All Domains Jean Inman | 1183 Questions & Answers with Explanations

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All Domains Jean Inman Questions with Explanations of Answers Which amino acids must be present in a parenteral solution? a. valine, leucine, glycine, alanine b. tryptophan, phenylalanine, threon... ine, isoleucine c. phenylalanine, methionine, arginine, tyrosine d. lysine, glutamic acid, alanine, glycine - ANS- b. tryptophan, phenylalanine, threonine, isoleucine A parenteral solution requires adequate supplementation of all essential amino acids. Essential amino acids = those that cannot be produced by the body. Mneumonic: PVT TIM HLL: phenylaline, valine, tryptophan, threonine, isoleucine, methionine, histadine, lysine, leucine. Last two L's are ketogenic amino acids (lysine and leucine). Mneumonic: Tim LIVs for this BRANCH of the military- branched amino acids are leucine, isoleucine, and valine. Note: arganine and glutamine are conditionally essential. When you check overrun, you are checking a. excess stock in the storeroom b. surplus soap and rinse aids used in the dishmachine c. the weight of ice cream d. Total costs of unexpected meals served - ANS- c. the weight of the ice cream Overrun is the increase in volume from freezing and whipping which is used to determine the weight. In ice cream, overrun should be 70-80% What is the process by which the water content of a vegetable is replaced by a concentrated salt solution? a. gelling b. osmosis c. diffusion d. retro-gradation - ANS- c. diffusion Diffusion is when particles move from higher to lower concentration. In this example, the concentrated salt (higher concentration) moves towards the area of lower concentration (the water in the vegetable). Osmosis is when fluid moves from less to more concentrated side of memebrane (semi-permeable membrane). Which recipe ingredient should be adjusted if a cake has a crunchy crust and compact moist texture? a. milk b. flour c. sugar d. baking powder - ANS- c. sugar Sugar provides tenderness (as hydrogroscopic) and flavor in baking. When too much is added, this results in falling in the center and coarse texture. Not enough sugar causes poor volume. Why do egg whites beat more easily at room temperature? a. the pH is increased b. the protein is denatured c. the surface tension is lower d. the surface tension is higher - ANS- c. the surface tension is lower Which pigment does not change color in an acid or an alkaline solution? a. anthocyanin b. chlorophyll c. carotenoid d. flavones - ANS- c. carotenoid Carotenoids have little to no change when exposed to acid or base. Anthocyanin is a type of flavone and turns bright red in acid, blue in base. Chlorophyll turns olive green in acid (pheophytin), and bright green in base (chlorophyllin). The end products of cellular oxidation are: a. water, carbon dioxide, energy b. carbon, hydrogen, nitrogen c. indigestible fiber, nitrogen d. monosaccharides, amino acids, energy - ANS- a. water, carbon dioxide, energy Cellular respiration is an oxidative process whereby an electron donor is oxidized and oxygen is reduced to produce carbon dioxide, water, and energy. Carbohydrates listed in order of decreasing sweetness are: a. fructose, glucose, sucrose, sorbitol b. sucrose, glucose, fructose, sorbitol c. fructose, sucrose, glucose, sorbitol d. sorbitol, fructose, sucrose, glucose - ANS- c. fructose, sucrose, glucose, sorbitol The order of carbohydrates from sweetest to least sweet is as follows: fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose. Mainly remember that fructose is the sweetest, sucrose is sweeter than glucose, and glucose is sweeter than sorbitol and mannitol. The flakiness of pie crust depends on: a. type of fat b. oxidation of fat c. temperature of the fat d. oven temperature - ANS- a. type of fat Flakiness is promote by leaving fat in coarse particles. Fat in pieces melts and flows, leaving a hole where steam colleccts and pushes upward against the upper surface of the resulting cell. The cell is locked into that extended position, resulting in a flaky crust A #10 can holds how many cups of product? a. 10 b. 13 c. 12 d. 5 - ANS- b. 13 #10 can = 6 cans per case, 6 lb 9 oz, 13 cups, 20-25 servings (it is also considered 3 quarts but dont get confused about cups because 3 quarts = 12 cups, most sources indicate 13 cups so just use that) If the sole source of protein is gelatin, growth is inhibited because: a. gelatin has no tryptophan and is low in methionine and lysine b. gelatin has no methionine and is low in tryptophan c. gelatin has no lysine or methionine, and is low in tryptophan d. gelatin has no arginine - ANS- a. gelatin has no tryptophan and is low in methionine and lysine Gelatin is not a complete protein source. It has no tryptophan and is low in methionie and lysine. Can to remember this by thinking gelaTiN has No Tyrpotophan, and geLatiN is LOW in LYSINE and methioNeNe. If you replace half and half with whipping cream in ice cream, the effects on the ice crystals will be: a. an increase in size because there is less fat b. a decrease in size because there is more fat c. no change d. an increase in size because there is more fat - ANS- b. a decrease in size because there is more fat The % fat in half and half is no less than 10.5% fat, and the % fat in whipped cream 35%. Subsequently, you are increasing the amount of fat in the ice cream. When increasing the amount of fat in ice cream, it decreases in size because fat inferes with crystal formation, making crystals small and smoother. More fat = smaller crystals, less fat = bigger crystals. Fat produces more calories than carbohydrate because: a. fat has more carbon and hydrogen in relation to oxygen b. fat has less carbon and hydrogen in relation to oxygen c. fat is a larger molecule d. fat is a smaller molecule - ANS- a. fat has more carbon and hydrogen in relation to oxygen Research has show that neural tube defects can be reduced with proper supplementation of: a. iron b. folic acid c. glutamine d. arginine - ANS- b. folic acid Supplement 400 mcg per day in pregnant women to prevent neural tube defects, such as spina bifida and anencephaly. The best laboratory value to use in assessing iron status is: a. hemoglobin b. hematocrit c. ferritin d. serum iron - ANS- c. ferritin Ferritin is the storage form of iron, and thus indicates if adequate stores. Ferritin indicates the size of iron storage pool. Hemoglobin and hematocrit will be low in IDA, pernicious anemia, and folate deficiency anemia so while it is a helpful indicator, it is not the best lab value to assess iron status specifically. Which is the best flour to use when making cakes? a. graham flour b. all-purpose flour c. whole wheat flour d. durum wheat flour - ANS- b. all-purpose flour When making cakes, you want to use a lower protein, higher starch flour as it has the weakest and least gluten formation. Low protein flour = tender crumb, higher protein flour = chewy crumb (i.e. pizza). The preferred flour would be cake flour. If cake flour is not available, would use pastry flour. If pastry flour is not available, then all-purpose flour would be used. Graham flour is whole wheat flour, which would not be used in cakes. Durum wheat flour is used to make pasta. Where is lactose absorbed a. small intestine b. stomach c. pancreas d. liver - ANS- a. small intestine Lactose is converted by lactase into glucose and galactose on the brush border membrane of the small intestine, where it is absorbed into the enterocyte. The pancreas releases digestive enzymes when food enters the duodenum, including pancreatic amylase. Considering the following smoke points of various fats, which would be the best to use for frying? a. 300F b. 323F c. 375F d. 400F - ANS- d. 400F Smoke point is the temperature at which an oil or fat begins to produce a continuous bluish smoke that becomes clearly visible. Most foods are fried between the temperatures of 350-450 degrees Fahrenheit so it is best to choose an oil with a smoking point above 400 degrees. Which minerals are involved in carbohydrate metabolism a. cobalt, zinc b. chromium, zinc c. copper, chromium d. iron, zinc - ANS- b. chromium, zinc Chromium aids in insulin action and zinc enhances insulin action. Acidic chyme becomes neutralized in the duodenum by: a. mixing with bicarbonate and fluids b. mixing with alkaline intestinal enzymes c. mixing with sodium and potassium d. mixing with bile - ANS- a. mixing with bicarbonate and fluids When the acidic chyme from the stomach enters the duodenum, secretin from pancreas releases bicarbonate and CCK. CCK releases digestive enzymes as well as "squeezes" the gallbladder to release bile. Bicarbonate + digestive enzymes is called "pancreatic juices". Bicarbonate and fluids work to neutralize the aciditity from chyme. The colon functions in the absorption of: a. amino acids, fatty acids b. unsaturated fatty acids, electrolytes c. water, salts, vitamin K, thiamine, riboflavin d. glucose and fatty acids - ANS- c. water, salts, vitamin K, thiamine, riboflavin In the colon, the majority of water absorption occurs. Think about if someone has a colectomy and colostomy. Output will be greater since the colon isn't there to absorb the water. Bile salts are also absorbed to be recycled. Vitamin K can be synthesized and absorbed by gut bacteria in the colon. Thiamin and riboflavin are primarily absorbed in the jejunum but some are absorbed when water is absorbed in colon as they are water-soluble. To prevent frozen gravy from separating when thawed a. reheat slowly and stir constantly b. thaw it before heating and stir constantly c. prepare it with modified starch d. cook it longer before freezing to stabilize the gravy - ANS- c. prepare it with modified starch Starch is a thickner, which would prevent seperating with thawed. Gelatinization is the swelling that occurs when starch is heated in water close to the boiling point- heat dissociates the bonds, water moves in, and swell granules which causes the paste to thicken. How much fluid is lost through insensible losses? a. 0.5 liters b. 1 liter c. 2 liters d. 3-4 liters - ANS- b. 1 liter Insensible fluid loss is the amount of body fluid lost daily that is not easily measured, from the respiratory system, skin, and water in the excreted stool. The exact amount is unmeasurable but is estimated to be 0.8-1.2L per day. An amino acid that cannot be produced by the body is: a. alanine b. glycine c. tyrosine d. tryptophan - ANS- d. tryptophan Essential amino acids = those that cannot be produced by the body. Mneumonic: PVT TIM HLL: phenylaline, valine, tryptophan, threonine, isoleucine, methionine, histadine, lysine, leucine. Last two L's are ketogenic amino acids (lysine and leucine). Mneumonic: Tim LIVs for this BRANCH of the military- branched amino acids are leucine, isoleucine, and valine. Note: arganine and glutamine are conditionally essential. Since this question is asking which cannot be produced by the body, it is asking which is essential. Tryptophan is an essential amino acid. The following is an irreversible reaction: a. pyruvic acid into lactic acicd b. pyruvic acid into acetyl coA c. glucose-6-phosphate into glycogen d. glucose-6-phosphate into pyruvate - ANS- b. pyruvic acid into acetyl coA Riboflavin, thiamine, niacin are all involved in the: a. metabolism of carbohydrate b. metabolism of fat c. metabolism of protein d. production of amino acids - ANS- a. metabolism of carbohydrate Riboflavin = FAD, FMN Thiamin = coenzyme is TTP; cofactor for enzymes that break down glucose for energy production; plays a role in the synthesis of ribose from glucose Niacin = NAD, NADP An increased plasma pyruvate level is an indication of: a. iron deficiency b. riboflavin deficiency c. excess carbohydrate ingestion d. thiamine deficiency - ANS- d. thiamine deficiency Vitamin B1 (thiamine) is a co-factor for pyruvate dehydrogenase, an essential enzyme for aerobic metabolism. In the absence of thiamine, the conversion of pyruvate to acetyl-CoA is inhibited and pyruvate cannot enter the Kreb's cycle. Which of the following stabilizes an egg white foam? a. an acid b. water c. flour d. salt - ANS- a. an acid An acid stiffens an egg white foam by tenderizing the protein and allowing it to extend more easily. Winterized oil is: a. cloudy when refrigerated b. clear when refrigerated c. cloudy when stored for long periods of time d. clear only if kept at room temperature - ANS- b. clear when refrigerated Winterized oils are oil that is chilled to 45 degrees F, and then fatty acids with high melting points crystallize and are filtered out. Subsequently, winterized oil will not crystillize when cold and is CLEAR not cloudy. Winterized oils are commonly used for salad dressings and include corn, soy and cottonseed oils. Olive oil is NOT winterized. What may cause EKG abnormalities? a. high serum potassium level b. low serum potassium level c. low serum sodium level d. high serum sodium level - ANS- a. high serum potassium level Potassium is vital for regulating the normal electrical activity of the heart. Increased extracellular potassium reduces myocardial excitability, with depression of both pacemaking and conducting tissues.Progressively worsening hyperkalaemia leads to suppression of impulse generation by the SA node and reduced conduction by the AV node and His-Purkinje system, resulting in bradycardia and conduction blocks and ultimately cardiac arrest. In the fed state, the brain uses which nutrient as a source of energy? a. fatty acid b. lactic acid c. glucose d. ketone bodies - ANS- c. glucose Glucose is the preferred fuel source for the brain. Those in starvation ketosis will have to use ketone bodies in place of glucose and all glycogen stores have been depleted and gluconeogenesis can no longer occur. In starvation, the brain uses which nutrient as an energy source? a. fatty acid b. lactic acid c. glucose d. ketone bodies - ANS- d. ketone bodies Glucose is the preferred fuel source for the brain. Those in starvation ketosis will have to use ketone bodies in place of glucose and all glycogen stores have been depleted and gluconeogenesis can no longer occur. Gluconeogenesis is the: a. catabolism of carbohydrate b. creation of glucose from glycerol and amino acids c. breakdown of glycogen releasing glucose d. creation of glycogen - ANS- b. creation of glucose from glycerol and amino acids Gluconeogenesis is the creation of glucose from non-CHO sources, specifically, glycerol, glucogenic amino acids, and lactate. Glycolysis is the: a. catabolism of carbohydrate b. creation of glucose from glycerol and amino acids c. breakdown of glycogen releasing glucose d. creation of glycogen - ANS- a. catabolism of carbohydrate Glycolysis is the breakdown of glucose into pyruvate. Glycogenolysis is the: a. catabolism of carbohydrate b. creation of glucose from glycerol and amino acids c. breakdown of glycogen releasing glucose d. creation of glycogen - ANS- c. breakdown of glycogen releasing glucose Lysis = breakdown. The end product of aerobic glycolysis is: a. acetyl - CoA b. pyruvic acid c. lactic acid d. glycogen - ANS- b. pyruvic acid Glucose --> pyruvate in aerobic Glucose --> lactic acid in anaerobic Protein-bound iodine (PBI) measures: a. nutritional status b. toxic levels of iodine c. deficiency of epinephrine d. level of thyroxine being produced - ANS- d. level of thyroxine being produced Protein-bound iodine test, also called PBI test, laboratory test that indirectly assesses thyroid function by measuring the concentration of iodine bound to proteins circulating in the bloodstream. Makes sense since the major function of iodine is the synthesis of thyroid hormones (thyroxine & triiodothyronine). The hormone epinephrine: a. lowers blood glucose during catabolic stress b. raises blood glucose during catabolic stress c. is secreted from the pituitary gland d. dtimulates glycogen production - ANS- b. raises blood glucose during catabolic stress A provitamin is: a. a nutrient that can be converted into a vitamin b. a vitamin that can be converted into a nutrient c. the endogenous form of a vitamin d. the man-made copy of a vitamin - ANS- a. a nutrient that can be converted into a vitamin Beta-carotene (found in orange and yellow fruits and vegetables) is an important antioxidant and an example of provitamin A because it can be converted to Vitamin A by the human body. The formula for producing the active form of vitamin D is: a. vitamin D3 converting into 7-dehydrocholesterol b. ergosterol converting into calciferol c. cholesterol converting into calciferol d. 7-dehydrocholesterol converting into cholecalciferol - ANS- d. 7- dehydrocholesterol converting into cholecalciferol In cutaneous Vitamin D synthesis, the skin absorbs UVB rays at a specific wavelength with the precursor 7-dehydrocholesterol. 7-dehydrocholesterol is converted to previtamin D when it is absorbed by the skin. Previtamin D is then converted into vitamin D3 (cholecalciferol) in the bloodstream. Once vitamin D is in the bloodstream, whether from cutaneous synthesis or dietary intake, it must undergo two hydroxylation reactions. First hydroxylation reaction: in the liver, vitamin D is converted to 25-hydroxyvitamin D3, 25(OH)vitamin D3, the main blood form. Second hydroxylation: 25-hydroxyvitamin D3 travels to the kidneys where it is hydroxylated into 1,25 dihydroxyvitamin D3 (1,25(OH)2 vitamin D3), the active form of the vitamin. In the human, vitamin K is affected by: a. anticoagulants and antibiotics b. iodine c. water-soluble vitamins d. gluten - ANS- a. anticoagulants and antibiotics Vitamin K = Koagulation (coagulation), blood clotting. Vitamin K increase prothrombin time and thus consistent vitmain K is necessary when someone in on a anticoagulant. Vitamin K (in form of menaquinone) can be sythnesized by gut bacteria in the colon, and thus antibiotics would limit this ability. Which hormone regulates calcium levels: a. insulin b. thyroid c. parathyroid d. aldosterone - ANS- c. parathyroid When blood calcium levels fall too low: Parathyroid gland releases are stimulated to produce parathyroid hormone (PTH). PTH stimulates the kidney to convert 25(OH) vitamin Dà1,25 (OH)2 vitamin D. 1, 25 (OH)2 vitamin D then travels to the intestine where it increases synthesis of calcium transport proteins (i.e. calbindin) which increases calcium absorption. 1, 25 (OH)2 vitamin D also increases renal calcium and phosphorus reabsorption in kidney. 1, 25 (OH)2 vitamin D and PTH help to mobilize calcium and phosphorus from bone by increasing osteoclast activity (resorption). Pyridoxine acts as a coenzyme in: a. iron transfer b. deamination and transamination c. fat transfer through the lymphatic system d. osmotic pressure of body fluids - ANS- b. deamination and transamination Pyridoxine (vitamin B siX), is a coenzyme in deamination and transamination (protein metabolism). More specifically, pyridoxine is the coenzyme for AST/ALT enzyme that is inolved in transamination process. Ex: alpha ketoglutamate + amino acid --- vit B6 --> glutamate + alpha keto acid Which of the following are synthesized by intestinal bacteria? a. biotin, pantothenic acid, vitamin K b. vitamin E, vitamin K, biotin c. Pyridoxine, vitamin E d. ascorbic acid, pyridoxine, vitamin K - ANS- a. biotin, pantothenic acid, vitamin K Vitamin K (in form of menaquinone) can be sythenzied by gut bacteria in the colon. Several bacterial genera that are common in the distal intestine (e.g., Bacteroides, Bifidobacterium, and Enterococcus) are known to synthesize vitamins. Thiamine, folate, biotin, riboflavin, and panthothenic acid are water-soluble vitamins that are plentiful in the diet, but that are also synthesized by gut bacteria. Ascorbic acid aids in healing, which of the following applies? a. collagen --> hydroxyproline b. Proline --> hydroxyproline --> collagen c. hydroxyproline --> proline --> collagen d. hydroxyproline --> proline - ANS- b. Proline --> hydroxyproline --> collagen Major function of vitamin C is collagen synthesis. Vitamin C is needed to form hydroxylysine (from lysine) and hydroxyproline (from proline), which help form the crosslinks that strengthen the collagen molecule. Biotin is considered a coenzyme in the synthesis of: a. protein b. carbohydrate c. glycogen d. fatty acids - ANS- d. fatty acids Biotin serves as a carboxyl (adds CO2) carrier in 4 carboxylase enzymes (carboxylations), including fatty acid synthesis (acetyl CoA to malonyl CoA). Food iron is reduced in the stomach to the more absorbable form of: a. ferric b. ferrous c. transferrin d. ferritin - ANS- b. ferrous Ferric (3+) is found in foods (sometimes foods can be ICk). Ferritin is the storage form of iron. Transferrin is the the iron TRANSporter. Ferrous (2+, "s" looks like a 2) is what ferric iron is converted to in the body and is often the supplemental form of iron the body for that reason (ferrous sulfate). Food iron is in the ____ form a. ferric b. ferritin c. transferrin d. ferrous - ANS- a. ferric Ferric (3+) is found in foods (sometimes foods can be ICk). Ferritin is the storage form of iron. Transferrin is the the iron transporter. Ferrous (2+, "s" looks like a 2) is what ferric iron is converted to in the body and is often the supplemental form of iron the body for that reason (ferrous sulfate). Which would aid the absorption of an iron supplement? a. cows milk, eggs b. orange juice, hamburger c. milk, eggs, cheese d. dates, eggs - ANS- b. orange juice, hamburger Vitamin C source OJ. Bile is produced in the ____ and stored in the ______. a. liver; gallbladder b. gallbladder; liver c. liver; liver d. gallbladder; gallbladder - ANS- a. liver; gallbladder Cholecystokinin causes: a. contraction of the gallbladder b. peristalisis c. secretion of pancreatic juice d. contraction of the liver - ANS- a. contraction of the gallbladder CCK causes contraction of gallbladder, releasing bile for fat emulsification, and release of pancreatic digestive enzymes, including trypsinogen. Which enzymes are involved in protein digestion? a. ptyalin, lipase, sucrase b. amylase, lipase, trypsin c. pepsin, trypsin, chymotrypsin, carboxypeptidase d. trypsin, lipase, amylase - ANS- c. pepsin, trypsin, chymotrypsin, carboxypeptidase Pepsinogen (zymogen form) is converted to pepsin (active form) in the stomach by HCl. Pepsin then hydrolyzes peptide bonds. Zymogens (trypsinogen, chymotrypsinogen, procarboxypeptidase) are converted to active form on the brush border membrane of the enterocyte. Trypsinogen is converted to active form trypsin by enterokinase on brush border membrane. Tyrpsin then converted the other zymogens (chymotrypsinogen, procarboxypeptidase) into their active forms (chymotrypsin, carboxypeptidase), which can then hydrolyze to di and oligosaccharides. Protein digestion begins in the: a. mouth b. stomach c. small intestine d. ileum - ANS- b. stomach No protein digestion in the mouth. Protein digestion begins with gastric hormone, gastrin, releasing HCl and pepsinogen. HCl (from parietal cells) begins protein denaturation. HCl also converts the zymogen pepsinogen to pepsin, which hydrolyzes peptide bonds. Lactase is produced in the: a. stomach b. small intestine c. gallbladder d. pancreas - ANS- b. small intestine Lactose is converted by lactase into glucose and galactose on the brush border membrane of the small intestine, where it is absorbed into the enterocyte. Which enzymes are secreted by the pancreas? a. amylase, lipase, cholesterol esterase, trypsin, chymotrypsin b. sucrose, maltase, lactase, aminopeptidase c. ptyalin d. aminopeptidase, dipeptidase - ANS- a. amylase, lipase, cholesterol esterase, trypsin, chymotrypsin When food enters the duodenum, the pancreas releases digestive enzymes including pancreatic amylose, pancreatic lipase, cholesterol esterase, trypsin, and chymotrypsin. Which conversion requires glucose-6-phosphatase? a. glucose into liver glycogen b. glucose into pyruvic acid c. pyruvic acid into lactic acid d. liver glycogen into glucose - ANS- d. Liver glycogen into glucose Glycogen --- G6P --> glucose *Muscles are selfish, so liver is only one that releases glycogen stores in body. Muscles do not have G6P enzyme It is NOT glucose into liver glycogen. Glucose --- hexokinase (in muscles) --> glycogen Glucose --- glucokinase (in liver) --> glycogen NADPH is: a. essential in the synthesis of fatty acids b. essential in the synthesis of glycogen c. involved in the catabolism of protein d. essential in transamination - ANS- a. essential in the synthesis of fatty acids Lipogenesis requires NADPH (think NADPH, ends with PH which sounds like "f", "f" for fat) The following are required for the conversion of pyrivic acid into active acetate: a. thiamine, NAD, oxaloacetic acid, magnesium b. oxygen, pantothenic acid, vitamin E c. thiamine, niacin, riboflavin, pantothenic acid, magnesium d. pantothenic acid, oxaloacetate, citric acid - ANS- c. Thiamine, niacin, riboflavin, pantothenic acid, magnesium Pyruvate to acetyl CoA requires thiamin, riboflavin, niacin, pantothenic acid and magnesium. Oxaloacetete and ctiric acid are essential in Kreb's cycle, which is prior to pyruvate to acetyl CoA. Which vitamin acts as a coenzyme in transamination? a. pyridoxine b. thiamine c. riboflavin d. vitamin B12 - ANS- a. pyridoxine Pyridoxine (vitamin B siX), is a coenzyme in deamination and transamination (protein metabolism). More specifically, pyridoxine is the coenzyme for AST/ALT enzyme that is inolved in transamination process. Glucocorticoids are: a. thyroid hormones b. pituitary hormones c. adrenal hormones d. parathyroid hormones - ANS- c. adrenal hormones Glucocorticoids are steroid hormones produced by the zona fasciculata of the adrenal cortex. Glucocorticoids promote gluconeogenesis in liver, converting proteins to glucose (GLUCOcorticoids promote GLUCOneogenesis) Glucocorticoids: a. convert glucose into protein b. convert fatty acids into glucose c. convert glucose into fat d. convert protein into glucose - ANS- d. convert protein into glucose Glucocorticoids are steroid hormones produced by the zona fasciculata of the adrenal cortex. Glucocorticoids promote gluconeogenesis in liver, converting proteins to glucose (GLUCOcorticoids promote GLUCOneogenesis). Dietary fat enters the blood as ____ and leaves the liver as ______. a. phospholipids; chylomicrons b. chylomicrons; phospholipids c. chylomicrons; lipoproteins d. lipoproteins; chylomicrons - ANS- c. chylomicrons; lipoproteins After passing through the brush border membrane of the enterocyte as a micelle, triglycerides re-esterfy into triglycerides. TG's, cholesterol, monoglycerides, and phospholipids join together to form chlyomicron. Chylomicrons enter the lymphatic system via lacteals in the villi. Chylomicrons travel to the thoraic duct where they are sent to the portal vein adn ultimately sent to the liver for processing. The liver then produces various lipoproteins, such as VLDL, LDL, and HDL, which can leave the liver into circulation. The oxidation of fatty acids forms: a. acetyl CoA b. pyruvic acid c. lactic acid d. oxaloacetate - ANS- a. acetyl CoA Oxidation of fatty acids is a process that occurs to spare protein/muscle breakdown for energy during periods of starvation/fasting/malnutrition. Glucagon or epinephrine will trigger beta-oxidation to occur. The end product of beta-oxidation is 2 carbon fragments of fatty acids that combine with CoA to make acetyl CoA, which can then go to the TCA cycle and then ETC to make energy (a LOT of energy compared to CHO or protein) due to more carbons and hydrogens. The best way to monitor an infants failure to thrive is to plot: a. weight for length b. length for age c. weight d. weight for age - ANS- a. weight for length Failure to thrive is slow physical development in a baby or child. Wt-for-ht (length) can be used to assess short-term changes in nutritional status, as well as wasting and FTT. Which of the following can be reversed with vitamin A? a. xerophthalmia b. nyctalopia c. Wilson's disease d. homocysteinuria - ANS- b. nyctalopia Vitamin A deficiency causes night blindness (nyctalopia), which can be reversed by vitamin A supplementation. Xerophthalmia (dry eye) can also be caused by vitamin A deficiency. It often cannot be reversed. Fresh meat contamination comes mainly from: a. botulism b. staphylococcus c. clostridium d. salmonella - ANS- d. salmonella Salmonella is a bacterial foodborne infection commonly caused by low acid foods at body or room temperature, raw/undercooked meat and poultry, eggs, raw dairy, seafood, melons. Iron absorption is enhanced by: a. acidic chyme in the duodenum b. the alkalinity of the duodenum c. oxalates and phytates d. the absence of ascorbic acid - ANS- a. acidic chyme in the duodenum Gastric acid lowers the pH in the proximal duodenum, enhancing the solubility and uptake of ferric iron. When gastric acid production is impaired (for instance by acid pump inhibitors such as the drug, prilosec), iron absorption is reduced substantially. Ascorbic acid ENHANCES absorption of iron. Oxalates and phytates INHIBIT iron absorption. Which of the following inhibits gluconeogenesis? a. glycogen b. insulin c. catecholamines d. glucocorticoids - ANS- b. insulin Gluconeogenesis is the formation of glucose from non-CHO sources (glycerol, glucogenic AA, lactate). Gluconegenesis is a ANABOLIC reactant (building, creating), so insulin glucagon of epinephrine would be release to initiate the process. This question acts what would INHIBIT gluconeogenesis. Insulin is release when there is ENOUGH glucose in the body. If insulin were released, you know that there is circulating glucose that must be uptaken by the cells. Subsequently, insulin would inhibit gluconeogenesis. Glucocorticoids stimulate gluconeogenesis. Catecholamines, including epinephrine, can also stimulate gluconeogenesis espeically during metabolic stress. Glycogen is the storage form of glucose, which doesn't make sense for the question. Which has the lowest cholesterol content? a. peanut butter and crackers b. yogurt with fruit c. chocolate cake d. roast beef sandwich - ANS- a. peanut butter and crackers Dietary cholesterol is found in animal products/byproducts. Subsuquently, peanut buter and crackers would have the lowest cholesterol content. What is the difference between cake flour and bread flour? a. cake flour has less gluten, weaker gluten, less protein b. bread flour has less gluten, weaker gluten, less protein c. cake flour has weaker gluten, but has more protein d. bread flour has stronger gluten and less protein - ANS- a. cake flour has less gluten, weaker gluten, less protein Think of cakes vs breads. Breads are have stronger gluten because it's typically firmer/tougher. Cakes are moister. Bread also has more protein content (chewy crumb vs lower protein content = tender crumb), and thus A is the answer. Vitamin A is involved in: a. growth and development b. blood clotting c. growth of bones and teeth d. development of tissue and skin - ANS- a. development of tissue and skin Vitamin A has a variety of functions. Vitamin A is involved in the visual cycle (uses 11-cis-retinal, which binds with protein opsin to form rhodopsin), maintenance of epithelial tissue (skin and lining of eyes, gut, lungs, vagina & bladder), growth (stimulates growth of epithelial cells, possibly by increasing cell surface receptors for growth factors), cellular differentiation, reproduction, and immune function. Assuming growth in the above mentioned function would fall more under development of tissue/skin. Growth and development would be different in that case and thus not the answer. A patient with metabolic alkalosis would have: a. excess excretion of base through the kidneys b. retention of base by the lungs c. excretion of base by the lungs d. retention of base by the kidney - ANS- d. retention of base by the kidney Metabolic = kidneys, respiratory = lungs Alkalosis = retention of bicarb by kidneys, acidosis = excretion of bicard by kidneys Subsequently, metabolic alkalosis would be retention of base by the kidneys. Which foods should be washed just before serving? a. plums and grapes b. peaches and carrots c. strawberries and mushrooms d. apples and celery - ANS- c. strawberries and mushrooms Berries and mushrooms should be washed right before serving, as it they are washed well before they are intended to be eaten, they will become mushy. Which government agency inspects and grades meat? a. FDA b. DHHS c. USDA d. department of commerce - ANS- c. USDA Inspection of meat is mandatory per Whole Meat Act of 1967 and is done at slaughter by USDA. If linoleic acid replaces carbohydrates in the diet: a. LDL decreases, HDL increases b. LDL and HDL decrease c. LDL and HDL increase d. LDL increases, HDL decreases - ANS- A - LDL decreases, HDL increases Lioleic acid, or omega 6, is an essential fatty acid. Replacing carbohydrates with omega 6 causes LDL to decrease and HDL to increase If linoleic acid (omega 6) replaces saturated fat, total cholesterol decreases and HDL decreases Which is not absorbed directly into the portal blood? a. monosaccharides b. amino acids c. medium chained fatty acids d. long chained fatty acids - ANS- d. long chained fatty acids When substituting buttermilk for whole milk in pastry: a. decrease the liquid b. increase the baking soda c. increase the amount of butter d. increase the liquid - ANS- b. increase the baking soda Buttermilk is cultured by adding lactic acid bacteria to skimmed or partly skimmed milk. The recipe includes 1 Tbsp vinegar or lemon juice or 1 3/4 tsp cream of tartor. Subsequently, buttermilk is more acidic than whole milk. To make it more alkaline when using buttermilk in place of regular milk in a reciple, increase the baking soda. Ground meat will spoil faster than sliced meat because: a. it has more enzyme activity b. it has more fat c. more surface area is exposed d. it has less fat - ANS- c. more surface area is exposed Evaporated milk has: a. slightly more than half of the water removed b. added sugar c. a fat content of 3-6% d. lactose removed - ANS- a. slightly more than half of the water removed Evaporated milk has ~60% of water removed, must contain not less than 7.9% milkfat, and brown color is due to carmelization of lactose in canning. Ketones are most associated with: a. complex carbohydrates b. simple sugars c. fats d. amino acids - ANS- c. fat Which best describes sorbitol and glucose? a. sorbitol is sweeter than glucose b. they each provide 7 calories per gram c. sorbitol is absorbed more slowly d. they both convert into fructose - ANS- c. sorbitol is absorbed more slowly Sweetness of carbohydrates from sweetest to least sweet: fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose. Sorbitol a sugar alcohol. Sorbitol is degraded to fructose, but glucose is already a monosaccharide and isn't converted to fructose. Sorbitol is slowly absorbed by passive diffusion in the small intestine. CHO provides 4 kcal / gm. What causes egg yolk color to change? a. alteration of the feed provided b. storage length c. shell color d. storage conditions - ANS- a. alteration of the feed provided Color of the yolk depends on the amount and type of pigmen in the hen's diet. Which data is needed to convert weight into volume? a. mass b. temperature c. specific gravity d. pH - ANS- c. specific gravity Relative density, or specific gravity, is the ratio of the density of a substance to the density of a given reference material. In other words, the ratio of the density of any substance to the density of some other substance taken as standard, water being the standard. The tartness in fruits and vegetables is due to: a. flavones b. chlorophyll c. anthoxanthins d. tannins - ANS- d. tannins Tannins provides the tart taste in fruits/vegetables. When a white sauce tastes starchy and grainy, the likely cause is: a. too much starch b. improper proportions of ingredients c. starch was added before the fat melted d. uncooked flour - ANS- d. uncooked flour If a product is starchy tasting and grainy, this is due to uncooked flour. To get a shiny, clear, translucent sauce, use cornstarch as a thickner. The scientific process by which water makes lettuce crisp is: a. osmotic pressure of water-filled vacuoles b. diffusion c. transamination d. water acitve diffusion - ANS- a. osmotic pressure of water-filled vacuoles Think of adding water to a stalk of celery to make it seem fresh again. When analyzing correlations, when r=1: a. there is a perfect correlation from one to the other b. there is no correlation among data presented c. the data presented move in opposite directions d. there is a weak correlation among data presented - ANS- a. there is a perfect correlation from one to the other r= =/- 1 is perfect correlation; cannot have correlation outside of this range. </= 0.4 would be a poor correlation, 0.4-0.7 would be moderate correlation, >/= 0.7 would be a strong correlation (this is true for positive or negative values. Which hormone greatly influences the BMR? a. the endocrine hormone b. thyroxine c. the growth hormone d. insulin - ANS- b. thyroxine BMR, or basal metabolic rate, is typically measured in the morning when reclining, awake, relaxed, at normal body termpature, for at least 12 hours after last meal, and several hours after strenuous exercise. It measures the oxygen consumed and carbon dioxide produced. BMR is primarily effected by sex (women 5-10% lower BMR than men), age (0-2 have highest BMR, lower BMR in older adults), body composition/body surface area, and endocrine glands, specifically thyroid. Thyroid hormones stimulate diverse metabolic activities, leading to an increase in basal metabolic rate. Thyroxine is a thyroid hormone and thus would impact BMR the most. If linoleic acid replaces saturated fat in the diet: a. total cholesterol including HDL decrease b. HDL increases c. LDL increases d. no change in lipid levels - ANS- a. total cholesterol including HDL decrease If linoleic acid (omega 6) replaces saturated fat, total cholesterol decreases and HDL decreases Lioleic acid, or omega 6, is an essential fatty acid. Replacing carbohydrates with omega 6 causes LDL to decrease and HDL to increase Which oil is highest in monounsaturated fatty acids? a. olive b. canola c. peanut d. sunflower - ANS- a. olive Most predominant (from greatest to least) MUFAs: olive, canola, peanut, sunflower, coconut oil PUFAs: safflower, corn, soybean, cottonseed, sunflower, palm kernel Saturated fat: coconut oil, palm kernel, cocoa butter, butter, palm oil, canola Which oil is highest in saturated fat? a. coconut b. palm c. cocoa butter d. butter - ANS- a. coconut Most predominant (from greatest to least) Saturated fat: coconut oil, palm kernel, cocoa butter, butter, palm oil, canola MUFAs: olive, canola, peanut, sunflower, coconut oil PUFAs: safflower, corn, soybean, cottonseed, sunflower, palm kernel Which of the following may result in metabolic acidosis? a. decreased retention of bicarbonate b. decreased retention of hydrogen c. decreased retention of chloride d. increased retention of bicarbonate - ANS- a. decreased retention of bicarbonate Metabolic = kidneys, respiratory = lungs Alkalosis = retention of bicarb by kidneys, acidosis = excretion of bicard by kidneys Subsequently, if metabolic acidosis, there was increased excretion/decreased rention of bicarb Examples of moist heat cooking include: a. braising, stewing b. grilling, frying c. broiling, braising d. steaming, frying - ANS- a. braising, stewing TIP: remember moiSt heat meathods (aside from roasting) all contain "s": braiSing, Simmering, Steaming, Stewing Dry heat methods: frying, broiling, roasting, grilling Dry heat cookery should be used for which cut of meat? a. shoulder b. neck c. brisket d. near the backbone - ANS- d. near the backbone Connective tissue has two properties: collagen and elastin. Collagen becomes tender in heat (collagen + moist heat = gelatin). This is why we use MOIST HEAT for tought meat, such as flank, bottom round, brisket. Dry heat methods (no water involved) can be used for tender (soft) cuts which are near the backbone (loin, sirloin). What color do onions turn when cooked in an aluminum pan? a. purple b. blue c. red d. yellow - ANS- d. yellow Onions are anthoxanthin, and thus turn yellow in base or in aluminum pan. Which cooking method would best convert collagen to gelatin in a bottom round roast? a. grilling it to medium rare b. braising c. broiling d. searing - ANS- b. braising Connective tissue has two properties: collagen and elastin. Collagen becomes tender in heat (collagen + moist heat = gelatin). This is why we use MOIST HEAT for tought meat, such as flank, bottom round, brisket. TIP: remember moiSt heat meathods (aside from roasting) all contain "s": braiSing, Simmering, Steaming, Stewing. Thus, braising is the answer. Which method of bread making is not as dependent on the length of time the dough sits to rise? a. straight dough method b. sponge dough method c. continuous method d. prime bake method - ANS- c. continuous method The continuous bread-making method is a commerical process that substitutes intense mechanical energy to a large degree for traditional bulk fermentation, which reduces processing time. Straight dough method is when all ingredients are added before a dough is allowed to rise. The sponge method is when you combine liquid with yeast and part of flour and allow the batter (sponge) to ferment for several hours. You then add sugar, salt, fat, rest of flour and knead Which nutrient is added for flour enrichment? a. vitamin A b. iodine c. fluorine d. iron - ANS- d. iron Enriched flour is flour with specific nutrients returned to it that have been lost while being prepared. These restored nutrients include iron and B vitamins (folic acid, riboflavin, niacin, and thiamine). What does the term "USDA graded" on meat tell the consumer? a. it assures wholesomeness b. it was free of disease at the time of slaughter c. the meat is fit for human consumption d. it defines quality - ANS- d. it defines quality Inspection of meat is mandatory under the Wholesome Meat Act, while grading is voluntary. The purpose of inspection is to determine if meat is fit for human consumption, and this is done at the time of slaughter. Grading however determines the quality of the meat, which is based on the marbling of the cut of meat. The order of meat grading, from best to lowest quality, is prime, choice, select, and standard. In other words, standard has the least marbling. A cake with a fallen center may be the result of: a. too little fat b. too little sugar c. excess sugar and excess fat d. too little baking powder - ANS- c. excess sugar and excess fat Sugar and fat are HEAVY, and typically work to add tenderness and shape to a cake. If too much of either or both of these are added, the cake will be "weighed down" and thus collapse. Which of the following has the least amount of saturated fat? a. 2% milk b. half and half c. non-dairy creamer d. evaporated skim milk - ANS- d. evaporated skim milk Skim milk itself has <0.5% fat, and thus evaporated skim milk would have the least (?) Half and half has no less than 10.5% fat, 2% milk has 1.50-2.25% fat, non-dairy creamer would vary dependent on source (coconut, soy, almond, etc). Coarse texture in a cake is due to: a. too little baking powder b. over-mixing c. too much baking powder or sugar d. oven temperature too high - ANS- c. too much baking powder or sugar A coarse texture in a cake can be caused by excess sugar, excess baking powder, low temperature, and inadequate gluten formation (too little mixing). Nitrogen equilibrium is associated with: a. a 25 year old pregnant female b. a 25 year old male c. a 15 year old girl d. a 4 year old child - ANS- b. a 25 year old male Nitrogen equilibrium means that there is a relatively equal nitrogen intake and nitrogen output (nitrogen balance). In a pregnant female, the body becomes anabolic and enters positive nitrogen balance. Positive nitrogen balance is also associated with periods of growth, such as in children. A 25 year old male would be the most likely to be in nitrogen equilibrium. Children's diets are found to be low in iron due to emphasis on: a. vegetables b. milk c. fruits d. cereals - ANS- b. milk Children tend to be encouraged to drink a lot of milk. Calcium is high in milk, and calcium can inhibit iron absorption. While some vegetables can inhibit iron absorption (oxalates, phytates), vegetables are emphasized as much as milk in children's diets. Fruits/veg rich in vitamin C, such as oranges and strawberries, would increase iron absorption. Which mineral is involved in blood clotting? a. calcium b. phosphorus c. iron d. selenium - ANS- a. calcium Calcium functions include bone metabolism, blood coagulation, neuromuscular excitability, cellular adhesiveness, transmission of nerve impulses, maintenance and function of cell membranes, and activation of enzyme reactions and hormone secretions. Both calcium and vitamin K are needed to synthesize Protein C, an anticoagulant that prevents excessive coagulation after the coagulation cascade occurs. Deficiency of any of these clotting cofactors will cause an impaired ability for blood to coagulate, which can contribute to excessive bleeding and hemorrhage. Which of the following is true regarding flour? a. all-purpose is made from soft wheat b. all-purpose flour has more protein than bread flour c. cake flour has the least and the weakest gluten d. cake flour has less starch than bread flour - ANS- c. cake flour has the least and the weakest gluten Cake flour has the least gluten, least protein and most starch while bread flour has the most gluten and most protein. Cake flour and pastry flour made from soft wheat. The main function of glycolysis is to provide: a. pyruvate for the TCA cycle b. lactic acid for energy use by muscles c. muscle and liver glycogen d. a substrate for the Cori cycle - ANS- a. pyruvate for the TCA cycle Glucose -- G6P --> pyruvate -----> acetyl CoA ---> oxaloacete in TCA cycle Food service employees should wash their hands for at least: a. 30 sec b. 25 sec c. 20 sec d. 15 sec - ANS- c. 20 sec Metabolites of the Kreb's cycle are: a. water, energy, carbon dioxide b. energy and pyruvic acid c. electrolytes and water d. lactic acid and glycogen - ANS- a. water, energy, carbon dioxide Kreb's cycle produces NADH and FADH2, which are essential in ECT. In addition, a lot of CO2 and water are produced. Meat graded "US standard" is the grade given at the: a. time of purchase b. time of delivery c. storage facility d. time of slaughter - ANS- d. time of slaughter Which of the following substitutions will most decrease the sodium content of a biscuit? I. Low sodium milk for whole milk II. Egg substitute for egg III. Low sodium baking powder for baking powder a. I b. I, II c. all of the above d. I, III - ANS- d. low sodium milk for whole milk & low sodium baking powder for baking powder Substituting low sodium milk for whole milk would of course reduce sodium content. Substituting low sodium baking powder for regular baking powder would also reduce sodium content as baking powder contains baking soda (sodium bicarbonate). Which pasta contains egg? a. noodles b. spaghetti c. macaroni d. linguini - ANS- a. noodles A patient who is iron-deficient should consume ____ with a good iron source: a. apple juice b. orange juice c. milk d. cheese - ANS- b. orange juice Vitamin C enhances iron absorption. A serum sodium level of 150 mEq/L indicates: a. sepsis b. dehydration c. hypertension d. hyperglycemia - ANS- b. dehydration Normal serum sodium: 135-145 mEq/L. If blood is more concentrated with sodium, means dehydrated. Cabbage should be cooked: a. covered b. in a small amount of water c. in a large quantity of water d. covered in a small amount of water - ANS- c. in a large quantity of water To minimize the development of a strong flavor, cook for a short time, keep the lid off initially to let acids escape, and cook in a large amount of water. To decrease sodium intake, substitute: a. carrots for celery b. unsalted margarine for regular margarine c. diet margarine for regular margarine d. carrots for pepper - ANS- b. unsalted margarine for regular margarine Don't get confused on wording. Substitute unsalted margarine FOR regular margarine. Apples stored in a controlled environment would: a. ripen quickly b. last one or two years c. have extended life and improved marketing quality d. only be used as processed fruit - ANS- c. have extended life and improved marketing quality The following oils can be winterized: a. corn, soy, cottonseed b. olive, corn, soy c. cottonseed, olive d. olive, corn - ANS- a. corn, soy, cottonseed Winterized oils are oil that is chilled to 45 degrees F, and then fatty acids with high melting points crystallize and are filtered out. Subsequently, winterized oil will not crystillize when cold and is CLEAR not cloudy. Winterized oils are commonly used for salad dressings and include corn, soy and cottonseed oils. Olive oil is NOT winterized. Which would you give to a person who is mildly hypokalemic? a. 1 cup blueberries b. 1 cup cranberries c. 1/2 cup applesauce d. 1 piece cantaloupe - ANS- d. 1 piece cantaloupe High potassium foods include bananas, oranges, cantaloupe, honeydew, apricots, grapefruit, cooked spinach, cooked broccoli, potatoes, sweet potatoes, mushrooms. Remember in renal rotation would recommend berries and apples as a lower potassium food source. Cranberries are also lower in potassium. A serum sodium level of 150 mEq/L is a sign of: a. very high sodium intake b. very low sodium intake c. hyponatremia d. hypernatremia - ANS- d. hypernatremia Normal serum sodium: 135-145 mEq/L. To increase potassium intake, consume a snack of: a. cheese and crackers, plums, cranberry juice b. a bagel, milk and an apple c. a grilled cheese and tomato sandwich and strawberries d. tuna salad, a wheat roll, and cola - ANS- c. a grilled cheese and tomato sandwich and strawberries Fruit is the primary source of potassium, so D is out. Apple is a low potassium fruit, so B is out. Plums are a decent source of potassium, but cranberry juice is not. Strawberries are typically a berry to have for a lower potassium diet, but tomatoes are high. Subsequently, C is the answer. If protein intake is doubled, which nutrient needs to be increased? a. pyridoxine b. folic acid c. niacin d. vitamin c - ANS- a. pyridoxine Pyridoxine is essential for transamination reactions and thus needs would increase if protien intake increased. The level of significance of test results is measured using the p value. Which of the following represents the most significant factor? a. <0.0002 b. <0.002 c. <0.02 d. <0.20 - ANS- a. <0.0002 Statistically significant --> p</= 0.5 The smaller the value, the more statistically significant. The Cori Cycle: a. glucose into galactose b. lactate into pyruvate c. lactic acid into glycogen d. glycogen into glucose - ANS- b. lactate into pyruvate In the Cori cycle, glucose is metabolized to pyruvate and then to lactate in muscle, the lactate is released into the blood and carried to the liver, where it is reconverted to pyruvate and used for gluconeogenesis, and the resulting glucose is released and travels back to muscle. Fats high in monounsaturated fatty acids include: a. olive and canola b. safflower and corn c. coconut and palm d. soy and peanut - ANS- a. olive and canola Most predominant (from greatest to least) MUFAs: olive, canola, peanut, sunflower, coconut oil PUFAs: safflower, corn, soybean, cottonseed, sunflower, palm kernel Saturated fat: coconut oil, palm kernel, cocoa butter, butter, palm oil, canola Fats high in polyunsaturated fatty acids include: a. olive and canola b. safflower and corn c. coconut and palm d. soy and peanut - ANS- b. safflower and corn Most predominant (from greatest to least) MUFAs: olive, canola, peanut, sunflower, coconut oil PUFAs: safflower, corn, soybean, cottonseed, sunflower, palm kernel Saturated fat: coconut oil, palm kernel, cocoa butter, butter, palm oil, canola Green beans cooked in tomato sauce turn ____ due to _____. a. bright green; chlorophyllin b. olive green; pheophytin c. brown; carotenoids d. black; anthoxanthins - ANS- b. olive green; pheophytin Chorophyll (in green vegetables) turns olive green in an acidic environment (tomato sauce) due to the enzyme pheophytin. If you are on a low phosphorous diet, what food should you most avoid? a. yogurt b. orange juice c. beef d. bread - ANS- a. yogurt Phosphorus = protein foods and grains. B and C are out based on that. Yogurt and other dairy products are particularly high in phosphorus and thus should be avoided. A 5 month old is diagnosed with salmonella. What is likely the cause? a. fruit juice b. milk c. table food d. evaporated milk - ANS- c. table food Typical foods for Salmonella include low acid foods at body or room temperature, raw/undercooked meat and poultry, eggs, raw dairy, seafood, melons. Crosscontamination would be most likely the cause of salmonella in a 5 month old, as they put things in their mouths constantly. An 8 month old baby contracts botulism. What is likely the cause? a. cereal and evaporated milk b. cereal and honey c. cereal and table food d. cereal and fruit juice - ANS- b. cereal and honey Babies younger than 1 year old should not be given honey due to risk of botulism. Which is the best source of emulsification? a. eggs b. milk c. salt d. flour - ANS- a. eggs Eggs contain lecithin, which is a very effective emulsifier The kidneys respond to respiratory acidosis by: a. increasing the secretion of magnesium b. exchanging sodium for calcium c. increasing the retention of bicarbonate d. exchanging potassium for hydrogen - ANS- c. increasing the retention of bicarbonate Metabolic = kidneys, respiratory = lungs Alkalosis = retention of bicarb by kidneys, acidosis = excretion of bicard by kidneys Subsequently, if respiratory acidosis the kidneys would respond by increasing retention or decreasing excretion of bicarbonate to try to increase pH. A serum sodium level of 150 mEq/L may be due to: a. an increase in the intake of sodium-rich food b. decreased steroid formation c. an increased level of aldosterone d. a decrease in the intake of sodium-rich foods - ANS- c. an increased level of aldosterone Normal serum sodium: 135-145 mEq/L. Aldosterone is a hormone produced by the adrenal glands that tells the kidneys to increase sodium retention and decrease potassium retention in order to increase BP when it falls low. Subsequently, an increased aldosterone level would cause an increase in sodium retention and potentially hypernatremia. Green peas held on the serving line may turn olive green due to: a. pheophytin c. chlorophyllin c. anthoxanthins d. flavones - ANS- a. pheophytin In cereal production, enrichment adds: a. vitamin A b. vitamin D c. iron d. iodine - ANS- c. iron Enrichment adds back some lost nutrients. These restored nutrients include iron and B vitamins (folic acid, riboflavin, niacin, and thiamine). Cured meat is pink due to: a. sugar b. salt c. vinegar d. nitrites - ANS- d. nitrites A serum sodium level of 115 mEq/L may be due to: a. over-hydration b. dehydration c. a very high sodium intake d. a sodium intake of 5.5g per day - ANS- a. over-hydration Normal serum sodium 135-145 mEq/L. Overhydration would cause hyponatremia because the amount of sodium relative to volume would be much lower then normal. Butter has fatty acids in this order of predominance: a. PUFA, MUFA, SAT b. SAT, MUFA, PUFA c. MUFA, SAT, PUFA d. MUFA, PUFA, SATq - ANS- b. SAT, MUFA, PUFA Butter has more saturated fat and less PUFAs than margarine. Margarine has fatty acids in this order of predominance: a. PUFA, MUFA, SAT b. SAT, MUFA, PUFA c. MUFA, SAT, PUFA d. MUFA, PUFA, SAT - ANS- a. PUFA, MUFA, SAT Margarine has more PUFAs and less saturated fat than butter. Lactic acid is produced through: a. glycolysis b. gluconeogenesis c. glycogenesis d. lactolysis - ANS- a. glycolysis Lactic acid is produced in anaerobic glycolysis. Think of lactic acid building up after sprinting. Which of the following amino acids is a precursor for serotonin? a. Phenylalanine b. Methionine c. Tryptophan d. Tyrosine - ANS- c. Tryptophan When on Dicumarol, avoid increasing your intake of: a. spinach b. beets c. corn d. beef - ANS- a. spinach Dicumoral is an anticoagulant medication, and thus consistent vitamin K is essential to prevent issues with blood clotting. Spinach is a source of vitmain K. If there is not enough oxaloacetic acid available to the TCA cycle: a. pyruvic acid cannot be converted to pyruvic acid b. glucose-6-phosphate cannot be converted to pyruvic acid c. acetyl CoA coming in from fat cannot be handled properly d. glycogen cannot be converted back to glucose-6-phosphate - ANS- c. acetyl CoA coming in from fat cannot be handled properly Oxaloacetate is the essential start and ending substrate of the TCA cycle. Without oxaloacete, acetyl CoA builds up as the TCA cycle cannot occur. Subsequently, the acetyl CoA molecule produced by beta-oxidation can't be used properly and ketone bodies must be formed. Energy expenditure of humans can be measured by: a. heat intake b. food intake c. nitrogen output d. oxygen consumption - ANS- d. oxygen consumption With indirect calorimetry, the energy expenditure is calculated from gaseous exchange of oxygen and carbon dioxide. The result is the total energy expenditure of the body for heat production and work output. With direct calorimetry, only heat loss is measured. Gastric proteolysis requires: a. pyridoxine b. ascorbic acicd c. hydrochloric acid d. the intrinsic factor - ANS- c. hydrochloric acid Proteolysis is the breakdown of proteins into smaller polypeptides or amino acids. HCl is required to being protein denaturation in the stomach and to convert pepsinogen to pepsin, which breaks peptide bonds. Patients with early signs of xerophthalmia should consume? a. chicken, fish, summer squash b. liver, milk, eggs c. oatmeal, almonds, berries d. high fiber cereals, salad greens - ANS- b. liver, milk, eggs There are two types of vitamin A- preformed vitamin A and provitamin A (mainly beta-carotene). Preformed vitamin A comes from animal produces, include liver, milk, and eggs Sorbitol is: a. less sweet than sucrose and has a lower glycemic index than sucrose c. sweeter than sucrose d. sweeter than sucrose and has a lower glycemic response than sucrose - ANS- a. less sweet than sucrose and has a lower glycemic index than sucrose Sweetness of carbohydrates from sweetest to least sweet: fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose. Sorbitol is slowly absorbed by passive diffusion in the small intestine and thus has a lower glycemic index than sucrose. Which mineral is absorbed through the intestine and transported with ceruloplasmin in the blood? a. copper b. iodine c. sodium d. calcium - ANS- a. copper Ceruloplasmin is a protein that is made in the liver. It stores and carries copper from the liver into the bloodstream and to the parts of your body that need it. Copper is a mineral that is found in several foods, including nuts, chocolate, mushrooms, shellfish, and liver. The Schilling test detects defects in the absorption of: a. folic acid b. cyanocobalamin c. pyridoxine d. iron - ANS- b. cyanocobalamin Vitamin B12 Which of the following should be avoided on a low sodium diet? a. pork loin b. turkey roll c. beef sirloin d. lam chop - ANS- b. turkey roll Turkey roll is a processed meat so highest in sodium. What is the effect of excess caffeine intake? a. insomnia b. nausea c. bloating d. weight gain - ANS- a. insomnia The toxic level of vitamin A has been identified as: a. 5,000 IU b. 10,000 IU c. 15, 000 IU d. 20,000 IU - ANS- b. 10,000 IU Vitamin A RDA is 900 µg (3,000 IU) for men and 700 µg (2,300 IU) for women. How many oranges are needed to produce one quart of juice? a. 12 b. 15 c. 18 d. 20 - ANS- a. 12 About 12 oranges = 1 quart apparently The amino acid tryptophan can be converted into: a. serotonin b. catecholamines c. phenylalanine d. tyrosine - ANS- a. serotonin Tryptophan --> serotonin Remember by thinking going on a TRIP will make you happier (increase serotonin) A muffin has long tunnels from top to bottom, next time you make this recipe you should: a. add more baking soda b. avoid over-mixing the batter c. add less butter d. cook it for a shorter time - ANS- b. avoid over-mixing the batter Over-developed gluten. Nitrites added to cured meats may cause: a. a slightly salty taste b. a slightly sour taste c. a slight pink color d. a slightly brown color - ANS- c. a slight pink color Phenylalanine is a precursor for: a. serotonin b. catecholamines c. tryptophan d. tyrosine - ANS- d. tyrosine Remember by: Alaine can be a tyrant Which cheese has the highest moisture content: a. cheddar b. swiss c. mozzarella d. gorgonzola - ANS- c. mozzarella Percent moisture content from high to low: cottage cheese, cream cheese, mozzarella cheese, camembert cheese, blue cheese, Swiss cheese, cheddar cheese, gorgonzola cheese, parmesean cheese Decreased levels of serotonin are associated with: a. decrease in carbohydrate appetite b. increase in carbohydrate appetite c. decreased sensation of taste d. increased sensation of taste - ANS- b. increase in carbohydrate appetite Think: when your sad (low serotonin) you eat more carbs Carbohydrate, fat and protein are all converted into: a. pyruvic acid b. acetyl CoA c. Oxaloacetic acid d. ketoglutamic acid - ANS- b. acetyl CoA If energy needs increase, which vitamins are needed in higher amounts? a. A, C, folate b. A, C, thiamin c. thiamin, niacin, riboflavin, pantothenic acid d. pyridoxine, cyanocobalamin - ANS- c. thiamin, niacin, riboflavin, pantothenic acid B vitamins = energy! Essential in CHO metabolism particularly but also used in lipid and protien metabolism. How many mEq of sodium are in 1 gram of sodium? a. 25 b. 43 c. 65 d. 110 - ANS- b. 43 mEq = mg / atomic weight x valence AW in sodium: 23 (K+ is 39, Ca++ is 40) Valence in sodium: 1 (K+ is 1, Ca++ is 2) 1000mg / 23 x 1 = 43.5 mEq How can you preserve thiamin when cooking pork? a. use the drippings after the fat has been removed b. insert a meat thermometer and cook it to 145F in an oven at 325F c. increase the cooking temperature to lessen cooking time d. add a small quantity of water during cooking - ANS- b. insert a meat thermometer and cook it to 145F in an oven at 325F To prevent thiamin loses from cooking, cook for the minimum amount of time possible; a high temperature for a short time is preferable. A good source of vitamin A for pre-school children would be: a. grapes b. watermelon c. cantaloupe pieces d. banana - ANS- c. cantaloupe pieces Cantaloupe is high in beta-carotene. Grapes are a choking hazard. Banana and watermelon would have to be cut to an appropriate size Which amino acid is especially glucogenic? a. alanine b. threonine c. valine d. methionine - ANS- a. alanine Alanine is the most glucogenic amino acid. Glutamine is also glucogenic. In humans, the glucogenic amino acids are: Alanine, Arginine, Asparagine, Aspartic acid, Cysteine, Glutamic acid, Glutamine, Glycine, Histidine, Methionine, Proline,, Serine, Valine Amino acids that are both glucogenic and ketogenic (mnemonic "PITTT"): Phenylalanine, Isoleucine, Threonine, Tryptophan, Tyrosine Only leucine and lysine are not glucogenic (they are only ketogenic). If carbohydrate intake is increased, which vitamin needs to be increased? a. thiamin b. niacin c. riboflavin d. pyridoxine - ANS- a. thiamin Thiamin is essential for conversion of pyruvate to acetyl CoA. "Thiamine plays a vital role in metabolism of glucose. Thus, emphasis is placed on the fact that ingestion of excessive simple carbohydrates automatically increases the need for this vitamin." The rate of oxidation of which branched-chain amino acid increases significantly during moderate exercise? a. leucine b. phenylalanine c. tyrosine d. threonine - ANS- a. leucine Mneumonic (off PVT TIM HLL mneumonic for essential AA's) Tim LIVs for this BRANCH of the military- branched amino acids are leucine, isoleucine, and valine. What should you do with leftover sliced beef from lunch? a. throw it out b. let the meat cool at room temp and then serve within two days c. refrigerate immediately and then serve within two days d. keep it in the warmer until dinner time - ANS- c. refrigerate immediately and then serve within two days Assuming it hasn't been out for more than 6 hrs if kept at <70 degrees F. Otherwise, would discard within 4 hrs. Given this question, that assumption is being made. Subsequently, you would want to refrigerate it immediately and serve within two days. A food is bacteria-safe if it is: a. neutral and moist b. neutral and dry c. acidic and dry d. acidic and moist - ANS- c. acidic and dry Remember mneumonicf for things bacteria needs to grow: FAT TOM Food, acidity (grows at low pH, aka acidic), time, temperature, oxygen, and moisture (more moisture = more growth) French fries made from stored potatoes would have changes in: I. taste II appearance III. texture a. I, II, III b. II, III c. I d. I, III - ANS- a. I, II, III Stored/old potatoes taste sweeter, cook to a darker brown (Maillard reaction), and are softer in texture. What percent of protein and fat converts to glucose? a. 58% protein, 10% fat b. 10% protein, 60% fat c. 30% protein, 30% fat d. 20% protein, 40% fat - ANS- a. 58% protein, 10% fat 58% of amino acids are glucogenic amino acids, meaning they yield glucose following deamination. 10% of fat in the form of glycerol can be coverted to glucose. Excess amounts of zinc may lead to a deficiency of: a. copper b. magnesium c. folate d. cobalt - ANS- a. copper Zinc supplementation is also a common cause of copper deficiency. This is because zinc and copper compete for absorption in the stomach, with zinc being the usual winner. As a result, copper isn't absorbed. When adding bran to a flour mixture, what should be changed? a. baking temperature b. increase the fat and liquid c. increase the oxidizing agent d. increase the flour and liquid - ANS- d. increase the flour and liquid Adding bran decrease the volume of the end product, as bran is heavy/weighing down the product. To compensate for the added volume you would increase the flour and liquid. Flour provides gluten, which provides the elastic property of breads and such. The liquids are what hydrates the gluten and contributes to gelatinizaiton. A food item provides 45g of carbohydrate, 10g of protein, and 10g fat, what percent of total calories comes from fat? a. 34% b. 29% c. 23% d. 20% - ANS- b. 29% 45 gm CHO x 4 kcal/gm = 180 kcal 10 gm pro x 4 kcal /gm = 40 kcal 10 gm fat x 9 kcal/gm = 90 kcal 180 kcal + 40 kcal + 90 kcal = 310 kcal 90 kcal / 310 kcal = 29% from fat Which of the following is a digestive enzyme secreted by the pancreas? a. pepsin b. amylase c. lactase d. maltase - ANS- b. amylase Pepsin is released by the chief cells in the stomach. Amylase is released by the pancreas into the duodenum. Lactase and maltase are released by the small intestine on the brush border membrane. Sugar tenderizes a baked good by: a. absorbing some of the water that gluten needs b. increasing the strength of the gluten c. increasing the action of the leavening agent d. starting gluten development - ANS- a. absorbing some of the water that gluten needs Sugar is hygroscopic, meaning it modifies texture by tenderizing. Sugar softens gluten and prevent gluten development by absorbing some of the water that gluten needs. Dermatitis, diarrhea, dementia, pellagra, are signs of a: a. riboflavin deficiency b. thiamin deficiency c. pyridoxine deficiency d. niacin deficiency - ANS- d. niacin deficiency Niacin deficiency causes pellegra, which is characterized by the four D's: diarrhea, dermatitis, dementia and death. Riboflavin deficiency causes ariboflavinosis, which is characterized by agular glossitis, stomatitis, bright red tongue. Thiamin deficiency cause beriberi, which can be wet or dry beriberi. Wet beriberi causes cardiovascular complications (think wet = fluid buildup). Dry beriberi causes neurological impairements. Vitamin B6 deficiency would cause issues with transamination and deamination, as well as seizures, anemia, glossitis, and peripheral neuropathy What must be fortified with folic acid? a. skim milk b. cornmeal c. orange juice d. canned vegetables - ANS- b. cornmeal To further improve folic acid intake in women of childbearing age, the US Food and Drug Administration (FDA) mandated in 1996 that by January 1, 1998, all enriched cereal-grain products (e.g., wheat flour and related products, corn meal, and rice) would be fortified with folic acid at 140 micrograms per 100 grams of product. Cornmeal contains flour. During processing, folate is lost and thus must be fortified. To determine whether classes on lowering sodium intake have been effective, conduct: a. a process evaluation b. an impact evaluation c. a structure evaluation d. an efficiency evaluation - ANS- b. an impact evaluation An impact/outcome/effectiveness evaluation measures the effects the program had on the target population by assessing progress on outcomes; did the program accomplish the stated goal? Formative evaluation is made early or during course of education and it can change direction. It allows for revision of plans and methods to improve the process. An example would be a pilot test. Structure evaluations are used to determine if internal resources required to deliver program are adequate and/or effective. What is the main purpose of water in the body? a. it acts as a medium for cell metabolism b. it helps transport calcium through cell membranes c. it maintains electrolyte balance d. to maintain body temp - ANS- a. it acts as a medium for cell metabolism What is fluid seeping from a congealed product called? a. retrogradation b. syneresis c. coagulation d. gelatinization - ANS- b. syneresis Syneresis is the extraction or expulsion of liquid from gel. Strict vegans may need supplements of: a. chromium b. zinc c. iron d. thiamin - ANS- b. zinc Zinc is primarly found in meat and animal products, which a vegan does not eat. The citric acid cycle occurs: a. in the cytoplasm of the cell and produces energy as ATP b. in the mitochondria and produces energy as ATP c. in the cytoplasm of the cell and produces pyruvic and lactic acids d. in the mitochondria and produces pyruvic and lactic acid - ANS- b. in the mitochondria and produces energy as ATP Glycolysis is in the cytoplasm, citric acid cycle and ETC are in the mitochondria. This makes sense, considering glycolysis makes very little energy and the vast majority comes from ETC and the mitochondria is the powerhouse of the cell Frozen chicken has been thawed in warm water. You should: a. prepare it immediately b. discard it c. refreeze it d. refrigerate it - ANS- b. discard it The only proper ways to thaw TCS foods are: -Refrigerated and under 41 degrees F -Submerged in running potable water at least 70 degrees F or below for a period of time that doesn't allow thawed portions of food above 41 degrees F for more than 4 hours, with that time including cooking and time needed to cool back to 41 degrees F -Thawed in microwave if will be used within 24 hours -Thaw as part of cooking process (i.e. increase cooking time) When substitution butter for lard in pastry: a. use the same amount b. use less c. use more d. use less and decrease the water content - ANS- c. use more Butter contains less fat than lard, and thus more would be needed to get the correct flakiness/texture. The purpose of an emulsifier in margarine is to: a. keep water and fat from separating b. keep water and fat separated c. sustain the natural flavor of the ingredients d. retain the color - ANS- a. keep water and fat from separating An emulsifer is an additive which helps two liquids mix. The margarine is a fat (hydrophobic), and the water is a liquid (hydrophilic) which do not mix without an emulsifer. Which of the following must be reduced before it can be further transported for absorption? a. dipeptides b. whey c. casein hydrolysate d. crystalline amino acids - ANS- b. whey Dipeptides, crystalline amino acids, and casein hydrolysate are all broken down. Whey needs to be further broken down (contains 95% of the original water, most of the lactose, 20% of the milk protein and traces of fat. The remaining milk solids, about 50%, are incorporated into cheese. The composition of whey depends upon the type of cheese produced. Adding bran to a bread recipe will: a. increase the volume b. decrease the volume c. require an increase in oven temp d. require a decrease in oven temp - ANS- d. decrease the volume Adding bran decrease the volume of the end product, as bran is heavy/weighing down the product. An angel food cake is made without cream of tartar. What is the result? a. a yellowy cake b. a bright white cake c. a cake with large volume d. a very tender cake - ANS- a. a yellowy cake A cake will be yellow if excess baking soda is added (alkaline). Similarly if you do not add something acidic (like cream of tartar), then the cake will be too alkaline and still become yellowish. All baking powders contain: a. sodium bicarbonate b. tartrate c. phosphate d. acetate - ANS- a. sodium bicarbonate Baking soda = sodium bicarbonate Baking powder = sodium bicarbonate + acid *Remember difference by baking powder has more power than baking soda Beef bottom round should be cooked: a. at a high temp for a short time b. in water for an extended time c. in dry heat d. in moist heat for short time - ANS- b. in water for an extended time Connective tissue has two properties: collagen and elastin. Collagen becomes tender in heat (collagen + moist heat = gelatin). This is why we use MOIST HEAT for tought meat, such as flank, bottom round, brisket. Dry heat methods (no water involved) can be used for tender (soft) cuts which are near the backbone (loin, sirloin). The reason D is not the answer is because, while you would use moist heat, you would not cook if for a short time. Subsequently, B would be the answer. Which of the following combines with CoA in two carbon fragments to make acetyl CoA to then enter the Kreb's cycle to make energy? a. lactic acid b. fatty acids c. glucose d. fructose - ANS- b. fatty acids Beta-oxidation is the process of fatty acid oxidation. The end product of betaoxidation is 2 carbon fragments of fatty acids that combine with CoA to make acetyl CoA, which can then go to the TCA cycle and then ETC to make energy (a LOT of energy compared to CHO or protein) due to more carbons and hydrogens. What is the best way to cook roast? a. sear the meat first, roast at 400F b. cook slowly in the oven at 325F c. cook it at 400F for 10min, then at 350F d. brown the meat, then cook it at 350F - ANS- b. cook slowly in the oven at 325F If you are comparing the prevalence of heart disease in two states, the study design is: a. analytical research b. case control research c. descriptive research d. quasi-experimental - ANS- c. descriptive research Descriptive research is research that cannot determine causal relationships (cause/effect); only associations. For example, if you looked at prevelance of heart disease in Mississippi vs Massachusetts and found that more people currently have HD in Mississippi, you can't say living in Mississippi causes HD. In the example provided, the researchers could not determine causation because this is not an experimental design. Which of the following has the most bacteria? a. roast chicken b. ground beef c. roast veal d. roast pork - ANS- b. ground beef What is the product of pyruvate breakdown? a. acetyl CoA b. glycogen c. NADPH d. glucose-6-phosphate - ANS- a. acetyl CoA Pyruvate --> acetyl CoA --> TCA cycle Which of the following is true? a. fructose has sucrose b. fructose is less concentrated than glucose c. fructose take longer to digest than glucose d. fructose is sweeter than glucose - ANS- d. fructose is sweeter than glucose The order of carbohydrates from sweetest to least sweet is as follows: fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose. Mainly remember that fructose is the sweetest, sucrose is sweeter than glucose, and glucose is sweeter than sorbitol and mannitol. Infants should be given solid foods at: a. 4-6 months b. 3-4 months c. 2-4 months d. 6-8 months - ANS- a. 4-6 months Which of the following is a grade for fresh produce? a. US select b. US Grade A c. US No. 1 d. US standard - ANS- c. US No. 1 Best to worst grade: Fresh F/V: Fancy, Extra #1, #1, Combo, #2 Of note: Canned F/V: Grade A (Fancy), Grade B (Choice), Grade C (Select) What is the recommended weight gain during pregnancy for a woman with a BMI of 28? a. 25-35 pounds b. 28 - 40 pounds c. 15-25 pounds d. 11-20 pounds - ANS- c. 15-25 pounds For underweight BMI: 28-40 lbs For normal BMI: 25-35 lbs For overweight BMI: 15-25 lbs For obese: 11-20 lbs What gives the structure to quick breads? a. flour and milk b. flour and water c. eggs and flour d. eggs - ANS- c. eggs and flour Eggs provide stability. Flour provides gluten, meaning the elastic properties of the bread. When taking an anticoagulant, avoid the following: a. thiamin supplements b. vitamin E supplements above 400 IU per day c. supplements of calcium and vitamin D d. niacin supplements - ANS- b. vitamin E supplements above 400 IU per day EXCESS vitamin E interacts with vitamin K and can reduce clotting ability, leading to hemorrhage. The RDA for vitamin E is 15 mg/day, so a 400 IU would greatly exceed needs (15 mg of natural alpha-tocopherol would equal 22.4 IU). What is a function of cream of tartar in a recipe? a. prevents the Maillard reaction b. enhances the Maillard reaction c. increases the alkalinity allowing for better leavening d. enhances gelation - ANS- a. prevents the Maillard reaction Maillard reacction is a chemical reaction (non-enzymatic) between amino acid and sugar that results in browning when heated; creates flavor and colors in foods. Maillard reaction is increased when there is alkalinity, and thus preventing when acidity is added. Subsequently, adding cream of tartar (an acid) would inhibit/prevent the Maillard reaction. The flour with the most starch is: a. cake b. whole wheat c. instantized d. durum - ANS- a. cake In interpreting correlation data, if the r value is greater than 1: a. the relationship is strong b. the result is not valid c. the relationship is weak d. is it within 1 standard deviation - ANS- b. the result is not valid r= =/- 1 is perfect correlation; cannot have correlation outside of this range. </= 0.4 would be a poor correlation, 0.4-0.7 would be moderate correlation, >/= 0.7 would be a strong correlation (this is true for positive or negative values. Homemade rolls are crumbly and fall apart easily, the most likely cause of the poor texture in the yeast bread is: a. use of a high-protein flour b. use of a lower-protein flour c. insufficient proofing time d. excessive proofing time - ANS- b. use of a lower-protein flour Doughs from high-protein flours are physically stronger and more stable than those made with lower protein content. For yeast dough, use high protein bread flour, as low protein flour causes crumbly products with poor texture. Replacing carbohydrate with fat in the diet will: a. raise the respiratory quotient b. lower the respiratory quotient c. increases the respiratory rate d. spares protein - ANS- b. lower the respiratory quotient Carbohydrates > protein > fat CHO RQ = 1 Proteins RQ = 0.82 Fats RQ = 0.7 A commercial muffin mix is described as a "rich formula", which means it contains: a. high proportions of sugar and shortening b. high fructose corn syrup instead of crystalline sugar c. high amounts of whey instead of nonfat dry milk solids d. more chemical leavening than is used in a "lean formula" - ANS- a. high proportions of sugar and shortening Rich cake: increased fat, sugar, and egg which increases keeping quality The greatest effect on the yield of meat cooked to a uniform internal temp is produced by the: a. type of oven and source of the heat b. weight of meat and the oven load c. degree of tempering and the grade of meat d. cooking time and the oven temp - ANS- d. cooking time and the oven temp Cooking time and oven temp would have the greatest impact. Think: if recipe called for 45 minutes at 325 degrees F, and you cooked it at 425 for an hour, that would the impact on internal temperature. Type of oven wouldn't have a major impact on internal temperature if put at the correct temperature (ex: 325 degrees F). Tempering involves warming the frozen meats to temperatures slightly below their freezing point—for example, between -4 and -1 °C (25 and 30 °F). Tempering of frozen foods is often carried out in industrialscale microwave ovens. In the quasi-experimental design "time series", there is: a. a series of control groups b. no control groups c. an experimental and a control group d. a placebo group - ANS- b. no control groups Quasi-experimental deisng (aka time series or before and after study) measures something before and after the intervention to see how successful the intervention was Which of the following will stabilize the egg in a recipe? a. a base b. an acid c. sugar d. salt - ANS- b. an acid An acid stiffens an egg white foam by tenderizing the protein and allowing it to extend more easily. A natural plant hormone that is used to ripen fruits is: a. methanol b. ethylene c. acetyl acid d. ethanol - ANS- b. ethylene Aseptically packaged milk should be stored: a. in dry storage b. in the refrigerator c. in the freezer d. below 40 degrees - ANS- a. in dry storage Aseptic milk is processed using ultra-high temperature pasteurization, which kills any harmful bacteria in the milk and then it is bottled immediately in a sterile environment into special packaging that prevents any air reaching it. This procedure makes the milk shelf stable. Ultra-high temperature pasteurization (UHT) is done under sterile and aseptic conditions, resulting in product that does not need to be refrigerated. Aspetically packaged milk can be stored without refrigeration if unopended. The sensitivity of a screening tool evaluates: a. the proportion of non-afflicted individuals identified as non-afflicted b. the consistency or reproducibility of test results c. the proportion of afflicted individuals who tested positive d. the amount of variation that occurs randomly within the population - ANS- c. the proportion of afflicted individuals who tested positive SensiTiviTy = number of TRUE positive; speciFicity = number of FALSE (negative) that are actually false (negative). The consistency/reproducibility of test results is reliability / precision. A processed food entree includes TVP which is used to: a. add color b. improve taste c. add protein d. act as an emulsifier - ANS- c. add protein Textured or texturized vegetable protein, also known as textured soy protein, soy meat, or soya chunks is a defatted soy flour product, a by-product of extracting soybean oil. It is often used as a meat analogue or meat extender. It is quick to cook, with a protein content comparable to certain meats If broccoli in a vegetable mixture turns olive green during holding, it may be due to: a. lemon juice b. baking soda c. salt d. sugar - ANS- a. lemon juice Chlorophyll + acid = pheophytin (olive green) Chlorophyll + base = chloryophillin (bright green) In the alanine cycle, alanine is released from muscle, taken up by the liver, and: a. excreted in the urine b. deaminated to release glucose c. converted into adipose d. oxidized to nitric acid - ANS- b. deaminated to release glucose Alanine = amino acid (MOST glucogenic amino acid), if alanine is released from muscle and taken up by the liver, it will be used to synthesis glucose in times of need via gluconeogenesis. In the Cori cycle, lactate is converted into: a. ribose b. NADPH c. pyruvate d. acetyl coA - ANS- c. pyruvate In the Cori cycle, glucose is metabolized to pyruvate and then to lactate in muscle, the lactate is released into the blood and carried to the liver, where it is reconverted to pyruvate and used for gluconeogenesis, and the resulting glucose is released and travels back to muscle. Normal saline has ___mEq sodium/L a. 154 b. 100 c. 50 d. 200 - ANS- a. 154 An amylase deficiency would result in: a. decreased gluconeogenesis b. decreased lipolysis c. decreased glycolysis d. decreased proteolysis - ANS- c. decreased glycolysis Amylase = enzyme involved in CHO metabolism (lipase = fat, protease = protein). If amylase was not present, the breakdown of glucose (glycolysis). Fresh eggs in the shell can be stored in a refrigerator at 40F for: a. 3 weeks b. 2 weeks c. 10 days d. 4-6 days - ANS- a. 3 weeks How to remember: egg has three letters, so three weeks Trypsin and chymotrypsin are: a. pancreatic enzymes that provide proteolytic action b. intestinal enzymes that digest starch c. liver hormones involved in fat digestion d. intestinal enzymes that digest protein - ANS- a. pancreatic enzymes that provide proteolytic action Pepsinogen (zymogen form) is converted to pepsin (active form) in the stomach by HCl. Pepsin then hydrolyzes peptide bonds. Zymogens (trypsinogen, chymotrypsinogen, procarboxypeptidase) are converted to active form on the brush border membrane of the enterocyte. Trypsinogen is converted to active form trypsin by enterokinase on brush border membrane. Tyrpsin then converted the other zymogens (chymotrypsinogen, procarboxypeptidase) into their active forms (chymotrypsin, carboxypeptidase), which can then hydrolyze to di and oligosaccharides. Acid-base abnormalities in an uncontrolled diabetic are likely due to: a. respiratory alkalosis b. metabolic acidosis c. respiratory acidosis d. metabolic alkalosis - ANS- b. metabolic acidosis An uncontrolled diabetic is at increased risk for developing DKA. Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes. A patient consumed 12 grams of protein and released 8 grams of nitrogen in the urine, this is: a. nitrogen balance b. negative nitrogen balance c. positive nitrogen balance d. plus 4 nitrogen balance - ANS- b. negative nitrogen balance To determine nitrogen balance: Nitrogen intake: 12 gm protein consumed / 6.25 = 1.92 Nitrogen output: 8 gm in urine + 4 gm = 12 1.92 - 12 = -10.08 Kidneys help control pH by: a. excreting sodium and calcium b. controlling the ratio of hydrogen irons to bicarbonate excretion c. excreting carbon dioxide and carbonic acid d. excreting NADPH - ANS- b. controlling the ratio of hydrogen irons to bicarbonate excretion The kidneys have two main ways to maintain acid-base balance - their cells reabsorb bicarbonate HCO3− from the urine back to the blood and they secrete hydrogen H+ ions into the urine. By adjusting the amounts reabsorbed and secreted, they balance the bloodstream's pH. Pernicious anemia is likely to occur following a: a. colectomy b. colostomy c. gastretomy d. esophagostomy - ANS- c. gastrectomy Pernicious anemia, also known vitamin B12 deficiency anemia, can occur s/p gastrectomy, or excision of the stomach. In stomach vitamin B12 binds to R protein, allowing it to travel to GI tract where it will be spilt away from R protein and bind to IF in ileum before being absorbed there· IF is glycoprotein produced by gastric parietal cells Patients undergoing gastrectomy can develop IF deficiency resulting in vitamin B12 deficiency due to inadequate absorption and requires intramuscular vitamin B12 A patient's I/O form indicates the following data. What is his total insensible fluid loss? Input(ml) Oral fluids: 1800 Solid foods: 800 Metabolic water: 250 Total: 2850 Output (ml) urine: 1900 intestinal: 250 lungs and skin: 700 total: 2850 a. 700ml b. 950ml c. 1900ml d. 2850ml - ANS- a. 700ml Insensible fluid loss is the amount of body fluid lost daily that is not easily measured, from the respiratory system, skin, and water in the excreted stool. Urine would not be an insensible loss because it can be easily measured. I am assuming that "intestinal" losses means total stool output, not the amount of water in excreted stool. Subsequently, the insensible losses would be just from lungs and skin. Which pigment can be converted into a vitamin? a. chlorophyll b. carotenoids c. anthocyanin d. anthoxanthins - ANS- b. carotenoids A provitamin is a nutrient that can be converted into a vitamin. Beta-carotene (found in orange and yellow fruits and vegetables) is an important antioxidant and an example of provitamin A because it can be converted to Vitamin A by the human body. The amount of ceruloplasmin is affected by what disease? a. Addison's disease b. Pheochromocytoma c. Cushing's syndrome d. Wilson's disease - ANS- d. Wilson's disease Ceruloplasmin is a protein that is made in the liver. It stores and carries copper from the liver into the bloodstream and to the parts of your body that need it. Copper is a mineral that is found in several foods, including nuts, chocolate, mushrooms, shellfish, and liver. Wilson's disease is an inherited disorder that causes too much copper to accumulate in the organ. Subsequently, the amount of ceruloplasmin in the blood would increase as copper accumulates. An edematous person may actually be dehydrated because: a. intravascular fluid is retained b. intravascular fluid is diluted c. fluid is retained intracellularly d. fluid is retained extracellularly - ANS- d. fluid is retained extracellularly When someone is experiencing edema, fluid is pulled interstitially, meaning extracellularly. When alpha linolenic acid is substituted for saturated fatty acids in the diet, the results will be: a. increased HDL, reduced LDL b. decreased triglycerides, lower total cholesterol c. decreased triglycerides, little change in total cholesterol d. lower HDL, increased LDL - ANS- c. decreased triglycerides, little change in total cholesterol When alpha-linolenic (omega-3) is substituted for saturated fatty acids, there is decreased hepatic production of triglyercides (inhibits VLDL synthesis) and has little effect on total cholesterol levels. Lioleic acid, or omega 6, is an essential fatty acid. Replacing carbohydrates with omega 6 causes LDL to decrease and HDL to increase. If linoleic acid (omega 6) replaces saturated fat, total cholesterol decreases and HDL decreases When substituted for saturated fats in the diet, which of the following oils will likely lower total cholesterol but also lower HDL cholesterol? a. olive oil b. canola oil c. peanut oil d. safflower oil - ANS- d. safflower oil When alpha-linolenic (omega-3) is substituted for saturated fatty acids, there is decreased hepatic production of triglyercides (inhibits VLDL synthesis) and has little effect on total cholesterol levels. If linoleic acid (omega 6) replaces saturated fat, total cholesterol decreases and HDL decreases. Subsequently, omega 6 should lower total cholesterol. The best source of omega 6 is safflower oil. What is the best way to reduce the fat content of a brownie recipe? a. use margarine instead of butter b. cut out all the fat c. cut out half the fat d. use prune puree in place of half the fat - ANS- d. use prune puree in place of half the fat Prune puree is a sugar, and thus the tenderidizing properties of sugar take place for the half fat. Using margarine instead of butter and cutting out half the fat would reduce the amount of tenderizing agent (fat), making a hard product. Cutting out all the fat would make it very hard. What are the caloric needs of a 4 month old infant weighing 14 lbs? a. 510 b. 582 c. 602 d. 687 - ANS- d. 687 4 month old needs ~108 kcal/kg 14 lbs = 6.4 kg 6.4 kg x 108 = ~687 kcal A child is lethargic and irritable with diarrhea. The cause may be: a. zinc toxicity b. lead poisoning c. iron overload d. vitamin A toxicity - ANS- b. lead poisoning Lead depletes iron, leading to anemia. Iron-deficiency anemia can cause lethargy. A child is at the 95th percentile for BMI for age. He is: a. normal b. obese c. overweight d. tall for his age - ANS- b. obese BMI-for-age is used to evaluate for excess adiposity and undernutrition. -BMI-for-age above 95th percentile is considered obese -BMI-for-age between 85th and 95th percentile is considered overweight -BMI-for-Age below 5th percentile is considered underweight A child is at the 85th percentile for BMI, he is: a. overweight b. tall for his age c. muscular for his age d. normal weight - ANS- a. overweight BMI-for-age is used to evaluate for excess adiposity and undernutrition. -BMI-for-age above 95th percentile is considered obese -BMI-for-age between 85th and 95th percentile is considered overweight -BMI-for-Age below 5th percentile is considered underweight Cross-sectional studies: a. describe past events and conditions b. are useful in predicting future-events c. are a snap-shot look at one point in time d. measure before and after an intervention occurs - ANS- c. are a snap-shot look at one point in time To determine whether promotional efforts have increased sales in a business use: a. the experimental design b. an observational study c. a survey d. a segmentation process - ANS- a. the experimental design An experimental design is the only test that can suggest causation. All other are just associations. What should you do with a new client who sits scowling at you during the session? a. presume she understands what you are saying b. ask her if she is uncomfortable about the session c. recognize that new clients are seldom relaxed d. presume that she just would rather be somewhere else - ANS- b. ask her if she is uncomfortable about the session The absence of reinforcement following an undesirable behavior is: a. positive reinforcement b. punishment c. extinction d. avoidance - ANS- c. extinction The types of behavioral modification methods include positive reinforcement, avoidance learning, and extinction. Positive reinforcement is encourages reptition of a given behavior- it should be specific and immediate. Extinction is aimed at reducing undesirable behaviors- absense of reinforcement following an undesired behavior (ignore). The belief is, if extinction is repeated, behavior will eventually disappear. Avoidance learning is learning to escape from unpleasant consequencesavoiding futre critism by improving future behavior. A study design that tracts the occurrence of infections in patients who are at nutritional risk and in the hospital for longer than seven days is: a. a cohort study b. a time series method c. a case control study d. descriptive research - ANS- a. a cohort study A cohort study looks at exposures, either retrospectively or retrospectively. For example, a prospective cohort would look at smokers vs non-smokers and follow them for 5 years so see who develops lung cancer among exposed and nonexposed. In this example, they plan to follow one group who are at nutrition risk (exposed) and those in the hospital for greater than seven days (non-exposed) to compare rates of infection. This is a prospective cohort. In order to be a case control, it would have to be retrospective and look at those with infections vs those without and then look back at exposures. Which of the following foods is the best source of omega-3 fatty acids a. shrimp b. anchovies c. sardines d. olive oil - ANS- c. sardines Before you teach a class on nutrition, you should: a. research all current materials at the library b. read a current nutrition textbook c. take a survey to determine what they are interested in d. assess the student's current nutrition knowledge - ANS- d. assess the student's current nutrition knowledge You are explaining to a new client how making a few changes in his food choices will benefit his overall health. The learning domain is: a. psychomotor b. cognitive c. affective d. human - ANS- c. affective The three types of learning domains are cognitive, affective and psychomotor. Cognitive is acquisition of knowledge or subject matter (factual information). Affective is acquisition of attitude and value, growth in feelings or emotions. Psychomotor learning is the acquisition of muscular skills (exercises, food prepartion). In this example, you are not actually providing factual information. You are trying to target his values- his health. Active listening in counseling sessions involves: a. probing into specific areas of behavior b. empathizing c. selective perception d. paraphrasing and responding - ANS- d. paraphrasing and responding A study reported a 10% morbidity rate in infants in the country and a 12% morbidity rate for infants in the city. This means that: a. 10% of infants died in the country b. more infants died in the city than in the country c. more disease in infants in the city than in the country d. more disease in infants in the country than in the city - ANS- c. more disease in infants in the city than in the country Morbitity = sickness The first step in planning a continuing education program is to: a. locate the guest speaker b. survey participants to see what interests them c. survey other groups to see what they are doing d. select a topic that has not been offered lately - ANS- b. survey participants to see what interests them When planning a program for rural elderly, which is the most important? a. the number of participants b. what you will serve c. where it will be held d. how they will get to you - ANS- d. how they will get to you The additional factors listed will not matter if those in the rural community cannot access the services. Which exhibits a definite positive correlation? a. 0.05 - 0.07 b. 1.2 - 1.3 c. 0.8 - 1.0 d. 0.2 - 0.9 - ANS- c. 0.8 - 1.0 r= =/- 1 is perfect correlation; cannot have correlation outside of this range. </= 0.4 would be a poor correlation, 0.4-0.7 would be moderate correlation, >/= 0.7 would be a strong correlation (this is true for positive or negative values. Subsequently, 0.8-1.0 would show a definite positive correlation. Where would this be placed in a research article: "most of the changes seen were probably due to..." a. introduction b. discussion c. results d. summary - ANS- b. discussion In the discussion, the results are interpreted, comparison with other studies. Discussing the results addresses the research question, objectives, and hypothesis. It places results in context of existing science. Provides implications for future research or cinical practice, limitation and strengths. You are asked to give an in-service to the staff. What should you do first? a. ask them what they want to learn b. read up on the subject c. observe the staff at work to identify problems d. see what other hospitals are teaching - ANS- c. observe the staff at work to identify problems When should an explanation of how a worker will be evaluated be given to them? a. one month prior to their eval b. they should not be shown to the worker c. the day of the evaluation before you meet with them d. the day they are hired - ANS- d. the day they are hired When developing educational plans, when do you plan the evaluation criteria? a. before implementation of the plan b. do it before you plan anything else c. plan evaluation criteria at each step in the process d. plan it just before you offer the program - ANS- c. plan evaluation criteria at each step in the process Assessment, planning, implementation, and evaluation of outcomes The first step in developing a training program is to: a. assess the needs of the group b. review training programs offered in other locations c. provide the trainer with detailed instructions d. estimate approximate length of time needed to complete training - ANS- a. assess the needs of the group Community needs assessment to see what the individuals actually need from you, not what you think they need. Which of the following is the most useful for evaluating long term nutrition in children? a. height for age b. weight for height c. weight for age d. length for weight - ANS- a. height for age Stature/length for age defines shortness/tallness and reflects long term nutritional status; determines extent of stunting Weight for length/stature identifies under/over nutrition and detects short term changes to nutritional status. Weight for age is NOT used to classify under/over weight and is a short term marker of growth that cannot distinguish between stunting and wasting becuase it does not include height What denotes a high correlation? a. 0.2 b. 0.4 c. 0.6 d. 0.8 - ANS- d. 0.8 r= =/- 1 is perfect correlation; cannot have correlation outside of this range. </= 0.4 would be a poor correlation, 0.4-0.7 would be moderate correlation, >/= 0.7 would be a strong correlation (this is true for positive or negative values. 0.8 is the answer because it is closet to 1. The mean is a measure of: a. a normal curve b. central tendency c. a frequency curve d. a straight line - ANS- b. central tendency Mean, median, and mode are all measures of central tendency. In interpreting statistical data, if half the observations are above the number 8, and half are below the number 8, the number 8 is the: a. mode b. median c. mean d. average - ANS- b. median Median = middle. We don't know mean (average) because we don't know the actual number for the observations. Similarly, for mode (the most) we would need to know the actual numbers. Median = middle, so the 8th value would be the median. In a study of the effects of following a low fat diet on the incidence of breast cancer, women were randomized to follow either their usual dietary pattern, or a low fat diet. The study design is: a. descriptive research b. analytical research c. cross-sectional d. qualitative research - ANS- b. analytical research Randomized, provided intervention (low fat diet) compared to control (usual dietary pattern). This is an experimental design and thus is analytical research. A study showed the morbidity of children with anemia to be 5:1000. This means: a. 5 children out of 1000 died of anemia b. 5 children out of 1000 had anemia c. 1000 children had anemia d. 1000 children died of anemia - ANS- b. 5 children out of 1000 had anemia Morbidity = sickness, mortality = death (think mortal) A 5 month old infant has changed from the 65th to the 95th percentile weight for height. The dietitian should first: a. suggest the infant receives more solid foods b. change the feeding formula c. check to see if weights have been plotted properly d. increase the amount of formula provided - ANS- c. check to see if weights have been plotted properly That's a really big change and subsequently the RD would want to check the chart and check with the nurse to make sure that is correct. If there is any uncertainity, remeasure the infant. You are analyzing a client's physical ability to prepare meals. The learning domain is: a. conceptual b. affective c. human d. psychomotor - ANS- d. psychomotor The three types of learning domains are cognitive, affective and psychomotor. Cognitive is acquisition of knowledge or subject matter (factual information). Affective is acquisition of attitude and value, growth in feelings or emotions. Psychomotor learning is the acquisition of muscular skills (exercises, food prepartion). This is an example of psychomotor because you are assessing the client's physical ability to prepare meals. At your first counseling session with a new patient you should: a. tell him you have to change his diet b. find out what he eats c. give him instructional materials d. teach him meal exchanges - ANS- b. find out what he eats An appropriate purpose of analytical research is to _____. a. test the hypothesis... b. investigate the... c. formulate a hypothesis... d. distinguish between.... - ANS- a. test the hypothesis... Analytical research tests hypotheses concerning the effects of specific factors of interest and allows causal associations to be determined. Which defines the statistical term "mean" a. the number that occurs most frequently b. the average c. the central tendency d. a value in an ordered set of numbers below and above which fall in an equal set of numbers - ANS- b. the average If patients in a counseling session become restless: a. shorten the sessions b. use a series of guest speakers c. realize that this is to be expected d. cancel the sessions - ANS- a. shorten the sessions Be flexible, make adjustments to make the client comfortable. You will be introducing new methods of production to your staff. The most effective method would be to: a. include them during discussions of proposed methods b. introduce the new method quickly c. let them know it is a better process d. ask employees if they will go along with the decision - ANS- a. include them during discussions of proposed methods The best indicator that children applied knowledge from a nutrition education program about vitamin D is: a. their parents know about good sources of vitamin D b. the children can name good sources of vitamin D c. the children request more snacks with vitamin D d. the children know the reasons for including the vitamin - ANS- c. the children request more snacks with vitamin D Answer A would show that the child was discussing what they learned with their parents, but not that they were actually applying that knowledge. This same logic can be applied to B and D. The answer is C becaues this shows that the childen understood the information provided and realized the importance of vitamin D in the diet, so they are applying that knowledge by trying to get more foods with vitamin D. In a study on custards which would be the dependent variable? a. the amount of milk and sugar in the recipe b. the cooked custard c. the temperature of the oven d. the time of cooking - ANS- b. the cooked custard Dependent variables are outcomes. Independent variables are what you manipulate in the study. For example, treatment for diseases are independent (you can change the treatment to affect disease). Another example is the effect that cholesterol levels (independent) have on heart attacks (dependent). In this example, the custard is the independent variable (what you manipulate in the study) and the cooked custard is the dependent variable (the outcome). What is the mean of the following set of numbers: 3, 2, 2: a. 3 b. 2.3 c. 3.2 d. 2.5 - ANS- b. 2.3 3 + 2 + 2 = 7/3 = 2.3 Statistics that let you draw probable conclusions beyond your immediate universe of data, are called a. descriptive statistics b. inferential statistics c. variable interest statistics d. continuous statistics - ANS- b. inferential statistics Inferential statistics makes inferences or conclusions from observed data (ex: probability hypothesis testing, variance). Descriptive statistics summarizes and describes small amounts of numerical information (ex: mean, median, mode, range, SD). A performance objective should be based on: a. a review of the literature for the latest research b. what the learner should know or be able to do c. existing standards of practice d. a SWOT analysis - ANS- b. what the learner should know or be able to do Employee performance objectives are goals and targets agreed between the employee and their employer. They help employees understand their role and their contribution to the business, so they can focus on activities, development and progression that contribute to the organization's overall goals. Which would provide the best source of omega-3 fatty acids? a. walnuts, flaxseeds b. tuna, cod c. sardines, herring, mackerel d. canola oil - ANS- c. sardines, herring, mackerel Omega-3 rich foods are typically FISH. Mackerel (4,107 mg per serving), Salmon (4,123 mg per serving), Cod liver oil (2,682 mg per serving), Herring (946 mg per serving), Oysters (370 mg per serving), Sardines (2,205 mg per serving), Anchovies (951 mg per serving), Caviar (1,086 mg per serving). Synergistics is: a. two people working together b. two people working in separate areas c. a person working alone d. a group of people working together to solve a problem - ANS- d. a group of people working together to solve a problem Synergy: the group production (decision) is superior to what the most resourceful individual within the group could have produced by working alone When counseling an anorexic, the best advice is to: a. be real strict in their food choices b. be flexible and help them choose reasonable goals c. provide a large variety of menu items d. give them free rein with their intake - ANS- b. be flexible and help them choose reasonable goals After you review the patient's medical record, the first step in counseling is: a. assess the patient's nutritional status b. collect all relevant data c. establish a climate of trust d. establish an overall evaluation plan for the patient - ANS- c. establish a climate of trust Steps of interviewing: -Prepare (collect background information, establish objectives for collecting information during interview) -Build rapport (first step when meeting client) - Collect data (open-ended, non-judgemental) ANOVA is used when: a. several products compete against one another b. comparing two similar products c. testing whether results can be generalized to a larger group d. testing whether the difference between two groups is real - ANS- a. several products compete against one another The t-test is a method that determines whether two populations are statistically different from each other, whereas ANOVA determines whether three or more populations are statistically different from each other. Both of them look at the difference in means and the spread of the distributions (i.e., variance) across groups; however, the ways that they determine the statistical significance are different. A chi-square test is a statistical test used to compare observed results with expected results. The purpose of this test is to determine if a difference between observed data and expected data is due to chance, or if it is due to a relationship between the variables you are studying. If you measure a group before and after a treatment to see whether or not there has been a significant change, the study design is: a. experimental b. quasi-experimental c. descriptive d. qualitative - ANS- b. quasi-experimental Quasi-experimental deisng (aka time series or before and after study) measures something before and after the intervention to see how successful the intervention was. There is no control group which is what makes it different from experimental. The number of individuals in a population diagnosed with a specific condition during a specified time is the: a. prevalence b incidence c. rate of the condition d. duration of the condition - ANS- b. incidence IncideNce = New cases, prEvelance = Existing cases Results of a three day food record were obtained in June and again three months later. What is this called? a. validity b. reliability c. sensitivity d. specificity - ANS- b. reliability The ReProducibility / abity to retest the test results and get same thing is Reliability / Precision. Validity is the accuracy- did we measure what we ended to measure? SensiTivity = # TRUE positive, speciFicity = # of FALSE test results that are truley false Which of the following responses by a counselor indicates "reflection"? a. "yes, you can do that" b. "you said, 'you want to lose weight?'" c. "explain what you mean by that please" d. "I can help you" - ANS- b. "you said, 'you want to lose weight?'" Active/reflective listening is paraphrasing or repeating back what was just said. How do you begin an interview with a patient? a. obtain height and weight b. get a nutritional history c. introduce yourself and make them comfortable d. give the diet instruction - ANS- c. introduce yourself and make them comfortable Build rapport and make the client feel comfortable talking with you. Inferential statistics are associated with: a. probability b. mean c. mode d. graphs - ANS- a. probability Inferential statistics makes inferences or conclusions from observed data (ex: probability hypothesis testing, variance). In behavior modification, the absence of reinforcement following an undesired behavior is referred to as: a. avoidance learning b. extinction c. negative reinforcement d. negative consequence - ANS- b. extinction The types of behavioral modification methods include positive reinforcement, avoidance learning, and extinction. Positive reinforcement is encourages reptition of a given behavior- it should be specific and immediate. Extinction is aimed at reducing undesirable behaviors- absense of reinforcement following an undesired behavior (ignore). The belief is, if extinction is repeated, behavior will eventually disappear. Avoidance learning is learning to escape from unpleasant consequencesavoiding futre critism by improving future behavior. What is your first concern when deciding how to teach? a. the time you and the students have b. what learning resources are available c. what you are best at d. the needs and abilities of your students - ANS- d. the needs and abilities of your students The needs assessment is the first step when attempting to implement communitybased intervention/project. The statement "After class, the patient will be able to write a day's menu following the guidelines" is... a. a goal b. an objective c. a plan d. a research hypothesis - ANS- b. an objective Objectives: specific, measurable, actions with a time frame Goals: broad direction, general purpose To determine the reading level of a text: a. count the number of words with more than one syllable b. count the number of paragraphs c. count the average number of letters in the words d. count the number of sentences in a paragraph - ANS- a. count the number of words with more than one syllable Reading level is typically determined by finding the average number of polysyllabic words using readibility index such as SMOG index. Reading materials should be kept around 8th grade reading level for general public and 6th grade for audiences of low literacy. In a normal curve, what % of data falls between +1 and -1 standard deviation? a. 52 b. 93 c. 35 d. 68 - ANS- d. 68 68% of data falls BETWEEN +1 and -1 SD (w/in 1 SD, not 2) Others to know for exam: 32% of data lies OUTSIDE the range of +1 / -1 SD (outside 1 SD) 95% of data falls WITHIN +/- 2 SD (2 SD) The statement "this further shows daily weighing is an effective weight loss tool" should be placed in which section of the research report? a. implications b. results c. analysis d. methodology - ANS- a. implications Implications are how the informaiton might be applied in practice. The statement "the country's infant mortality rate is 12.8, and the state's infant mortality rate is 10.5" means that: a. more infants died in the country than in the state b. for every 1000 live births in the country, 12.8 infants died c. two more infants died in the country than in the state d. 12.8% of the infants born in the country died before the age of 1 - ANS- b. for every 1000 live births in the country, 12.8 infants died Mortality = deaths What reading level is appropriate for educational material for the general population? a. 4th grade b. 5th grade c. 8th grade d. 10th grade - ANS- c. 8th grade Reading level is typically determined by finding the average number of polysyllabic words using readibility index such as SMOG index. Reading materials should be kept around 8th grade reading level for general public and 6th grade for audiences of low literacy. What reading level is appropriate for written materials for a population with low literacy skills? a. 4th grade b. 6th grade c. 8th grade d. 9th grade - ANS- b. 6th grade Reading level is typically determined by finding the average number of polysyllabic words using readibility index such as SMOG index. Reading materials should be kept around 8th grade reading level for general public and 6th grade for audiences of low literacy. The formula that counts the number of polysyllabic words in text to calculate the reading level is the: a. SMOG index b. BACM index c. Smith Reading index d. Text index - ANS- a. SMOG index Reading level is typically determined by finding the average number of polysyllabic words using readibility index such as SMOG index. Reading materials should be kept around 8th grade reading level for general public and 6th grade for audiences of low literacy. Which is the dependent variable? a. leavening b. storage days c. volume d. oven temperature - ANS- c. volume Dependent variables are outcomes. Independent variables are what you manipulate in the study. For example, treatment for diseases are independent (you can change the treatment to affect disease). Another example is the effect that cholesterol levels (independent) have on heart attacks (dependent). In this example, volume is the outcome. Leavening, storage days and oven temperatures would all be independent variables, or what is manipulated in the study. The incidence of xeropthalmia in children between the ages of 1-5 is 5:1000. This means: a. morbidity rate of xeropthalmia is 5 in every 1000 children ages 1-5 b. mortality rate of xeropthalmia is 5000 in this age group c. morbidity rate of xeropthalmia is 5000 in this age group d. mortality rate is 5 in every 1000 children aged 1-5 - ANS- a. morbidity rate of xeropthalmia is 5 in every 1000 children ages 1-5 IncideNce = # NEW cases, so morbidity (sickness) If there is no statistical difference between study groups, the hypothesis is: a. negative b. null c. even d. positive - ANS- b. null Null = NO association between variables Alternative = affirmation of relationship between variables (Ex: eating vegan and lower rates of heart disease) A focus group contributes what data? a. analytical b. experimental c. attitudinal d. objective - ANS- c. attitudinal Attitudinal data is providing qualitive data about how someone feels about something. Focus groups are a great example of attitudinal data. An example of nominal (frequency) data is: a. temperature b. weight c. differentiate between men and women d. rank in class - ANS- c. differentiate between men and women NOminal data = variables that fit into categories with NO order (ex: gender, race, marital status, ethnicity). Differentiating between men and women (M or W), would be an example of nominal data. Weight would be numerical discrete. Rank in class would be rank order/ordinal scale (I think). Temperature would be numerical continous, because it is a numerical variable that is part of a continous scale (I think). Compared to whole milk, breast milk is: a. higher in protein and fat, lower in carbohydrate b. lower in protein, higher in carbohydrate and fat c. lower in protein, carbohydrate, and fat d. has the same nutrient composition - ANS- b. lower in protein, higher in carbohydrate and fat Breast milk is lower in protein, higher in CHO and fat, higher in antibodies Which result is desirable? Before After Experimental group A B Control group C D a. the difference between A and B is more significant than the difference between C and D b. the difference between B and D is statistically significant c. the difference between A and C is more significant than the difference between B and D d. the difference between A and D is more significant than the difference between C and B - ANS- a. the difference between A and B is more significant than the difference between C and D Think of an example. If you were doing an experiment comparing intake of blueberries and blood glucose levels, Group A would get blueberries with breakfast and Group C would get their normal breakfast (no blueberries). After you conduct the study, you would want/desire that the blueberry group after the experiment (B) has a significantly lower blood sugar value than when they started (A). You would want that change to be more significant than any changes after the experiment in the control group (D) compared to when the experiment started (C). Subsequently, the answer is A. A patient relates a story to the RD. The RD says: "this happened to me, too" This is: a. reflection b. clarification c. attribution d. self-disclosure - ANS- d. self-disclosure The RD is sharing personal information, likely in order to make the client feel more comfortable and know that the RD understands where they are coming from. An example of formative evaluation is: a. IQ test b. RD exam c. Pretest quiz d. Comparative evaluation - ANS- c. Pretest quiz A formal evalution includes an objective test, which is not well-suited for clinic or community setting, and a performance test, in which the client is asked to complete a task based on learning objectives. A pretest quiz would be an example of a performance test. An informal evaluation would be an unstructured observation of food selection and behaviors. The lecture: a. increases teacher-student involvement b. is student oriented c. reinforces material presented d. provides the most material covered in a short time - ANS- d. provides the most material covered in a short time The lecture is the portion where you provide as much material as possible in a short period of time. How can you encourage preschool children to eat more fruits and vegetables? a. Have them participate in preparing fruits and vegetables b. Have them draw pictures of fruits and vegetables c. Give examples of food choices using a slide show d. Give examples of food choices using picture - ANS- a. Have them participate in preparing fruits and vegetables Children tend to be kinesthetic learners, so getting them involved in preparing fruits and vegetables will be the most effective. Which is the best way to teach food service workers to prepare a new menu item? a. show a video of the process b. have them prepare it following a recipe c. provide and review detailed, written instructions d. demonstrate the process, then watch them prepare it - ANS- d. demonstrate the process, then watch them prepare . Following counseling, a client is able to plan a low sodium diet. The learning domain is: a. affective b. cognitive c. psychomotor d. psychosocial - ANS- b. cognitive The three types of learning domains are cognitive, affective and psychomotor. Cognitive is acquisition of knowledge or subject matter (factual information). Affective is acquisition of attitude and value, growth in feelings or emotions. Psychomotor learning is the acquisition of muscular skills (exercises, food prepartion). In this example, the client is able to perform the task of planning a low sodium diet, and thus is showing cognitive learning. A client says: "I want to change my eating habits." You ask why. The learning domain is: a. affective b. cognitive c. psychomotor d. psychosocial - ANS- a. affective The three types of learning domains are cognitive, affective and psychomotor. Cognitive is acquisition of knowledge or subject matter (factual information). Affective is acquisition of attitude and value, growth in feelings or emotions. Psychomotor learning is the acquisition of muscular skills (exercises, food prepartion). This example is affective because it is showing that the client values and is motivated to change their eating habits. What is the best way to assess what a group of students has learned after diet instruction? a. list their skills b. have them explain their skills c. have them demonstrate their skills d. post-test on their skills - ANS- c. have them demonstrate their skills At which step in the educational process do you begin evaluation? a. assessment b. planning c. implementation d. evaluation - ANS- a. assessment Program evaluation occurs at every step of the the educational process (assessment, planning, implementation, and evaluation of outcomes). Subsequently, evaluation starts right in the beginning with assessment. The dietitian days to the client: "I hear you say that on some days you just cannot stay with the plan. Is that right?" this is: a. a statement of affirmation b. an open-ended question c. a reassuring response d. reflective listening - ANS- d. reflective listening Active/reflective listening is paraphrasing or repeating back what was just said. An advantage of using focus groups to collect data is that they: a. help you generalize to larger populations b. help the researcher understand participants' perspectives c. help participants stay focused on the topic d. are inexpensive because many can be interviewed at once - ANS- b. help the researcher understand participants' perspectives Focus groups provide attitudinal data, which gives insight to the reseachers on what the participants believe about certain topics. This information cannot be generalized to a larger population as it is just qualitative and very subjective. An example of a survey with a negative correlation is: a. when folic acid intake increases prior to pregnancy, the incidence of neural tube defects declines b. when LDL levels increase, the rate of heart disease increases c. when a person becomes more obese, their LDL levels likely rise d. as the intake of peanut butter and potato chips increases, dental caries increase - ANS- a. when folic acid intake increases prior to pregnancy, the incidence of neural tube defects declines Negative correlation does NOT mean "bad". Negative correlation means moving in oppositve directions, while positive correlation means moving in the same direction. In this example, a negative correlation would be A because when folic acid intake increases, neural tube defects move in the opposite direction (decreases). When providing nutrition education to a pregnant teenager, which characteristic of adolescents should be kept in mind? a. interested in planning for the future b. responds more to emotional stimuli c. desire to be like their peers d. has well-defined self-image - ANS- c. desire to be like their peers Teenagers often have a desire to be liked by their peers and thus must be taken into consideration when counseling adolescents, especially teenagers. A new mother may hesitate to become involved with a breast-feeding informational program due to: a. lack of funds b. lack of social support c. lack of knowledge about benefits d. lack of medical care - ANS- b. lack of social support During motivational interviewing, the question "Do you think you can try this" is: a. an affirmation b. a reflection c. a closed question d. an exploration - ANS- c. a closed question This is a closed-ended question because it can be answered with yes or no. A statement of affirmation in motivational interviewing would be: a. "taking a walk during your lunch hour shows how determined you are" b. I would like you to try to reduce portion sizes at dinner" c. "perhaps eating lunch away from you desk would be helpful" d. try to increase you intake of fruits and vegetables" - ANS- a. "taking a walk during your lunch hour shows how determined you are" Affirmations are statements and gestures that recognize client strengths and acknowledge behaviours that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one's ability to change. To be effective, affirmations must be genuine and congruent. To estimate REE in normal weight and obese individuals, use: a. Harris Benedict b. Mifflin St. Jeor c. BMR d. indirect calorimetry - ANS- b. Mifflin St. Jeor Mifflin St. Jeor measures REE/RMR Harris Benedict measures BEE/BMR (Benedict = BMR) To estimate energy needs in the critically ill, use: a. Harris Benedict b. Mifflin St Jeor c. BMR d. indirect calorimetry - ANS- d. indirect calorimetry Indirect calorimetry is the method by which measurements of respiratory gas exchange are used to estimate the type and amount of substrate oxidized and the amount of energy produced by biological oxidation. This is most helpful in critically ill patients as it is more difficult to effective estimate RMR when critically ill. Indirect calorimetry would give the most accurate estimate of nutritional needs, but is often unable to be done due to cost and reality. Of the following oils, which is highest in vitamin E? a. safflower b. corn c. cottonseed d. olive - ANS- c. cottonseed Wheat Germ Oil — 135% DV per serving, Hazelnut Oil — 43% DV per serving, Sunflower Oil — 37% DV per serving, Almond Oil — 36% DV per serving, Cottonseed Oil — 32% DV per serving, Safflower Oil — 31% DV per serving, Rice Bran Oil — 29% DV per serving, Grapeseed Oil — 26% DV per serving Water soluble nutrients are absorbed through: a. active transport b. simple diffusion c. carrier-facilitated passive diffusion d. inactive transport - ANS- c. carrier-facilitated passive diffusion Water-soluble vitamins, minerals and the simple sugar fructose are absorbed in a process called facilitated diffusion. Nutrients become attached to specific molecules outside the absorptive cell surface. These carrier molecules take the nutrients across the cell membrane and free them once inside the cell. To determine the effectiveness of a nutrition program to be offered at fitness facilities throughout the city: a. first determine how many locations are willing to offer the program b. pilot test the program in one location c. request a review of the program by local dietitians d. offer an incentive for facilities to provide the program - ANS- b. pilot test the program in one location Pilot tests allow you to implement your program on a small scale in order to make any adjustments needed prior to actually implementing it. The two most abundant minerals in the body are: a. zinc and chromium b. calcium and zinc c. iron and calcium d. calcium and phosphorus - ANS- d. calcium and phosphorus Calcium is the most abundant- involved in bone metabolism, blood coagulation, neuromuscular excitability, cellular adhesiveness, transmission of nerve impulses, maintenance and function of cell membranes, and activation of enzyme reactions and hormone secretions. Phosphorus is also very abundant, as it is a component of many structural and regulatory molecules, such as ATP & DNA. Think: phospholipid bilayers Increased plasma pyruvate is an indication of a: a. riboflavin deficiency b. thiamin deficiency c. pyridoxine deficiency d. iron deficiency - ANS- b. thiamin deficiency Vitamin B1 (thiamine) is a co-factor for pyruvate dehydrogenase, an essential enzyme for aerobic metabolism. In the absence of thiamine, the conversion of pyruvate to acetyl-CoA is inhibited and pyruvate cannot enter the Kreb's cycle. A serum calcium level of 11.5 mg/dl will bring on a release of: a. PTH from parathyroid gland b. calcitonin from the thyroid glands c. calcium d. calcium-binding protein from the intestine - ANS- b. calcitonin from the thyroid glands Calcium in the body is tightly regulated at 8.5 - 10.5 mg/dL. When blood calcium levels rise too high, the thyroid gland releases the hormone, calcitonin. Calcitonin helps sequester calcium in the bone. Removing calcium from the bloodstream helps lower serum calcium to a normal level. PTH is involved in regulating serum calcium if levels are LOW. A neonate at birth was at the 75th percentile for weight for age. At 6 months he appears healthy and was at the 60th percentile weight for age. This indicates that: a. he has a low caloric intake b. he is experiencing normal growth c. he may have protein energy malnutrition d. birth measurements were incorrect - ANS- b. he is experiencing normal growth Weight for age is NOT used to classify under/over weight. Weight is for age is a short term marker of growth that CANNOT distinguish between stunting and wasting because it does not include height. Further evaluation if needed if below 5th or above 95 percentile. To determine whether your client has applied your suggestions on decreasing his fat intake, ask him to: a. name a few foods that should be consumed infrequently b. name four foods to avoid c. list the foods he has consumed over the past three days d. select an appropriate breakfast from a menu - ANS- c. list the foods he has consumed over the past three days When is breastfeeding contraindicated? a. when the mother is underweight b. when the mother has hyperlipidemia c. when the mother has a breast infection d. when the mother has AIDS - ANS- d. when the mother has AIDS In the U.S. and in other countries when women have access to clean water, breastfeeidng is contraindicated to reduce risk of transmisison Prior to conducting a healthy eating class to local residents, assess their: a. medical histories b. physical activity levels c. readiness to make life-style changes d. occupations and lifestyle - ANS- c. readiness to make life-style changes BMI for age percentiles start at age: a. 24 months b. 36 months c. 48 months d. 5 years - ANS- a. 24 months Starts at age 2 yeras, age and sex specific. Pale conjunctiva is associated with a deficiency of: a. vitamin C b. vitamin D c. zinc d. iron - ANS- d. iron Iron gets prioritized to most vital regions of body. The conjunctiva is not prioritized, so the amount of red-colored oxyhemoglobin circulating in the dermal and subconjunctival capillaries and venules is reduce (hypochromic). A typical meal of a pregnant teenager consists of a hamburger. French fries and diet soda. Which of the following changes would be most beneficial? a. substitute fresh vegetables for french fries b. substitute a milkshake for diet soda c. add fresh fruit to the meal d. add another hamburger - ANS- b. substitute a milkshake for diet soda Diet soda provides empty calories, and the milkshake provides a good source of fat and calcium. There is also some research that suggests expectant mothers who consume artificially sweetened beverages may double their children's risk of being overweight at 1 year old. Subsequently, to avoid any potential risk, B is the answer. Which of the following nonessential amino acids may be considered conditionally essential in catabolic stress such as heart failure? a. arginine b. asparagine c. proline d. leucine - ANS- a. arginine Arginine and glutamine are conditionally essential amino acids. They are found in a lot of formulas for this reason, such as Peptamen VHP. Which of the following would be most productive when conducting a workshop for teenage mothers about proper portion sizes for feeding toddlers? a. role-playing b. lecture c. discussion d. demonstration - ANS- d. demonstration Teenagers may get bored with lecture/discussion. Role-playing may feel awkward to them, so demonstration (kinesthetic learning) is the best option. Implementing the baby friendly hospital initiative begins with: a. advertising the initiative to members of the community b. developing the plan c. conducting in-service training for all disciplines involved d. recruit social service agencies to assist in informing the public - ANS- b. developing the plan The Baby Friendly Hospital Initiative is a global effort to increase incidence and duration of breastfeeding. You would need to develop the plan prior to taking any further steps. Cheilosis, stomatitis and a magenta tongue are signs of a: a. riboflavin deficiency b. niacin deficiency c. thiamin deficiency d. biotin deficiency - ANS- a. riboflavin deficiency When green vegetables begin to lose their color during serving, consider: a. changing vendors or brands b. decreasing holding time during heating c. use different cooking equipment d. changing the storage temperature - ANS- b. decreasing holding time during heating Reduce holding time to preserve color. In metabolic acidosis, which of the following is involved? a. excretion of potassium b. excess calcium retention c. excretion of sodium bicarbonate d. excess calcium loss - ANS- c. excretion of sodium bicarbonate Metabolic = kidneys, respiratory = lungs Alkalosis = retention of bicarb by kidneys, acidosis = excretion of bicard by kidneys. Subsuquently, if the kidneys are excreting more sodium bicarbonate (base), then metabolic acidosis is occuring. Fats used in frying can become rancid due to the: a. oxidation of unsaturated fats b. uptake of oxygen at the point of saturation c. removal of high-melting triglycerides d. prolonged exposure to high temperatures - ANS- a. oxidation of unsaturated fats Rancidification is the process of complete or incomplete oxidation or hydrolysis of fats and oils when exposed to air, light, or moisture or by bacterial action, resulting in unpleasant taste and odor. Specifically, it is the hydrolysis or autoxidation of fats into short-chain aldehydes, ketones and free fatty acids, which are objectionable in taste and odor. The process of hydrogenation (adding hydrogen to unsaturated fatty acids to increase saturation) is done to reduce rancidity of the fats. At what age should children be measured standing up? a. 6 months b. 12 months c. 18 months d. 24 months - ANS- d. 24 months 2 years What is normal weight gain during the first trimester? a. 1-2 lb b. 2-5 lb c. 5-8 lb d. 8-10 lb - ANS- b. 2-5 lb Normal weight gain: 1 lb / month in first three months 1 lbs per week thereafter Subsequently, normal weight gain in the first trimester (12 weeks) is about 3 lbs. After the first trimester, 4 lbs a month is normal. This makes sense because think of how much more growth occurs in 2nd and 3rd trimester vs 1st, so it would make sense you want to gain more weight (and eat more!). The breast fed infant is *drinking primarily colostrum* for: a. the first 24 hours b. the first few days c. 1-2 weeks d. 3 months - ANS- b. the first few days Colustrum is the yellowish transparent fluid secreted from the breast during the first few days, which meets all infant needs during the first week. Colustrum has more protein, less fat, and less CHO than mature milk. It also contains antibodies. A normal pregnancy requires supplementation of: a. iron b. vitamin C, calcium, iron c. iron and folic acid d. calcium and zinc - ANS- c. iron and folic acid 30 mg ferrous sulfate in 2nd and 3rd trimester 400 mcg folic acid Which hormone is involved in developing the placenta? a. progesterone b. estrogen c. lactogen d. testosterone - ANS- a. progesterone Progesterone develops Placenta Which supplements should you give to a breast-fed baby? a. vitamin D and fluoride b. fluoride c. vitamin D d. vitamins A and C - ANS- a. vitamin D and fluoride Breastmilk is lacking in vitamin D breastfed infants should receive 400 IU vitamin D from birth and as well as 0.25 mg flouride/day after 6 months of age if water contains inadequate fluoride. Which of the following represents cow's milk? a. it creates a low renal solute load b. high in iron, low in vitamin C c. low in phosphorus, low in iron d. it creates a high renal solute load - ANS- d. it creates a high renal solute load Cow's milk is high in protein (casein 80%, whey 20%). Subsequently, infants fed cow's milk receive much more protein and minerals than they need. The excess has to be excreted in the urine. The high renal solute load leads to higher urine concentration during the feeding of cow's milk than during the feeding of breast milk or formula. A child who is below the 5th percentile weight for height.. a. is tall for his age b. has a condition inhibiting growth c. may have experienced long term under-nutrition d. may have experienced short term under-nutrition - ANS- d. may have experienced short term under-nutrition Weight for length/stature identifies under/over nutrition and detects short term changes to nutritional status. <5th percentile may reflect acute illness or wasting; > 95th percentile may reflect overnutrition. Stature/length for age defines shortness/tallness and reflects long term nutritional status; determines extent of stunting. Weight for age is NOT used to classify under/over weight and is a short term marker of growth that cannot distinguish between stunting and wasting becuase it does not include height Which hormone regulates breast milk production? a. prolactin b. progesterone c. estrogen d. oxytocin - ANS- a. prolactin Prolocatin stimulates milk Production. Oxytocin mOves milk throught the ducts ("let down") A low birth weight infant weighs: a. less than 2500 grams b. between 500 and 150 grams c. between 100 and 500 grams d. between 100 and 500 grams - ANS- a. less than 2500 grams Normal BW: 2500-4000 gm LBW: <2500 gm VLBW: <1500 gm ELBW: <1000 gm An 18 month old child should receive: a. whole milk b. 2% milk c. 1% milk d. skim milk - ANS- a. whole milk Infants should NOT receive cow's milk in the first year of life. Since this is an 18- month old, it is okay. Whole milk is desired because infants need the most calories, protein, and water / unit weight and thus it is not recommended to consume low-fat and non-fat milks during first two years of life. Which of the following indicates stunted growth? a. weight for height b. height for age c. weight for age d. weight for length - ANS- b. height for age Stature/length for age defines shortness/tallness and reflects long term nutritional status; determines extent of stunting Weight for length/stature identifies under/over nutrition and detects short term changes to nutritional status. Weight for age is NOT used to classify under/over weight and is a short term marker of growth that cannot distinguish between stunting and wasting becuase it does not include height The treatment for hyperbilirubinemia is: a. high calorie b. high protein c. high fluid d. high fat - ANS- c. high fluid Hyperbilirubemia occurs in newborns when unconjugated bilirubin levels are elevated during first week of life as result of increased breakdown of red blood cells, or decreased intestinal mobility. Encourage 9-12 feedings per day of human milk or formula to promote hydration and intestinal motility. Creatine supplements may be beneficial for the: a. body builder b. marathon runner c. soccer player d. hockey player - ANS- a. body builder Creatine supplements do NOT enhance endurance and thus would not be helpful for a marathon runner, soccer player, or hockey player. A body builder does short and quick burst of energy expenditure so creatine would be most likely to help them. Science: Creatine is produced from arginine, glycine, methionine, and found high concentrations in blood, brain, muscle, and testes. About 95% of the body's total creatine is contained in skeletal muscle as one of two forms: - PCr (phosphocreatine, ~60%) and free creatine (Cr,~40%). • PCr is used as an energy source for quick, intense bouts of work. Creatine supplementation increases total Cr, but not necessarily PCr in skeletal muscle. Supplementation results in an initial increase in body. In many people, Cr supplementation enhances performance of particularly repeated and high-intensity exercise Which of the following weight gains puts pregnant women at risk? a. less than 4lb/month in the last half of pregnancy b. less than 5lb/month in the last half of pregnancy c. less than 6lb/month in the last half of pregnancy d. more than 2lb/month in the last half of pregnancy - ANS- a. less than 4lb/month in the last half of pregnancy Normal weight gain: 1 lb / month in first three months 1 lb per week thereafter Less than 4 lb per month in last half of pregnancy would fall below goal of minimum 4 lbs per month (1 lb per week). Which is the primary fuel used by resting muscle and at low intensity exercise? a. glucose b. fatty acids c. branch chain amino acids d. keto-acods - ANS- b. fatty acids As low- to moderate-intensity exercise continues using aerobic metabolism, fatty acids become the predominant fuel source for exercising muscles. In community surveys, a frequent symptom of malnutrition is: a. scurvy b. rickets c. low serum albumin d. low hemoglobin - ANS- d. low hemoglobin Low hemoglobin (<14 mg/dL in men, <12 mg/dL in women) can be indicative of malnutrition. Hemoglobin is often used in nutrition surveillance programs along with ht, wt, hematocrit, and serum cholesterol, to monitor health status of a population. Scurvy is a disease caused by vitamin C deficiency, which doesn't necessarily indicate overall malnutrition. Similarly, rickets is a condition caused by vitamin D deficiency. Finally low serum albumin does not indicate malnutrition, as it is a negative acute phase reactant which is influenced by factors such as stress and inflammation. Additionally, albumin has a long half life and thus is not a great indicator of nutritional status. Which is the least common symptom in the elderly? a. osteomalacia b. osteoporosis c. obesity d. hypertension - ANS- 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 weightbearing 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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. <1 liter fluid, low sodium b. low sodium, low saturated fat, low cholesterol, high calorie c. restricted calorie, 0.8 protein/kg, fluid restriction d. normal protein, follow DASH - ANS- 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 (<2gm), low saturated fat needs are indicated for a heart healthy diet. ***Of note, Jean says low cholesterol as well. However, we know from research that dietary cholesterol does not impact serum cholesterol so while this is included I don't think this is actually correct. Which infant is at the greatest risk? a. 20lb, hemoglobin 10 b. 22lb, hemoglobin 10.5 c. 19lb, hemoglobin 11 d. 30lb, hemoglobin 9 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 <30 b. age <25, overweight c. BMI >30, history of GDM d. conception within 10 months of last pregnancy - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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% - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- a. assess the needs of the community The needs assessment is the first step when attempting to implement communitybased 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- a. shellfish, peanuts, wheat Which of the following is a non-nutritive sweetener? a. Stevia b. Sorbitol c. Mannitol d. Agave - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 lowprotein 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- c. a balanced diet he can tolerate An ulcer is an eroded mucosal lesion. Diet therapy includes eating as tolerated, wellbalanced, 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 selfinduced 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- a. inspection Assessing for fat stores includes inspection of orbital region, upper arm region, midaxillary 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 - ANS- 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 - ANS- 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 - ANS- 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. Two liters of a 5% dextrose solution provides how many calories? a. 170 b. 340 c. 212 d. 195 - ANS- b. 340 5gm dextrose per 100mL 5 gm x 20 = 100 gm 100 gm x 3.4 kcal = 340 kcal When instructing a patient on diet therapy needing during intake of a monoamine oxidase inhibitor, which would not be included? a. milk, cottage cheese, yogurt b. yogurt, ricotta cheese c. swiss cheese, yogurt d. cheddar cheese, swiss cheese - ANS- d. cheddar cheese, swiss cheese When a patient is taking an MAOI, they need to limit the amount of tyromine in their diet, as it will cause hypertension as MAOI interact with releasing norepinephrine which elevates BP. Foods to avoid include aged cheese (cheddar, Swiss), pickled foods, fermented foods, smoked foods, tofu, luncheon meats. Foods ok: cottage cheese, cream cheese During trauma, the catecholamine epinephrine: a. induce diuresis b. cause hypoglycemia c. causes hyperglycemia d. cause potassium retention - ANS- c. causes hyperglycemia Epinephrine increases hepatic glucose production by stimulating glycogenolysis and gluconeogenesis. Although its effect on glycogenolysis rapidly wanes, hyperglycemia continues because the effects of epinephrine on gluconeogenesis and glucose disposal persist. 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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. The Healthy People 2020 Goals are an outgrowth of a report by: a. ADA b. surgeon general, under HHS c. WHO d. FAO - ANS- b. surgeon general, under HHS Healthy People 2020 was born from the 1979 Surgeon General's Report on Health Promotion and Disease Prevention. This frameworks provide ambitious, measurable, 10-year objectives with the overall goal of improving health and well-being across America and include tools to track progress towards those objectives. 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 of the following is the appropraite diet for peritoneal dialysis? a. 0.8 grams protein, 35 cals/kg b. 2.0 grams protein, 30 cals/kg c. 1.3 grams protein, 35 cals/kg d. 1.0 grams protein, 35 cals/kg - ANS- c. 1.3 grams protein, 35 cals/kg Moderate-high protein, high calorie Which program provides food to needy individuals and families? a. food banks b. SNAP c. CACFP d. WIC - ANS- 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 - ANS- 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 - ANS- a. prevention of chronic disease While DGA's do provide standards for various federal programs, the program goal is to prevent chronic disease. If an IDDM tells you she eats meals on an irregular schedule, you should: a. obtain more information about her usual eating habits b. explain that insulin therapy is related to intake c. do nothing if blood sugar levels are okay d. ask her to complete a detailed food record - ANS- b. explain that insulin therapy is related to intake Since she is insulin dependent, you need to address insulin and the relationship to diet first. If she does not understand this, it would be difficult to talk more about the importance of diet in managing DM. 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 - ANS- 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 - ANS- 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. Why is an affluent couple (the man with diabetes, 67 years old and the wife with a broken arm, 50 years of age) not eligible for Meals on Wheels? a. she is too young b. they are affluent c. this program does not cater to special diets d. they can leave the house - ANS- d. they can leave the house To qualify for Meals on Wheels, the individual must be homebound. The wife's arm is broken, which means she is not homebound. If she were homebound, they would have qualified as those who are eligible for Meals on Wheels include all aged 60 and older plus spouse regardless of income. Which is permitted on a diet which excludes gluten? a. rye b. corn c. barley d. wheat bread - ANS- b. corn NO wheat, rye, oats, barley, bran, graham, malt, bulgar, couscous, durum, orzo, thickening agents OK: corn potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax, amaranth, millett, teff, quinoa 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 - ANS- 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 - ANS- 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 - ANS- 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. How can you enhance usage of commodity foods from a food donation program? a. teach food donation staff how to use the items b. make a poster on usage c. give each participant recipes using the food items d. calculate the amounts of nutrients provided in the donated foods - ANS- c. give each participant recipes using the food items A poor, healthy 19 year old mother is unsure how to feed her 4 year old child. Which program may offer her the most help? a. EFNEP b. WIC c. HHS d. CACFP - ANS- a. EFNEP Since this mother is unsure of HOW to feed her 4 year old, and the question doesn't indicate she needs help obtaining foods, EFNEP would be the best option. EFNEP would be able to teach the mother cooking skills. 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 - ANS- 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 - ANS- 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 - ANS- 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 since onset is about 2-4 hrs. If a person takes intermediate insulin at night (common because duration is 10- 16hrs so usually take 2x per day), then they would peak around 2-4hrs after going to sleep. 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- 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 - ANS- d. only give water in the bottle Giving a bottle with juice/milk increases risk of dental caries. A diabetic wants to exchange his bedtime snack of 8 ounces whole milk. What do you suggest? a. 1oz cheese and 1/2 cup orange juice b. 2 graham crackers and 1/2 cup orange juice c. 1 ounce cheese d. 2 ounces cheese - ANS- a. 1oz cheese and 1/2 cup orange juice 8 oz whole milk = 12 gm CHO, 8 gm protein, 8 gm fat, 160 kcal; need some CHO in snack so can't just do cheese; graham crackers and OJ minimum protein 1 oz cheese = 1 high fat protein exchange (0 gm CHO, 7 gm protein, 8 gm fat, 100 kcal), 1/2 cup OJ = 1 fruit/fruit juice exchange (15 gm CHO, 60 kcal) Total = 15 gm CHO, 7 gm pro, 8 gm fat, 160 kcal which is comporable to previous snack 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 - ANS- 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 *** A mother with 2 daughters, ages 8 and 11, does not earn enough money to feed her family. Which program would you suggest? a. WIC b. SNAP c. Child and Adult Care Food Program d. Medicaid - ANS- b. SNAP These children are too old to participate in WIC. Child and Adult Care Food Program would only be appropriate if the children were 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. Medcaid provides health insurance, not food. SNAP would be the best option to provide monthly benefits for food. Which drink would a Mormon choose? a. cola b. 7-up c. tea d. coffee - ANS- 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. What section of the intestine is more likely to be involved in Crohn's disease? a. ileum b. jejunum c. duodenum d. appendix - ANS- a. ileum The terminal ileum is most commonly affected in Crohn's disease. Which of the following would be classified as NC in the NCP? a. inadequate vitamin intake b. limited access to food c. swallowing difficulty d. inappropriate intake of food fats - ANS- c. swallowing difficulty NC is the clinical domain of nutrition diagnosis. Clinical includes functional, biochemical, and weight. Inadequate vitamin intake and inappropriate intake of food fats would be in the NI domain. Limited access to food would be in the NB domain. Swallowing difficulty is a functional issues and thus would classify as NI. An infants failure to thrive can be seen in: a. their behavior b. comparison with growth charts c. weight for height d. height for age - ANS- B - comparison with growth charts For infants 0-2 years, length-for-age, weight-for-age, weight-for-length, and headcircumferance-for-age are the primary measuers used to assesses growth. At this age, the WHO growth chart is used which was developed based on growth of infants exclusively breastfed and provide a better description of physiological growth in infancy; shows optimal growth patterns during infancy. Subsequently, a infants FTT can be seen by comparing with growth charts. Which of the following has the fewest calories? a. plain hamburger on a bun b. chefs salad with dressing c. green salad with Thousand Island dressing, and shredded cheese d. fried fish sandwich - ANS- a. plain hamburger on a bun ***Dumb question because we don't know serving sizes. Fried fish sandwich would obviously have quite a few calories from the oil. The green salad would probably have ~300 kcal, depending on serving size. Chef salad, depending on what's on it, would probably be about 300 kcal. A plain hambuger with a bun is probably ~250 kcal. Which of the following indicates protein calorie malnutrition? a. a creatinine height index of 93% b. height for weight ratio of 89% c. triceps skinfold and arm muscle circumference of 79% d. serum albumin of 4.5; transferrin of 410 - ANS- C - triceps skinfold and arm muscle circumference of 79% Protein-calorie malnutrition would be indicated by triceps skinfold and AMC of 79%. Triceps skinfold assesses body fat reserves and thus could assess fat loss. Tricep skinfold and AMC together tell arm muscle area. Cretinine height index is the ratio of creatinine excreted/24 hours to height; stimates lean body mass- somatic protein. Normal creatinine height index is >/=80%, so this is a normal range. Serum albumin would not be an indicator of nutrition malnutrition. A child with AIDS needs a high calorie and _____ intake. a. megadose vitamins b. high protein c. low fat d. low residue - ANS- b. high protein An appropriate measurement for iron status in a local community is: a. serum iron b. transferrin c. TIBC d. hematocrit - ANS- d. hematocrit Hematocrit is the ratio of the volume of red blood cells to the total volume of blood; volume of packed cells in whole blood. Worldwide, the most common method of screening individuals or populations for iron deficiency involves determining the prevalence of anemia by measuring blood hemoglobin or hematocrit levels. Which of the following may help decrease cavities? a. raisins b. carrots c. cheese d. yogurt - ANS- c. cheese Cavities are caused by fermentation of bacteria from CHO on teeth. Cheese has the lowest CHO level and thus is least likely to cause cavities Which test helps you determine if a diabetic has been following his diet? a. blood glucose b. urine ketones c. glycosylated hemoglobin d. urine sugar - ANS- c. glycosylated hemoglobin HgA1c, or glycosylated hemoglobin, measures % of hemoglobin that has glucose attached. A high concentration of glucose forms chemical bond with hemoglobin, meaning the longer the BG is high, the higher the HgA1c. You discover an incorrect diet order entered in the patient's chart. a. chart the order as incorrect b. file the order because it was written by a physician c. discuss the order with the physician and make suggestions d. change the order in the chart - ANS- c. discuss the order with the physician and make suggestions What is the best therapy for weight loss? a. reducing 500 calories per day, and exercise b. support groups, exercise, diet control c. exercise, diet, behavior modification d. exercise and diet control - ANS- c. exercise, diet, behavior modification Which is most associated with the incidence of type 2 diabetes? a. sugar intake b. protein intake c. overweight d. salt - ANS- c. overweight In an obese individual, the amount of NEFA, glycerol, hormones, cytokines, proinflammatory substances, and other substances that are involved in the development of insulin resistance are increased. Insulin resistance with impairment of β-cell function leads to the development of diabetes. According to the ADA exchange lists, what is the nutrient content of the following... 1 cup raspberries, 1/2 cup cereal, 1 cup 1% milk, 1 tsp margarine, black coffee, 1 slice toast, 1 egg. a. 397 kcal, 12 pro, 61 CHO, 6.5 fat b. 346kcal, 12 pro, 52 CHO, 9 fat c. 365 kcal, 21 pro, 57 CHO, 14 fat d. 327 kcal, 13 pro, 58 CHO, 10 fat - ANS- c. 365 kcal, 21 pro, 57 CHO, 14 fat 1 cup raspberries: 1 fruit exchange (15gm CHO, 60 kcal) 1/2 cup cereal: 1 starch exchange (15 gm CHO, 3 gm pro, 1 gm fat, 80 kcal) 1 cup 1% milk: 1 low fat milk exchange (12 gm CHO, 8 gm protein, 0-3 gm fat, 100 kcal) Black coffee: minimal 1 tsp margarine: 1 fat exchange (5 gm fat, 45 kcal) 1 slice toast: 1 starch exchange (15 gm CHO, 3 gm pro, 1 gm fat, 80 kcal) 1 egg: 1 medium-fat protein (0 gm CHO, 7 gm protein, 5 gm fat, 75 kcal) Total kcal: ~440 kcal (her kcal seem very off) Total pro: ~22 gm Toatl CHO: ~57 gm Total fat: ~15 gm St. John's wort has which effect of Coumadin? a. decreases drug metabolism and decreases its effect b. increases drug metabolism and decreases its effect c. decreases drug metabolism and increases its effect d. increases drug metabolism and increases its effect - ANS- b. increases drug metabolism and decreases its effect In the literature, St John's wort decreases the INR through induction of cytochrome P450-mediated metabolism of warfarin and increases warfarin clearance. In other words, St John's wort increases the metabolism of Coumadin which decreases Coudamin's effect. Which bacteria may cause gastric ulcers a. salmonella b. streptococcus aureus c. Helicobacter pylori d. clostridium perfringens - ANS- c. Helicobacter pylori The appropriate diet therapy following a Billroth II is: a. high carbohydrate, low fat, high protein b. high fat, high protein, high carbohydrate c. decrease simple carbohydrates, high protein, moderate fat, B12 supplements d. low fat, low protein, high carbohydrate - ANS- c. decrease simple carbohydrates, high protein, moderate fat, B12 supplements Billroth II is a gastrojejunectomy. The appropriate diet therapies following a Billroth II include frequent, dry feedings, fluids before or after meals, restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat, potential B12 injections. Which of the following diseases may lead to anemia a. myocardial infarction b. galactosemia c. renal failure d diabetes mellitus - ANS- c. renal failure Anemia may occur during renal failure may d/t decreased renal synthesis of erythropoietin, which acts to stimulate bone marrow to produce RBC To learn about prenatal problems in the community, go to: a. Center for Disease Control b. WIC c. NHANES d. FDA - ANS- b. WIC WIC addresses prenatal, perinatal, and postnatal needs of women. CDC serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States. National Health and Nutrition Examination study is an ongoing (repeated) survey to obtain information on the health of American people. The FDA is responsible for is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation Which best applies to nutritional screening? a. HIPAA standards must be followed b. It should include nutritional parameters are identified c. It is done after nutritional problems are identified d. It is only done on at risk patients - ANS- b. It should include nutritional parameters are identified Nutrition screening is the use of preliminary nutrition assessment techniques to identify people who are malnourished or at risk for malnutrition. Subsequently, nutrition screening should include nutritional parameters. Nutrition screening is done before the nutrition diagnosis is identified. Nutrition screening is done on all patients, not just those who are at nutritional risk. HIPPA. Which of the following can be offered to a patient when his diet prescription is moved from NDD level 3 to level 2? a. soft pancake b. bread pudding c. rice pudding d. saltine crackers - ANS- a. soft pancake The levels of the National Dysphagia Diet are: Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability). NDD Level 2: Dysphagia-Mechanically Altered (cohesive, moist, semisolid foods, requiring some chewing). NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability). Regular (all foods allowed). The IDDSI replaced the National Dysphagis die, and includes: 0- Thin 1- Slightly Thick 2- Mildly Thick 3- Moderately Thick/Liquidized 4- Pureed Extremely Thick 5- Minced and Moist 6- Soft and Bite-Sized 7- Regular/Easy to Eat Bites A pork chop is which type of protein exchange? a. high fat protein b. medium fat protein c. medium fat protein plus one fat exchange d. lean protein - ANS- d. lean protein Pork chop is a lean protein, which provides 0 gm CHO, 7 gm protein, 3 gm fat, and 45 kcal per 1 oz serving) What should most be encouraged in a Headstart program? a. nutrition activities related to food b. participation for at least one year c. class instructions d. healthy snacks - ANS- a. nutrition activities related to food Headstart is a federal program, run by USDHHS, that helps low income children (ages 3-5) by introducing new foods and teaching good food habits. Children's participation in food activities is important. However, there isn't a set duration set for participation. Subsequently, the most encouraged would be nutrition activites related to food. Medicaid benefits apply to: a. healthy adults b. a 60 year old female c. those at nutritional risk d. low income individuals - ANS- d. low income individuals Medicaid is federally funded, state run program which provides payment for medical care for all eligible needy; all ages, blind, disabled, dependent children. Eligibility is based on income. The symbol U on the food label indicates: a. it is treated with ultraviolet light b. it is treated with radiation c. vitamin retention has be retained during processing d. it is a kosher designation - ANS- d. it is a kosher designation The letter "U" on a food means that the food is kosher. There are other Kosher designations (Google for pictures) Congregate meals and home delivered meals fall under: a. WIC b. EFNEP c. Older Americans Nutrition Act Program Title III d. Medicare - ANS- c. Older Americans Nutrition Act Program Title III The OAA provides one hot meal each day, 5 days/week. Provides ~1/3 recommended intake. Congregate meals are provided to those who are ambulatory, transportation essential for rural elderly. Home delivered meal/Meals on Wheels, must be homebound. Services provided include counseling, nutrition education, referrals, social interaction Eligibility: all aged 60 and older plus spouse regardless of income Which is most characteristic of marasmus? a. serum albumin of 2.5 g/dl b. edema c. severe fat and muscle wasting d. decreased lymphocytes - ANS- c. severe fat and muscle wasting Marasmus, or protein-calorie malnutrition, may have ne characterized by wasted appearance and depresses somatic and visceral protein stores. The patient will have a low weight, muscle wasting, and low body temperature and/or cold intolerance. Subsequently, marasmus is charactersized by severe fat and muscle wasting. Edema and albumin are not indicators of marasmus. Lymphocytes measure immunocompetency and may be decreased in protein-energy malnutrition. However, it is not characteristic. The stasis of pancreatic juice and bile could result in: I. autodigestion II. fat malabsorption III. obstructive jaundice a. I and II b. I and III c. II and III d. I, II, and III - ANS- d. I, II, and III Lack of bile in the duodenum is usually due to blockage of the main bile duct, or papilla. The liver continues to produce bile, which then spills backwards into the blood stream. Eventually this causes jaundice, or a buildup of excess bilirubin and typically caused by obstruction of the bile duct, by liver disease, or by excessive breakdown of red blood cells. Lack of pancreatic juices results in inadequate digestion, particularly of fat which causes steatorrhea. Autodigestion occurs when there is premature activation of enzymes within pancreas leads to autodigestion. A side effect of antidepressants is: a. chronic diarrhea b. muscle wasting c. excess weight gain d. nausea and vomiting - ANS- c. excess weight gain Ex: Seroquel Which would you recommend to a Mexican American on a low fat diet? a. low fat cottage cheese b. skim milk c. beans and rice d. low fat yogurt - ANS- c. beans and rice Hypertension will decrease with a decrease in: a. fiber b. alcohol c. potassium d. calcium - ANS- b. alcohol Treatment for HTN includes diuretics, sodium restriction (1500-2300 mg/day); DASH- encourages WG, fruits, vegetables, low fat dairy products, poultry, fish, limit alcohol, decrease sweets, calcium to meet DRI What medication is affected by serum sodium levels? a. lithium carbonate b. mallril c. valproate d. tetracycline - ANS- a. lithium carbonate Recommended to maintain consistent sodium and caffeine intake to stabilize levels while on lithium. A child has been measured several times before the age of two years. Results of the measurements were not accurate because the child was measured: a. first thing in the morning b. standing up c. after breakfast d. with light clothing - ANS- b. standing up A child should not be measured standing up until 24 months (2 years old). Which of the following is not a governmental agency? a. Health and Human Services b. Food and Drug Administration c. Food and Nutrition Board d. American Heart Association - ANS- d. American Heart Association American Heart Association is a nonprofit organization. Low levels of folate, pyridoxine, and cyanocobalamin are associated with: a. glycogen storage disease b. homocystinurias c. phenylketonuria d. galactosemia - ANS- b. homocystinurias Homocystiurias is a treatable inherited disorder of amino acid metabolism, characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocysteine in urine. Those newly dx with homocystinuria require increased doses of folate, pyridoxine (B6), B12. The reason there are increased requirements for these vitamins is because vitamin B6, vitamin B12 and folate are all required to convert homocysteine to amino acids. A patient with low hemoglobin and low MCV might have: a. microcytic anemia b. macrocytic anemia c. magaloblastic anemia d. normochromic anemia - ANS- a. microcytic anemia Microcytic anemia is characterized by low hemoglobin and low MCV. Macrocytic anemia would be characterized by low hemoglobin and high MCV. According to the Food Lists for Diabetes Exchanges, 2T peanut butter is equivalent to: a. 2 high fat proteins b. 1 high fat protein c. 2 fats d. 1 high fat protein plus 2 fats - ANS- a. 2 high fat proteins 1 tbsp = 1 high fat protein exchange After a gastrectomy, the diet order should indicate a decrease in: a. disaccharides b. fats c. protein d. complex carbohydrates - ANS- a. disaccharides Following a gastrectomy, there is an increased risk for dumping syndrome. Subsequently, it would be advisable to limit intake of disccharides. Complex carbohydrates, proteins, and fats wouldn't need to be decreased and should be consumed as tolerated to meet estimated nutritional needs. Children and adolescents need what level of physical activity? a. 60 min every day b. 30 minutes every day c. 60 minutes at least 3 days each week d. 90 minutes at least three days each week - ANS- a. 60 min every day Which of the following provides 45g of CHO? a. one cup pasta b. one cup black beans c. 1 1/2 cups blueberries d. 2 small tortillas - ANS- a. one cup pasta 1 cup pasta = 3 starch exchanges (45 gm CHO, 9 gm pro, 3 gm fat, 240 kcal) 1 cup black beans = 2 exchanges (30 gm CHO, 14 gm protein, ~3 gm fat, 250 kcal) 1 1/2 cup bluberries = 1.5 fruit exchanges (22.5 gm CHO, 120 kcal) 2 small tortilla = 2 starch exchanges (30 gm CHO, 6 gm pro, 2 gm fat, 160 kcal) The Prader Willi syndrome is associated with... a. hyperactivity b. deficiency of gucose-6-phosphatase c. macrocytic anemia d. obesity - ANS- d. obesity Prader-Willi Syndrome is a condition in which partial deletion of chromosome 15 interferes with control of appetite, muscle development, and cognition. Ghrelin levels are elevated and satiety is not achieved after eating. Because of this, obesity ensues. Typical intervention for this condition includes keep foods away from patient when not meal/snack time. Which of the following is permitted on a diet restricting tyramine? a. hard cheese like cheddar or swiss b. uncured cheese like cottage and ricotta c. pickled or smoked foods d. tofu - ANS- b. uncured cheese like cottage and ricotta Tyramine is an amino acid that helps regulate blood pressure. It occurs naturally in the body, and it's found in certain foods. Foods to avoid include aged cheese (cheddar, Swiss), pickled foods, fermented foods, smoked foods, tofu, luncheon meats. Foods ok: cottage cheese, cream cheese What does a fecal fat of 12 gram indicate? a. severe fat malabsorption b. normal fat absorption c. high normal fat absorption d. nothing - ANS- a. severe fat malabsorption Normal stool fat: 2-5 gm Malabsorption: >7 gm If a patient cannot metabolize urea properly, what will accumulate in his blood? a. uric acid b. ammonia c. protein d. glucose - ANS- b. ammonia The urea cycle (also known as the ornithine cycle) is a cycle of biochemical reactions that produces urea from ammonia. During the urea cycle, highly toxic ammonia is converted to urea for excretion. If body can't excrete urea normally, ammonia will build up. A patient with cystic fibrosis, who is non-compliance with their nutritional prescription, may present with: a. hypernatremia b. hyponatremia c. hypokalemia d. hyperkalemia - ANS- b. hyponatremia CF is a disease of exocrine glands in which there is secretion of thick mucus that obstructs glands and ducts. Leads to chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration, abnormal electrolyte levels, malabsorption. Those with CF lose large amounts of sodium and chloride in their sweat, especially with exercise, hot weather, fevers and infections. People with CF lose 3-4 times more salt through their sweat than those without CF. Subsequently, non-compliance to the nutrition prescription may lead to hyponatremia. Who is the most appropriate candidate for parenteral nutrition? a. a 12 year old girl coming in for an appendectomy b. a middle aged woman who will begin chemotherapy c. an elderly lady with emphysema d. a young man going in for gallbladder surgery - ANS- b. a middle aged woman who will begin chemotherapy PN should only be administered if absolutely necessary. A middle aged women who will begin chemotherapy is most likely to need PN because she could experience severe N/V, stomatitis/mucositis, and other side effects from her treatment that will make oral intake and EN not viable options. A 12-year old coming in for an appendectomy will likely have no problem going back to a normal PO following surgery. Similarly, a young man having gallbladder surgery should also tolerate PO intake. An elderly woman with emphysema also should not have an issue eating, and if she did, EN would be a appropriate intervention as there are no contraindications to EN. An example of a primary prevention program for a local community would be: a. low sodium cooking classes for hypertensive patients b. have local farmers bring fresh fruits and vegetables into schools c. at health fairs, refer high risk individuals to appropriate programs d.education programs for those recently diagnosed with diabetes - ANS- b. have local farmers bring fresh fruits and vegetables into schools Primary prevention programs aim to reduce exposure to promoter of diseaseshealth promotion. Having local farmers bring fresh fruits and vegetables to schools would be an example of primary prevention as it is aiming to reduce incidence of chronic disease later in life by increasing intake of plant foods. Low sodium cooking class, education program for diabetics would be an example of teritary prevention. Refering high risk individiuals to programs would be considered screening and thus secondary prevention. WIC encourages women with babies to: a. formula feed b. breast feed c. food solid foods early d. feed a mixture of formula and solid foods early - ANS- b. breast feed In reviewing the patient's medical record, you note a hemoglobin of 10 g/dl and an MCV of 110 cu mm. You should document: a. anemia due to intrinsic factor b. anemia without nutritional implications c. anemia with larger than normal erythrocytes d. that the iron content of the diet should be increased - ANS- c. anemia with larger than normal erythrocytes Normal Hgb: males 14-18 g/dL, females 12-16 g/dL Normal MCV: 80-95 fL Subsequently, this patient has low Hgb, high MCV. This indicates macrocytic anemia, and thus anemia with larger than normal erythrocytes would be the answer. For which disease would a low sodium diet be recommended? a. ascites b. esophageal varices c. pancreatitis d. appendicitis - ANS- a. ascites A patient needs a 2000 calorie, 2 gram sodium feeding. Which formula is best? a. formula 1: 1kcal/cc, 2g Na/L b. formula 2: 1.5kcal/cc, 2g Na/L c. formula 3: 2kcal/cc, 1g Na/L d. formula 4: 1kcal/cc, 1g Na/L - ANS- d. formula 4: 1kcal/cc, 1g Na/L If getting 2000 kcal... Formula 1: 2L, 4 gm Na/L Formula 2: 1.33L, 4 gm Na/L Formula 3: 1L, 1 gm Na/L Formula 4: 2L, 2 gm Na/L A 75 year old female with adequate income would benefit from: a. SNAP b. Congregate Meals c. EFNEP d. WIC - ANS- b. Congregate Meals Congregate meals are provided to those who are ambulatory, transportation essential for rural elderly. No income requirements, just have to be 60 or older. The other programs are for lower income individuals. Which can be included in a meal for gluten-induced enteropathy? a. spaghetti and tomato sauce b. cheese and crackers c. potatoes with butter d. oatmeal with sugar - ANS- c. potatoes with butter NO wheat, rye, oats, barley, bran, graham, malt, bulgar, couscous, durum, orzo, thickening agents *Note: oats may be contaminated by wheat so avoid unless certified GF OK: corn potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax, amaranth, millett, teff, quinoa Phytochemicals, which may influence the development of tumors, are found in: a. fruits, vegetables, grains b. lean poultry and fish c. low fat dairy products d. polyunsaturated fats - ANS- a. fruits, vegetables, grains Phytochemicals are compounds that are produced by plants ("phyto" means "plant"). They are found in fruits, vegetables, grains, beans, and other plants. Some of these phytochemicals are believed to protect cells from damage that could lead to cancer. Phytochemicals include compounds such as salicylates, phytosterols, saponins, glucosinolates, polyphenols, protease inhibitors, monoterpenes, phytoestrogens, sulphides, terpenes, lectins, and many more. A patient with hyperphosphatemia, hyperkalemia, and hypermagnesemia may have: a. renal disease b. re-feeding syndrome c. pancreatic disease d. liver disease - ANS- a. renal disease When kidneys are not working properly, they can not properly filter out electrolytes and thus they accumulate in the body, causing hyperphosphatemia, hyperkalemia, and hypermagnesia. ***Note: don't get confused with hypophosphatemia, hypokalemia, and hypomagnesemia in refeeding syndrome. Which supplements are recommended with hemodialysis? a. vitamins C, B6, folate, B12 b. vitamins A, D, E, K c. thiamin, riboflavin, vitamin C d. thiamin, folate, vitamins E and C - ANS- a. vitamins C, B6, folate, B12 Water soluble vitamins are most effected by HD, as during dialysis, blood is cleaned/purified in a dialysate and water-soluble vitamins and some proteins are lost. Mneumonic: Ce, BeBe I am a FOol for you (vitamin C, vitamin B6, vitamin B12, folate); iron, zinc and vitamin D may potentially be supplemented as well. Vitamins A, D, E, and K are fat-soluble vitamins, D may supplemented by not the others. RDA for thiamin and riboflavin are recommended, but not additional supplementation. A person with the dumping syndrome cannot handle: a. complex carbohydrates b. polysaccharides c. disaccharides d. amino acids - ANS- c. disaccharides In a person with dumping syndrome, 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 Subsequently, those with dumping syndrome should avoid simple carbohydrates, such as disaccharides. Complex carbohydrates digest slower and thus may be better tolerated. What is the appropriate diet for heart failure? a. low potassium b. low calcium c. low sodium d. low fat - ANS- c. low sodium Following a low sodium diet reduces risk of fluid accumulation, which can increase cardiac workload and increase blood pressure. How many calories are provided in 1.5 liters of D25W? a. 1275 b. 2275 c. 1500 d. 2000 - ANS- a. 1275 25 gm dextrose per 100 mL 25 gm x 15 = 375 gm 375 gm x 3.4 kcal/gm = 1275 kcal A homeless patient who is deficient in all nutrients is to be discharged. What organization may help? a. WIC b. EFNEP c. a local social services organization d. a shelter for the homeless - ANS- c. a local social services organization WIC is not appropriate given information, a shelter would likely not provide food. EFNEP could help teach a homeless patient how to cook but does not provide food itself. Subsuquently, a local social service organization would be best equiped to help this patient. Why might a child with PKU have an increased incidence of dental caries? a. phenylalanine is not converted to tyrosine b. the diet is high in carbohydrates, low in protein c. pyruvate is not converted to alanine d. the diet is devoid of protein - ANS- b. the diet is high in carbohydrates, low in protein In children with PKU, you restrict the substrate phenylalanine (PHE), supplement the product tyrosine (TYR). Avoid aspartame. Low protein, high CHO intake is recommneded and can cause dental caries as dental caries form from fermentable CHO. Trauma can place the patient in: a. an anabolic state b. a hypermetabolic state c. a hypothermic state d. a hypometabolic state - ANS- b. a hypermetabolic state Trauma creates increased demand on the body, and thus is in a hypermetabolic state. A patient who had an ileal resection is placed on a tube feeding and begins to have diarrhea. This may be due to: a. use of a hypertonic formula b. use of an isotonic formula c. blockage of the GI tract d. lactose intolerance - ANS- a. use of a hypertonic formula A hypertonic formula means that it has an osmolality greater than that of the body fluid. Hypertonic formulas create an osmotic gradient that attracts water from the body into the lumen of the GI tract, and thus can cause diarrhea. An isotonic formula has the same osmolality as blood and is less likely to cause diarrhea. A blockage of the GI tract would be more likely to cause constipation. Lactose intolerance would cause diarrhea but is not likley the cause in this situation. Which is restricted in a diet for hepatic encephalopathy? a. protein, sodium, fluid b. protein, fluid, calories c. calories, protein, fat d. sodium, fat, calories - ANS- a. protein, sodium, fluid Protein may be restricted due to the buildup of ammonia. ***Just note: it has been found that protein intake should only be limited in patients with acute cases, with an initial dose of 0.5g/kg/day increasing to 1-1.5g/kg/day. Otherwise, up to 95% of patients with HE can tolerate diets with protein up to 1.5g/kg body weight. Sodium and fluid restrictions are likely in place as well due to ascites/fluid accumulation. How many non-protein calories are provided by 2 liters of a 7% Aminosyn and 1 liter of 10% dextrose in water? a. 340 b. 390 c. 170 d. 255 - ANS- a. 340 Aminosyn = amino acid solution; protein calories 10 gm per 100mL 10 x 10 = 100 gm 100 gm x 3.4 kcal = 340 kcals When should you provide nutrition counseling to an AIDS patient? a. when nausea and vomiting become problems b. immediately upon diagnosis c. when diarrhea occurs d. no counseling is needed - ANS- b. immediately upon diagnosis Medicare is for: a. the elderly b. the financially needy c. those at nutritional risk d. those with medical needs - ANS- a. the elderly Medicare is a health insurance program for people over 65 years and those of any age with end-stage renal disease. What best measures excess calorie reserves? a. weight b. creatinine c. triceps skinfold d. arm circumference - ANS- c. triceps skinfold Tricep skinfold measures body fat reserves and calorie reserves. Why might a patient with ascites be dehydrated? a. fluid has moved to interstitial spaces b. fluid has moved to intravascular spaces c. fluid has moved to vascular spaces d. fluid has moved to the lung - ANS- a. fluid has moved to interstitial spaces Ascites occurs when blood cannot leave the liver. Connective tissue overgrowth blocks blood flow out of liver into vena cava. The liver expands. When storage capacity has been exceeded, pressure caused by increased blood volume forces fluid to sweat through the liver into the peritoneal cavity. This fluid is almost pure plasma with a high osmolar load, pulling more fluid in to dilute the load, leading to sodium and water retention. Subsequently, a patient with ascites may be dehydrated as fluid has moved into the interstitial space. Which of the following is equivalent to a lean protein exchange? a. 1/4 cup low fat cottage cheese b. 2 T grated parmesan cheese c. 1 ounce mozzarella cheese d. 1 ounce swiss cheese - ANS- a. 1/4 cup low fat cottage cheese 1/4 cup low fat cottage cheese = 1 lean protein exchange (0 gm CHO, 7 gm protein, 3 gm fat, 55 kcal) ?? 2 T grated parmesan cheese also = 1 lean protein exchange 1 oz mozzarella cheese = 1 medium fat protein exchange (0 gm CHO, 7 gm protein, 5 gm fat, 75 kcal) 1 oz swiss cheese = 1 high fat protein exchange (0 gm CHO, 7 gm protein, 8 gm fat, 100 kcal) Which is a common complication of AIDS? a. constipation b. diarrhea c. hypoglycemia d. hyperkalemia - ANS- b. diarrhea Diarrhea is common in people with HIV, particularly those with a low CD4 count. It can be caused by infection, malaborption, and is also a possible side-effect of some anti-HIV drugs. A post-surgical patient with prolonged ileus should be treated with: a. a high fiber diet b. enteral nutrition with added fiber c. enteral nutrition d. parenteral nutrition - ANS- d. parenteral nutrition A common result of treating an AIDS patient with zidovudine is? a. diarrhea b. constipation c. macrocytic anemia d. hypokalemia - ANS- c. macrocytic anemia Zidovudine is an NRTI (nucleotide nucleoside reverse transciptase inhibitor. Use of Zidovudine can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, and carnitine. Subsequently, low vitamin B12 status can cause macrocytic anemia. A 140lb female on dialysis should have how many grams of protein? a. 38-55 b. 58-63 c. 70-89 d. 30-38 - ANS- c. 70-89 HD protein requirements ~1.1-1.4gm/kg 140 lb/ 2.2 = 63.6 kg 63.6 kg x 1.1 = 70gm 63.6 x 1.4 = 89 gm An obese person with Type 2 diabetes should: a. time meals b. decrease the frequency of feedings c. achieve DBW d. increase the frequency of feedings - ANS- c. achieve DBW (desired body weight) Reducing body weight by even 5-10% can increase insulin sensitivity. Timing meals (small frequent) is also very important but weight loss would be priority. A tube fed patient receiving bolus feedings develops a distended abdomen. What should you recommend? a. change the tube feeding to isotonic, lactose-free b. decrease the osmolality of the feeding c. decrease the amount of water flush d. decrease the rate - ANS- d. decrease the rate Decreasing the rate would be the best answer, as "too much too quickly" can be a major cause of gas, abdominal discomfort, etc. Isotonic formula should be well tolerated, and using a lactose-free formula does not necessarily mean it will be better tolerated. Decreasing the osmolality of the feed would require higher volume of formula to meet needs, which would likely not be well tolerated in bolus feeds. Water flushes are important to prevent clogging as well as to help meet fluid needs. Which food is highest in fiber? a. cooked dried beans b. a tomato c. wheat bread d. lettuce - ANS- a. cooked dried beans 1 cup cooked beans = ~15 gm fiber 1 cup tomato = ~1.5 gm fiber 1 slice wheat bread = ~1.9 gm fiber 1 cup lettuce = ~0.5 gm fiber Which of the following is lowest in fat? a. hamburger b. salami c. goat cheese d. Canadian bacon - ANS- d. Canadian bacon Hamburger = (as beef); high-fat protein exchange Salami = high-fat protein exchange Goat cheese = high-fat protein exchange Canadian bacon = lean-fat protein exchange Which is true with osteoporosis? a. it is more common in men than in women b. it is treated with 500mg calcium per day c. it is common in those 65 years of age and older d. weight bearing exercise exacerbates the problem - ANS- c. it is common in those 65 years of age and older The maximum hang time for open enteral systems is: a. 2 hours b. 8 hours c. 6 hours d. 4 hours - ANS- b. 8 hours Open EN system maximum hangtime is 8 hours, while closed EN system maximum hangtime is 24-48 hours. Open EN systems are at increased risk for contamination, while closed systems are more sterile and thus can hang longer. What is a guide for calculating water needs with tube feedings? a. 1cc water/ 0.5 calories b. 1cc water/ 1.0 calories c. 1cc water/ 2.0 calories d. 1cc water/ 3.0 calories - ANS- b. 1cc water/ 1.0 calories Following a colectomy, the absorption of which of the following would be of the most concern? a. vitmains D and E b. water and sodium c. B vitamins d. vitamin C - ANS- b. water and sodium Colectomy is excision of the colon. The colon is responsible for reabsorbing water and electrolytes, and thus these would be of most concern. Vitamins D and E are fat-soluble vitamins that are absorbed in small intestine (primarily jejunum) and stored in liver. The water soluble vitamins, including B vitamins and vitamin C, are also primarily absorbed in the jejunum. According to the diabetic exchange lists, which of the following is equivalent to one medium fat protein? a. 4 ounces tofu b. 2 ounces pork c. 2 eggs d. 2 T peanut butter - ANS- a. 4 ounces tofu 4 oz tofu = 1 medium-fat protein (0 gm CHO, 7 gm pro, 5 gm fat, 75 kcal) 2 oz pork = 2 medium-fat protein (0 gm CHO, 14 gm protein, 10 gm fat, 150 kcal) 2 eggs = 2 medium-fat protein exchanges (0 gm CHO, 14 gm protein, 10 gm fat, 150 kcal) 2 T peanut butter = 2 high-fat protein (0 gm CHO, 14 gm protein, 16 gm fat) A long term care patient has normal intestinal function but cannot eat. What tube feeding should you provide? a. high protein, high calorie formula b. isotonic, polymeric formula c. elemental formula d. low fiber, low fat formula - ANS- b. isotonic, polymeric formula Provide standard formula to start and make changes if needed. Which food should someone on an MAOI not eat? a. cottage cheese b. herbal tea c. pepperoni d. butter - ANS- c. pepperoni Those on MAOI's need to avoid tyramine. Tyramine is high in foods including aged cheese, processed meats, beer/wine, overripe fruits. Subsequently, pepperoni should be avoided as is processed meat. If you have a lactose intolerance, which food could you most likely tolerate? a. whole milk b. skim milk c. ice cream d. yogurt - ANS- d. yogurt Yogurt may be better tolerated in those with lactose intolerance as has lower levels of lactose compared to milk and ice cream. The normal range for hemoglobin A1C is: a. 1-2% b. 4-6% c. 10-12% d. 35-40% - ANS- b. 4-6% Normal HgA1c is <5.7% in non-diabetic and <7% in diabetics. HgA1c of 5.7-6.5% indicates pre-diabetes and HgA1c over 6.5% indicates DM. If a diabetic patient reduces his calorie intake from 2300 to 1800 calories per day, how much will he lose in one month? a. 4 pounds b. 6 pounds c. 2 pounds d. 8 pounds - ANS- d. 4 pounds 3500 kcal deficit per week = 1 lb weight loss 2300 kcal - 1800 kcal = 500 kcal per day 500 kcal per day x 7 days per week = 3500 kcal per week = 1 lb per week 1 lb per week x 4 weeks per month = 4 lbs per month A spastic quadriplegic requires: a. lower energy intake b. fewer calories c. increased fluid and fiber, acid ash diet d. lower energy intake, acid ash diet - ANS- b. fewer calories Those with spastic CP have limited activity, stiff movement, commonly obese so provide low calorie, high fluid, high fiber. Remember spaSTIC is STIFF movement, if stiff need less calories Those with non-spastic (athetoid) CP have involuntary wormlike movement, high calorie, high protein, finger foods. Remeber, worms look like fingers and so those with wormlike movement can have finger foods. An athlete complains of weakness, rapid weight gain and muscle spasms. What may be the cause? a. lack of adequate rest b. too much exercise c. carbohydrate loading d. not enough iron - ANS- c. carbohydrate loading Carbohydrate loading can result in rapid weight gain, muscle spasms, weakness, and digestive discomfort. Who is most at risk from protein calorie malnutrition? a. a cancer patient on chemotherapy b. a patient with gastric ulcers c. a patient with Crohns disease d. a patient with megaloblastic anemia - ANS- a. a cancer patient on chemotherapy A patient actively on chemotherapy treatment would be most at risk for proteincalorie malnutrition due to the likely side effects of said treatment, including dygeusia, mucositis/stomatitis, nausea/vomiting, etc. A patient with megaloblastic aemia and gastric ulcers are least at risk of malnutrition compared to other answers. If the Crohn's patient was having an active flare, that may be the answer but since it doesn't specific that we assume they are undercontrol/in remission, so in that case it wouldn't be as much of a risk. Patients with decubitus ulcers will likely demonstrate low: a. serum sodium b. serum albumin c. serum potassium d. serum glucose - ANS- b. serum albumin... [Show More]

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