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.

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

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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 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.

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.

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.

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.

Urea excretion is related to ___, while creatinine excretion is related to ____.

a. muscle mass, protein intake

b. protein intake, muscle mass

c. protein intake, adipose reserves

d. protein intake, calcium intake

b. protein intake, muscle mass

Urea production changes in parallel to the degradation of dietary and endogenous proteins. Subsequently, urea excretion is related to protein intake.

Creatinine is a byproduct of muscle breakdown. Creatinine will increase during renal disease as the kidneys cannot clear creatinine. Creatinine excretion is thus related to muscle mass.

When conducting a physical assessment of a patient, which method is used to estimate fat stores?

a. inspection

b. palpation

c. pallor

d. auscultation

a. inspection

Assessing for fat stores includes inspection of orbital region, upper arm region, mid-axillary to iliac crest, and ribs. Fat stores are estimated to estimate by visualizing.

Which statement applies to nutritional screening?

a. only a physician makes the referral

b. only a dietitian makes the referral

c. it is exclusively done by nursing

d. all health team members can participate according to policy

d. all health team members can participate according to policy

Per Joint Commission, nutrition risk screening must be completed within 24 hours and can be performed by anyone who the hospital designates (does not have to be RDN).

A sandwich with two pieces of white bread and two ounces of turkey provides how many calories?

a. 250

b. 145

c. 198

d. 290

a. 250

2 slices white bread = 2 starch exchanges (30 gm CHO, 6 gm protein, 2 gm fat, 160 kcal)

2 oz turkey = 2 lean fat protein exchanges (0 gm CHO, 14 gm protein, 6 gm protein, 90 kcal)

160kcal + 90kcal = 250 kcal

Current research on the relationship between cancer and diet includes all of the following except...

a. cancer is associated with the intake of vitamin A

b. it is related to demographic factors

c. it is related to epidemiologic data

d. it is associated with ascorbic acid

b. it is related to demographic factors

Epidemiological data pertaining to cancer includes the interrelationship between host, agent, and environment in causing disease. There is some evidence that fruit and veg consumption are beneficial for overall cancer prevention (carotenoids and vitamin C). Finally, there is some evidence that exercise in post-menopausal women decreases risk of breast disease.

Demographic factors would not be included as the research pertaining to demographic factors (post-meopausal women), is not related to diet; it's related to exercise.

A patient with dehydration exhibits the symptoms of:

a. high blood pressure, dizziness

b. sunken eyes, decreased renal function, increased tachycardia

c. decreased BUN, decreased serum creatinine

d. low blood pressure, low serum sodium

b. sunken eyes, decreased renal function, increased tachycardia

Sxs of dehydration include rapid breathing, sunken eyes, sleepiness, lack of energy, confusion or irritability and fainting. Sunken eyes will occur because when the body is dehydrated, layers of tissue become less plump. The skin around the eyes is already thinner than other parts of the body, so any reduction in plumpness is visible relatively quickly. As a result, dehydration can cause the eyes area to appear darker, discolored, sunken, or hollow. Tachycardiac will occur as a result of the heart attempting to compensate for the lack of fluid in the body.

Why would a man who eats very little protein have an albumin of 5.5g/dl

a. carbohydrate keeps albumin levels elevated

b. he is dehydrated

c. serum albumin falls quickly with protein deprivation

d. it is a sign of protein malnutrition

b. he is dehydrated

Increased albumin can be caused by dehydration

The diet for stomatitis is:

a. low fat, high carb, normal protein

b avoid spices, very hot, very cold, sour, tart foods

c. high protein, high carbohydrate

d. liquids, mostly carbohydrates

b. avoid spices, very hot, very cold, sour, tart foods

Minimize discomfort.

The BMI for a woman who is 5'7" tall and weighs 148lb. Indicates:

a. underweight

b. normal weight

c. overweight

d. obese

b. normal weight

BMI = kg/m^2

BMI = 67.3 / 1.7m^2

BMI = 23.3 kg/m^2, which is considered healthy

Which of the following is not a guideline for Medicaid?

I. low income

II. over the age of 60 only

III. nutritional need

a. I

b. II, III

c. II

d. III

b. II, III

Medicaid is run by DHHS- federal law administered by state. Medicaid is payment for medical care for all eligible needy; all ages, blind, disabled, dependent children. Subsequently, the only eligibility criteria that is true for Medicaid is low income.

Which survey is repeated every few years?

a. NHANES

b. WHO

c. Ten State

d. FAO

a. NHANES

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.

WHO is the world health organization, not a survey. Ten State was a survey that was conducted between 1968 and 1970 to describe the magnitude of malnutrition and nutrition problems in the country among those living at the lowest income quartile. Ten state was conduceted because no nutrition data to answer these questions existed at this time; this was the first survey to evaluate nutritional status among large segment of US population. FAO is Food and Agricultural Organization, which is an international organization aimed at increasing efficiency of production and distribution of foods.

An example of a "Healthy People 2020" goal is:

a. a decrease in saturated fat consumption

b. an increase in iron intake

c. promote healthy behaviors across every stage of life

d. an increase in the intake of complex carbohydrates

c. promote healthy behaviors across every stage of life

Goals of Healthy People 2020:

-Attain high-quality, longer lives free of disease, disability, injury, and premature death

-Achieve health equity, eliminate disparities, and improve health of all groups

-Create social and physical environments promoting good health for all

-Promote quality of life, healthy development, and healthy behaviors across all life stages

***Note goals of Healthy People 2030 which could be asked:

-Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death

-Eliminate health disparities, achieve health equity, and attain health literacy to improve health and well-being of all

-Create social, physical, and economic environments that promote attaining full potential for health and well-being for all

-Promote healthy development, healthy behaviors, and well-being across all lie stages

-Engage leadership, key constituents, and public health across multiple sectors and take action and design policies that improve the health and well-being of all

When a starved patient begins to eat, they might expect:

a. constipation

b. increased workload on the heart

c. lethargy

d. diarrhea

b. increased workload on the heart

In a starvation state, the catabolism of muscle and fat leads to electrolyte losses (notably potassium, magnesium, and phosphate) which may or may not manifest in low lab values. When normal nutrition intake resumes, electrolytes shift into cells, causing low blood levels that manifests in test results and serious medical consequences. For example, hypervolemia and shifting of electrolytes increase cardiac workload and heart rate, which can lead to acute heart failure.

Which of the following would be classified as NB in the NCP?

a hypermetabolism

b. inadequate enteral intake

c. impaired ability to prepare foods

d. excessive protein intake

C - impaired ability to prepare foods

NB is Nutrition Behavioral-Environal domain of nutrition diagnosis. NB includes knowledge and beliefs, physical activity, food safety and acess. Inadequate enteral intake and excessive protein intake would fall into the NI category, and hypermetabolism would fall into the NC cateogory. Impaired ability to prepare foods is a knowledge deficit, and thus would be in NB.

The immediate post-stress release of glucagon:

a. increases glucose uptake into cells

b. increases glucose release into the blood stream

c. increases insulin release

d. increases fluid and sodium excretion

b. increases glucose release into the blood stream

Epinephrine, a catecolamine, stimulate glucagon release after stress (flow phase of ebb and flow). Glucagon mobilizes glycogen from the liver to be used as energy. Subsequently, the post-stress release of glucagon increases glucose release into the blood stream, and can cause hyperglycemia.

Which program provides food to needy individuals and families?

a. food banks

b. SNAP

c. CACFP

d. WIC

a. food banks

Child and Adult Care Food Program supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers. WIC is for women, infants, and children. SNAP provides monthly benefits from which participants can buy food. Food banks is where needy invidiuals and families can directly get food.

Which of the following increase the risk of developing heart disease?

a. elevated small dense LDL-c particles

b. elevated large buoyant LDL particles

c. elevated total cholesterol

d. decreased triglycerides

a. elevated small dense LDL-c particles

LDL transports cholesterol from the diet and liver to all cells. LDL = "bad cholesterol". Small dense LDL-c is associated with incrased risk of heart disease and is responseive to dietary changes. Larger buoyant LDL is NOT associate with increased risk of heart disease. Decreased TG's would not be associated with heart disease, increased TG's would be.

Not sure why elevated total cholesterol would not be an increased risk- per Mayo Clinic total cholesterol less than 200 mg/dl decreases risk of developing heart disease.

What is the goal of the Dietary Guidelines?

a. prevention of chronic disease

b. provide standards for SNAP allocation

c. provide standards for WIC

d. provide standards for EFNEP

a. prevention of chronic disease

While DGA's do provide standards for various federal programs, the program goal is to prevent chronic disease.

The allowance for SNAP is based on:

a. the average cost of food used by a family of the same size

b. the USDA Thrifty Food Program

c. Data from the Congregate Meal Program

d. the cost of the MyPlate components

b. the USDA Thrifty Food Program

SNAP maximum allotments are updated each year based on the cost of the Thrifty Food Plan in June and take effect on October 1. The Thrifty Food Plan is the cost of groceries needed to provide a healthy, budget-conscious diet for a family of fou

A single man with two daughters, ages 10 and 11, is looking for aid. Which program might approve assistance?

a. WIC

b. Food Stamps

c. Child Care Food Program

d. Headstart

b. Food Stamps

Although not called Food Stamps anymore, SNAP/Food Stamps would be most appropriate. The children are too old to qualify to WIC and too old for Headstart. The Child [and Adult] Care Food Program supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare center. Subsequently, SNAP would be most appropriate but would depend on household income.

Nutritional advice to a parent with a child with autism spectrum disorder should include:

a. oral supplements between meals

b. high sodium, high fiber foods

c. normal intake based on age

d. low fiber, high calories

c. normal intake based on age

There is no special diet that is backed by research for children with ASD at this time.

Where can a pregnant teen learn to cook?

a. EFNEP

b. child nutrition services

c. UNICEF

d. WIC

a. EFNEP

EFNEP improves food practice of low income homemakers with young children. Works with small groups. Does not provide food. WIC does not provide regular cooking classes so EFNEP would be most appropriate.

Which of the following tube feeding ingredients might precipitate an allergic reaction in a child with a milk allergy?

a. hydrolyzed maltodextrin

b. modified starch

c. casein

d. carrageenan

c. casein

Casein, the chief protein in milk and the essential ingredient of cheese. Subsequently, it would likely cause an allergic reaction in a child with a milk allergy. Carrageenan is an extract from a red seaweed that is commonly used as a thickner. Hydrolyzed maltodextrin and modified starch do not contain dairy.

An athlete weighs more than the average person of his height. What should you do first?

a. put him on a slow weight reduction diet

b. examine other anthropometric measurements

c. have him increase his exercise

d. suggest he drink more water

b. examine other anthropometric measurements

Athletes may have much larger muscle mass than the average person and thus typical anthropometrics like BMI are not reliable measures.

Which of the following affects bioelectrical impedance analysis?

a. adipose stores

b. muscle mass

c. water

d. protein stores

c. water

Bioelectrical impedance analysis is used at bedside to evaluate fat free mass and total body water. Must be well hydrated, no caffeine, no alcohol, and no diuretics in past 24 hours, no exercise in past 4-6 hours. Fever, electrolyte imbalance, and extreme obesity may affect reliability.

Which is the most appropriate bedtime snack for a diabetic on NPH insulin

a. apple juice and crackers

b. graham cracker and diet soda

c. fresh fruit and crackers

d. cheese and crackers

d. cheese and crackers

Evening snack with carbohydrates and protein is important for someone using an intermediate insulin so they do not wake up hypoglycemic.

What can be done to lower the respiratory quotient of a tube fed pulmonary patient?

a. add MCT oil to decrease energy required for growth

b. change the type of fat to improve oxygen exchange

c. add carbohydrate to decrease the respiratory quotient

d. add a fat emulsion to replace some of the carbohydrate

d. add a fat emulsion to replace some of the carbohydrate

RQ is he ratio of the volume of carbon dioxide evolved to that of oxygen consumed in a given time. Carbohydrates have the highest RQ (fat ~0.7 , proteins ~0.8, carbohydrates ~1). Subsequently, replacing some CHO with fat would reduce the RQ.

Which correlates best with energy intake?

a. lean body mass

b. triceps skinfold

c. body mass index

d. body weight

d. body weight

Body weight is used consistently in the hospital setting as a way to assess energy intake. If a patient loses 5% of body weight in a week, there is concern is that energy intake is poor.

Which of the following most affects osmolarity?

a. protein

b. sugar

c. electrolytes

d. fat

c. electrolytes

Electrolytes affect osmolarity the most, followed by sugar. Think sodium- it is the major solute in extracellular fluids, so it effectively determines the osmolarity of extracellular fluids.

Which fiber is insoluble in water?

a. pectin

b. gums

c. hemicellulose

d. polysaccharide

c. hemicellulose

Soluble fiber dissolves in water, and includes plant pectin and gums. Insoluble fiber doesn't dissolve in water. It includes plant cellulose and hemicellulose.

An infant wants a bottle at bedtime. You should counsel the parents to:

a. give the bottle only at bedtime

b. give the bottle only if the baby insists

c. only give milk in the bottle

d. only give water in the bottle

d. only give water in the bottle

Giving a bottle with juice/milk increases risk of dental caries.

Which of the following may result in hypoalbuminemia?

a. amino acid supplementation prior to surgery

b. a high protein diet with inadequate water

c. providing only a 5% dextrose in water solution after stress

d. giving a trauma patient enteral feeding only

c. providing only a 5% dextrose in water solution after stress

Albumin is a negative acute phase reactant that decreases in times of stress, infection, and inflammation. It has a long half-life and thus is not a great indicator of nutritional status. If I am understanding this question correctly, the other answers do not address the underlying fact that albumin wouldn't decrease from underfeeding in a short period of time. However, stress would impact albumin and thus this answer is correct because of the stress the patient is enduring ***

Which drink would a Mormon choose?

a. cola

b. 7-up

c. tea

d. coffee

B - 7-up

Mormon's strictly avoid tea, coffee, and alcohol. There is mixed information of caffination, but a safe bet is to choice caffeine free drinks. Subsequently, 7-Up would be the best choice.