Chris is a 38-year-old man with severe loss of muscle mass, loss of about 15% of body weight over the past 6 months, and multiple feeding difficulties associated with traumatic brain injury and post-traumatic stress disorder. Using the Subjective Global Assessment, he is most likely to be classified in which category?
A. Well nourished
B. Mild malnutrition
C. Moderate malnutrition
D. Severe malnutrition
Using the Subjective Global Assessment, a patient with nausea, vomiting, and a 6% weight loss would be considered to be:
A. well nourished.
B. moderately malnourished.
C. severely malnourished.
D. none of the above
Which of the following nutrition assessment techniques is a measure of protein status?
A. Serum albumin
B. Body mass index
C. Mean corpuscular volume
D. Plasma creatinine
A brief assessment for quickly identifying clients at risk for malnutrition so that they can receive complete nutrition assessments is called a
A. nutrition questionnaire.
B. health history.
C. health screening.
D. nutrition screening.
What is the body"s first line of defense against infection?
A. Skin and mucous membranes
B. Fever
C. Leukocytes
D. None of the above
A 24-hour recall is used to collect a food and nutrition history. The client states that she didn"t eat breakfast. She had a soft drink and an apple for lunch, and for dinner, she had a slice of pizza. What is the best question the health care professional could ask next regarding this finding?
A. 'Is this a usual day"s food intake?'
B. 'What was on the slice of pizza?'
C. 'Do you normally skip breakfast?'
D. 'Are you on a busy schedule?'
Which of the following clients is at greatest risk of malnutrition?
A. A body builder, 5"8' and 190 lbs, taking amino acid supplements
B. An 85-year-old woman, 5"4' and 122 lbs
C. A 30-year-old woman, 5"6', 192 lbs, with a recent unexplained weight loss of 25 lbs
D. A 15-year-old boy 5"8', 132 lbs, with a good appetite, going through a growth spurt
Mrs. Sealy is an 85-year-old woman who states she has a poor appetite. She is 5", 2' tall, her current weight is 80 pounds, and her usual body weight is 115 pounds. The nurse determines:.
A. her %IBW is 82%
B. her %UBW is 70%.
C. she is at risk for mild malnutrition.
D. she is at risk for moderate malnutrition
Which of the following statements is the best way to begin the interview for a 24-hour dietary history?
A. 'What did you have for breakfast today?'
B. 'You do eat breakfast everyday, don"t you?'
C. 'Do you begin the day with juice or coffee?'
D. 'What is the first thing you ate or drank when you woke up?'
A nutritional assessment involves
A. collecting data and using it to evaluate a patient"s nutrition status.
B. implementing a nutrition care plan.
C. identifying existing and potential nutrition problems.
D. all of the above
A
Which of the following is an important benefit of follow-up care?
A. It allows evaluation and if necessary, modification of the nutrition care plan
B. It allows updating of basic patient data such as address and phone number
C. It is typically required by insurance companies to qualify for payment
D. It allows clinicians to sharpen their skills
A
Which of the following approaches is likely to be helpful in implementing long-term dietary changes?
A. Insist that the individual get ready for change.
B. Emphasize what not to eat, rather than what to eat .
C. Encourage only one or two changes at a time.
D. All of the above
C
Which of the following is true of food allergies and food intolerances?
A. Food allergies reflect immune responses while food intolerances reflect other physiologic processes
B. Food intolerances reflect immune responses while food allergies reflect other physiologic processes
C. Food intolerances and food allergies have no clinical differences
D. Food allergies and intolerances reflect the same processes, but allergies are more severe.
D
For which of the following clients would diet progression be appropriate?
A. Betty, who just had gallbladder surgery and is being discharged on a standard diet
B. Jim, who has been on a clear liquid diet and now is ready to start eating solid foods again C. Susan, who has been diagnosed with celiac disease and must exclude gluten from her diet
D. David, whose cancer has returned and has been transferred to hospice care
B
When long-term dietary changes are necessary, a nutrition care plan must take into account the patient"s:
A. current food habits.
B. lifestyle.
C. degree of motivation.
D. all of the above
D
Which of the following foods might be included in a fiber-restricted diet?
A. Dried beans
B. Watermelon
C. Raisins
D. Ryebread
B
Why are diets for dysphagia highly individualized?
A. Because of best practice standards
B. Because Swallowing difficulties can vary greatly over time
C. to challenge the patient to improve wallowing ability
D. To eliminate patient boredom
N
Miss. Keppler has lost her dentures during transfer. Which diet would be the best choice to help her meet her nutritional needs?
A. Tube feeding
B. Clear liquids
C . Mechanically altered diet
D. High-calorie, high-protein diet
C
A patient on a sodium-controlled diet has been observed ordering Chinese take-out only a few hours after his nutrition consult. The patient reports that a 'little salt won"t hurt me.' The dietitian:
A. decides that the patient needs a stricter sodium-controlled diet.
B. concludes that providing a list of high sodium foods will help him.
C. suggests that he also add an exercise plan and more fiber to his current diet.
D. concludes that the patient is not ready to learn and implement the diet changes.
D
When a regular diet fails to meet the nutrient needs of a client, a _____ is used.
A. standard diet
B. nutrition care plan
C. modified diet
D. nursing diagnosis
C
Louis has been diagnosed with dysphagia. Which diet order would not be potentially appropriate for him?
A. NPO
B. Pureed diet
C. Regular
D. Mechanical soft with nectar-thick liquids
C
Dietary interventions for nausea include consuming all of the following except
A. ice cream.
B. clear, cold fluids.
C. crackers.
D. small meals.
A
Examples of substances that cause the lower esophageal sphincter to weaken include
A. caffeine-free soft drinks.
B. high-fat foods.
C. decaffeinated coffee.
D. all of the above
B
The home health care nurse is visiting Paul Cantu, an 82-year-old man recovering from a stroke. Upon assessment, the nurse observes that Mr. Cantu has lost weight, has a hoarse voice, and exhibits a gurgling noise after swallowing. In this situation, the nurse should suspect
A. reduced saliva flow.
B. dysphagia.
C. reflux esophagitis.
D. peptic ulcer disease.
B
All of the following may cause dysphagia except
A. heart disease.
B. thyroid enlargement.
C. strokes.
D. brainstem tumors.
A
All of the following conditions may lead to dysphagia except
A. esophageal tumor.
B. brain tumor.
C. poliomyelitis.
D. T7 fracture.
D
Trevor complains of bloating and stomach gas. Which of the following should be omitted to resolve this problem?
A. Eating slowly
B. Drinking iced tea
C. Chewing gum
D. Sipping from a cup
C
To minimize symptoms of dyspepsia, patients might be advised to do which of the following?
A. Consume large meals
B. Eat only raw foods
C. Avoid overly seasoned foods
D. Drink coffee rather than fruit juice
E. All of the above
C
All of the following may cause symptoms of dyspepsia except:
A. aspirin and other NSAIDs.
B. antibiotics.
C. high-dose iron supplements.
D. a low-fat diet.
D
Mrs. Nichols is 5"2', weighs 103 lbs., and suffers from GERD. She smokes and occasionally drinks wine. Today she is being prepared for discharge. Which of the following statements by Mrs. Nichols indicates the need for further discharge instructions?
A. 'I should lose weight to reduce my symptoms.'
B. 'I will avoid wine.'
C. 'I will go to the lung association classes.'
D. 'I will eat small, frequent meals.'
A
Steve is finally able to eat solid foods after being hospitalized with acute pancreatitis six days ago. Which kind of diet would be most appropriate at this time?
A. Low protein
B. Low carbohydrate
C. Low fiber
D. Low fat
D
The protein fraction in wheat gluten that has toxic effects in celiac disease is called:
A. gluten.
B. gliadin.
C. casein.
D. whey.
B
_____ are non-digestible substances in food that stimulate the growth of bacteria in the intestine.
A. Flora
B. Pathogens
C. Prebiotics
D. Probiotics
C
Alison has had chronic and recurring diarrhea. She also has a past history of depression and anxiety. Which of the following is the most likely diagnosis for Alison?
A. Short bowel syndrome
B. Irritable bowel syndrome
C. Crohn"s disease
D. Diverticulosis
B
Supplementation of which amino acid seems to improve lower gastrointestinal function?
A. Glutamine
B. Raffinose
C. Glycine
D. Oxalate
A
An appropriate food for a client with celiac disease is
A. a peanut butter and jelly sandwich on wheat bread.
B. oatmeal cookies.
C. applesauce.
D. cheese and rye crackers.
C
Research indicates that the development of diverticula is strongly influenced by the amount of _____ a person consumes.
A. fat
B. protein
C. fiber
D. sugar
C
Which of the following foods would be the most appropriate for a person with diverticulosis?
A. White bread
B. Low-fat milk
C. Peanuts
D. Wheat bran
D
Liana is a four years old and suffering from diarrhea. Her mother should allow her to eat which of the following to thicken her stool?
A. Applesauce
B. Milk
C. Grape juice
D. Green beans
A
Which of the following menus best meets the objectives of a fat-controlled diet for a client with steatorrhea?
A. Tuna fish salad, crackers, ice cream, tea
B. Baked chicken, macaroni and cheese, biscuits, milk
C. Pork tenderloin, plain baked potato, applesauce, tea
D. Sirloin steak, potato salad, broccoli au gratin, milk
C
_____ are the leading cause of death in people with diabetes, accounting for 70% of deaths.
A. Strokes
B. Hypoglycemia-induced comas
C. Cardiovascular diseases
D. Kidney diseases
C
For a diabetic, overdoses of insulin, strenuous physical activity, skipped meals, and inadequate intake of food can all result in
A. hyperglycemia.
B. hypoglycemia.
C. dawn phenomenon.
D. rebound hyperglycemia.
B
Which of the following statements is true regarding carbohydrate counting?
A. You do not need to worry about portion size
B. Breakfast meats are counted as a carbohydrate
C. Works well with those patients using intensive insulin therapy
D. You can eat as much as you want and not gain weight
C
Mr. Jacobs has high blood lipids. The physician would instruct him to limit dietary intake of which of the following from sweeteners but not from whole foods (i.e., fruits and vegetables)?
A. Fructose
B. Sucrose
C. Glucose
D. Sucralose
A
Which of the following is true of type 2 diabetes?
A. Age at onset is usually younger than 30 years
B. There is little or no insulin secretion
C. Insulin is not always required
D. It used to be called juvenile diabetes
C
Women with diabetes who are attempting to become pregnant should be aware that uncontrolled blood glucose can contribute to all of the following EXCEPT:
A. diabetes in the infant
B. high birthweight of the infant
C. risk of spontaneous abortion
D. birth defects
A
While you are making rounds at the beginning of the evening shift at 4 p.m., Mrs. Davis complains of feeling dizzy. When taking her pulse, you note that her hand trembles slightly and feels cool and moist. It is most likely that Mrs. Davis is experiencing
A. a relapse into ketoacidosis.
B. hypoglycemia.
C. respiratory alkalosis from hyperventilation.
D. hyperglycemia.
B
High protein diets used for diabetes management:
A. are known to decrease glycemic control
B. have been proved to promote long-term weight loss
C. may cause kidney problems
D. a and b
C
Mason has type 1 diabetes. He is amazed at how many people are not aware of the differences between type 1 and type 2 diabetes. Which of the following is true about his illness?
A. It occurs mostly in those over 40
B. Obesity is the major cause
C. There is no link with genetic inheritance
D. It is caused by autoimmune destruction
D
Which of the following factors influences glycemic response to foods?
A. Sodium content of food
B. Fiber content of the food
C. Individual preferences
D. All of the above
B
The red blood cell component most commonly used for screening and monitoring diabetes is
A. hemoglobin A1c.
B. heme iron.
C. heme protein.
D. none of the above
A
People with type 1 diabetes need insulin because they
A. have become insulin resistant.
B. have developed hyperinsulinemia.
C. no longer synthesize sufficient insulin.
D. digest insulin with GI enzymes.
C
Mrs. Barclay has type 2 diabetes and you are preparing her for discharge. She tells you that she loves red beans and rice and knows that she must eliminate them from her diet because they will elevate her blood glucose level. You should explain to her that
A. on a carbohydrate counting meal plan these foods can fit within her carbohydrate allowance at meals.
B. red beans are eliminated because they are high in complex carbohydrates.
C. red beans are high in water-soluble fiber and should be avoided.
D. peas are a better choice than red beans.
A
Mrs. Filbert, age 56, has been diagnosed with type 2 diabetes. During discharge instruction, she makes a number of statements. Which one indicates some understanding of her diabetes management?
A. 'If my blood glucose is between 100 and 180 mg/dL I should not exercise.'
B. 'If I eat high-fat foods my blood sugars will be elevated.'
C. 'Drinking diet soda made with aspartame won"t increase my blood sugar.'
D. 'Red beans can be exchanged for broccoli on my diet.'
C
Martha has a triglycerides level of 350 mg/dL, a waist circumference of 45 inches, a fasting plasma glucose of 100 mg/dL, and an HDL cholesterol level of 35 mg/dL. What is her diagnosis likely to be? (Choose the best answer.)
A. Hypertriglyceridemia
B. Heart disease
C. Metabolic syndrome
D. Borderline diabetes
C
Glycosylated hemoglobin (AIc) can best be described as a(n)
A. by-product of fat metabolism.
B. reflection of mean blood glucose concentration over two to three months.
C. end-product of protein metabolism formed in the liver.
D. summary of hemoglobin rates for type 1 diabetes.
B
Although the precise cause of metabolic syndrome is not known, the close relationship between _____ and _____ suggests that obesity is at least partly responsible.
A. type 2 diabetes, heart disease
B. abdominal obesity, insulin resistance
C. type 2 diabetes, insulin resistance
D. abdominal obesity, stroke
B
During an acute illness, clients with type 1 diabetes should
A. decrease their medications if their appetite is poor.
B. decrease their fluid intake to prevent nausea.
C. drink fluids with sugar if their blood glucose is greater than 240 mg/dL
. D. monitor their urine for ketones.
D
Which of the following is true of type 1 diabetes?
A. Age at onset is usually older than 40 years
B. There is little or no
insulin secretion
C. Insulin is not always required
D. It used to be called adult-onset diabetes
B
Hector Martinez is a 70-year-old Hispanic man recently diagnosed with type 2 diabetes. He is having difficulty understanding the exchange system and has limited financial resources. Which of the following strategies is most likely to help him control his diabetes?
A. Emphasize how important it is to follow only the exchange list.
B. Try an alternate diet approach.
C. Give him a printed exchange list of traditional Hispanic foods.
D. Encourage him to join a spa and exercise.
B
High intakes of carbohydrates (> 60% of total kcalories) cause triglyceride levels to _____ and HDL cholesterol to _____.
A. decrease, decrease
B. decrease, increase
C. increase, decrease
D. increase, increase
C
Red yeast rice may enhance the effects of:
A. statins
B. ACE inhibitors
C. calcium channel blockers
D. nicotinic acid
A
Which of the following is a good source of unsaturated fats
A. Avocados
B. tropical oils
C. cheese
D. organ meats
A
Mr. Goldman is a 55-year-old Caucasian who has suffered an MI. His total cholesterol level is 242 mg/dL, LDL is 172 mg/dL, HDL is 35 mg/dL, and triglycerides are 400 mg/dL. Which statement by Mr. Goldman suggests some accurate recall of dietary instructions for lowering his cholesterol?
A. 'I should drink a glass of wine every day to raise my HDL cholesterol.'
B. 'I"m supposed to eat 300 mg of cholesterol/day.'
C. 'I must eliminate red meat from my diet.'
D. 'Avoidance of saturated fat is a primary concern.'
D
What is the term for an accumulation of fatty deposits, smooth muscle cells, and fibrous connective tissue in blood vessels?
A. plaque
B. thrombosis
C. platelets
D. embolism
A
Based on the limited data provided, which of the following individuals has the lowest risk for developing CHD?
A. A 40-year-old man with controlled hypertension
B. A 50-year-old post-menopausal woman
C. A 45-year-old woman who is 5"2' and weighs 125 lbs
D. A 45-year-old woman with an HDL level of 50 mg/dL
C
Mrs. Gonzales has been placed on a two-gram sodium diet for her hypertension. Which of the following statements suggests some understanding of her dietary restriction?
A. "I will only eat ham twice per week"
B. I will use monosodium glutamate (MSG)
C. "I will not use salt at the table"
D. "I can eat foods seasoned with garlic salt."
C
Which reading is indicative of pre-hypertension?
A. 117/80 mm Hg
B. 125/80 mm Hg
C. 140/90 mm Hg
D. 140/80 mm Hg
B
Mr. Kline is a 36-year-old African American with hypertension. He is currently taking a potassium-sparing diuretic to help lower his blood pressure. Which of the following meals would be most appropriate for Mr. Kline?
A. Vegetable soup (canned), 1/2 c. chocolate pudding, and carrot sticks
B. Ham sandwich, potato salad, and frozen yogurt with strawberries
C. Cheese sandwich, garden salad, and dried apricots
D. Chicken, vegetable salad, whole-wheat bread, and an apple
D
Which of these conditions is not considered a cardiovascular disease?
A. Coronary heart disease
B. Hypertension
C. Stroke
D. Diabetes
D
Martha has been advised to limit trans fats in her diet. Which of the following snack foods would this include?
A. chocolate
B. skim milk
C. french fries
D. pretzels
C
The main source of trans fat in baked goods is
A. milk or other dairy products
B. eggs
C. partially hydrogenated vegetable oil
D. tropical oils
C
Which of the following is a good source of fiber that will help reduce blood lipids?
A. barley
B. oats
C. wheat
D. a and b
E. a, b, and c
D
Which of the following is a cause of atherosclerosis?
A. Persistent infection or inflammation in the body
B. Elevated blood HDL levels
C. Chronic hypoglycemia
D. a and c
E. All of the above
A
The term for malnutrition associated with chronic heart failure is
A. cardiac cachexia.
B. anorexia nervosa.
C. dyspnea.
D. tachycardia.
A
Mr. Johnson is a 60-year-old Caucasian. He has a BMI of 36. His cholesterol screening revealed: LDL 172 mg/dL, HDL 30 mg/dL, and total cholesterol 250 mg/dL. Which of the following lifestyle changes should he implement?
A. Low-carbohydrate diet
B. Low-fat, low-cholesterol diet
C. Exercise program
D. a and c
E. b and c
E
In atherosclerosis, blood flow to the kidneys
A. decreases.
B. increases.
C. remains unchanged.
D. is re-routed.
A
Which of the following is a good choice for use in preparing salad dressing?
A. Walnut oil
B. Coconut oil
C. Palm oil
D. Palm kernel oil
A
Mr. Johnson is a 60-year-old Caucasian. He has a BMI of 36. His cholesterol screening revelaed: LDL 172 mg/dL, HDL 30 mg/dL, and total cholesterol 250 mg/dL. From the above information, what is Mr. Johnson"s risk of CHD?
A. Very low
B. Moderate
C. Very high
D. Not enough information is provided
C
The effect of diets rich in omega-3 fatty acids is a(n)
A. decrease in serum cholesterol.
B. decrease in serum triglycerides.
C. increase in serum triglycerides.
D. tendency to form thrombi.
B
After a patient sustains trauma from a car accident, his heart rate, respiratory rate, and blood pressure increase. What is happening?
A. Respiratory stress
B. Metabolic stress
C. Acute-phase response
D. Bacterial translocation
B
What is derived from omega-6 fatty acids?
A. Cytokines
B. Eicosanoids
C. Histamines
D. Complementary proteins
B
Which of the following are nonessential amino acids that are sometimes supplemented in patients undergoing metabolic stress?
A. Aspartic acid and arginine
B. Arginine and glutamine
C. Glycine and glutamine
D. Alanine and glycine
B
What is a dietary change that can help to suppress inflammation?
A. Increase intake of fish oils rich in omega-3 fatty acids
B. Increase intake of vegetable oils rich in omega-6 fatty acids
C. Increase intake of vitamin C
D. Increase intake of zinc
A
Why is the assessment of nutritional needs during acute stress not always straightforward?
A. Equations for estimating energy needs of individuals experiencing stress have not been developed.
B. Laboratory data may reflect the metabolic alterations of illness rather than the person"s nutritional status.
C. Hypoglycemia can be common.
D. Fluid retention may obscure weight gain in the patient.
B
A disruption to the body"s chemical environment that threatens its normal and healthy functioning is called
A. metabolic stress.
B. severe stress.
C. physiological stress.
D. none of the above
A
Which of the following micronutrients are important for tissue repair?
A. Thiamin and riboflavin
B. Folic acid and pyridoxine
C. Vitamin C and zinc
D. Iron and magnesium
C
For critically ill patients, _____ provide the majority of energy.
A. carbohydrate and protein
B. protein and fat
C . fat and carbohydrate
D. fiber and fat
C
Barbara is an overweight 64-year-old woman diagnosed with COPD. Which of the following is true?
A. She should not lose weight, as COPD causes wasting.
B. Barbara should not exercise, as her lungs will weaken further.
C. Barbara will benefit from weight loss to decrease respiratory strain.
D. She should consume a high-kcalorie, high-protein diet.
C
In response to metabolic and respiratory stress the body experiences
A. hypometabolism.
B. breakdown of muscle mass.
C. a decrease in carbon dioxide in the blood.
D. only minor complications.
B
The rationale for limiting raw or undercooked foods in a patient with neutropenia is that this diet
A. prevents potassium loss.
B. prevents steatorrhea.
C. decreases risk of foodborne illness.
D. helps support the immune system.
C
There is evidence that an adequate intake of _____ protects against the development of cancers of the lung, mouth, pharynx, larynx, and esophagus.
A. meat
B. fruits and vegetables
C. unsaturated fat
D. protein
B
The main reason cruciferous vegetables are considered cancer fighters is because they
A. are high in fiber.
B. are low in fat.
C. contain phytochemicals.
D. support the immune system.
C
Which of the following cancer sites is associated with high intakes of red meat?
A. Cervix
B. Colon
C. Liver
D. Stomach
B
Cancer-causing substances are called:
A. carcinogens.
B. tumors.
C. neoplasms.
D. none of the above
A
Medical nutrition therapy for cancer patients depends on which of the following factors?
A. Type of cancer
B. Severity of cancer
C. Side effects of treatment
D. a and c
E. All of the above
E
Which of the following cancer sites may require tube feeding, TPN, or a fat- and lactose-restricted diet prescription?
A. Kidneys
B. Pancreas
C. Intestine
D. Brain
C
Thrush interferes with dietary intake for all of the following reasons except
A. it induces altered taste sensations.
B. it results in difficulty with swallowing.
C. it impairs fat absorption.
D. it causes oral pain.
C
Mr. Nelson asks you what he can do to prevent cancer. You should recommend that he do all of the following except
A. choose grilled and smoked meats frequently.
B. be physically active.
C. limit salt consumption.
D. eat a variety fresh fruits and vegetables.
A
All of the following contribute to reduced food intake, which leads to wasting in HIV infection, except
A. cancer.
B. diarrhea.
C. medical treatments.
D. respiratory infection.
B