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1

The Guthrie test is used to diagnose:

A. Galactosemia
B. Ornithine transcarboxylase deficiency
C. Glycogen storage disase
D. Phenylketonuria

Answer: D - The Guthrie test is a blood assay used to diagnose phenylketonuria in newborn infants. It detects bacterial growth in an agar culture that is due to the presence of excess phenylalanine.

2

Cow's milk is unsuitable for infants less than a year of age due to:

A. Large amounts of whey protein
B. Inadequate fat content
C. High cholesterol level
D. High renal solute load

Answer: D - Cow’s milk is unsuitable for infants less than a year of age due to its high renal solute load, which stresses the infant’s kidneys. Cow’s milk contains casein protein, which is less digestible than whey, and its percentages of fat and cholesterol are not significantly different from that of breast milk.

3

Level Two of the National Dysphagia Diet permits which of the following foods?
A. Crackers, toast, and baked potatoes
B. Finley chopped cooked meats and soft textured cooked veggies
C. Raw carrots, celery and apple slices
D. Chunky peanut butter, rice, pudding fruited yogurt

Answer: B - Level Two of the National Dysphagia Diet permits finely minced or chopped cooked meats and soft-textured cooked vegetables. Level Two Dysphagia diet, also known as the Mechanical Altered Diet, is intended for use by those with minimal chewing ability. Raw fruits and vegetables as well as hard-to-chew foods and hard-to-swallow foods are prohibited.

4

A PES statement (or Nutrition Diagnosis Statement) is a structured sentence that describes the specific nutrition problem that you (the dietitian) is responsible for treating and working toward resolving, the cause/s of the problem and the evidence that this problem exists. A PES statement is needed for all nutrition assessments except those with “no nutrition diagnosis.” Components of PES statement are:

The Problem (P)– the Nutrition Diagnosis
The Etiology (E)– the cause/s of the nutrition problem (Nutrition Diagnosis)
The Signs and Symptoms (S)– the evidence that the nutrition problem (Nutrition Diagnosis) exists.

The PES statement is a structured sentence, hence has a specific format to follow. Here’s a sample of how to structure your statement:

Nutrition Diagnosis term (the nutrition Problem)
related to
The Etiology (the cause/s of the problem or Nutrition Diagnosis)
as evidenced by
The Signs and Symptoms (the evidence that the nutrition problem or Nutrition Diagnosis exists).

5

Antidiuretic hormone (ADH) is released in response to:

A. Decreased serum osmolality
B. Increased serum osmolality
C. Decreased urinary urea nitrogen
D. Increased urinary urea nitrogen

Answer: B - Antidiuretic hormone (ADH) is released in response to increased serum osmolality. ADH promotes retention of water by the kidneys, in response to increased osmolality, which causes increases the solute content of the blood.

6

The usual dietary treatment for cholecystitis is:

A. Restriction of foods that stimulate pancreatic enzymes
B. 20% fat diet with MCT supplementation
C. 25% fat diet with fat-soluble vitamin supplementation
D. Lowering cholesterol intake to less than 300 mg/day

Answer: C - The usual treatment for cholecystitis is a 25% fat diet with fat-soluble vitamin supplementation. Cholecystitis is inflammation of the gall bladder, usually caused by the accumulation of bile due to blockage of the bile duct or gallstone formation. Lower fat restriction is not used because some fat is needed to stimulate gallbladder constriction and drainage of bile.

7

Which of the following is not included in extracellular water (ECF)?

A. Plasma
B. Lymph
C. Metabolic water
D. Spinal fluid

Answer: C - Metabolic water, the water produced by the digestion and absorption of food, is not included in extracellular water, which is composed of plasma, lymph, and spinal fluid, as well as water from secretions.

8

Brown adipose tissue performs what function in the body:

A. Protects internal organs from injury
B. Storage site for triglycerides
C. Is considered to be "essential fat" that supports metabolic processes
D. Heat production and regulation of body temperature

Answer: D - Brown adipose tissue is believed to regulate heat production and body temperature, particularly in infants who are susceptible to hypothermia. White adipose tissue is the major type of fat in the body. It protects internal organs from injury, stores triglycerides, and makes up the essential fat that supports many metabolic processes.

9

Guthrie test detects____ growth in an agar culture that is due to the presence of excess _____

bacterial, phenylalanine

10

Level Two of the National Dysphagia Diet permits which of the following foods?

A. Crackers, toast, and baked potatoes
B. Finely chopped cooked meats and soft-textured cooked vegetables
C. Raw carrots, celery, and apple slices
D. Chunky peanut butter, rice pudding, fruited yogurt

Answer: B - Level Two of the National Dysphagia Diet permits finely minced or chopped cooked meats and soft-textured cooked vegetables. Level Two Dysphagia diet, also known as the Mechanical Altered Diet, is intended for use by those with minimal chewing ability. Raw fruits and vegetables as well as hard-to-chew foods and hard-to-swallow foods are prohibited.

11

The most common pediatric food allergies are:

A. Shellfish, citrus fruit, beef
B. Corn, rice, rye
C. Milk, soy, peanuts
D. Potatoes, bananas, tomatoes

Answer: C - The most common pediatric food allergies are milk, soy, and peanuts. Allergic reactions to the other foods listed have been reported but are much less common.

12

Which of the following gastrointestinal surgeries has the most detrimental effect on nutritional status?

A. Jejunal resection
B. Ileal resection
C. Billroth I
D. Billroth II

Answer: B - Ileal resection, removal of part or all of the ileum, has the most detrimental effect on nutritional status because it causes decreased absorption of many nutrients, including fat-soluble vitamins, and interferes with bile salt activity needed for fat metabolism. In jejunal resection surgery, the ileum is able to compensate and take over some of the jejunum’s absorptive functions. The Billroth I and Billroth II surgeries are gastric resections in which part of the stomach is removed for the purpose of promoting weight loss. In both of these surgeries the small intestine is able to compensate and handle activities related to digestion and absorption.

13

The level of sodium restriction recommended for congestive heart failure (CHF):

A. Depends on the level of cardiac decompensation
B. Is usually 2-3 grams per day
C. May range from 100-150 mEq
D.. Is dependent on which diuretics are used

Answer: A - The level of sodium restriction recommended for congestive heart failure depends on the level of cardiac decompensation; as cardiac output decreases, the level of sodium restriction becomes stricter. The maximum sodium load tolerated by individuals with acute CHF is usually 1-2 grams a day. One to grams of sodium equals 43 to 87 mEq (milliequivalents).

14

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) uses which of the following criteria to qualify participants?

A. Nutritional risk
B. Income
C. Proof of US citizenship
D. A & B

Answer: D - The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) uses nutritional risk (low birth weight, underweight, anemia, poor maternal weight gain, etc.) and income to qualify potential recipients. Proof of US citizenship is not a requirement.

15

The following nutrition diagnosis is written in what type of format: “Poor glycemic control is related to skipping use of oral hypoglycemic agents as evidenced by random blood glucose levels greater than 200 mg/dl”.
A. SOAP note
B. POMR
C. PES statement
D. Continuity of care record

C. The nutrition diagnosis “Poor glycemic control is related to skipping use of oral hypoglycemic agents as evidenced by random blood glucose levels greater than 200 mg/dl” is written as a PES statement (P is problem, E is etiology, S is signs or symptoms). Problem = poor glycemic control, Etiology = skipping use of oral hypoglycemic agents, S = blood glucose levels greater than 200 mg/dl.

16

Which dietary measures are recommended for treating hypercalcuria that is not associated with renal stones?
A. Limiting calcium to 1000 mg per day
B. Increasing fluid intake to 2 liters per day
C. 400 IU vitamin D per day
D. Limiting animal protein to less than 1.7 g/kg per day

D. Limiting animal protein to less than 1.7 g/kg per day is recommended for the treatment of hypercalcuria because excessive intakes of animal protein cause calcium loss from the bones. A moderate calcium intake of 600-800 mg of calcium per day is recommended, since lowering calcium intake results in increased absorption. Increasing fluid intake does not prevent hypercalcuria.

17

A medication which needs to be discontinued in a uremic patient is:
A. Epogen
B. Kayexelate
C. Humulin
D. Triamterene

D. A medication which may need to be discontinued in uremia is Triamterene, a potassium-sparing diuretic. Because serum potassium levels are high in uremia, use of potassium-sparing diuretics such as Triamterene is contraindicated. Epogen stimulates red blood cell production, Kayexelate is a potassium-binder, and Humulin is synthetic insulin, all of which may be indicated for use in uremia.

18

Stomatitis is treated with which of the following dietary interventions?
A. Supplementation with iron
B. Clear liquid diet
C. Avoidance of acidic and spicy foods
D. A & C

Stomatitis is an inflammation of the mucous membranes of the mouth. It may be caused by iron deficiency, in which case it is treated with iron supplementation. The usual dietary regimen is avoidance of acidic and spicy foods.

19

Which of the following is a common side effect of immunosuppressive drug therapy used in organ transplantation?

A. Sodium and fluid diuresis
B. Hyperphosphatemia
C. Hyperkalemia
D. Decreased vitamin C requirements

C - Hyperkalemia

(elevated potassium levels) is a common side effect of immunosuppressive drug therapy used in organ transplantation, as a result of disturbances in renal hormone activity. Sodium and fluid retention and hypophosphatemia are also side effects of immunosuppressive drugs.

20

Nutrient needs of infants diagnosed with bronchopulmonary dysplasia:

A. Are linked with linear growth
B. May include a resting energy expenditure 50% higher than that of normal infants
C. May include use of diuretics to regulate water balance
D. All of the above

D - All of the above

Nutrient needs of infants diagnosed with bronchopulmonary disease are linked with linear growth (a measure of lung development), may include a resting energy expenditure that is 50% higher than that of normal infants, and may include the use of diuretics to regulate water balance. Bronchopulmonary disease is a common lung disorder in premature infants which increases energy needs. Diuretics are often needed to regulate water balance as a result of respiratory compromise.

21

Examples of foods avoided on a low-purine diet are:

A. Eggs, cheese, peanut butter
B. Sardines, broth, organ meats
C. Carrots, tomatoes, corn
D. Bread, crackers, cold cereal

B. Sardines, broth, organ meats

Examples of foods avoided on a low-purine diet are sardines, broth, and organ meats. These foods are high in purine and are eliminated in the treatment of gout, caused by high levels of uric acid in the blood.

22

Steatorrhea may be caused by:

A. Disruption in the activity of pancreatic enzymes
B. Excessive production of bile salts by the liver
C. Lack of intrinsic factor
D. Intake of more than 70 grams of fat per day

A - Disruption in the activity of pancreatic enzymes

Steatorrhea may be caused by disruption in the activity of pancreatic enzymes that help to digest fat. It may also be caused by inadequate production of bile salts, which are needed for fat absorption.

23

Maple-syrup urine disease (MSUD) is an autosomal recessive disorder in infants caused by:

A. The inability to metabolize branched-chain amino acids
B. Plasma leucine levels exceeding 10 mg/dl
C. A defect in the gene that controls the activity of alpha-keto acid hydrogenase
D. A & C

D - A & C

Maple-syrup urine disease (MSUD) in an autosomal recessive disorder in infants caused by the inability of the body to metabolize the branched-chain amino acids leucine, isoleucine, and valine. The inability to break down branched-chain amino acids is due to a mutation in the gene that controls the activity of the enzyme alpha-keto acid dehyrogenase. Plasma levels of leucine exceeding 10 mg/dl are associated with the symptoms of MSUD, including lethargy, vomiting, and neurologic changes.

24

Addison’s disease is caused by the deterioration of the adrenal cortex, and results in hypoglycemia, weight loss, and muscle wasting. Dietary intervention includes:

A. A high protein diet with liberal sodium
B. A high protein diet with restricted sodium
C. Frequent meals with 50-60 grams of complex carbohydrates
D. A & C

D. A & C

The dietary intervention for Addison’s disease includes a high protein diet with liberal sodium intake, as well as frequent meals with 50-60 grams of complex carbohydrates. Muscle wasting and weight loss require high protein intakes, and decreased activity of the adrenal hormone aldosterone causes large losses of sodium. Increasing complex carbohydrates helps stabilize blood glucose.

25

An effective nutrition screening program:

A. Involves all members of the health care team who want to participate
B. Is based on the principles of sensitivity and specificity
C. Always uses food frequency questionnaires
D. Is used only to screen for childhood diseases

B. Is based on the principles of sensitivity and specificity

An effective nutrition screening program is based on the principles of sensitivity and specificity. Sensitivity helps ensure that a nutrition screening program picks up individuals at nutritional risk, while specificity helps to exclude individuals not at nutritional risk. Nutrition screening programs may use different types of tools to collect dietary information, and are used in populations of all ages, not just children.

26

Impaired glucose tolerance is defined as:

A. Fasting plasma glucose (FPG) > 140 mg/dl
B. 2-hour plasma glucose between 140-199 mg/dl
C. Casual plasma glucose of 200 mg/dl or greater
D. An HbA1c level of 6 or greater

B. 2-hour plasma glucose between 140-199 mg/dl

Impaired glucose tolerance is defined as a 2-hour postprandial blood glucose between 140-199 mg/dl. Impaired glucose tolerance is also characterized by a fasting plasma glucose of 100-125 mg/dl. A casual plasma glucose level of 200 mg/dl or greater is diagnostic of diabetes.

27

Nutritional therapy for AIDS/HIV infection includes which of the following?

A. Supplementation with ginseng and other herbs
B. Avoidance of raw fruits and vegetables
C. Protein intake of 0.8-1.2 g/kg per day
D. Use of milk-based shakes to boost caloric intake

B - Avoidance of raw fruits and vegetables

Nutritional care for AIDS/HIV infection includes avoidance of raw fruits and vegetables, since they may be contaminated with pathogens. Increasing protein intake to 1.5-2 g/kg per day is recommended to prevent muscle wasting. Use of ginseng and other herbal supplements is not recommended, since they may interfere with the activity of drugs used to treat AIDS. Use of milk-based shakes may cause diarrhea due to lactose intolerance.

28

Which microorganism is involved in the etiology of peptic ulcer:

A. Clostridium difficile
B. Heliobacter pylori
C. Heliobacter baculiformis
D. Vibrio vulnificus

B - Heliobacter pylori

The microorganism which causes peptic ulcer is Heliobacter pylori, commonly known as H. pylori. H. pylori causes peptic ulcer by eroding the mucosal lining of the stomach.

29

Age-associated bone loss among the elderly:

A. Is always reversed with calcium supplementation
B. Can be prevented by cardiovascular exercise such as swimming
C. Affects both trabecular and cortical bone
D. May be slowed by the use of steroid drugs

C - Affects both trabecular and cortical bone

Age-associated bone loss among the elderly affects both trabecular (spongy) and cortical (hard) bone. Age-associated bone loss may be slowed by calcium supplementation, through may not be reversed. Bone loss is slowed by weight-bearing exercise, such as walking, aerobics, and weight training, and accelerated by the use of steroid drugs.

30

Which of the following measures are used to calculate serum osmolality?

A. Sodium, chloride, and glucose
B. Sodium, potassium, and magnesium
C. Sodium, lactic acid, and glutamine
D. Sodium, glucose, and BUN

D - Sodium, glucose, and BUN

Sodium, glucose, and BUN are used to calculate serum osmolality, which is a measure of osmotically active particles in the blood. Normal serum osmolality is about 300 mEq/liter.