.

A nutraceutical is a food containing health-giving additives and having medicinal benefit.

Which foods are most likely to cause an allergic reaction?

a. shellfish, peanuts, wheat

b. wheat, chocolate, rice

c. citrus fruits, milk, corn

d. chocolate, milk, corn

a. shellfish, peanuts, wheat

Which of the following is a non-nutritive sweetener?

a. Stevia

b. Sorbitol

c. Mannitol

d. Agave

a. Stevia

Stevia is a constituents of the leaves of Stevia rebaudiana (Bertoni) Bertoni, a plant native to parts of South America. They are non-nutritive sweeteners and are reported to be 200 to 400 times sweeter than table sugar.

Sorbitol and mannitol are types of sugar alcohols. Sugar alcohols provide fewer calories (about a half to one-third less calories) than regular sugar. This is because they are converted to glucose more slowly, require little or no insulin to be metabolized and don't cause sudden increases in blood sugar. Agave is a sweetener from plants that contains fructose.

A 1500 calorie diabetic diet with 45% of the calories from carbohydrate is prescribed. One third of the carbohydrate grams is met with 1/2 cup orange juice, 1 cup milk, and:

a. 1 slice toast

b. 2 slices toast

c. 2 slices toast and 1/2 cup oatmeal

d. 1/2 slice toast

b. 2 slices toast

1500 kcal x 0.45 = 675 kcal from CHO

675 kcal / 4 kcal per gm = ~169 gm for day

1/3 of 169 gm = ~56 gm for this snack/meal

1/2 cup OJ (4 oz) = 15 gm CHO, 60 kcals

1 cup milk (whole) = 12 gm CHO, 8 gm pro, 8 gm fat, 160 kcals

So far provides: 12+15 = 27 gm

Remaining needs: 56 gm - 27 gm = 29 gm (~2 exchanges)

1 slice toast = 1 exchange, so 2 slices = 30 gm

Which of the following is a medium fat protein?

a. peanut butter

b. tuna fish packed in water

c. corned beef

d. chicken without skin

c. corned beef

PB = 1 high-fat protein + 1 fat exchange (0 gm CHO, 7 gm protein, 13 gm fat, 145 kcal); serving is 1 tbsp

Tuna in water = 1 lean protein (0 gm CHO, 7 gm protein, 3 gm fat, 55 kcal); serving size 1 oz

Corned beef = 1 medium protein (0 gm CHO, 7 gm protein, 5 gm fat, 75 kcal); serving 1 oz

Chicken without skin = 1 lean protein (0 gm CHO, 7 gm fat, 3 gm fat, 55 kcal); serving size 1 oz

**If chicken with skin, would have been medium-fat protein.

Which government agency would you contact regarding food distribution?

a. USDA

b. FDA

c. HHS

d. FTC

a. USDA

USDA's food distribution programs strengthen the nutrition safety net through the distribution of USDA Foods and other nutrition assistance to children, low-income families, emergency feeding programs, Indian reservations, and the elderly. Ex: CSFP, TEFAP

Which has the greatest effect on the renal solute load?

a. potassium

b. sodium

c. glucose

d. protein

d. protein

Renal Solute Load mainly measures nitrogen (60%) and sodium.

Which is not a fiber in the diet?

a. cellulose

b. hemicellulose

c. amylose

d. pectin

c. amylose

Cellulose, hemicellulose, and pectin are all types of fiber. Amylose is a type of starch.

What is the diet for hypertension?

a. low sodium

b. low sodium, high potassium

c. low sodium, high calcium

d. low sodium, high potassium, high calcium

a. low sodium

DASH diet used for HTN. Encourages intake of whole grains, fruits, vegetables, low fat dairy products, poultry, fish, limit alcohol, decrease sweets, calcium to meet DRI. While potassium intake may be higher in a diet that is high in fruits and vegetables, it is not specifically listed as "high potassium".

The NHANES study looks at which parameters?

a. nutritional

b. nutritional, biochemical

c. nutritional, biochemical

d. nutritional, clinical, biochemical

d. nutritional, clinical, biochemical

National Health and Nutrition Examination study is an ongoing (repeated) survey to obtain information on the health of American people. Evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometrics, nutritional data. Run by CDC

What is a major reason for constipation in the elderly?

a. a diet low in high residue foods

b. a diet high in low reside foods

c. decreased gastric motility

d. lack of physical exercise

c. decreased gastric motility

Gastric motility decreases with age for a variety of reasons, including medications, concomitant diseases, and polypharmacy

the program that provides nutrition education training to teachers and food service personnel is the:

a. TEFAP

b. CACFP

c. EFNEP

d. NETP

d. NETP

Nutrition Education Program is the amendment to School Lunch Act. Provides nutrition education training to teachers and school foodservice personnel. Run by USDA

TEFAP is The Emergency Food Assistance Program; Quarterly distributions of commodity foods by local, public, or private nonprofit agencies, food banks, soup kitchens, homeless shelters; supplements diet of low income households, short term hunger relief. Run by USDA.

CACFP is the Child and Adult Care Food Program. Federal entitlement program;guarantes reimbursement for meals/snacks served to eligible children, youth, and adults;children: preschoolers enrolled at participating child-care center, homeless shelters, eligible after school programs (run by community organizations in areas with > 50% children eligible for free/reduced meals Adults: over 60 years old, those with disabilities enrolled in day care facility (i.e. adult day care center)Meals must meet guidelines, must offer free or reduced-price to eligible, which are same as NSLP (1/3 RDA). Run by USDA

EFNEP is the Expanded Food and Nutrition Education program. Grants to universities that assist in community development. Trains nutrition aides to educate the public. Improves food practice of low income homemakers with young children. Works with small groups. Does not provide food. Run by USDA

A 6'2" male, large frame, 230lbs with type II diabetes should:

a. gain 5lb to be at a desirable body weight

b. lose 20lb slowly following balanced diet

c. lose 20lb in 4 weeks on a 800 calorie diet

d. lose 10lb slowly by following a balanced diet

b. lose 20lb slowly following balanced diet

Weight loss of 5-10% can improve insulin sensitivity. Rapid weight loss/extreme dieting is not appropriate.

A patient with chronic pancreatitis should consume oral pancreatic enzymes:

a. with large meals and fatty foods

b. only if steatorrhea increases

c. with all meals and snacks

d. only if consuming a high fat, low protein diet

c. with all meals and snacks

Pancreatic enzymes should be taken with all meals/snacks to aid in digestion. Those with chronic pancreatitis have irreversible inflammation leading to fibrosis with tissue calcification.

If a patient is about to be discharged when you receive the discharge diet order, you should...

a. give him something to take home

b. there is not enough time so forget it

c. enroll him in the outpatient clinic and schedule an appointment

d. teach him what you can in the time you have now

c. enroll him in the outpatient clinic and schedule an appointment

Following a cholecystectomy, bile is produced by the:

a. pancreas

b. liver

c. spleen

d. portal vein

b. liver

Cholecystectomy is a surgical removal of gallbladder; bile now secreted from liver directly into intestine.

How many calories are in 1.5 liters of a 25% dextrose solution?

a. 850

b. 1275

c. 1000

d. 1500

b. 1275

25 gm dextrose in 100 mL

25 gm x 15 = 375 gm dextrose

375 gm x 3.4 = 1,275 kcal

Research suggests that in order to guard against cancer you should ingest:

a. carotene and vitamin C

b. vitamins C and B12

c. protein and vitamin A

d. vitamins E and K

a. carotene and vitamin C

There is scientific evidence that fruits and vegetables are beneficial in overall cancer prevention, specifically carotenoids and vitamin C.

Which of the following may be the cause of loose stools in a tube fed patient?

I. feeding was administered at too rapid a rate

II. the osmolality of the feeding was too low

III. the patient is constipated

IV. an inadequate amount of intestinal surface area

a. I

b. I, II

c. II, III

d. I, IV

d. I, IV

If the rate of EN feeds is too rapid, loose stools can occur (too much too quickly). If the patient had inadequate intestinal surface area, absorption/digestion would be impaired and thus loose stools may occur.

If the osmolality of the feed was low, it would not cause loose stools (would have to be too high). The patient being constipation also does not make sense.

An elevated T4 indicates:

a. galactosemia

b. hypothyroidism

c. hyperthyroidism

d. ketonuria

c. hyperthyroidism

Hyperthyroidism is characterized by increased T3 and T4 hormones which increases the metabolic rate leading to weight loss.

Hypothyroidism is characterized by T4 low; T3 low or normal which decreases BMR leading to weight gain.

Before discontinuing a parenteral feeding, provide enteral support to prevent:

a. development of fatty liver

b. ketoacidosis

c. hypogylcemia

d. hepatic encephalopathy

c. hypogylcemia

D/c'ing PN feeds, which provide dextrose directly into blood stream, would put the patient at high risk for hypoglycemia. The patient has likely not being using their gut much if at all while on PN, so there would be an adjustment period to get the gut functioning normally. The patient may not eat much and thus risks hypoglycemia.

An example of a positive nutrition care outcome is:

a. increased intake of foods high in iron and vitamin C

b. increase in the number of participants in a weight management class

c. increase in physician referrals to the outpatient department

d. decrease in the number of complaints regarding low sodium meals

a. increased intake of foods high in iron and vitamin C

Nutrition care outcomes prove the value of the intervention. They represent the nutrition professionals specific contribution to care. Subsequently, increasing intake of high iron and vitamin C foods would be the nutrition care outcome.

Increased # of participants, increase physician referrals, and decreased complaints about low-sodium meals aren't direct nutrition care outcomes.

Iron deficiency anemia has the following characteristics:

a. large cells laden with hemoglobin, hypochromic, microcytic

b. small, pale cells, hypochromic, microcytic

c. large cells laden with hemoglobin, macrocytic, megaloblastic

b. small, pale cells, hypochromic, microcytic

IDA is a microcytic-hypochromic anemia. Most common cause of anemia include chronic blood loss most common cause (GI bleeding - NSAIDs, aspirin). IDA is associated with deficiency of iron intake or absorption, eating disorders such as pica. IDA sxs typically include fatigue, weakness, SOB, pale earlobes, spooned and brittle nails (symptomatic when hgb 7-8). IDA is evaluated using serum ferritin. Treat IDA with iron supplement (ferrous sulfate), eliminate blood loss. Vitamin C increases iron absorption

Which hormone moves milk through the mammary ducts?

a. prolactin

b. progesterone

c. estrogen

d. oxytocin

d. oxytocin

The two hormones of milk production are prolactin and oxytocin. Prolactin stimulates milk production/synthesis from alveoli. Oxytocin is released during letdown and causes milk to be ejected into ducts. Subsequently, oxytocin moves milk through mammary glands

Which anthropometric measurements are useful in assessing adults?

a. triceps skinfold, head circumference, arm muscle circumference

b. head circumference, arm muscle circumference, height, weight

c. serum albumin, triceps skinfold

d. triceps skinfold, arm muscle circumference, height, weight

d. triceps skinfold, arm muscle circumference, height, weight

Head circumference is only used in infants. Serum albumin is not a good indicator of nutritional status. Subsequently, triceps skinfold, AMC, height, and weight are the most useful.

Which is a measure of somatic protein?

a. serum albumin

b. serum transferrin

c. mid-arm muscle circumference

d. triceps skinfold

C - mid-arm muscle circumference

Somatic protein status is a measure of skeletal muscle. Visceral protein status is a measure of all other proteins (organs, viscera, serum, blood cells, white blood cells). Serum albumin and serum transferrin are visceral proteins (in blood). Triceps skinfolds measures body reserves.

Arm muscle area measure skeletal muscle mass

Muscle mass is determined using the:

a. triceps skinfold and arm circumference

b. skinfold caliper

c. BEE

d. urinary creatinine measurement

a. triceps skinfold and arm circumference

Arm muscle area is detemined using triceps skinfold and AC

Gastric irritants include:

a. black pepper, chili powder, caffeine, alcohol, cocoa

b. seeds, nuts, chili powder, black pepper, alcohol

c. caffeine, black pepper, nuts, alcohol

d. orange juice, black pepper, chili powder, alcohol

a. black pepper, chili powder, caffeine, alcohol, cocoa

Black pepper, chili powder, caffeine and alcohol are well known. Cocoa can cause the intestinal cells that relax the esophageal sphincter to release a surge of serotonin. When this muscle relaxes, gastric contents can rise.

Good advice for a patient with a hiatal hernia is to:

a. increase intake of complex carbohydrates

b. lower the fat content of the diet

c. don't eat before bed

d. avoid coffee

c. don't eat before bed

A hiatal hernia is a protrusion of part of the stomach into the mediastinum through the esophageal hiatus of the diaphragm. Nutritional therapies for hiatal hernia include small, bland feedings, avoiding late night snacks, avoiding caffeine, chili powder, and black pepper, as heart burn is common symptom

The dumping syndrome:

I. follows a gastrectomy

II. is secondary to carbohydrate overload

III. draws fluid into the intestine

IV. needs a high carbohydrate diet

a. I, III, IV

b. II, III, IV

c. I

d. I, II, III

d. I, II, III

Dumping occurs following gastric surgery (i.e. gastrectomy). When rapidly hydrolyzed carbohydrate enters the jejunum, water is drawn in to achieve osmotic balance. This causes a rapid decrease in the vascular fluid and signs of cardiac insufficiency appear. About two hours later, the CHO is digested and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin, causing a drop in blood sugar below fasting. This is called reactive/alimentary hypoglycemia.

The only answer that is not correct is high carbohydrate diet. In fact, a diet limiting simple carbohydrate is essential.

Nutritional therapy for hepatitis includes:

a. high protein, high carbohydrate, moderate fat, high calories

b. high protein, low carbohydrate, low fat, moderate calories

c. low protein, high carbohydrate, low fat, high calories

d. low protein, high carbohydrate, low fat, low calories

a. high protein, high carbohydrate, moderate fat, high calories

Nutrition therapy for hepatitis includes increase fluid to prevent dehydration, 50-55% CHO to replenish liver glycogen and spare protein, 1-1.2 g/kg, moderate to liberal fat if tolerated, small frequent feedings, multi-vitamin.

Esophageal varices may be caused by:

a. portal hypotension

b. portal hypertension

c. a high fiber diet

d. a high fiber, high residue diet

b. portal hypertension

Fibrosis and nodules of regenerating hepatocytes cause resistance to blood flow through the liver, leading to increased pressure in the portal vein. When portal pressure rises to 10 mm Hg, collateral circulation develops between it and nearby veins so that blood can be diverted into the systemic veins. Increased pressure causes edema, both general and ascites. Pressure can also lead to esophageal varices

The diet for hepatic coma is low in protein due to:

a. low ammonia levels

b. high cholesterol levels

c. high ammonia levels

d. high LDL

C - high ammonia levels

Hepatic Encephalopathy is a major (reversible) complication of end-stage liver disease. In HE, portal blood is diverted into general circulation via the collateral vessels. Subsequently, toxic substances like ammonia accumulate in blood as a result of liver failure & impaired urea synthesis. The high levels of ammonia can cause impaired consciousness, memory loss, tremors, stupor, and coma. A low-protein diet may be indicated to prevent further ammonia accumulation.

In cystic fibrosis, the most impaired nutrient is:

a. protein

b. disaccharides

c. electrolytes

d. fat

d. fat

CF is an inherited disease affecting the epithelial cells & endocrine glands that produce mucus, sweat, saliva & digestive juices. Most CF patients malabsorb dietary fats because of pancreatic insufficiency, which leads to impaired lipolysis. PERT is used to minimize risk of fat malabsorption and steatorrhea.

Hormones that control blood pressure and blood components are produced in:

a. the heart

b. the liver

c. the kidneys

d. the lungs

c. the kidneys

The RAAS system is a mult-organ process that regulates blood pressure. When BP falls, the kidneys release renin into the bloodstream. Renin splits angiotensinogen, released from the liver, into angiotensin I. Angiotensin I (relatively inactive) is spilt by angiotensin-converting enzyme (ACE), produced by the lungs, into angiotensin II, which is very active. Angiotensin II causes muscular wall of small arteries (arterioles) to constrict, which increases BP. This triggers the release of aldosterone from the kidneys. Aldosterone causes kidney to retain sodium and water and excrete potassium. Ultimately, this causes an increase in blood volume and BP

An acid ash would be created by ingesting:

a. corn, cranberries

b. milk

c. vegetables

d. fruits

a. corn, cranberries

Creating "acid ash" in urine would be a dietary intervention to prevent alkaline stones. An acid ash is created by increasing anions through increased consumption of food such as meat, fish, fowl, eggs, shellfish, cheese, corn, oats, and rye.

Creating an "alkaline ash" in urine would be a dietary intervention to prevent acidic stones. An alkaline ash is created by adding cations thorugh increased consumption of vegetables, fruits, brown sugar and molasses.

***This is rarely done as use medications now.

Symptoms of nephrosis include:

a. dehydration, hypocholesterolemia

b. albuminuria, hypercholesterolemia

c. edema, hypochelesterolemia

d. hypotension, hyperalbuminemia

b. albuminuria, hypercholesterolemia

Nephrosis/nephrotic syndrome is a defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules. Common sxs include albuminuria, edema, malnutrition, hyperlipidemia (increased synthesis and decreased clearance of VLDL).

The catecholamines released during stress cause:

a. hypertension

b. hyperglycemia

c. diuresis

d. elevated BUN

b. hyperglycemia

Epinephrine, a catecholamine, suppresses insulin secretion during trauma, leading to hyperglycemia.

Which is a part of the nutritional therapy for IDDM in a lean person?

a. time meals

b. decrease caloric intake

c. it is not crucial to maintain consistency of calories if average intake is low

d. decrease frequency of feedings

a. time meals

If an indivdiual is lean, the primary intervention would be improving meal timing to prevent any peaks or valleys in blood sugars.

Increased serum uric acid levels may lead to:

a. galactosemia

b. glycogen storage disease

c. gout

d. PKU

c. gout

Gout is a disorder of purine metabolism characterized by increase serum uric acid. Uric acid deposits in joints causing pain and swelling.

The diet for galactosemia should exclude:

a. high fat foods

b. high cholesterol foods

c. organ meats, MSG

d. simple carbohydrates

c. organ meats, MSG

Galactosemia is a genetic disease where there is a deficiency in converting galactose to glucose. The diet followed should be low in galactose. Foods to be avoided include organ meats, MSG extenders, milk, lactose, galactose, whey, casein, dry milk, calcium or sodium caseinate, dates, bell peppers.

Foods okay for those with galactosemia include soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG.

The ketogenic diet is used to help treat:

a. cystic fibrosis

b. seizures

c. chronic renal failure

d. hypotension

b. seizures

Immediately following a severe burn, nutritional therapy should include:

a. high calories

b. high protein

c. high calories, vitamins, minerals

d. fluid and electrolyte replacement

d. fluid and electrolyte replacement

In the first 24-48 hours following burn injury, fluids and electrolytes should be restored. When fluid status is stabilized, feeding can begin. The diet should be high calorie, high protein, high fluid, and high in vitamin C and zinc. Calorie needs should increase by 20 - 30% and may be as high as 2 x REE.

Orlistat is a medication used in the treatment of:

a. renal disease

b. liver disease

c. obesity

d. gastroparesis

c. obesity

Orlistat is an approved weight loss medication that works by inhibiting pancreatic lipase, thereby decreasing digestion & absorption of dietary fats. Side effects include diarrhea, malabsorption.

Closed enteral nutrition systems can hang for:

a. 12 hours

b. 24-48 hours

c. 12-24 hours

d. unlimited because the container is closed

b. 24-48 hours

Closed enteral systems are Ready to Hang. The containers are sterile until spiked for hanging. Can be used for continuous or bolus delivery. No flexibility in formula additives. Less nursing time. Increases safe hang time. Less risk of contamination. More expensive than canned formula. Overall, closed systems can be hung for 24-48 because of decreased risk of contamination.

In open enteral systems, the product is decanted into a feeding bag. Allows modulars such as protein and fiber to be added to feeding formulas. Less waste in unstable patients (maybe). Shortens hang time. Increases nursing time. Increased risk of contamination. Overall, open systems can be hung for up to 8 hours because of increased risk of contamination.

A fecal excretion of __grams of fat/24 hours is considered fat malabsorption

a. less than 1

b. more than 7

c. 3-5

d. 2-4

b. more than 7

Normal stool fat: 2-5 gm

Malabsorption: >7 gm

Iatrogenic malnutrition is:

a. vitamin and mineral malabsorption

b. protein malabsorption

c. protein, calorie malnutrition

d. kwashiorkor

c. protein, calorie malnutrition

Iatrogenic malnutrition is a protein-calorie malnutrition that is brought on by treatment, hospital, and/or medications.

What are the similarities between WIC and SNAP?

I. regulated by USDA

II. have at risk criteria

III. have income criteria

IV. a health exam is required

a. I, II, III, IV

b. I, II, III

c. II, III, IV

d. I, III

d. I, III

SNAP and WIC are both federal programs regulated by USDA, administered by states. WIC does have risk criteria (maternal nutritional risk, including abnormal weight gain, history of high risk, LBW, underweight, overweight, anemia), while SNAP does not. Both WIC and SNAP have income requriements. A health exam is required for WIC, but not SNAP.

WIC is NOT an entitlement program, while SNAP is an entitlement program.

A 60kg female receives 2700 calories on PN. The calorie to nitrogen ratio is 150:1. How many grams of nitrogen is she getting?

a. 14

b. 16

c. 18

d. 20

c. 18

150:1 = 150 kcals to 1 gm nitrogen

2700/150 = 18 gm nitrogen

What type of food would you feed to a patient who has the athetoid form of cerebral palsey?

a. milk-based products

b. finger foods like a hot dog in a roll

c. milk-free products

d. galactose-free foods

B - finger foods like a hot dog in a roll

Athetoid CP, also known as non-spastic CP, occurs when there are involuntary wormlike movements. Subsequently, these patients require high calorie, high protein, and can handle finger foods.

Osteoporosis is most likely to occur in:

a. the physically active adult

b. a non-smoker

c. a black female

d. a white female

d. a white female

Which is a quick diet assessment tool for a large group?

a. food frequency lists

b. diet history forms

c. weighing food samples and recording intake

d. food records

a. food frequency lists

FFQ is the most appropriate dietary intake tool for the community setting. FFQ is a retrospective questionnaire ascertaining frequency of food groups. FFQ's can be comprehensive (100 questions) or short, and are useful in research studies with large sample sizes.

Compared to human milk, commercially prepared infant fomula is:

a. similar in nutrient content

b. equivalent to human milk in nutrient content and antibodies

c. higher in protein and iron but lacks antibodies

d. lower in protein and iron and lacks antibodies

c. higher in protein and iron but lacks antibodies

Exclusively breastfed mom's must give iron to infant after 6 months of age. Up until that point, the infant has a good supply from mom's placenta. Protein is higher in infant formula (remember fortifying formula vs breastmilk during peds rotation). Presence of antibodies cannot be replicated in formula.

Which of the following is not associated with anorexia nervosa?

a. food aversions

b. distorted body image

c. schizophrenia

d. constant concern about weight status

c. schizophrenia

Anorexia nervosa is restricted eating leading to a significantly low body weight (BMI < 18.5), intense fear of gaining weight even though at a low weight, and distorted perception of body image. Schizophrenia is a seperate psychological condition all together.

Which of the following is appropriate for treatment for gastroparesis?

a. gingerale

b. oranges

c. bran cereal

d. rice

d. rice

Gastroparesis is delayed gastric emptying. Foods to avoid include high fiber foods, foods high in simple sugars, high fat, and avoid caffeine, mint, alcohol, and carbonation. It is also instructed to avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars. A bezoar is a mass of undigested food. Because the stomachs of people with gastroparesis don't effectively break down food and move it into the intestines, food can collect into a mass, which can be detected on X-ray, ultrasound, or CT scan.

Subsequently, rice would be the correct answer.

A female who eats a wide variety of foods and take supplemental iron and birth control pills may be:

a. marginally deficient in folic acid

b. low in calcium

c. low in vitamin A

d. low in zinc

a. marginally deficient in folic acid

Oral contraceptives can cause low levels of folate, B6, and C. Since this female is eating a wide varity of foods, it is unlikely she would be very deficient in any of these nutrients. However, it would be possible she is marginally deficient in folic acid.

The immobilized state can lead to low levels of:

a. albumin and calcium

b. albumin and sodium

c. calcium and potassium

d. potassium and zinc

a. albumin and calcium

Immobilization from paralysis decreases ability to absorb calcium and increases nitrogen losses.

A man with a peptic ulcer should consume

a. milk every two hours

b. a bland diet

c. a balanced diet he can tolerate

d. a low roughage diet

c. a balanced diet he can tolerate

An ulcer is an eroded mucosal lesion. Diet therapy includes eating as tolerated, well-balanced, avoid late night snacks. Omit cayenne and black pepper, large amounts of chili powder, and avoid excess caffeine and alcohol.

Which nutrient may be absorbed during peritoneal dialysis and continuous renal replacement therapy, thus requiring a modification of his diet?

a. carbohydrate

b. protein

c. fat-soluble vitamins

d. water-soluble vitamins

a. carbohydrate

Peritoneal dialysis is generally more liberalized than HD, as occuring for longer duration per session (10-12hrs per day, 3x/week on PD vs 4-6hrs per day, 3x/week on HD). With that being said, this also means there will be increased protein losses, so protein needs are higher in PD.

In terms of carbohydrates, the dialysate in PD contains high levels of glucose, which are instilled into peritoneum. Subsequently, glucose control/carbohydrate intake must be monitored more closely in PD than HD.

An infant formula for lactose intolerance might include:

I. whey, coconut oil

II. casein hydrolysate, corn oil, glucose

III. soy protein, corn syrup solids

IV. sodium caseinate, hydrolyzed cornstarch

a. I, II, III

b. II, III

c. II

d. I, III

b. II, III

Lactose intolerance = lack of lactase enzyme. Whey is a non-hydrolyzed milk protein that contains lactose, so it would not be appropriate. Casein hydrolysate is hydrolyzed, meaning the lactose is broken down into it's amino acid form. Subsequently, casein hydrolysate would be appropriate. Sodium caseinate is not hydrolyzed, and thus is not suitable for lactose intolerance. The other listed ingredients do not contain dairy, and thus II and III would be the acceptable ingredients.

A patient with the nephrotic syndrome will likely exhibit:

a. hypercholesterolemia, hypoalbuminemia, edema

b. hypertension, hypocholesterolemia

c. hypotension, azotemia

d. malnutrition, hyperalbuminemia

a. hypercholesterolemia, hypoalbuminemia, edema

Nephrotic syndrome is a defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules. Sxs include albuminuria, edema, malnutrition, hyperlipidemia (increased synthesis and decreased clearance of VLDL).

Since albumin is being excreted excessively in the urine, hypoalbuminemia would occur. Hypercholesterolemia and edema would also occur.

A nephrotic syndrome patient should receive how many grams of protein per KG?

a. 0.5 - 0.6

b. 0.6 - 0.8

c. 0.8 - 1.0

d. 1.0 - 1.4

c. 0.8 - 1.0

A nephrotic syndrome patient should have a moderate protein restriction, meaning 0.8-1 g/kg.

***Not really a restriction. I would say more like maintenance protein needs.

Fiber, like that found in oats, beans and bran cereals, results in:

a. increased water absorption from the intestine

b. binding of bile acids

c. decreased sodium excretion in the stool

d. small, compact stools

a. increased water absorption from the intestine

Oats, beans, and bran cereals all contain soluble fibers. Soluble fiber delays gastric emptying, absorbs water, and forms a soft gel in the small intestine.

A patient suffering from bulimia may have all of the following symptoms except:

a. a sore throat

b. dental problems

c. extreme weight loss

d. rectal bleeding

c. extreme weight loss

Bulimia is a condition characterized by repeat episodes of binge eating, recurrent inappropriate compensatory behaviors to prevent weight-gain (at least 1x/week for 3 months), selfevaluation heavily influenced by body shape and weight; often 18.5 ≤ BMI < 30. Inappropriate compensatory behaviors to prevent weight gain include self-induced vomiting, misuse of enemas, diuretics, laxatives, fasting, excessive exercise.

Subsequently, extreme weight loss is not likely.

Research on the effects of a low sugar, low artificial flavor diet on hyperkinesis has shown that:

a. it works in two out of three patients

b. it has not been scientifically proven effective

c. it has never been tested on humans

d. it has been proven effective

b. it has not been scientifically proven effective

Which of the following is not a sign of marasmus?

a. severe protein and calorie wasting

b. weight loss

c. edema

d. low anthropometric measurements

c. edema

Marasmus is a protein-calorie malnutrition. Those with marasmus will be extremely thin/emaciated, and would not experience edema as lacking in protein intake as well as calorie intake. All other answers would be a sign.