EatRightPrep Questions Flashcards
(176 cards)
1
Q
Astringency
A
Astringency is a taste sensation that is most often associated with the tannins in foods. It should not be confused with sour taste like in lemons and grapefruit. Astringency has a puckering and “dry” sensation in the mouth and is found in tea, coffee, wine, chocolates, and certain fruits (most notably underripe fruit).
2
Q
educational objectives vs educational goals
A
Educational objectives specify the means to achieve an outcome, whereas educational goals do not specify how an outcome will be reached
example: Given a list of foods, participant will identify those highest in MUFA
3
Q
Q. What percentage of total energy from fat should be provided through an elemental (hydrolyzed) formula to prevent essential fatty acid deficiency (EFAD)?
A
Enteral formulas should provide the patient with at least 3%-4% of total energy as fat in order to decrease the chances of developing EFAD.
4
Q
Sepsis
A
is a life-threatening chain reaction triggered when the body’s response to infection-fighting chemicals is out of balance
5
Q
Ascites
A
Ascites is the accumulation of fluid in the peritoneal cavity. It may be caused by portal hypertension.
6
Q
Q. Which of the following indicates a breastfeeding infant has a good latch?
A
Among the signs that a breastfeeding infant has a good latch are that the infant’s cheeks are rounded, swallowing is audible, there are no clicking or smacking sounds, and the infant’s chin is touching the breast.
7
Q
Q. What is the recommended parts per million of available chlorine for a lukewarm, 1-minute chlorine bath used to sanitize dishes and utensils?
A
It is recommended that a minimum of 50 ppm available chlorine be used in a lukewarm chlorine bath to sanitize dishes and utensils.
8
Q
Q. Which of the following is a person with opioid addiction likely to experience?
A
Opioids delay gastric emptying, leading to constipation.
9
Q
Q. Women with gestational diabetes typically require less carbohydrates at which meal, compared to the others?
A
Many women with gestational diabetes are more insulin resistant in the early morning and can thus tolerate less carbohydrate at breakfast.
10
Q
Q. Which of the following processes occurs in response to an increase in plasma glucose concentrations?
A
With an increase in plasma glucose, glycogen synthesis occurs. Gluconeogenesis is stimulated by glucagon, growth hormone, epinephrine, and cortisol; insulin increases; and glycogenolysis takes place when there is a decrease in glucose levels.
11
Q
Q. Which of the following actions would likely be the result of systems thinking?
A
Systems thinking is the management approach to considering the entire organization when making decisions or allocating resources. Rescheduling kitchen staff to prepare food to meet customer expectations changes the kitchen and staff/resource entirely. Making a change to the produce delivery does not change the kitchen.
12
Q
Q. Among the following foods, which would be reintroduced last after bowel resection?
A
Fluids and soft foods are reintroduced to the diet first following bowel resection. Coffee has proven to be effective in stimulating postsurgical bowel movements. It is recommended that eating any fresh fruit except bananas be delayed until 4-6 weeks postsurgery.
13
Q
Q. Which of the following should be the frontline test when diagnosing food allergy?
A
For diagnosing a true food allergy, the gold standard is the double-blind, placebo-controlled food challenge. According to the National Institute of Allergy and Infectious Diseases, basophil histamine release/activation, lymphocyte stimulation, facial thermography, gastric juice analysis, endoscopic allergen provocation, hair analysis, applied kinesiology, provocation neutralization, allergen-specific IgG, cytotoxicity assays, electrodermal test (Vega), and mediator release assay (LEAP diet) all lack the requisite evidence to be recommended for use in diagnosing food allergy.
14
Q
Q. Which acts as an emulsifier in food preparation?
A
Egg yolks are high in phospholipids, which contain both lipophilic fatty acid groups and hydrophilic head groups. These allow aqueous and fatty substances to become stable in an emulsion.
15
Q
Q. Which laboratory values can be abnormally low when evaluating nutritional status in patients with liver disease?
A
Albumin and prealbumin may be moderately or abnormally low in patients with liver disease, even in the presence of good nutrition. These proteins decrease in production in a diseased liver.
16
Q
Q. Which substance is necessary for production of bile?
A
Cholesterol is of one of many components of bile; it is the primary sterol in bile.
17
Q
Q. Which of the following is the best option for a vegan menu?
A
Among those listed, quinoa mixed with tamari is the best option for a vegan diet. Many nondairy creamers contain a small percentage of sodium caseinate, which is derived from milk; honey is derived from animals; and buffalo sauce often contains butter.
18
Q
TCS
A
TCS refers to time/temperature control for safety. TCS foods are safe at 41°F or below and 135°F and above.
19
Q
Q. Which of the following is the term for “a general or modified diet prescribed and documented in a client’s medical record”?
A
A diet order is a general or modified diet prescribed and documented in a client medical record by a credentialed provider as part of a medical treatment plan
20
Q
Q. People with cystic fibrosis are most likely to become deficient in
A
Both zinc and fat-soluble vitamins are lost in the stool of individuals with cystic fibrosis due to pancreatic insufficiency.
21
Q
Q. Which vitamin deficiency is likely to develop in a patient with liver disease?
A
Vitamin D deficiency is frequently reported in liver disease patients and is thought to result from impaired synthesis and absorption.
22
Q
Q. Which of the following lists the tasks, duties, and responsibilities of a job, the job’s working condition, and the tools, materials, and equipment used to perform it?
A
A job description details the tasks, duties, and responsibilities of a job, as well as the working conditions and tools and equipment to be used on the job.
23
Q
Q. Which non-essential compound is used to transport non-esterified long-chain fatty acids into the mitochondria for beta oxidation?
A
Carnitine, found in most body tissues, is needed for the transport of fatty acids. This is especially true for long-chain fatty acids, which need carnitine across the inner mitrochondrial membrane for oxidation.
24
Q
Q. Stools that are clay-colored indicate a disturbance in the production or secretion of which of the following?
A
Clay color in stool may indicate biliary obstruction of the flow of bile to the intestine. This obstruction may be caused by a tumor or gallstone in the bile duct or pancreas. The change in stool color as related to these conditions is often a gradual process.
25
Q. Intake of _____ should be carefully monitored in patients with kidney disease because phosphorous is more easily absorbed from this source.
Dietary phosphorus is found in organic and inorganic sources. Organic sources are animal and vegetarian; inorganic sources are food preservatives. A concern for patients with chronic kidney disease is that the body could absorb as much as 100% of inorganic phosphorus via processed foods. Because absorption rate is variable among different sources, whether a phosphorus source is organic or inorganic and whether it is animal or vegetarian, is noteworthy for this population. Emphasize intake of plant-based proteins and foods containing no inorganic phosphorus additives in these patients.
26
Q. What is the recommended test to screen for gestational diabetes in a client who has a history of roux-en-Y gastric bypass surgery and is experiencing dumping syndrome?
It is recommended to check fasting and 2-hour postprandial blood glucose levels for 1 week during 24–28 weeks gestation. A 1-hour glucose tolerance test (GTT) or 3-hour GTT could trigger dumping syndrome, as a high glucose load causes a hyperosmolar environment in the small bowel and the GTT can also result in hypoglycemia in patients who are post gastric bypass surgery. Checking Hgb A1c levels is not recommended for diagnosing gestational diabetes since it is not as reliable as oral glucose tolerance testing.
27
Q. What should be avoided when purchasing bivalve mollusks?
Living bivalve mollusks have tightly closed shells. Open shells indicate that they are dead and should not be consumed. Shucked and canned mollusks are safe to eat.
28
Q. Which of the following budget types requires justification for all expenses at each new budgetary period?
In zero-based budgeting, all expenses must be justified for each new period. In this budgeting type, the process begins from a "zero base," with every function within an organization analyzed for needs and costs. The budget is then developed based on what is needed for the upcoming period, regardless of whether the budget represents an increase or decrease compared to the previous one.
29
Q. Promptly removing rotten apples from produce storage helps to prevent the formation of what toxin on other apples?
Apples are particularly vulnerable to patulin, a toxic chemical that produces a mold that infects produce. Promptly removing rotten apples helps to protect the other apples in produce storage.
30
Q. Where in the body does leptin relay the status of fat stores?
Leptin is a satiety factor that represents a major signal that relays the status of fat stores to the hypothalamus and plays a significant role in energy homeostasis
31
Q. What is the recommended way to serve fruit on the IDDSI Level 5 diet?
According to the International Dysphagia Diet Standardisation Initiative, fruits served on Level 5 Orange Minced & Moist should be served mashed with excess thin juice drained and skin and pips removed.
32
Q. An employee who goes out of their way to succeed in one area or activity to make up for deficiencies in another area or activity is exhibiting what type of behavior?
Compensation is a defense mechanism wherein a person tries to make up for deficiencies by overachieving in other areas or activities.
33
Piperine
is chemical compound found in black peppers.
34
Q. Which transporter distributes fructose across the intestinal apical membrane?
Glut-5 is primarily located in the apical membrane of the jejunum and is the main transporter of fructose from the lumen to the enterocytes. Fructose is passively transported by glut-5 across the intestinal apical membrane and then glut-2 transports fructose from the cytosol to the blood.
35
Q. Which of the following correctly reflects what is required on a Nutrition Facts label?
Nutrition Facts labels include both the actual amount of a nutrient as well as its % daily value. Vitamin D, calcium, iron and potassium must appear on the label and all others are declared voluntarily.
36
Q. At what age should peanut-containing foods be introduced to an infant with egg allergy and severe eczema?
To reduce risk of peanut allergy, it is recommended that infants with severe eczema, egg allergy, or both be introduced to age-appropriate, peanut-containing foods as early as age 4-6 months. Infants should be introduced to other solid foods first to determine developmental readiness.
37
Q. Which of following are defined by standards of identity?
The Standards of Identity define what a given food product is, its name, and the ingredients which must or may be used, and which ones must be declared on the label.
38
Q. What type of standards must be met to attain LEED certification?
LEED stands for Leadership in Environmental and Energy Design certification, a green building rating system. There are four levels of LEED certification: certified, silver, gold, and platinum. LEED is intended to promote design and construction practices that minimize the negative environmental impacts of buildings and improve the interior of buildings for their occupants.
39
Q. When a person has phenylketonuria, which amino acid becomes essential?
Phenylalanine is converted to tyrosine by phenylalanine hydrolase, a missing enzyme in individuals with PKU; therefore, tyrosine is an essential amino acid for these individuals.
40
Q. Which of the following is a calibrated device used to measure height?
A stadiometer is used to measure human height.
41
Q. Employment background checks typically include which of the following?
Employment background checks may include records related to criminal, driving, education, and credit history, including bankruptcy
42
Q. How does one typically become a union shop steward?
A shop steward—also known as a union steward or union representative—is a volunteer position held by an employee who serves as a labor official representing and defending nonmanagement employees' interests. The person serving in this role is typically selected by democratic election, though a higher union body may appoint the individual.
43
Q. Which of the following may develop from taking antiretroviral therapy?
Antiretroviral therapy (ARV) is a treatment for HIV/AIDS and includes a host of long-term and short-term side effects. Type 2 diabetes is a potential side effect with ARV.
44
Q. What is the protein requirement for medically stable patients on peritoneal dialysis for stage 5D chronic kidney disease (CKD)?
Medically stable adults with stage 5D CKD receiving maintenance peritoneal dialysis have recommended estimated protein needs of 1.0 g to 1.2 g protein/kg body weight per day to maintain a stable nutritional status.
45
Q. Which milk alternative typically contains the most protein per 8-oz serving?
Hemp milk generally contains 5 g protein per 8 oz as compared to almond milk, coconut milk, and rice milk, which contain 1 g protein per 8 oz.
46
Q. Which of the following is an example of a violation of “beneficence” according to the Code of Ethics?
Beneficence represents the concept of professionalism. Within this category, the Code of Ethics requires that individuals “demonstrate respect, constructive dialogue, civility and professionalism in all communications, including social media.” Any suspicions of theft in the workplace should be addressed confidentially. In the Code of Ethics, state licensure and respecting intellectual property rights are related to autonomy, and practicing within professional limits is related to non-maleficence.
47
Q. A foodservice operation’s Net Profit is $41,137, Cost of Goods Sold is $145,350, Average Inventory Value is $7,330, and Total Meals Served Per Day is 200. What is the inventory turnover rate?
The inventory turnover rate is determined by dividing the cost of goods sold by the average inventory value. $145,350/$7,330 = 19.83.
48
Q. Which of the following glucose-lowering medications would require patient education about treatment of hypoglycemia?
Among the options, glimepiride (Amaryl) is the only secretagogue, which means the mechanism of action is stimulating the pancreas to make insulin, thereby causing the possibility of low blood glucose.
49
Q. What percentage of a food product's ingredients must be organically produced to allow the claim “Made with Organic Ingredients”?
When packaged products indicate they are “made with organic [specific ingredient or food group],” this means they contain at least 70% organically produced ingredients. If there is less than 70% organic ingredients in a product, the manufacturer can list them on the ingredient panel and can list the organic ingredient percentage on the information panel, but “organic” cannot be claimed on the principal display panel.
50
Q. "DMAIC" is associated with which of the following quality improvement programs?
DMAIC is a tenet of Six Sigma. The DMAIC approach represents managers doing the following:
Defining the project goals
Measuring the current performance of the process
Analyzing and determining causes of defects
Improving the process by eliminating defects
Controlling and standardizing future process performance
51
Q. The most influential perception factor in a person's preference for a particular food is
Taste, or gustatory perception, is the most influential factor in food preferences, more so than mouthfeel (texture), smell (olfactory), or visual.
52
Q. Which of the following is true with regard to recommendations for introducing first foods to a healthy infant?
The first solid foods introduced should comprise a single ingredient and be fed in conjunction with human milk or formula, which should be gradually reduced to 28 oz to 32 oz per day. The American Academy of Pediatrics Committee on Nutrition recommends that pureed meats or infant cereals be introduced first, as they are good sources of iron and zinc, which are the most likely deficient nutrients in the diets of US infants.
53
Q. Which of the following is a disadvantage to using concrete for foodservice flooring?
The advantage of using concrete for foodservice flooring is that it is inexpensive. However, the fact that it can become slippery when wet represents a disadvantage. Other disadvantages are that concrete is a porous material and it is not recommended for use in food preparation areas
54
Q. Which of the following is a characteristic symptom of food protein-induced enterocolitis syndrome (FPIES)?
FPIES is characterized by prolonged vomiting 1 to 4 hours after ingestion of a food but without any IgE-mediated skin or respiratory symptoms.
55
Q. Why is it critical to use a valid and reliable malnutrition screening tool?
A malnutrition screening tool that is valid and reliable increases the likelihood of positively identifying possible malnutrition, thereby reducing referrals for individuals who do not have malnutrition. Screening is intended to identify risk and not evaluate and diagnose; as such, screening takes place before the Nutrition Care Process.
56
Q. One advantage of using a crossover design over a parallel design is
Crossover design includes a washout period and does not have to be a shorter study duration. The advantage to crossover design is that it uses the same subjects who serve as the control, thus receiving the same treatment, resulting in a reduction in variability. This reduction in variability allows for a smaller sample size.
57
Q. Which type of federal grant is used to fund state programs for housing, health, and nutrition-related social service programs?
Block grants, such as TANF, are given by the federal government to states so that they can implement the programs, including for housing, health, and nutrition-related social service programs, that meet the unique needs of that state.
58
Q. Which conceptual model suggests that an individual's perception of why a medical condition developed and how it should be treated is influenced by cultural beliefs?
The explanatory model of illness suggests that individuals' beliefs about why a condition started, how long it will last, and what treatments are appropriate is affected by cultural beliefs.
The Health Belief Model focuses on individuals’ perceptions of the threat posed by a health problem, the benefits of avoiding the threat, and factors influencing the decision to act. The Stages of Change Model focuses on individuals’ motivation and readiness to change a problem behavior. The Common Sense Model focuses on individuals’ ability to control and regulate impulses, regardless of emotion
59
Q. Which of the following body mass index (BMI)-for-age percentiles is considered class I obesity in children?
Beginning at age 2 and through adolescence, BMI at or above the 95th percentile to less than 120% of the 95th percentile of BMI-for-age is categorized as class I obesity.
Overweight: 85th to less than 95th percentile
Class 2 obesity: BMI at or above 120% to less than 140% of the 95th percentile, or BMI at or above 35 kg/m2
Class 3 obesity: BMI at or above 140% of the 95th percentile, or BMI at or above 40kg/m2
60
Q. Which of the following is an example of a food that has been preserved by lowering water activity by adding a solute?
Solutes such as sugar added to jams and jellies and salt added to cured meats inhibit microbial growth by lowering water activity. Canning does not lower water activity; freezing forms ice crystals, which removes water from the solution in the foods that are frozen. The lower water activity of sun-dried tomatoes is due to the removal of water, not the addition of a solute. While the vapor pressure is decreased due to the higher levels of sugar and or salt in dehydrated foods, salt and sugar are not added to the product as a solute.
61
Q. Home health agencies and long-term care hospitals are categorized as which of the following?
Transitions of Care settings include home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities.
62
Q. What type of power is used when placing an employee on a performance improvement plan?
Placing an employee on a performance improvement plan, or PIP, is a form of punitive power. PIPs are typically implemented when an employee is not meeting specific job goals or demonstrates behaviors of concern to management. The PIP gives the employee the opportunity to address the deficiency and succeed.
63
Q. Which of the following conditions may be affected by the chromium and nickel content of stainless steel cookware?
Stainless steel cookware contains nickel and chromium. Nickel and, to a lesser extent, chromium can induce contact allergic dermatitis. Stainless steel grade, cooking time, and cookware usage may play a role in leaching during food preparation.
64
Q. Which would be added to a cola beverage as a natural colorant?
Amber-hued colas get their color from natural caramel.
65
Q. Which of the following is an example of focus strategy?
Focus strategy uses a cost leadership or differentiation strategy to target a specific, limited-size market niche. This approach is exemplified in a hospital's plan to market home meal replacements and delivery for its hospital staff.
66
Q. Heat applied to a food will denature which of the food’s components?
Denaturation of proteins occurs when foods are subjected to heat, agitation, or ultraviolet light. Denaturation is the relaxing of a protein’s tertiary structure to the secondary structure. Heat can degrade vitamins, fats, and carbohydrates.
67
Q. What organization creates national standards for foodservice equipment?
NSF is accredited by the American National Standards Institute (ANSI). NSF has developed more than 80 voluntary American National Standards under the scope of public health, safety, environment, and sustainability assessment. NSF/ANSI standards are developed through a public process that ensures balanced input from industry representatives, public health/regulatory officials, and users/consumer representatives. The CDC investigates foodborne illnesses. The FDA issues the Model Food Code. OSHA investigates workplace accidents.
68
Q. What is the minimum recommended frequency for measuring height, weight, and waist circumference as part of obesity screening in adults?
It is recommended that weight, height, and waist circumference be measured in all adults as part of obesity screening at least annually.
69
Q. Under which category within nutrition-focused physical findings would lanugo be documented?
Lanugo is fine, pale hair. Lanugo is present in undernourished patients; an example of a patient who may present with lanugo hair formation is one with protein-energy malnutrition related to anorexia nervosa. According to the Nutrition Care Process, lanugo is documented in the Hair category of Nutrition-Focused Physical Findings.
70
Q. The Emergency Food Assistance Program and the Disaster Feeding Program are examples of food distribution programs. Which of the following statements best describes the similarities of the two programs?
Both of these programs serve children, adolescents, and other age groups and provide commodity foods that serve meals. The Emergency Food Assistance Program does not distribute to individual households.
71
Q. According to the Joint Commission, which of the following is fundamental to cost-effective performance improvement?
Patient safety is a major concern in all health care settings. A focus on safety in performance improvement programs leads to cost savings through prevention of medical errors.Q. Which of the following can be used as an assessment parameter in adolescents to evaluate bone development?
72
Q. Which of the following can be used as an assessment parameter in adolescents to evaluate bone development?
Calcium and phosphorus absorption and metabolism are important to bone development during adolescence, and vitamin D plays a role in facilitating these processes. Waist-to-hip ratio is used in evaluating weight status, mean corpuscular volume measures average size of red blood cells, and calcinosis is a medical condition.
73
Q. What is secreted in the bloodstream in amounts equal to insulin secretion and thus can be used as a clinical indicator of endogenous insulin production?
Insulin is secreted as two polypeptide chains joined by disulfide bonds. C-peptide is released when the two chains separate.
74
Q. In a foodservice operation, which of the following is the most critical point of control?
The menu, a list of food items, serves as the primary control of the foodservice operation and is the common core to all functions. The menu controls each subsystem, is a major determinant for the budget, and reflects the “personality” of the foodservice operation. The menu affects the layout of the operation and the equipment needed to produce it.
75
Q. Which of the following is a principle of behavioral learning theory?
Positive reinforcement is one of the most important principles of behavioral learning theory. Providing good role models is a principle of social learning. Cognitive theory uses goal setting and repetition and review.
76
Q. Which decision-making process would be most appropriate for determining whether medication, consultations with a registered dietitian nutritionist, or some combination of the two is the best approach for lowering serum triglyceride levels?
Various techniques have been developed to assist managers with decision making. In this scenario, cost-effectiveness analysis is the best process. Cost-effectiveness provides a comparison of alternative course of action in terms of their cost, savings, and effectiveness of reaching the objective (lowering triglycerides). A decision tree is a decision support tool that uses a tree-like model of possible decisions and their possible consequences but does not include effectiveness. Network charts are useful for presenting a graphic representation of a project, depicting the flow and sequence of activities and events; most appropriate in an example like planning, scheduling, and controlling a catered lunch. Finally, cost-benefit provides a comparison of cost but does not consider effectiveness so would not meet the needs of this scenario.
77
Q. The hydrolysis of sucrose with an acid to form a mixture that has equal amounts of fructose and glucose is known as
Inversion occurs when a sugar solution is boiled with the addition of an acid. Hydrolysis of the sucrose molecule results in equal amounts of fructose and glucose.
78
Q. For a food to be labeled “light” or “lite,” how many calories can it contain?
The food labeling law defines “light” or “lite” as 1/3 fewer calories than the regular food.
79
Q. Which type of rice is whole-grain with only the outer hull removed?
Brown rice is whole-grain with only the outer hull removed. It retains most of the bran layers that give it a light brown color. White rice has been milled to remove the outer husk and layers of bran. Long-grain rice refers to the length of the rice. Wild rice is not a true rice but is a large rice-looking weed of an aquatic reed-like grass.
80
Q. Which of the following is an example of internal benchmarking?
Internal benchmarking involves comparing outcome variables within an organization over time to determine if performance has improved or is in need of improvement.
81
Q. What condition must be present for using chlorine bleach to wash produce?
Federal regulations specify that there are two conditions for the permitted use of chlorine bleach solutions for washing produce:
* The concentration of sanitizer in the wash water must not exceed 2000 ppm hypochlorite
* The produce must be rinsed with potable water following the chlorine treatment
82
Q. In which part of the Nutrition Care Process would an RDN contrast a patient’s actual energy intake with estimated energy needs?
A patient’s results compared against thresholds of standards is done as part of the Comparative Standards component of a nutrition assessment.
83
Q. Which of the following was used when calculating estimated energy needs presented in the US Dietary Guidelines?
Estimated energy needs presented in the DGA were based on estimated energy requirement (EER) equations. These estimates were calculated using reference heights (average) and reference weights (healthy) for each age-sex group.
84
Q. Which of the following types of fish is safest for consumption by someone who is trying to get pregnant?
Orange roughy, swordfish,and marlin all have higher levels of mercury. Because it is low in mercury, cod is considered one of the safest fish choices for people who are pregnant, may become pregnant, or are breastfeeding
85
Q. Which of the following is the most accurate way to evaluate energy expenditure in critically ill patients?
Indirect calorimetry evaluates energy expenditure by measuring oxygen consumption and carbon dioxide production. Although it is considered to be the most effective measurement in critically ill patients, its use is limited, often due to availability and cost.
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86
Q. After a power outage, how long will food keep safely in the freezer if the freezer is full?
A full freezer will hold its temperature for 48 hours. If the freezer is half-full, it will only hold its temperature for 24 hours.
87
Q. Which organ is mainly responsible for ethanol metabolism?
Acetaldehyde (one of the metabolites of ethanol) is postulated to play an etiologic role in alcoholic liver disease. The liver is the main organ responsible for ethanol metabolism. The stomach and other organs play a minor role.
88
Q. Which of these food products is made primarily from wheat?
Seitan is a protein-rich food product that is made from wheat gluten. Tempeh and miso are made from soy. Lecithin added to US food products is typically derived from soy.
89
Q. Why should a foodservice manager be informed about MSDs?
MSDs are musculoskeletal disorders, which can develop from standing for long periods of time.
MSDs are machine servicing departments and working with these contractors requires specialized knowledge.
MSDs are meat sautéing devices, which have become obsolete in foodservice operations.
MSDs are marketing and sales development, which will be relevant in any business context.
MSDs are musculoskeletal disorders, which can develop from lifting, repetitive movements, and standing for long periods of time. MSDs can compromise efficiency and worker health.
90
Q. Which of the following is an eligibility requirement for FMLA?
Eligibility for the Family and Medical Leave Act, or FMLA, is as follows: If employee has worked for employer at least 12 months, at least 1,250 hours over the past 12 months, and works at a location where the company employs 50 or more employees within 75 miles.
91
Q. Why are excipients added into the formulation of medications?
To decrease medication metabolism
To increase or decrease the rate that the drug dissolves in the GI tract
To increase the pH of the drug
To make the drug more acidic
Excipients are added to affect dissolution or dissolving of medication in the GI tract. The dissolution of the medication has to occur first, and then the medication can be absorbed.
92
Q. A patient recently diagnosed with acute kidney injury has no evidence of chronic kidney disease but requires hemodialysis. If the patient is a 57-year-old male, weighs 70 kg, has a normal body mass index with no signs or symptoms of malnutrition, and skin is intact, what amount of protein should be recommended?
Patients with acute kidney injury treated with hemodialysis demonstrate positive nitrogen balance with 1.5 g/kg/day of protein. 70 kg × 1.5 = 105 g. The other options underestimate or overestimate protein needs.
93
Q. A patient has developed vancomycin resistant enterococcus and is being treated with Linezolid. What type of food should be avoided?
Non-nutritive sweeteners
Shellfish
Tree nuts
Sauerkraut
Linezolid is an antibiotic in the same class of medications as MAOI. As a result, a patient on Linezolid should avoid high-tyramine foods to prevent potential interaction.
94
Q. What happens to pancreatic exocrine gland secretions during the fasted state?
Secretion decreases
No change to exocrine secretions
Secretion increases
Same output as during the fed state
During fasting periods, very little secretion takes place. Once food enters into the stomach, the pancreas exocrine glands release proteases, amylase, and lipase enzymes to aid in digestion.
95
Q. What is the recommended medication for hyperglycemia in gestational diabetes mellitus (GDM)?
Insulin is the preferred medication for treating hyperglycemia in GDM. Metformin and glyburide cross the placenta to the fetus so they are not appropriate as first-line treatments. Currently there are no long-term safety data regarding use of oral and noninsulin injectable glucose-lowering medications in GDM.
96
Q. What do wholesalers represent in the marketing channel?
Producers
Manufacturers
Suppliers
Distributors
Producers produce raw food to sell. Manufacturers take raw food items and make packaged products. Distributors transfer products from the processor/manufacturer to suppliers. Examples of distributors are wholesalers, brokers, and manufacturer's representatives. The wholesaler is the distributor that purchases from various processors/manufacturers and then stores, sells, and delivers products to suppliers. Suppliers then sell the products to the final buyer, the customer.
97
Q. What should happen if a shelter-in-place order is imposed during business hours?
Shelter-in-place orders might be imposed if a natural disaster occurs or if chemical, biological, or radiological contaminants are released into the environment. Shelter-in-place orders apply to everyone present at the business, so even customers should be asked to stay. It is recommended that businesses immediately close and change the voicemail recording to indicate that the business is closed and that staff and visitors will remain in the building until it is deemed safe to leave.
98
Q. Which of the following phytochemicals can reduce serum low-density lipoprotein cholesterol by 10% to 15%?
Terpenes
Carotenoids
Flavonoids
Phytosterols
Sterols and stanols can lower LDL cholesterol
99
Q. What is the term for a client’s probable response to therapy?
Diagnosis
Remission
Prognosis
Cure
Prognosis is a person’s expected outcome and response to treatment.
100
Q. According to the Fried criteria, which of the following is a criterion for diagnosing an elderly individual as frail?
Shortness of breath, poor appetite, weight loss of >10 lb in 1 year
Number of comorbid conditions, depression, needing assistance with activities of daily living
Exhaustion, cognitive impairment, limited social support
Loss of 10 lb or more in 1 year, weakness, slow walking pace
The Fried criteria require that three of the five following criteria are present for a diagnosis of frailty: Unintended weight loss (measured as 10 pounds or more lost in 1 year), weakness (measured as grip strength in lowest 20% at baseline using dynamometer), exhaustion (self-reported exhaustion, identified by 2 questions on CES-D scale), slow walking speed (measured as slowest 20% of population at baseline based on 15 feet timed walk), and low physical activity level (based on weighted score of energy expended per week calculated from patient report of physical activity)
101
Q. Which protein found in beef softens with moist cooking?
Collagen is a connective tissue found in beef that begins to break down when exposed to heat. When exposed to moist heat, hydrogen bonds in collagen begin to break and form a gelatin. Although elastin is a connective tissue as well, it is not altered by heat. Myocommata is found in fish and albumen is found in eggs.
102
Q. Which financial measurement is reflected in the equation below?
(Cash + Accounts receivable + Marketable securities) ÷ Current liabilities
Acid-test ratio
Profit margin
Inventory turnover
Debt-to-asset ratio
The acid-test ratio, which is also called the quick ratio, is a means to accurately project ability to pay bills. In this equation, current liabilities are measured against cash and additional assets that can be readily converted to cash.
103
Q. Which one of the following foods would likely cause an increase in the gut level of TMAO (trimethylamine-N-oxide)?
The blood concentration of TMAO has been shown to increase after ingestion of dietary l-carnitine and phosphatidylcholine, which are both high in beef.
104
Q. If a person who has been on a gluten-free diet needs testing for celiac disease, what is included in the typical testing protocol?
Continuing a gluten-free diet throughout the testing process
Consuming at least 4 slices of wheat-containing bread 4 hours before blood tests and biopsies
Consuming at least 4 slices of wheat-containing bread daily starting 48 hours before blood tests and biopsies
Consuming at least 4 slices of wheat-containing bread daily for 4 weeks before blood tests and biopsies
For a diagnostic test for celiac disease to be reliable, the individual must have gluten in their system. If the individual being tested has fully omitted gluten from the diet, a gluten challenge with intake of at least 4 slices of wheat-containing bread daily for at least 4 weeks before testing is recommended.
105
Question
Q. What is the age range when weight and body mass index peak?
30-39 years
40-49 years
50-59 years
60-69 years
Weight and BMI peak between age 50 and 59 years, then stabilize and start slowly dropping around age 70.
106
Q. Which is an example of upward communication in an organization?
Exit interview
Newsletter
Pay insert
Policy manual
Effective upward communication provides employees with an opportunity to have a say in what happens in the organization and for managers to receive vital information from lower levels in organization. Therefore, exit interviews are considered a form of upward communication.
107
Q. Which approach is based on the assumption that everyone is capable of achieving health and well-being independent of weight, so long as they have access to non-stigmatizing health care?
Weight inclusive
Weight normative
Weight considerate
Weight neutral
Unlike the weight normative approach, which emphasizes weight and weight loss when defining health and well-being, the weight inclusive approach views health and well-being as multifaceted and advocates for efforts toward improving health care access.
108
Q. Which of the following does not have an OSHA Hazard Communication Standard warning symbol?
Health hazard
Flame hazard
Explosion hazard
Broken glass hazard
The Occupational Health and Safety Administration’s Hazard Communication Standard uses symbols for the following hazards: health hazard, flame, irritant, gas cylinder (under pressure), corrosion, explosive material, oxidizers, aquatic toxicity (non-mandatory), and acute toxicity.
109
Q. What is ozone used for in food processing?
Freezing food
Modifying atmospheric packaging
Blanching vegetables
Effectively disinfecting and sanitizing
Ozone is a safe, powerful disinfectant used by the food industry because of its ability to disinfect microorganisms without adding chemical byproducts to the food being treated, to the food processing water, or to the environment in which food is stored.
110
Question
Q. What comorbidity is typically diagnosed in patients with alcoholic cirrhosis?
Edema
Kidney failure
Malnutrition
Cachexia
Global malnutrition or nutritional status alteration such as micronutrient deficiency (potentially caused by poor nutritional intake, poor absorption, or increased losses) is often diagnosed in patients with cirrhosis. Malnutrition is present in almost every patient with alcoholic cirrhosis.
111
Question
Q. What is the most practical strategy to assist with providing culturally relevant resources for clients?
Advertise a preference for clients of the same ethnic background
Contract on-call translators fluent in multiple languages
Hire peer counselors that represent the cultures of clientele
Specify in job listings that only certain ethnicities will be considered
Trained health care providers should be able to relate to patients in a fair and equal manner, and studies suggest that a provider of the same ethnicity as their patients tends to provide more effective interpersonal care than a practitioner from a different background. But this matching of client-practitioner backgrounds is not always possible. Peer counselors have been shown to be effective educators and can work with RDNs to provide culturally relevant nutrition care to clients of different ethnicities.
112
Q. Which of the following foods should be limited in women taking tamoxifen?
Tofu
Edamame
Chickpeas
Grapefruit juice
Grapefruit is known as interfering with a host of medications, including tamoxifen. Meanwhile, there is a lot of misinformation regarding soy and estrogens. Though there are concerns regarding “phytoestrogens” in soy foods that have led to recommendations that women who take tamoxifen should avoid soy foods (the hypothesis is that these foods could negate the medication’s estrogen-blocking effects), research demonstrates that soy foods appear to enhance or improve tamoxifen’s breast cancer–blocking actions.
113
Q. Which pathogen accounts for the greatest percentage of foodborne illness?
Norovirus
Staphylococcus aureus
Mold
Clostridium perfringens
Norovirus is the most common cause of foodborne illnesses, accounting for 58% of domestically acquired foodborne illnesses. Staphylococcus aureus is among the top 5 causes but only accounts for 3% of domestically acquired foodborne illness.
114
Q. Which vitamins are potentially indicated for liver disease–related impaired bile flow?
Folic acid and vitamin B12
Vitamins A and E
Vitamins B12 and A
Thiamin and riboflavin
Bile acid is essential for the normal uptake of fat-soluble vitamins into the liver where they are metabolized. Vitamins A and E are fat soluble.
115
Q. This enzyme found in the kidney is needed for the conversion of 25-hydroxyvitamin D3 to the active form.
25-hydroxylase
24-hydroxylase
1- hydroxylase
22-hydroxylase
The 1-hydroxylase enzyme is found in highest concentrations in the kidneys and is responsible for converting 25-hydroxyvitamin D3 to 1,25-dihydroxyvitamin D (its active form). 25-hydroxylase is the enzyme responsible for the first required hydroxylation of D3 and is found in the liver. 24-hydroxylase is responsible for the breakdown of the vitamin.
116
Q. Which pancreatic function is involved in cystic fibrosis?
Exocrine
Endocrine
Hormonal
Glucoregulatory
The two main functions of the pancreas are the endocrine function, which is responsible for blood glucose homeostasis, and the exocrine function, which contributes to macronutrient digestion. Macronutrient digestion, particularly fat digestion, is compromised in the most common genetic variant of cystic fibrosis, which is cystic fibrosis with pancreatic insufficiency.
117
Q. Which of the following ingredients may negatively affect cardiovascular function in a person with high cola intake?
Citric acid
Sodium
Caramel coloring
Phosphate
A high-phosphate intake has been shown to impair endothelial cell function in the vascular system. ”Free” (unorganically bound) phosphate that is added to food is very efficiently absorbed in the gastrointestinal tract, unlike organically bound phosphate that occurs naturally in protein-dominant foods and some grain foods.
118
Q. What is OSFED?
A subsidiary of the US Food and Drug Administration
A type of obstructive sleep disorder
An eating disorder classification
An oncology specialist credential
OSFED, or other specified feeding or eating disorders, is a classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to assign a diagnosis to individuals with significant disordered eating behaviors but who don’t meet the threshold of strict diagnostic criteria. OSFED was introduced in the 5th edition of the DSM and replaced the previous classification of EDNOS, or, eating disorder not otherwise specified.
119
Q. Which of the following diabetes medications should not be prescribed to an elderly person as it has a higher risk of severe prolonged hypoglycemia and is listed in the 2015 Beers criteria?
insulin degludec (Tresiba)
Metformin
Sitagliptin (Januvia)
Glyburide
Metformin and sitagliptin do not cause hypoglycemia. Insulin degludec is a long-acting insulin that can be safely used in elderly individuals. Glyburide is unsafe to use in an elderly population and is among the medications listed in the Beers criteria for medications potentially inappropriate for older adults.
120
Q. Which of the following is true of the IDDSI Level 7 Regular (Black) diet
Crunchy and hard foods are the only restriction
There are no restrictions on allowable foods
Mixed-consistency foods are permitted for adult patients only
Food particle size is the only restriction
The Level 7 Regular (Black) diet of the International Dysphagia Diet Standardisation Initiative is not a texture-modified diet and therefore there are no restrictions on allowable foods on this diet.
121
Q. Prioritization of nutrition interventions includes client preference, urgency, impact potential, and which of the following?
Practice guidelines
Available resources
Insurance coverage
Hospital protocols
Many clients need multiple nutrition interventions to resolve or mitigate their nutrition problems. RDNs should prioritize the nutrition interventions based on client preference, urgency, impact potential, and available resources.
122
Q. Which of the following is a malnutrition diagnosis in Nutrition Care Process terminology?
New-onset illness malnutrition
Acute disease or condition-related malnutrition
Nutrient deficiency-related malnutrition
Chronic disease or condition-related malnutrition
The malnutrition diagnoses in the Nutrition Care Process terminology include the following: malnutrition (undernutrition), starvation-related malnutrition, chronic disease or condition-related malnutrition, acute disease or injury-related malnutrition, non-illness-related pediatric malnutrition, and illness-related pediatric malnutrition.
123
Q. Which of the following is a recommendation for people with dumping syndrome?
Avoid simple sugars such as sucrose
Consume a low-fat diet for more efficient stomach emptying
Sit up after meals
Consume more liquids because they empty out of the stomach most easily
Late dumping syndrome results from rapid movement of sugar into the intestine, which raises the body's blood glucose level and causes the pancreas to increase its release of the hormone insulin. The increased release of insulin causes a rapid drop in blood glucose.
124
Q. Breastmilk is rich in
glucose
maltose
amylose
lactose
Lactose is the predominant carbohydrate in human milk. Lactose enhances absorption of calcium in breastmilk.
125
Q. Which of the following enhances the vitamin D2 content in mushrooms?
Ultraviolet radiation
Pasteurization
Boiling
Thermal processing
D2 is the most common vitamin D in mushrooms, and using an ultraviolet light source such as sunlight or a UV lamp can generate nutritionally relevant vitamin D levels. Storage and cooking may result in decreased vitamin D2 in UV-exposed mushrooms, but if eaten fresh, the vitamin D level in these mushrooms may remain higher than the amounts in other foods containing vitamin D.
126
Q. Which of the following is categorized as dairy according to MyPlate?
Butter
Cream
Cream cheese
Fortified soy milk
According to MyPlate, foods made from milk that have little to no calcium—including cream cheese, cream, and butter—are not included in the Dairy Group. Soy milk is categorized as dairy when it is fortified with calcium.
127
Q. Which of the following is the fork drip test for IDDSI Level 4 Pureed/Extremely Thick?
Scooped sample sits in mound on fork and does not drip easily through prongs
Small sample amount drips continuously through the prongs
Sample drips slowly in dollops through the prongs, which do not leave a clear pattern
Sample shows no sign of dripping through the prongs
The fork drip test for the Level 4 Pureed/Extremely Thick diet of the International Dysphagia Diet Standardisation Initiative requires that a scooped sample sits in mound on the fork and does not drip easily through prongs.
128
. What is the minimum width that aisles should be to accommodate individuals who require wheelchairs in a hospital cafeteria’s foodservice line?
32”
34”
36”
40”
To accommodate wheelchairs, the aisle in a hospital cafeteria foodservice line needs to be a minimum of 36".
129
Q. What is the term for when two or more professionals from different disciplines learn about each other’s professions with the goal to improve collaboration and quality of medical care?
Interprofessional education
Multiprofessional education
Collaborative practice
Multidisciplinary education
Rationale: In multidisciplinary education and multiprofessional education, students can be taught together, but no interaction between professionals occurs. In interprofessional education, educators and learners from two or more health professions jointly create and foster a collaborative learning environment. These efforts are intended to develop knowledge, skills, and attitudes that enhance interprofessional team behaviors and competence.
130
. Why should meat be heated to 160°F before drying to make jerky?
To facilitate forming the meat into jerky shape
To destroy bacteria via wet heat
To prevent oxidation that could affect color of final product
To maximize the flavor retention
The USDA recommends heating meat to 160°F (poultry to 165°F) before dehydrating process to ensure that wet heat will destroy any bacteria present.
131
Q. How long should parenteral nutrition be withheld in a well-nourished ICU patient who is classified as NPO and enteral intake is not feasible?
Rationale: According to the American Society for Parenteral and Enteral Nutrition guidelines, parenteral nutrition is not initiated until after 7 days following ICU admission if enteral nutrition is not feasible. Parenteral nutrition can result in an increased risk of morbidity and mortality and increased blood glucose, among other complications.
132
Q. Which diet plan for patients with cardiovascular disease follows the US Dietary Guidelines for physical activity, saturated and trans fat, cholesterol, sodium, and consumption of fiber, stanol esters, and whole grains?
DASH
REAP
TLC
CAGE
Rationale: The Therapeutic Lifestyle Changes (TLC) diet incorporates physical activity; decreased saturated and trans fat, cholesterol, and sodium intake; and increased consumption of fiber, stanol esters, and whole grains.
133
. Warfarin acts as a vitamin K antagonist by inhibiting which of the following?
gamma-carboxylase
vitamin K epoxide reductase
formation of active proenzyme factor
breakdown of fibrinogen
Rationale: Warfarin inhibits the epoxide reductase enzyme in the vitamin K cycle.
134
Q. Which of the following is a function of insulin as an anabolic hormone?
Decreases glucose uptake into muscle
Increases fatty acid synthesis
Decreases glycogen synthesis
Increases gluconeogenesis
Rationale: Insulin increases fatty acid synthesis using excess glucose and fructose. Insulin increases glucose uptake into muscles and adipose tissue, increases glycogen synthesis in liver and skeletal tissue, and decreases gluconeogensis in the liver.
135
Q. Prolonged use of PPIs (proton pump inhibitors) such as omeprazole can lead to which of the following?
Bone fractures
Polyps
Constipation
Vitamin D deficiency
Rationale: PPIs have been overprescribed and recent guidelines have directed providers when benefits outweighs risk. Gastric acid secretion can facilitate calcium absorption and acid suppressants such as PPI can decrease calcium absorption and bone density.
136
Question
Q. Which of the following is characterized by customers selecting items from both displays and service counters and paying for those items at a centralized location within the establishment?
Takeout service
Table service
Self service
Counter service
Rationale: Self service is characterized by customers choosing what they want from displayed items and service counters and paying for the items in a centralized location within the establishment. Table service is provided by waitstaff. Counter service is characterized by efficiency and a structure wherein orders are placed with a counter attendant. Takeout service is characterized by consumers purchasing food in one location and enjoying their purchase at another location of their choosing.
137
Q. Which of the following is likely to be present in a patient with an alcohol use disorder (AUD)?
Aversion to sweets
Gut dysbiosis
Lower synthesis of bile acids
Elevated serum albumin
Gut dysbiosis may be present in people with AUD. These individuals also tend to have a preference for sweets and an increased synthesis of bile acids. People with AUD tend to have low serum albumin.
138
Q. Which of the foods listed has the highest environmental impact?
Orange
Salmon
Cow's milk
Broccoli
Rationale: Meat has been identified as having the highest greenhouse emissions, and thus the highest environmental impact, followed by dairy products, poultry, and fluid milk. (Note that according to the US Dietary Guidelines, meats comprise beef, goat, lamb, pork, and game meat such as bison, moose, elk, and deer.)
139
Q. Monitor, spokesperson, and disseminator are tenets of which type of managerial role?
Rationale: An information manager is a monitor, spokesperson, and disseminator.
140
Q. Which of the following is a young, castrated male chicken, which is very tender and meaty?
Broiler
Poussin
Capon
Fryer
Rationale: Broilers and fryers are young chickens of either sex. Poussin are small, immature chicken. Capons are young, castrated male chickens.
141
Q. Which of the following is a sampling method whereby names of prospective interview subjects for a statistical study are obtained from subjects already interviewed?
Snowball
Probability
Purposive
Convenience
Rationale: In snowball sampling, prospective interview subjects for a statistical study are culled from recommendations from an existing pool of interviewed subjects.
142
Q. When using the plan-do-study-act (PDSA) process, which of the following occurs during the plan phase?
Determine how to collect data
Train staff on new process
Evaluate the effectiveness of the project
Reduce wait time for appointments
Determination of data collection methods occurs during the planning phase. Staff training and evaluation of effectiveness occur after a project has been implemented. Reduction of appointment waiting times would be an example of a quality improvement project goal.
143
Q. Which of the following compounds is necessary for transporting non-esterified fatty acids (NEFA) into mitochrondria for beta-oxidation
Rationale: Carnitine is a part of carnitine acyltransferase (CAT) and necessary for transporting NEFA into the inner mitochondria for beta-oxidation.
144
Question
Q. Which of the following sweeteners is made with rebaudioside A?
Neotame
Aspartame
Sucralose
Stevia
Rationale: Stevia is made with rebaudioside A. The sweeteners neotame, aspartame, and sucralose are made with other compounds.
145
Question
Q. Which of the following questions is the best example of the “teach back” method?
“Does that make sense?”
”Do you know how many grams of sodium are in a can of chicken noodle soup?”
“What questions do you have for me?”
“Can you tell me in your own words what changes you will make when going home
Rationale: ”Because asking if something makes sense or if there are any questions call for yes or no answers, they are not examples of the teach back method. A question that quizzes about knowledge, as in Option B, is incorrect because it is a direct question that feels like a test. Option D is the correct answer because it is open-ended and allows the patient/client to demonstrate the knowledge they have attained.
146
Q. Which condition involves damaged enterocytes caused by ingesting foods that are not harmful to most people?
Food allergy
Lactose intolerance
Celiac disease
Fructose intolerance
Rationale: In celiac disease, enteropathy is caused by gluten in genetically predisposed individuals. Immune activation in response to proteins in certain grain foods that are not harmful to most results in intestinal damage.
147
Q. Non-steroidal anti-inflammatory drugs (NSAID) inhibits which enzyme to reduce inflammation?
Cytokines producing enzymes
Histamine producing enzyme
Lipooxygenase
Cyclooxygenase
Rationale: Cyclooxygenase—COX 1 and COX 2—are blocked by NSAIDs.
148
Q. “Affective commitment” is defined as a commitment to an organization because
the personal cost of leaving is too great.
there is a contractual obligation for a specific time frame.
the employee believes no one else is qualified for the role.
the employee is satisfied with working for the organization.
Rationale: Affective commitment refers to an employee’s positive emotional regard for an organization.
149
Which of the following is the safe and recommended method for canning foods above pH 4.6?
Boiling water canning
Pressure canning
Steam canning
Oven method canning
Foods that are low acid (pH of 4.6 or higher) include vegetables, meats, dried beans, and all soups. These will need to be preserved using a pressure canner. High acid foods contain enough acid to have a pH level of 4.6 or lower. These will need to be preserved using a water bath canner.
150
Q. When using IDDSI abbreviations (such as MM5 for minced and moist) in foodservice software, why is the number listed after the letters?
To ensure the number isn't misinterpreted as the amount of meals or drinks being ordered
To be in accordance with the Nutrition Care Process Terminology alphanumeric coding system
To be in accordance with the ICD-10 alphanumeric coding system
To avoid confusion with other medical terms with similar abbreviations
IDDSI abbreviations list letters before numbers to avoid misinterpretation that the number reflects the amount of meals or drinks being ordered.
151
Q. Which of the following is a synthetic functional fiber?
Polydextrose
B-glucan
Cellulose
Lignin
Rationale: Polydextrose is a synthetic functional fiber. B-glucan, cellulose, and lignin are naturally occurring plant fibers and are considered dietary fibers (unless extracted and isolated, at which point they may be considered functional fibers).
152
Q. The World Health Organization growth charts for children younger than age 2 are based on data from which of the following populations?
Infants who were primarily breastfed until at least 4 months of age and continued through 12 months
Infants who were primarily breastfed until at least 6 months of age and continued through 12 months
Infants who were formula fed due to free formula distribution for at least 12 months
Infants who were primarily breastfed until at least 2 months of age and continued through 12 months
Rationale: The WHO growth curves are expected to offer a single international standard that represents optimal physiological growth for all children from birth to 5 years of age and to establish the breastfed infant as the normative model for growth and development. The growth curves are based on data measured in infants who were primarily breastfed until age 4 months and continued through12 months.
153
Q. Which of the following denotes an enlargement of an organ or tissues caused by growth in cell size?
Hyperplasia
Hypertrophy
Maturation
Cellular replication
Rationale: Hypertrophy is an enlargement of an organ or tissues caused by cell growth. Hyperplasia is when this enlargement is caused by increase in number of cells.
154
Q. When is it recommended to test A1C quarterly?
When patient is newly diagnosed with type 2 diabetes
When patient's therapy has changed or glycemic goals are unmet
When patient is meeting treatment goals and has stable glycemic control
When patient is an older adult with advanced diabetes
The American Diabetes Association recommends quarterly A1C testing for patients whose treatment has changed or who are not meeting glycemic goals and that patients who are meeting treatment goals and have stable glycemic control be tested twice per year. The ADA also has noted that there is very little need for monitoring and lowering A1C in older adults with advanced diabetes.
155
Q. The first milk produced by the mother, colostrum, is particularly high in which of the following compounds?
Casein
Lactose
Carotenoids
Iron
Rationale: Colostrum is high in carotenoids, which is why it tends to be yellowish in color; it is low in lactose and fat and rich in protein and antibodies. Although breastmilk is eventually high in casein, this is not true of early breastmilk. The whey/casein ratio in human milk fluctuates between 70/30 and 80/20 in early lactation and decreases to 50/50 in later lactation.
156
Q. Which immunoglobulin mediates the classical type of food allergy?
IgA
IgM
IgG
IgE
Rationale: IgE is involved in the hypersensitivity response. IgG is a “memory” antibody that engages after exposure to the allergen. IgA levels play a role in autoimmune conditions. IgM is the first antibody secreted when the body is fighting a new infection.
157
Q. A patient presents with B12 deficiency. Which of the following conditions may be implicated, necessitating additional data and evaluation in this patient?
Dysphagia and gastroesophageal reflux disease
Hyperlipidemia and hypertension
Crohn’s disease and anemia
Pale skin and fatigue
Some assessment data may implicate more than one condition, requiring more information to identify the appropriate diagnosis and intervention. For example, patients with Crohn’s disease and anemia have greater risk for B12 deficiency, but B12 deficiency is not a symptom of dysphagia, GERD, hyperlipidemia, or hypertension. Pale skin and fatigue are symptoms of, not diagnoses related to, B12 deficiency.
158
Q. What is often present in the gut microbiota of people who eat a Western diet?
Firmicutes
Fusobacteria
Bacteroidetes
Cyanobacteria
Rationale: The typical, highly processed Western diet results in a preponderance of firmicutes in the gut microbiota. Bacteroidetes are common in the gut microbiota of Africans who consume a diet that is very high in fiber.
159
Q. Which of the following is a recommended approach to dealing with theft in the workplace?
Use taking small items like pens and tape as examples of theft
Avoid the topic until there is theft to avoid sounding accusatory
Only speak on the topic of theft in meetings with individual employees
Encourage employees to use their phone cameras for surveillance
It is recommended that conversations about workplace theft include giving specific examples of how stealing is wrong, even if it's a small item like a pen or tape dispenser that was taken. Preemptive discussions at staff meetings, in email, and on printed postings will help to make it clear that theft will not be tolerated and are preferred over waiting until there is a problem to address. Employees should be discouraged from taking matters into their own hands, so using phone cameras as surveillance tools is not recommended and may be illegal or against company policy.
160
Q. Which of the following would be considered a transitional food according to the IDDSI framework?
Honey
Ice cream
Oatmeal
Pudding
"Transitional foods" are substances that change quickly to become easier to chew or swallow with added moisture (eg, water or saliva) or a change in temperature. According to the International Dysphagia Diet Standardisation Initiative framework, frozen desserts such as ice cream, sherbet, malts, and frozen yogurt and some potato chips are considered transitional foods.
161
Q. Which of the following is highest in carbohydrate?
3 cups air-popped popcorn, plain
½ cup cooked oatmeal, plain
2 cups milk
½ cup cooked corn
Among the options listed, 2 cups milk is the highest in carbohydrate.
3 cups air-popped popcorn, plain: 19 g carbohydrate
½ cup cooked oatmeal, plain: 14 g carbohydrate
2 cups milk: 23 g carbohydrate
½ cup cooked corn: 16 g carbohydrate
162
Question
Q. Enterocytes are
cells of the colon
parietal cells
cells of the gastrointestinal tract
cells of the stomach lining
Rationale: The gastrointestinal tract is lined by a continuous sheet of epithelial cells, also known as “enterocytes,” which are responsible for processing and moving nutrients from the lumenal space into the vasculature for distribution to peripheral tissues.
163
Q. Which of the following is a concern in patients who require parenteral nutrition and are not receiving oral or enteral nutrition?
Decreased peristalsis
Increased peristalsis
Inadequate energy intake
Infection from bacterial translocation
Rationale: Bacterial translocation is a common concern in patients who require parenteral nutrition and are not receiving oral or enteral nutrition; bacterial translocation can possibly result in infection.
164
Question
Q. Which of these foods is among the highest in phospholipids?
Turkey
Eggplant
Liver
Brown rice
Phospholipids are present in all plant and animal membranes. They occur naturally in food and are both water soluble and fat soluble. The foods highest in phospholipid include pork and chicken liver, eggs, soybeans, wheat germ, and peanuts.
165
Q. GLP-1 is an incretin hormone that is produced in the
stomach
intestines
tongue
pancreas
Rationale: GLP-1 is synthesized in and secreted from enteroendocrine cells found throughout the small and large intestine. Secretion is upregulated with the presence of food in the GI tract.
166
Question
Q. The structure that anchors the yolk in the center of an egg is called _____.
vitelline membrane
albumen
cholesterol
chalazae
Rationale: Chalazae are two ropey egg white strands on opposite ends of the egg that anchor the egg yolk in the shell.
167
Q. What is the weight gain recommendation during a single gestation pregnancy for person with a body mass index of 20?
15–20 lb
28–40 lb
25–35 lb
35–45 lb
Rationale: The Institute of Medicine recommends normal weight women gain 25–35 lb. The recommendation for overweight women is 15–25 lb and 35–45 lb for twin gestation.
168
Q. Which of these fruits is safest for consumption by individuals with fructose intolerance?
Guava
Berries
Papaya
Watermelon
Rationale: Berries are among the recommended fruits for individuals with fructose intolerance. Guava, papaya, and watermelon are potentially safe in individuals with fructose intolerance but intake should be limited.
169
Question
Q. When diagnosing malnutrition in older adults, what is the measurement for determining diminished functional status?
Continence
Ambulation
Ability to self-feed
Handgrip strength
There are six characteristics recommended for identifying malnutrition in older adults:
Insufficient energy intake
Weight loss
Loss of muscle mass
Loss of subcutaneous fat
Localized or generalized fluid accumulation
Diminished functional status as measured by handgrip strength
Because there is no single, definitive parameter for diagnosing adult malnutrition, it is recommended that diagnosis be contingent on presence of at least two of these parameters.
170
Q. Fasting to ensure chylomicron triglycerides aren’t measured should be done before testing for which of the following conditions?
Dysphagia
Diabetes
Congenital sucrase-isomaltase disease
Crohn's disease
Triglyceride measurement as part of a lipid panel requires fasting, because blood triglycerides are present in substantial quantities in both chylomicrons and very-low-density lipoprotein (VLDL), and fasting to exclude chylomicron triglycerides helps to ensure an accurate measurement. Lipid panels are often evaluated in patients with diabetes, overweight/obesity, and high blood pressure. Dysphagia, CSID, and Crohn’s disease don’t require a lipid panel.
171
Q. A pot of chili was left on the counter for 5 hours after service. The next step should be:
Reheating it to 140°F and refrigerate in a shallow pan
Discarding it
Reheating it to 165° F and refrigerate it
Refrigerating it in shallow pans
The Food Code indicates that if a food hasn’t been cooled within 2 hours from 135°F to 70°F, it becomes a potentially hazardous food. The pot of chili has been in the temperature danger zone for a large period of time and is no longer considered safe to eat. The chili should be discarded.
172
Q. Which of the following is an example of a care conference?
A renal dietetics specialist at a national conference presents emerging evidence on a new treatment protocol
Volunteers from across allied health convene to review hospital protocols and identify targets for reassessment
Foodservice managers review the menus for patients with cancer to ensure they are aligned with treatment goals
Multidisciplinary professionals meet to discuss the progress of a patient who has had laparoscopic surgery
Solution:
The correct answer is D.
A care conference convenes to discuss the at-home or in-facility health care a patient receives and involves the entire multidisciplinary team. This care conference may include health care professionals who have worked with this patient and experts who have not been part of the delivery of care.
Quill TE, Jackson VA, Jacobsen JC. The initial interview in palliative care consultation. UptoDate. Updated July 2019. Accessed November 23, 2021. Available at: Website
173
Q. Which of the following classes of medication would require patient education on hypoglycemia?
SGLT2
DPP4
GLP1
Sulfonylureas
Sulfonylureas work by increasing the amount of insulin the body produces and can lower blood sugar levels by approximately 20% and can cause hypoglycemia.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors lower blood sugar by increasing the excretion of sugar in the urine. They do not cause low blood sugar.
DPP4 inhibitors lower blood sugar levels by increasing insulin release from the pancreas in response to a meal. These medicines do not cause hypoglycemia.
GLP-1 receptor agonists are given by injection that increase insulin release in response to a meal and slow digestion. They do not usually cause low blood sugar when used without other medications that cause low blood sugar.
174
Q. A child with phenylketonuria has deficiency of which enzyme?
Phenylalanine kinase
Phenylalanine hydroxylase
Phenylalanine dehydrogenase
Tyrosine kinase
Rationale: PKU is caused by deficiency of phenylalanine hydroxylase.
175
Q. Which of the following is best practice when translating educational materials from English to another language in a culturally sensitive way?
Contract with a native speaker of the language to do the translation
Avoid translating until the text is written well in English
Contract with one reviewer to check for cultural and linguistic appropriateness
Translate the content word for word
Rationale: Before translating a document, it should be written well in English, because if the original English text is too difficult, the translated text will probably also be too difficult. It cannot be assumed that native speakers of a given language are skilled at writing or at translating, so the person contracted to translate should it is more important that the translator be a professional translator than simply a native speaker. More than one individual should review the translation. Word-for-word, or literal, translations do not account for linguistic and cultural differences.
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Q. What is the maximum rate for providing dextrose via parenteral nutrition to a critically ill patient?
5 mg/kg/minute
6 mg/kg/minute
7 mg/kg/minute
8 mg/kg/minute
Rationale: When a person is experiencing ongoing catabolic process (such as critical illness), the maximum glucose oxidation rate is approximately 5 mg/kg/minute. Providing dextrose in amounts that exceed 5 mg/kg/minute may result in hyperglycemia and lipogenesis. Thus, dextrose provision should not exceed 5 m/kg/minute over a 24-hour period in critically patients. In patients who are stable and not critically ill, dextrose provision of 5-7 mg/kg/minute is generally tolerated.
