Practice Questions Flashcards
(238 cards)
1
Q
Long-term use of lithium, a treatment for bipolar disorder, can lead to which of the following?
Hypercalcemia
Hypomagnesemia
Hyperkalemia
Hypoalbuminemia
A
Hypercalcemia
2
Q
Which of the following is a potent immune modulator known to suppress the development of autoimmune diseases?
Vit C
Vit A
Zn
Vit D
A
Vit D; know the prevent devlopment and deficiencies linked to various AI diseases like Hashi’s
3
Q
Smokers are most at risk for which of the following nutrient deficiencies?
Vit E
Folate
Thiamin
Vit C
A
Vit C - require an additional 35 mg/day to counteract the accelerated depletion of the body’s ascorbic acid pool caused by smoking, ensuring sufficient levels repair ox damage
4
Q
In which condition might turmeric supp be contraindicated?
MS
Fatty liver
T2DM
Cholelithiasis
A
Cholelithiasis (gallstones) - turmeric may stimulate gallbladder contractions and increase bile flow so may worsen this condition
5
Q
Which of the following is not a characteristic of foodbourne viruses?
They can be destroyed by normal cooking temps
They are carried by humans & animals
They are highly contagious
They do not grow in food
A
They can be destroyed by normal cooking temps - hep A and norovirus are examples; they require a living host to grow but do not grow in food but can be transferred through food
6
Q
What is Addisons Disease? Wilsons?
A
Addisons - adrenals don’t produce enough cortisol and aldosterone
WIlsons - body can’t properly process copper, leading to its build up in organs like liver, brain, eyes
7
Q
Which of the following compounds, acting as co-substrates, accepts protons and electrons in the TCA cycle?
NADH and FADH2
NAD2 and FAD+
pyruvate and coenzyme A
NAD+ and FAD
A
NAD+ and FAD; once electrons and protons are accepted NADH and FADH2 are formed
8
Q
When cooking fish, the minimum internal temp should reach how many degrees F?
160
145
155
150
A
145
9
Q
What is the recommended protein intake for individuals with COPD?
0.8-1.1 g/kg
2-2.5 g/kg
1.2-1.5 g/kg
1.5-2 g/kg
A
1.2-1.5 g/kg
10
Q
Biocytin consistents of biotin bound to the amino acid ___
lysine
leucine
glycine
alanine
A
lysine
11
Q
What condition is characterized by the presence of gastrin-producing tumor, which can lead to vit b12 def?
pernicious anemia
zollinger-ellison syndrome
marfarn syndrome
atrophic gastritis
A
zollinger-ellison syndrome
12
Q
Which of the following conditions is likely to result in increased urinary losses of vit D binding protein?
liver disease
renal disorders
dyslipidemia
gout
A
renal disorders
13
Q
what prevents the backflow of chyme from the duodenum into the stomach? what controls the passage of chyme (partially digested food) from the SI into the large intestine?
A
pyloric sphincter
ileocecal sphincter
14
Q
Which of the following is NOT one of the three P’s associated with diabetes?
polydipsia
polyuria
polymyositis
polyphagia
A
Polymyositis
polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger)
15
Q
Why might a celiac disease client on a GF diet still require some form of supplementation?
Most specialty GF products are not fortified w/iron, folate, and other B vitamins
GF diets increase calorie intake, thus requiring additonal supplementation
GF products are usually replaced w/junk food
the body’s ability to absorb nutrients becomes permanently impaired after a celiac disease dx
A
Most specialty GF products are not fortified w/iron, folate, and other B vitamins
the intestinal mucosa does start to heal following a GF diet and absorption usually improves
16
Q
Polysaccharides contain how many saccharides? How about oligosaccharides? Examples of each?
A
more than 10 (starch, cellulose, glycogen)
2-10 (sucrose, lactose, raffinose, GOS, FOS)
17
Q
All of the following are benefits of breastfeeding for an infant except? decreased risk of…
T2DM
All are benefits
celiac
leukemia
A
all are benefits
18
Q
What is the recommended protein intake for individuals with CKD stages 1-4? What about if someones one dialysis?
0.8-1 g/kg
0.6-0.8 g/kg
0.4-0.6 g/kg
1-1.2 g/kg
A
0.6-0.8 g/kg
stages 1-4 is about .75 g/kg, stage 5 is 0.6 g/kg; protein restriction can minimize the sx of uremic toxicity by reducing the production of nitrogenous wastes in the blood; early protein restriction in the course of CKD may slow progression and delay need for dialysis
for dialysis ~1.2 g/kg
19
Q
At what stage is fluid restricted in CKD?
A
when on dialysis
20
Q
What vitamin deficiencies are associated with cheilosis
A
B2, B3, B6
21
Q
GI conditions that arise in those w/anorexia nervosa include all the following except?
increased gastric emptying
decreased small bowel motility
lactose intolerance
constipation
A
Increased gastric emptying
22
Q
Which of the following is not a major interaction with Metformin?
grapefruit
siberian cocklebur
all of these are major interactions
activated charcoal
A
grapefruit, known to interact w/many drugs, but metformin is not one of them
activated charcoal reduces systemic exposure to many drugs so may potentially reduce absorption and/or half life
siberian cocklebur has been associated w/severe hypoglycemia in humans
23
Q
What does a relative risk greater than 1 indicate?
- the event is more likely to occur in the exposed group compared to the non-exposed group
- the likelihood of the event occurring is the same in both the exposed and non-exposed group
- the event is not influenced by the exposure status of individuals
- the event is less likely to occur in the exposed group compared to the non-exposed group
A
the event is more likely to occur in the exposed group compared to the non-exposed group
24
Q
Which of the following inherited disorders can impair the conversion of pantothenic acid to coenzyme A?
pantothenate kinase-associated neurodegeneration
maple syrup urine disease
sickle cell anemia
hartnup disease
A
pantothenate kinase-associated neurodegeneration
25
What is the recommended daily protein intake post-bariatric surgery?
0.6-0.8 g/kg
1.1-1.5 g/kg
0.8-1.0 g/kg
protein should be avoided post bariatric surgery for a month
1.1-1.5 g/kg - protein deficiency is common
26
which of the following statements about lignin is false?
1. It primarily resides in the bran layer of cereals and in the stems of various fruits/veg
2. not generally fermented by colonic bacteria
3. is water soluble
4. wheat bran is a particularly rich source
is water soluble, FALSE, its water insoluble
lignin (dietary and functional fiber) - support within plan cell walls, water INSOLUBLE, and generally not fermented by colonic bacteria
foods rich in lignin = whole grains like wheat bran, rye, and broccoli, root veg like carrots, flax, and fruits containing edible seeds like berries (It contributes to the firm and crunchy texture of vegetables and is a key component of dietary fiber)
27
What types of foods should be limited or avoided to manage dumping snydrome?
foods high in protein
fiber-rich
foods high in fat
simple sugar foods
simple sugar foods
dumping syndrome - conditon where food moves too quickly from stomach into small intestine causing diarrhea, vomit, nausea. usually caused by stomach surgery but can also occur with GI disorders, diabetes, or certain meds
28
During the synthsis of catecholemines, which vitamin plays a role in reducing oxidized mineral cofactors?
vit C
selenium
vit A
vit E
Vit C
29
Which nutrient def is considered a global nutritional def?
vit D
calcium
zinc
pantothenic acid
vit D
30
Anticonvulsant treatment has been associated with lower ___ levels in those w/epilepsy
biotin
niacin
riboflavin
thiamin
biotin
31
What form of niacin in large doses lowers blood lipids?
nicotinic acid
nicotinamide
nicotinic acid
32
How do higher serum Mg concentrations affect PTH secretion?
1. higher serum Mg concentrations have no effect on PTH secretion
2. higher serum Mg concentrations suppress PTH
3. higher serum Mg concentrations increase PTH secretion
4. PTH only plays a role in calcium homeostasis
higher serum Mg concentrations suppress PTH
33
Vitamin B6 def can lead to which type of anemia? Why??
microcytic
macrocytic
thalassemia
pernicious anemia
microcytic, b6 is needed for hemoglobin formation
34
The bioavailability of ______ from vegetarian diets is lower than from non-vegetarian diets because vegetarians typically eat large amounts of legumes and whole grains, which contain phytates that bind ______ and inhibit its absorption . Fruits and vegetables contain very little ______. In addition, meat is high in bioavailable ______ . As a result, vegetarians and vegans usually have lower dietary intakes of ______ and lower serum ______ levels than non-vegetarians. The RDA for vegetarians is higher than for meat eaters due to lower bioavailability from plant foods.
b12
zinc
calcium
Mg
zinc
35
Chvostek’s sign is positive in significant deficiencies of which of the following minerals? (select the best answer from those listed)
Calcium
Magnesium
Phosphorus and Calcium
Calcium and Magnesium
calcium & mag
A positive Chvostek's sign indicates a twitching of the facial muscles on the same side as the tap, when the facial nerve is tapped in front of the ear. This is a sign of neuromuscular hyperexcitability, and is often associated with hypocalcemia (low calcium levels in the blood)
"Aside from hypocalcemia, other factors can be responsible for a positive Chvostek sign, including kidney failure, acute pancreatitis, and certain medications (e.g., bisphosphonates, proton pump inhibitors). Electrolyte imbalances, such as low levels of vitamin D and magnesium, can also increase the excitability of the facial nerves and indicate a positive Chvostek sign. Additionally, this sign may present in respiratory alkalosis, most commonly caused by hyperventilation, or fast breathing
36
__________ is required to convert thiamin to its biologically active form and is also required for certain thiamin-dependent enzymes
Magnesium
Zinc
Vitamin B6
Vitamin C
Magnesium
37
Which fat-soluble vitamins is not present in adequate amounts in breast milk?
K
The American Academy of Pediatrics recommends that all newborns, whether breastfed or formula fed, receive a one-time intramuscular shot of vitamin K within 6 hours after birth
38
38) What is the recommended daily intake of calcium for adults?
500-600 mg
700-800 mg
1000-1200 mg
1500-2000 mg
1000-1200 mg
39
Pair the following hormones w/actions
1. Glucagon
2. Gastrin
3. Secretin
4. Cholecystokinin
A. stimulates the secretion of gastric juices
B. stimulates the pancreas to secrete bicarbonate and other fluids
C. stimulates release of bile from gallbladder
D. increases when glucose levels are too low
1. D
2. A
3. B
4. C
40
A client reports increasing his water intake and is consuming 100 ounces daily, has noticed an improvement in his ability to fall asleep, but reports nocturia nightly. What recommendations might you consider?
1. Reduce soda consumption
2. Reduce water intake until nocturia subsides
3. Add trace minerals to fluids
4. All of the above
all the above
41
Which of the following is used to boost dopamine? Choose the best answer & state actions of others
Mucuna pruriens
Holy Basil
Ashwaghanda
Horse Chestnut
Mucuna pruriens AKA velvet bean - contains 6-9% levodopa by wt, so used to counteract Parkinson’s sx
Holy basil - stress/anxiety support/immune support
Horse chestnut - helps w/chronic venous insufficiency; condition where veins in legs have poor blood flow
42
Which of the following nutrients is a precursor for the synthesis of prostaglandins
Omega-9 fatty acids
Omega-6 fatty acids
Vitamin E
Vitamin K
omega 6 - derived from arachidonic acid; they are hormone like substances that play a vital role in many bodily functions like pain, inflammation, and blood clot formation
43
Which medication could interact with calcium and other minerals, potentially leading to mineral deficiencies? What are these drugs used for?
Lisinopril
Metformin
Alendronate
None of the above
Alendronate - med for osteoporosis;
Patients taking alendronate should be advised to take the medication with a full glass of water and to wait at least 30 minutes before consuming any food or other medications
Lisinopril is an ACE inhibitor
44
Which foods may you recommend avoiding for clients taking monoamine oxidase inhibitors (MAOIs)?
Sauerkraut, kimchi, pickled beets, pickled cucumbers, and pickled peppers
Grains, including pasta, bread, cereal, and rice.
Canned legumes, such as lentils, black beans, and chickpeas
Caffeinated beverages such as coffee, tea, and soft drinks
Sauerkraut, kimchi, pickled beets, pickled cucumbers, and pickled peppers
MAOIs can cause a dangerous rise in blood pressure when taken with tyramine-containing foods, such as aged cheeses, cured meats, and fermented soy products, as well as fermented foods and pickles like sauerkraut, kimchi, pickled beets, pickled cucumbers, and pickled peppers
45
Which supplement should not be taken with levothyroxine?
Calcium
Iron
Vitamin D
Magnesium
Calcium
may interfere with the absorption of thyroid hormone medication such as levothyroxine. It is recommended to wait at least 4 hours between taking thyroid medication and calcium supplements
46
Gluconeogenesis is the reverse of glycolysis. In the liver, glucose can be made from the following except:
Succinyl CoA
Pyruvate
Lactic Acid
Alanine
succinyl CoA
During gluconeogenesis, glucose is made from pyruvate, lactic acid, or alanine, mostly in the liver.
47
Which nutrient is important for maintaining the integrity of the skin barrier and preventing moisture loss?
Vitamin A
Vitamin C
Vitamin E
Vitamin K
E
48
What’s the function of lysosome in saliva?
Destroying cell walls of bacteria
Regulating electrolyte balance
Breaking down fats
Breaking down carbs
Destroying cell walls of bacteria
49
Fasting would relieve which type of diarrhea?
Secretory
All of these
Osmotic
Exudative
Osmotic - primarily caused by poor absorption of osmotically active solutes in the intestines like simple sugars. These solutes draw water into the intestines d/t osmotic pressure, leading to diarrhea. By fasting, one would be preventing the intro of these solutes, potentially alleviating sx
50
Which phase of liver detox consists of conjugation rxns that’s increase the water solubility of xenobiotics?
Phase IV
Phase II
Phase I
Phase III
Phase II
Ph I - enzyme mediated oxidation or reduction of toxic substrates, ph II enzymatic conjugation of newly added or exposed functional groups to glucuronide, sulfate, or glutathione moeties. The conjugation reactions increase the water solubility of xenobiotics and mark them for carrier mediated transport and excretion
Ph I is mediated by CYP450, ph II includes UDP, sulfotransferases, methyltransferases, glutathione S-transferases, and N-acetyltransferases
51
TUL for choline?
2500
1500
3500
4500
3500
52
Which hormones, secreted d/t gastric acid in duodenum, stimulates pancreatic juice secretion and inhibits gastric acid secretion and emptying?
Lipase
Gastrin
Secretin
Amylase
Secretin - stimulates pancreas to release bicarbonate-rich fluids which helps neutralize chyme (partially digested food) entering the SI. Also inhibitors gastric acid secretion and slows down gastric motility
53
Which statement best describes bone modeling?
Continuous turnover of bone tissue through resorption and formation
Art of creating skeletal structures for anatomical studies
The loss of bone tissue d/t aging and other factors
Process of skeletal growth
Process of skeletal growth
Bone REMODELING would be continous turnover of bone tissue theough resorption and formation
54
Where does the ETC take place?
IMM
55
Which of the following is not a risk factor for developing kidney stones? MNT for kidney stones
Obesity
T2DM
Gastric banding surgery
Certain oral ABs
Gastric banding surgery
Obesity is strongest predictor of stone reoccurrence in firs time stone formers - they tend to excrete more sodium, calcium, uric acid, and citrate and have lower pH urine
High insulin may contribute to calcium stone formation by increasing urine calcium excretion
MNT - increase fluids, like oxalate rich foods like spinach, beets, rhubarb, almonds
56
What monosaccharides exit the absolute real membrane of the enterocyte and into the portal circulation using GLUT2?
All - galactose, glucose, fructose
57
What government agency regulates supplements?
FDA (safety concerns) and FTC (federal trade commission; label and health claims)
58
Describe pectin
Water soluble fiber found outer skin and rind of fruits (apples) and veg. Nearly completely fermented by bacteria, and used in production of jellies and jams to facilitate gelling
59
Which of following is primary structural protein for atherogenic lipoproteins?
Apoliporotein D
Apoliporotein B
Apoliporotein E-2
Apoliporotein A-1
Apo B
60
Regular take of which may benefit the microbiota of those with IBD? What probiotic is recommended for IBD?
Oligosaccharides
Resistant starch
Fermentable fibers
All
All - regular intake of prebiotic foods like those listed above are beneficial to the gut. Probiotics like VSL #3 shown to be beneficial in maintaining remission in those with IBD, esp UC
61
Which deficiency has been associated with lower T and lower sperm quality?
D
A
K
E
D; calcium also important
62
What nutrients are affected when on an anticonvulsant? Short term and long term
Biotin and folate
After 6 months, might result n reduced BMD d/t inactivation of vit D which slows down calcium absorption in the gut, so supplementing with D and calcium may be needed for long term use
Mnemonic: "Big Fat Cat Dances"
Biotin
Folate
Calcium
D (Vitamin D)
Think:
a Big Fat Cat Dances—but gets shaky and needs anticonvulsants.
63
Thiamin def in underweight individuals with anorexia may be exacerbated during refeeding by which of the following?
Increased fat
Increased protein
Increased carb
Dehydration
Increased carb - thiamin def is common in anorexia and can worsen during refeeding when carb consumption is increased. B1 is needed for metabolization of carbs, w/o sufficient b1 the body struggles to convert reintroduced carbs into energy, making the deficiency worse
64
Which best describes the legal obligation of CNS
CNS must adhere to laws and regulations of the state in which they’re certified and resides
CNS must comply with laws and regulations of both their own state and the state where their clients resides
CNS must adhere to the laws and regulations of the state in which their clients reside
CNS must only follow regulations specific to their place of practice
CNS must comply with laws and regulations of both their own state and the state where their clients resides
65
What nutrient depletions are associated with oral BC?
Folate, magnesium, b6, b12
B2, C, E, zinc, selenium
66
Describe the 5R approach
Remove
Replace
Reinoculate
Repair
Rebalance
Remove - identify and remove factors that contribute to dysfunction (allergens, irritants, infections or pathogens)
Replace - restore digestive function by replacing what might be lacking - enzymes, bile, HCl
Reinoculate - support growth of beneficial bacteria through prebiotics and probiotics
Repair - promote healing and regeneration of the intestinal lining by using nutrients that support mucosal integrity - fiber, antioxidants, zinc, omega 3, collagen, bone broth, glutamine
Rebalance - This step emphasizes lifestyle factors that support long-term gut health, such as stress management, sleep hygiene, exercise, and mindful eating
67
Loop diuretics deplete which nutrients?
Magnesium, sodium, calcium, potassium; long term also zinc and B1
68
What is the normal fasting level for triglycerides?
Less than 150 mg/dL
69
What macronutrient is most commonly deficient after bariatric surgery?
Protein
70
MNT for those with latex food syndrome typically begins with which of the following?
Med diet
Low histamine
Elimination diet that removes foods know to cause rxns
Elimination diet that removes foods that can potentially be cross-reactive
Elimination diet that removes foods know to cause rxns; personalized elimination diet that removes foods known to cause reactions for that specific person rather than avoiding all foods know for cross-reactivity at once is most effective
71
What is the direct effect of cig smoking on GERD?
Prolonged acid clearance
All
Increased salivation
Increase LES pressure
Prolonged acid clearance - smoking decreases LES pressure and saliva which leads to prolonged acid clearance
72
For a product to be considered low sodium, how many mg or less per serving must it have/
20 mg or less
40 mg or less
140 mg or less
200 m g or less
140 mg or less
73
Large doses of niacin, up to ___ in divided doses are used in treatment of certain types of hyperlipidemia
4000 mg/d
2000 mg/d
6000 mg/d
800 mg/d
6000 mg/d
74
Exudative diarrhea results from what mechanism?
Active secretion of electrolytes and water
Poor absorption of solutes
Mucosal damage
Impaired digestion leading to excess nutrients in stool
Mucosal damage
75
TUL of folate
1000 mcg
5000 mcg
2000 mcg
None
1000 mcg
76
All of the following hormones stimulate synthesis of flavin coenzymes from B2 except?
Insulin
Aldosterone
ACTH
Thyroid hormone
Insulin
77
An estimated glomerular filtration rate of 62 is indicative of which stage of CKD? Describe all the states
1
3A
3B
2
2
1 - normal or high >/= 90
2 - mild decrease 60-89
3A - mild to mod decrease 45-59
3B - moderate to severe decrease 30-44
4 - severe decrease 15-29
5 (end stage renal disease) kidney failure < 15
78
Which of the following is suitable rec for women experiencing menopause associated hot flashes resulting in poor sleep?
Panax ginseng
Valerian
Mg
All
All
79
Fructose is absorbed from the intestinal lumen across the brush border membrane by using which glucose transporter?
GLUT3
GLUT1
GLUT4
GLUT5
What’s fructose absorption rate compared to glucose and galactose? Same? Slower? Faster?
What are the other transporters used for?
GLUT5
GLUT2 as well - fructose gets absorbed slower than galactose and glucose
GLUT3 - glucose, mostly in neurons
GLUT1 - glucose mostly in erythrocytes (RBC) and brain endothelial cells)
GLUT4 - transports glucose across cell membrane of muscle and fat cells in response to insulin and exercise
80
Which of the following represents the ranges of intakes of macronutrients associated with reduced of chronic disease?
Adequate macronutrient distribution ranges
Adequate intake of macronutrients and ranges
Acceptable intake of macronutrients and ranges
Acceptable macronutrient distribution ranges
Acceptable macronutrient distribution ranges (AMDRs)
81
Daily requirement for vit C for adult men who smoke cigarettes?
110 mg/d
125 mg/d
105 mg/d
120 mg/d
125 mg/d
82
Which of the following statements regarding fructose malabsorption is accurate?
Fructose is best absorbed on its own without the presence of other sugars
Those with IBS might be more susceptible to fructose malabsorption
Glucose ingestion hinders fructose absorption
Fructose malabsorption only occurs in those with GI disorders
Those with IBS might be more susceptible to fructose malabsorption
83
Histamine is secreted by mast cells and ___ in the stomach
Enterochromaffin-like cells
G cells
Parietal cells
Chief cells
Enterochromaffin-like cells
84
Which of the following is no a common sx of hyperthyroidism?
Bulging eyes
Constipation
Heat intolerance
Goiter
Constipation - sx of HYPOthyroidism
85
All of the following pops have an increased risk of biotin def except?
Pregnant/lactation
Adolescents
Those w/biotin deficiency
Those who consume excessive raw egg whites
Adolescents
86
What is not a function of motilin?
Sending hunger signals to the brain
Inhibiting intestinal motility
Promoting gastric emptying
Controlling the migrating motor complex
Inhibiting intestinal motility
Motilin plays crucial role in the migrating motor complex, promoting gastric emptying and stimulating intestinal motility between meals. Also similar to ghrelin and sends hunger signals to the brain
87
What supps interact with L-dopa (levodopa)?
Niacin and K+
Folate and b12
B6 and Mg
Pantothenic acid and choline
B6 and Mg - b6 enhances the metabolism of levodopa and Mg reduces bioavailability
88
If your client has elevated liver enzymes you should exercise caution when using what herbal supplement know to have potential hepatotoxic effects?
Kava kava
89
Clients taking anticoagulant meds should exercise caution when using which herbal remedy d/t potential interactions?
Turmeric
90
What is the primary storage form of carbs in the human body?
Glycogen
91
What effects can hibiscus tea have? What medications would we tell a client to avoid hibiscus tea if on?
Can lower BP, so someone on an ACE inhibitor, calcium channel blocker, or other BP meds
92
How often does the CNS credential need to be recertified?
2
5
No recert needed
10
5
93
ADORA2 SNP has what potential risks?
Multiple chemical sensitivity, depression, caffeine sensitivity
94
What amino acids are needed to synthesize L-carnitine?
L-lysine and L-methionine
95
A 62 year old female is experiencing fatigue and their OATs test shows abnormal succinate results. Which nutrient would be beneficial to increase?
B2 - succinate to fumurate needs B2 & iron
96
What are the ranges for waist hip ratio for low risk, moderate, and high for men? Women?
Men - under 0.95 = low risk, above 1 = high risk
Women - under 0.8 = low risk, above 0.86 = high
97
Which of the brush border enzymes cleave trypsinogen to trypsin?
Enterokinase / enteropeptidase
98
Which amino acids contain sulfur?
Methionine and cysteine
99
What is the basic structure of an amino acid?
4 groups = H+, an a-carboxyl group, an a-amine group, and an R-group
100
Name the conditionally essential amino acids
Arginine, tyrosine, glutamine, cysteine, serine, glycine, proline, isoleucine
101
Which of the following amino acids is commonly found in collagen and plays a crucial role in providing structural integrity to connective tissues?
Arginine
Isoleucine
Proline
Glycine
Proline
102
Which amino acid is esssential for the synthesis of creatine an important molecule involved in energy metabolism, particularly in muscle cells?
Proline
Arginine
Leucine
Valine
Arginine
Also glycine & methionine
103
What is the primary pathophysiological mechanism underlying the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?
Increased secretion of ADH
104
A common genetic variant in the COMT gene, known as the COMT SNP is associated with variations in the activity of which NT?
Dopamine
Serotonin
Epinephrine
Acetylcholine
Dopamine
105
Which sweetener is the best low-FODMAP sweetener?
Honey
Agave
Maple syrup
Stevia
Maple syrup
106
Nutrition recs for POTs
High sodium and hydration, electrolytes and small frequency meals
107
A 40 yr old man experiences sx of metallic taste, hair loss, and nerve damage. He reports excessive consumption of supps and nuts in diet. What toxicity are his sx r/t to?
Copper
Selenium
Zinc
Magnesium
Selenium
108
If someone has a ragweed allergy, they may want to limit or avoid certain foods that can trigger oral allergy syndrome (OAS) d/t cross-reactivity between rag pollen and proteins. What foods would they want to avoid?
Melons, banana, kiwi, cucumber, zucchini, chamomile, echinacea
109
If someone has a latex allergy, they may want to limit or avoid certain foods that can trigger latex-fruit syndrome d/t cross-reactivity (foods contain proteins structurally similar to those in natural rubber latex).
What foods would they want to avoid?
Banana, avocado, kiwi, chestnut, passion fruit, fig
110
Which of the following pathogens is commonly associated with improper poultry?
E.Coli
Salmonella
Vibrio Species
Listeria
Salmonella
111
TUL for iron?
45 mg
75 mg
100 mg
155 mg
45 mg
112
Retinal generated form provitamin A is converted to retinol by an enzyme dependent on which of the following?
NADH
Zn
Cu
FAD
NADH
113
Which statement is accurate regarding dietary vit D digestion?
D3 requires digestion but not D2
Both D3 and D2 require digestion
Both D2 and D2 require no digestion
D2 requires digestion but not D3
Both D2 and D2 require no digestion
114
Difference between wet beriberi and dry beriberi sxs
Wet - cardiovascular findings (tachycardia, heart failure, edema)
Dry - neurological findings (neuropathy, impairment of sensory, motor and reflux functions
115
During the initial phase of a newly diagnosed ct w/Wilson’s disease should consider limiting all of the following foods except?
Nuts
Shellfish
Asparagus
Mushrooms
Asparagus
116
Which of the following is not included in the assessment of food and nutrition-related hx?
Type of food currently and historically consumed by client
How diet is consumed
Ct characteristics that affect dietary needs
All of these
All of these
117
Which of the following is not a sign of low vit K status?
Purpura
Easy brushing
Petechiae
Dry skin
Dry skin
118
Which doesn’t interact with losartan?
Activated charcoal
K+ supplements
Calcium supplements
Grapefruit juice
SJW
Calcium supplements
119
Which of the following gives brown adipose tissue its brown color?
Chlorophyll
Iron
Hb
Melanin
Iron
120
Lisinopril may cause a deficiency in which nutrient?
Potassium
Zinc
Sodium
Mg
Zinc ; ACE inhibitor
121
Common unsaturated FA compared to saturated fatty acids
Myristic acid
Palmitic acid
Palmitoleic acid
Oleic acid
Stearic acid
Arachidic acid
Alpha linolenic acid
Arachidonic acid
EPA
DHA
Lignoceric acid
Saturated - Myristic acid, Palmitic acid, Stearic acid, Arachidic acid, Lignoceric acid
Unsaturated - Palmitoleic acid, Oleic acid, Alpha linolenic acid, Arachidonic acid, EPA, DHA
122
What nutrients are involved in ph I and ph II of the liver detox process?
Ph I - B2, B3, folate, B12, glutathione, BCAA, flavonoids, phospholipids
Ph II - amino acids like cysteine, methionine, taurine, glycine, glutamine, NAC
123
Which of the following gives white adipose tissue its slightly yellow color?
Chlorophyll
Hb
B2
Carotene
Carotene
124
Which of the following is not considered a low FODMAP food?
Rye bread
Dark chocolate
Quinoa
Pumpkin seeds
Rye
125
Where does the synthesis of ATP from ADT occur?
Glycolysis
TCA cycle
Complex II in ETC
Complex V in ETC
Complex V in ETC
126
Turmeric has the potential to interact with many meds. List some types of meds youd want to be cautious with
Antihypertensives (turmeric reduces BP)
Anti diabetic (turmeric reduces blood sugar)
Antiplatelet/anticoagulant (turmeric has same effects)
Chemo - antioxidant properties of turmeric may impact effectiveness
127
What types of foods would you recommend for gout? List examples of foods to avoid
Low purine
Avoid - organ meats, red meat, seafood like sardines, anchovies
128
List high oxalate foods
Leafy greens, almonds, raspberries, rhubarb, tea
129
list what each medication name ends with
PPI
ACE Inhibtor
Statins
SSRI
Diuretics
PPI ….zole (Omeprazole)
ACE Inhibitors …pril (Lisinopril)
Statins …end w/statin (Simvastatin)
SSRI …ine/pram (Fluvoxamine, Sertraline)
Diuretics …ide (hydrochlorothiazide)
130
What nutrient to be concerned about if on blood thinners?
Vit K foods need to be the same every day
131
What to know about GLP-1 agonists? What are sx?
Delayed gastric emptying (which causes increased satiety) so can cause constipation, pressure in stomach
132
What do diuretics deplete?
Zinc, electrolytes, some b-vitamins
133
What herb can’t be given to someone who’s on blood thinners or is two weeks out from surgery (or two weeks after surgery)?
Turmeric
Echinacea also shouldn’t ‘t be given to someone on an anticoagulant but ok around surgery
134
What herb can’t be given if someone is on Metformin or other blood sugar meds?
Berberine b/c it’s given to help w/blood sugar
135
What foods are rich in CoQ10?
Fatty fish and nuts, organ meat
136
Precursor to GABA? Dopamine (+cofactor) ? Serotonin (+cofactor)?
Glutamate
Phenylalanine, Tyrosine + B6
Tryptophan, 5-HTP + B6
137
The 5 steps to the Nutrition Care Process are:
a. Assessment, nutrition diagnosis, intervention, monitoring and evaluation
b. Subjective, objective, assessment, plan and intervention
c. Assessment, subjective, objective, assessment and plan
d. Subjective, assessment, nutrition diagnosis, monitoring and evaluation
a. Assessment, nutrition diagnosis, intervention, monitoring and evaluation
138
what does cachectic mean? someone who is cachectic has...
fat and muscle wasting
139
definition of antecedents, triggers, & mediators
Antecedents: These are predisposing factors or events that lay the groundwork for an illness or pattern. They are not the immediate cause but rather create a vulnerability or susceptibility. Antecedents can be genetic or acquired, such as family history, past illnesses, nutrition, or lifestyle choices.
Triggers: These are factors that provoke the symptoms and signs of illness. They are the specific events or exposures that initiate the onset of symptoms or worsen an existing condition. Triggers can be diverse, including microbes, allergens, trauma, toxins, or even social interactions.
Mediators: These are factors, biochemical or psychosocial, that contribute to pathological changes and dysfunctional responses, allowing an imbalance to continue or worsen. They are involved in the progression and perpetuation of the illness or condition. Examples include inflammatory cytokines, ongoing psychological stress, chronic sleep deprivation, or even certain behaviors
140
Nutrition screening is best described as:
a. the process of identifying key characteristics to quickly identify individuals who are at a health risk and determining if a more detailed assessment is warranted
b. the process of identifying key characteristics to quickly identify individuals who are malnourished or at nutrition risk and determining if a more detailed assessment is warranted
c. the process of identifying core imbalances to develop a nutritional plan
d. the process of identifying symptoms, antecedents and lifestyle factors to identify individuals who
are malnourished or at nutrition risk and determining if a more detailed assessment is warranted
b. the process of identifying key characteristics to quickly identify individuals who are malnourished or at nutrition risk and determining if a more detailed assessment is warranted
141
Dietary data interpretation utilizes both qualitative and quantitative methods. Describe both:
Quantitative methods use numbers and measurements. Examples include calculating nutrient intakes, determining macronutrient ratios, and assessing calorie consumption.
Qualitative methods focus on understanding the non-numerical aspects of diet. This includes food preferences, attitudes toward food, cultural influences on eating, and the context of food choice
142
A current weight (of usual body weight) of 86% is considered to be
a. Healthy
b. Mild malnutrition
c. Moderate malnutrition
d. Severe malnutrition
b. Mild malnutrition
143
All of the following are visceral blood markers of the body except:
a. Prealbumin
b. Transferin
c. Glucose
d. Albumin
c. glucose
Visceral proteins are proteins found in the blood that are produced by the liver and other organs. They are often used as indicators of nutritional status or severity of illness. Examples include albumin, prealbumin (transthyretin), transferrin, and retinol-binding protein. Glucose, while an important indicator of metabolic health, is not considered a visceral blood marker
144
Which is true of creatinine-height index (CHI)?
Is excreted in a altered form in the urine
b. Requires a midstream urine specimen
c. Creatine is derived from the breakdown of creatinine.
d. Creatinine excreted in urine remains at a constant rate in proportion to the amount of body
muscle
d. Creatinine excreted in urine remains at a constant rate in proportion to the amount of body muscle
Explanation: Creatinine is a waste product of muscle metabolism. The amount of creatinine excreted in the urine is proportional to the amount of muscle mass in the body, and it remains relatively constant in individuals with normal kidney function and stable muscle mass.
145
Which of the following is a more informative predictive of cardiovascular death?
a. Total cholesterol
b. Total cholesterol to HDL ratio
c. Total cholesterol to LDL ratio
d. LDL to HDL ratio
b. Total cholesterol to HDL ratio
146
Which of the following is untrue about prealbumin?
a. Serves as a transport protein for T4
b. Serves as a retinol-binding protein
c. Is a plasma protein marker of inflammatory status
d. Is sensitive to acute changes in protein status
D
While prealbumin does have a relatively short half-life (around 2 days) compared to albumin, making it more responsive to nutritional changes, it is now recognized that inflammation significantly affects prealbumin levels, potentially making it unreliable as a sole indicator of acute changes in protein status. Inflammation causes a rapid decrease in prealbumin synthesis, leading to lower levels even in the absence of acute malnutrition. Therefore, while changes in prealbumin can reflect nutritional interventions in some cases, they must be interpreted cautiously, especially in the presence of inflammation
147
Which is true of serum albumin lab tests?
a. Is an early indicator of protein malnutrition
b. Measures parietal protein status
c. Is more sensitive indicator than serum tranferrin tests
d. None of the above
None of the above
Explanation: Serum albumin is a major visceral protein synthesized by the liver. It is often used as an indicator of nutritional status, but it is not an early indicator of protein malnutrition due to its long half-life. It is also influenced by inflammation and hydration status. Therefore, none of the statements are entirely true about serum albumin lab tests.
Shows overall health of kidneys and liver; low levels can be from inadequate protein or difficulty absorbing nutrients
148
A baby was born at 38 weeks of gestation, weighing 4250 grams (>95th percentile). The baby was:
a. preterm
b. premature
c. full term
d. overdue
Before 37 weeks = preterm
38-42 weeks = full term
149
How many grams of protein per day should a pregnant woman add to her diet?
a. 15 grams
b. 20 grams
c. 25 grams
d. 30 grams
c. 25 grams ; 60 g/day or 1.1 g/kg
150
Which of the following oils is a significant source of omega-3 fatty acids?
a. Olive oil
b. Corn oil
c. Canola oil
d. Peanut oil
c. Canola oil
151
A client’s weight is 68 kg and height is 165 cm. What is the Body-Mass Index (BMI)?
a. 20. 24
b. 29. 48
c. 33.0
d. 24.98
d. 24.98
BMI = weight (kg) / height (m2)
152
The best practice for measuring wrist circumference is:
a. measurement is made with a tape just distal to the styloid process at wrist crease of right hand, calculate the ratio of height to wrist circumference and compare to standard range for weight
b. measurement is made with a tape just distal to the styloid process at wrist crease of right hand, calculate the ratio of height to wrist circumference and compare to standard range for gender
c. measurement is made with a tape just below the elbow of right hand, calculate the ratio of height to wrist circumference and compare to standard range for gender
d. none of the above
a. measurement is made with a tape just distal to the styloid process at wrist crease of right hand, calculate the ratio of height to wrist circumference and compare to standard range for weight
153
The public health department of Smoke City reported 40 new cases of lung cancer in its population of 100,000 people between January 1, 1998 and December 31, 1999. What is the annual incidence of lung cancer for this population?
a. 40 per 100,000 per year.
b. 20 per 10,000 per year.
c. 80 per 100,000 per year.
d. 2 per 10,000 per year.
d. 2 per 10,000 per year.
154
What is the protein requirement per kilogram of body weight per day for young adolescents?
a. 0.8g
b. 0.85 g
c. 0.9g
d. 0.95 g
d. 0.95 g
155
As a result of rapid growth and development associated with adolescence, the RDA for calcium during late adolescence has been set at:
a. 1000 mg/day.
b. 1100 mg/day.
c. 1200 mg/day.
d. 1300 mg/day.
d. 1300 mg/day.
156
Under the influence of insulin, which of the following pathways is increased?
a. Glycogenesis
b. glycogenolysis
c. phosphorylation of glycogen synthase
d. phosphorylation of glycogen phosphorylase
a. Glycogenesis
157
35. A low-glycemic index (GI) food has a GI rating of:
a. ≤55
b. ≤60
c. ≤65
d. ≤70
a. ≤55
low GI = 1-55
med 56-69
high 70+
158
In the first phase of intestinal TG digestion, large lipid molecules are dispersed into smaller lipid droplets called______ so that they will not seperate out into an oily later and thus can be further digestion
Micelles
Emulsions
Suspensions
Globules
Emulsions
159
In order for short- and medium-chain fatty acids to be circulated away from the small intestine in the blood, they are first bound to _____.
a. Cholesterol
b. vitamin D
c. triglycerides
d. albumin
d. albumin
Unlike long-chain fatty acids, they do not require packaging into chylomicrons for transport.
160
Amy got up late this morning so she skipped breakfast and went straight to her soccer practice. Which fuel source is her body relying upon to supply the glucose that her brain needs to function?
Fatty acids
Liver glycogen
Glycolysis
Muscle glycogen
Liver glycogen
161
What happens when blood calcium is high?
a. The parathyroid gland produces more parathyroid hormone (PTH).
b. Calcium resorption from bone increases
c. The thyroid gland releases a hormone called calcitonin
d. Less calcium is lost in urine.
c. The thyroid gland releases a hormone called calcitonin
162
The essential fatty acids that must be derived from the diet are:
a. Stearidonic acid and eicosatetraenoic acid
b. Eicosapentaenoic acid and docosapentaenoic acid
c. Linoleic and alpha-linoleic acid
d. Gamma-linoleic acid and arachidonic acid
c. Linoleic and alpha-linoleic acid
163
The CDC acronym “EIS” refers to which of the following?
164
You are responsible for evaluating a community’s physical activity levels to develop targeted interventions. Which assessment method is MOST appropriate?
(A) 24-hour activity recall
(B) Physical Activity Frequency Questionnaire
(C) 3-day activity log
(D) Exercise history interview
(B) Physical Activity Frequency Questionnaire
165
To minimize the risk of waterborne illness, the maximum number of hours untreated water should be stored at room temperature before boiling or disinfection is recommended is:
(A) 6 hours.
(B) 12 hours.
(C) 24 hours.
(D) 48 hours.
(C) 24 hours.
166
A group of attendees at a community health fair reports nausea and vomiting within two hours of consuming egg-based sandwiches stored at room temperature. What pathogenic strain is MOST likely involved?
(A) Salmonella
(B) Norovirus
(C) Staphylococcus aureus
(D) Clostridium botulinum
(C) Staphylococcus aureus
Staphylococcus aureus is a common cause of food poisoning, especially when foods like egg salad or sandwiches are left at room temperature for extended periods.
The onset of symptoms, including nausea and vomiting, typically occurs rapidly, ranging from 30 minutes to 8 hours after consuming contaminated food
167
Sx, incubation period, and food sources of Salmonella poisoning
nausea and vomiting,
Commonly associated with egg-based foods or undercooked poultry
typical incubation period is 6 hours to 6 days,
168
Sx, incubation period, and food sources of norovirus
nausea and vomiting
usually appear within 12 to 48 hours
Eating or drinking contaminated foods or beverages is a common way to contract Norovirus. Also spreads easily
169
Sx, incubation period, and food sources of Clostridium botulinum
neurological symptoms such as muscle weakness and paralysis
incubation period of 18 to 36 hours
Canned, preserved, or fermented foods that are not processed or preserved correctly can create low-oxygen conditions where C. botulinum spores can grow and produce toxins
170
Sources of Staphylococcus aureus
Foods that require a lot of handling during preparation and are kept at temperatures allowing bacterial growth are more likely to be contaminated
171
Internal cooking temp for...
ground meat
poultry
seafood
eggs
160
165
145
160
172
most common worm?
most common parasite
pinworms
protozoa/giardia
173
name of food poisoning from old fish that’s built up histamine sx flushing skin, heart palpitations 15-30 mins after eating
scombroid poisoning
174
E.coli comes from?
undercooked meat (med rare beef hamburgers) and raw veg
175
Who's NOT at increased risk for food poisoning?
A. those 50+
B. Children 0-5
c. Pregnant women
D. those immunocompromised
A. those 50+
correct answer would be 65+
176
A certified nutrition specialist is investigating a foodborne illness outbreak at a local community center. The investigation reveals that a large group of attendees at a potluck dinner experienced similar gastrointestinal symptoms, with most cases occurring within a few hours of the event. The epidemiologic curve shows a sharp increase in cases, followed by a gradual decline, with most illnesses occurring within one incubation period of the suspected foodborne pathogen.
Based on this information, which of the following is the most likely type of outbreak?
a) Propagated outbreak
b) Common-source outbreak
c) Point-source outbreak
d) Continuous source outbreak
c) Point-source outbreak
point-source outbreak is characterized by a brief exposure period to a common source, resulting in a rapid rise in cases followed by a peak and gradual decline, with most cases occurring within one incubation period.
177
A certified nutrition specialist working in public health is called to investigate a series of foodborne illnesses occurring over several weeks in a small town. The initial cases were spread out over a few days, but more cases have continued to be reported, and the epidemic curve shows a gradual rise in illnesses, followed by a plateau with no sharp peak. Investigators suspect a contaminated food product is being sold at a local grocery store, and they are working to identify the specific item.
Based on the information provided, what type of outbreak is most likely occurring, and what is a key challenge in managing this type of outbreak compared to a point source outbreak?
a) Point-source outbreak; The main challenge is identifying the initial event or specific meal.
b) Propagated outbreak; The main challenge is preventing person-to-person transmission.
c) Continuous source outbreak; The main challenge is identifying and removing the ongoing source of contamination.
d) Intermittent source outbreak; The main challenge is determining the specific time intervals of exposure
c) Continuous source outbreak; The main challenge is identifying and removing the ongoing source of contamination.
The scenario describes a gradual rise in cases over a prolonged period (several weeks), which is characteristic of a continuous source outbreak where the source of exposure is ongoing. The epidemic curve would likely show a plateau rather than a sharp peak because people are exposed to the source over a longer time
178
What is BUN? What are nutritional causes of levels being high or low?
Blood urea nitrogen - urea nitrogen is the byproduct of protein metabolism; high levels means kidneys aren't filtering adequately
high = dehydration, high protein
low = low protein intake or malabsorption
179
What is creatinine measuring?
nutritional causes of high levels?
waste product of muscle breakdown
high levels can mean kidneys aren't filtering adequately OR high levels of muscle breakdown (Rhabdo)
dehydration or high protein
180
What is the BUN:Creatinine ratio
nutritional causes of high levels? low levels?
this ratio helps assess how well your kidneys are filtering waste products from your blood
dehydration or high protein
low = low protein
181
What is eGFR?
nutritional causes of low levels?
used to assess kidney function and is a primary marker; estimates how much blood the kidneys filter per minute
a low eGFR = reduced kidney function, could be caused by poor nutrition
182
What herbs can prolong the effects of anesthesia and must be avoided prior to surgery?
kava and valerian
183
antioxidant supplements such as ___ and ___ might reduce effectiveness of some types of cancer treatments
C & E
184
A nutrition specialist is counseling a client with a history of consuming a diet high in fatty fish from a lake known to have industrial pollution. The client is experiencing symptoms such as chronic fatigue and skin issues. The specialist suspects potential exposure to environmental toxins. Considering the history and symptoms, which of the following environmental toxins is most likely a concern, and what are its potential health effects?
a) BPA; Endocrine disruption and reproductive problems.
b) PFAS; Immune system dysfunction and thyroid disruption.
c) Lead; Neurotoxicity and kidney damage.
d) PCBs; Skin disorders and potential effects on neurological development.
d) PCBs; Skin disorders and potential effects on neurological development.
PCBs found in farmed fish d/t industrial run off that sits in fat
185
A client expresses concern about exposure to Bisphenol A (BPA) and asks for guidance on reducing their intake. As a certified nutrition specialist, what advice would you provide regarding common sources of BPA exposure and effective nutritional interventions to minimize risk?
a) Focus on consuming more canned fruits and vegetables, as they are a good source of fiber, and avoid using plastic containers with recycle codes 3 or 7.
b) Emphasize avoiding processed foods and fast foods, opting for fresh, whole foods, and considering using BPA-free products.
c) Recommend cooking with plastic containers, especially when microwaving, to reduce BPA leaching into food.
d) Suggest drinking bottled water exclusively to avoid potential BPA contamination from tap water
b) Emphasize avoiding processed foods and fast foods, opting for fresh, whole foods, and considering using BPA-free products.
186
A family with young children residing in an older home with potential lead paint exposure is concerned about the health impacts on their children. What are the primary health concerns associated with lead exposure in children, and how can nutrition play a role in supporting their health?
a) Increased risk of cardiovascular disease in adults and improved cognitive function in children; Encourage a diet high in calcium and iron.
b) Neurotoxicity, developmental delays, and behavioral problems in children; Ensure adequate intake of calcium, iron, and vitamin C.
c) Endocrine disruption and reproductive issues in adults; Recommend reducing consumption of fatty foods.
d) Liver damage and kidney failure in adults; Promote a diet low in protein.
b) Neurotoxicity, developmental delays, and behavioral problems in children; Ensure adequate intake of calcium, iron, and vitamin C
Calcium and iron competes with lead for absorption, iron deficiency can increase lead absorption, and vitamin C is an antioxidant that can help protect against lead-induced oxidative stress
187
A client is concerned about Per- and Polyfluoroalkyl Substances (PFAS), also known as "forever chemicals," and their potential health effects. What are the common sources of PFAS exposure and the associated health concerns?
a) Sources: Pesticides and herbicides; Health concerns: Endocrine disruption and reproductive problems.
b) Sources: Fire-fighting foams, food packaging, and contaminated water; Health concerns: Immune system dysfunction, thyroid disruption, and certain cancers.
c) Sources: Industrial emissions and vehicle exhaust; Health concerns: Respiratory problems and cardiovascular disease.
d) Sources: Natural toxins in food; Health concerns: Acute poisoning and digestive issues.
b) Sources: Fire-fighting foams, food packaging, and contaminated water; Health concerns: Immune system dysfunction, thyroid disruption, and certain cancers.
PFAS are found in various products and environments, including fire-fighting foams, nonstick cookware, food packaging, and contaminated water.
Exposure to certain PFAS has been linked to adverse health effects, such as immune system dysfunction, thyroid hormone disruption, and an increased risk of certain cancers, including kidney and testicular cancer.
188
What does p-value mean?
STATISTICAL SIGNIF - if less than 0.05, we have statistically significant, if greater than weak evidence
189
’N’ means what in studies?
NNT means?
’N’ is the total # of people or cases in the population
NNT = # needed to treat to see something happen
190
What's on a superbill and when is this used?
1. Provider Information:
CNS Name and Credentials, Practice Name and Address,
National Provider Identifier - Your unique 10-digit NPI number assigned to healthcare providers, Tax Identification Number (TIN or EIN),
Contact Information
Referring Provider Information: If applicable, include the name and NPI of the referring physician.
2. Patient Information:
Patient Name and Date of Birth: Full name and DOB of the client receiving services.
Address and Phone Number: The client's contact information.
Insurance Information: If you have collected it, the client's insurance information, including their insurance ID number.
3. Visit Information:
Date(s) of Service, Diagnosis Codes (ICD-10): Codes that describe the client's medical condition or diagnosis that justifies the medical necessity of the services provided.
Procedure Codes (CPT): Codes that describe the specific services provided during the visit, the amount of time spent during the service, typically billed in 15-minute units.
Fees Charged: The cost for each service provided and the total charges for the superbill.
Amount Paid: The total amount paid by the client at the time of service.
USED FOR CLIENTS OUT OF NETWORK to submit to their insurance
191
A Certified Nutrition Specialist is preparing a superbill for a client who has out-of-network benefits. Which of the following information is essential to include on the superbill for the client to submit a claim for reimbursement?
a) Only the client's name and the total fee paid.
b) Only the date of service and a brief description of the services.
c) Diagnosis codes (ICD-10), procedure codes (CPT), and the CNS's National Provider Identifier (NPI).
d) The client's insurance ID number and a copy of the referring physician's referral.
c) Diagnosis codes (ICD-10), procedure codes (CPT), and the CNS's National Provider Identifier (NPI).
192
A CNS is asked by a new client how they can potentially get reimbursed for out-of-network nutrition counseling services. What is the primary purpose of providing a superbill in this situation?
a) To bill the client directly for the services rendered.
b) To submit a claim to the insurance company on behalf of the client.
c) To provide the client with a detailed receipt they can submit to their insurance company for reimbursement.
d) To track the client's progress and treatment plan
c) To provide the client with a detailed receipt they can submit to their insurance company for reimbursement.
193
Whats a CPT code?
Current Procedural Terminology
CPT codes are a numerical language used by healthcare providers, including physicians, hospitals, and clinics, to describe and report the medical services and procedures they perform
194
A Certified Nutrition Specialist is providing medical nutrition therapy to a client diagnosed with uncontrolled Type 2 Diabetes. When preparing the superbill or claim form for this service, which type of code is essential for the CNS to include to accurately describe the client's condition and demonstrate the medical necessity of the nutrition therapy?
a) CPT code
b) HCPCS code
c) ICD-10 code
d) DRG code
c) ICD-10 code
ICD-10 codes describe the client's diagnosis or condition (e.g., hypertension
195
A Certified Nutrition Specialist (CNS) provides individual medical nutrition therapy (MNT) to a client with a new diagnosis of hypertension. Which type of code would the CNS use on the superbill or claim form to specify the service provided during the session?
a) ICD-10 code
b) NPI
c) CPT code
d) HCPCS code
c) CPT code
CPT codes are used to identify and report medical services and procedures performed by healthcare providers. In this scenario, medical nutrition therapy (MNT) is the service provided, and it is represented by a specific CPT code
196
A client presents with paresthesia, cognitive impairment, and macrocytic anemia. Laboratory tests indicate elevated methylmalonic acid (MMA) and homocysteine levels. Which of the following best explains how vitamin B12 deficiency contributes to these results?
a. Vitamin B12 deficiency impairs succinyl-CoA production, leading to mitochondrial dysfunction and neurotoxicity
b. Vitamin B12 deficiency disrupts folate metabolism, impairing DNA synthesis and causing macrocytosis
c. Vitamin B12 deficiency leads to decreased acetylcholine, resulting in cognitive decline and neuropathy.
d. Vitamin B12 deficiency increases dopamine breakdown, causing oxidative stress and nerve damage
b. Vitamin B12 deficiency disrupts folate metabolism, impairing DNA synthesis and causing macrocytosis
197
Which nitrogenous waste product is primarily excreted in urine as a result of protein metabolism?
Uric acid
Creatinine
Ammonia
Urea
urea
198
Potassium is widely available in foods, but its bioavailability and absorption can vary.. Which of the following meals provides the most bioavailable potassium, optimizing both intake and absorption?
A spinach and Swiss chard salad with sesame seeds and a whole wheat roll
A fruit smoothie made with avocado, oranges, and unsweetened yogurt
A grilled chicken breast with brown rice and steamed broccoli
A cheese and deli turkey sandwich on white bread and potato chips
A fruit smoothie made with avocado, oranges, and unsweetened yogurt
Explanation:
While potassium is found in many foods, its bioavailability can be influenced by absorption inhibitors.
Fruits (e.g., bananas, avocado, oranges, apricots, melons) contain highly bioavailable potassium, as they have low levels of oxalates and phytates, which can interfere with mineral absorption.
Dairy (e.g., yogurt) also provides absorbable potassium and complements potassium absorption from fruit sources.
A fruit smoothie with bananas, oranges, and yogurt provides the most bioavailable potassium.
199
Which type of epidemiological study is most appropriate for assessing whether a new food additive increases the risk of metabolic disease in a population over time?
Case-control study
Randomized controlled trial (RCT
Cross-sectional study
Prospective cohort study
Prospective cohort study
200
Which of the following nutrients has the lowest tolerable upper intake level (TUL or UL) due to potential toxicity?
Iron
Vitamin C
Selenium
Calcium
Selenium
The tolerable upper intake level (UL) for selenium is 400 mcg/day for adults.
Excess selenium can lead to selenosis, characterized by hair loss, nail brittleness, gastrointestinal distress, and neurological abnormalities.
Incorrect Answers
Iron toxicity can occur, but the UL is higher (45 mg/day for adults).
Vitamin C has a high UL (2,000 mg/day), and excess is excreted in urine.
Calcium's UL is 2,500 mg/day for adults, and while excessive intake can lead to kidney stones, the threshold is much higher than selenium.
201
Which body composition measurement provides an estimate of visceral fat distribution?
Skinfold calipers
Waist-to-hip ratio
Bioelectrical impedance analysis (BIA)
Body mass index (BMI)
Waist-to-hip ratio
202
Which body composition method is most accurate for assessing total body fat percentage?
Bioelectrical impedance analysis (BIA)
Skinfold calipers
Dual-energy X-ray absorptiometry (DEXA)
Waist circumference
Dual-energy X-ray absorptiometry (DEXA)
203
what is the primary excretory pathway for copper and manganese?
saliva
urine
bile
sweat
bile
204
excessive supplemental of which nutrient can interfere with urinary glucose lab tests?
thiamin
iron
folate
vit CD
vit C
205
Who is considered a covered entity under HIPPA?
Any individual handling health info
Individuals w/insurance
Healthcare providers, health plans, and healthcare clearinghouses
Claims adjusters
Healthcare providers, health plans, and healthcare clearinghouses
206
Which of the following is not true about hereditary hemochromatosis?
Decreased transferrin sat may be a clinical finding
Associated with a mutation in the HFE gene
Life expectancy is normal is phlebotomy is initiated before the development of cirrhosis
Increased ferritin may be a clinical fining
Decreased transferrin sat may be a clinical finding
Transferrin sat is elevated, ferritin is usually >/= 2x normal
207
Difference between short and long chain fibers.
Short chain are highly fermentable and water soluble
Long chain fibers vary in degree of solubility and fermentability
208
Primary recommendations for NAFLD may consider all of the following except?
Vit E
Moderate coffee intake
3-5% weight loss
Thiamin
Thiamin
Omega’s are also good for NAFLD
209
Freshly expressed or pumped breastmilk can be stored in the fridge for how long?
Up to 2 days
Up to 4 days
Up to 10 days
Up to 7 days
Up to 4 days
210
What cells secrete secretin? When is secretin released?
S cells in SI in response to acidic chyme
211
Anions are ___ charged, whereas cations are __ charged
Negative, positive
212
Nutrient depletions of bile acid sequestrants
Folate and fat soluble vitamins, separate by 4 hrs
213
Another name for HMG-CoA reductase inhibitors
Statins
214
Difference between hypertrophy and hyperplasia
Hypertrophy = increase in size of individual cells
Hyperplasia = increase in the NUMBER of cells in a tissue or organ
215
Tolerable upper limit of daily copper intake for adults?
15,000 ug
No TUL
20,000 ug
10,000 ug
216
217
what is the leading risk factor for chronic kidney disease?
hypertension
gluomerulonephritis
diabetes
hyperlipidemia
diabetes
218
which of the following can be measured to differentiate between T1D and T2D?
amylase
c-peptide
glucose tolerance factor
c-reactive protein
c-peptide
its an insulin precursor released from pancreatic beta cells during the cleavage of insulin from proinsulin.
low in T1, normal or high in T2
219
what happens to hepcidin production when iron levels are low?
remains unchanged
decreases
increases
fluctuates randomly
decreases
a small protein that is the primary regulator of iron absorption and metabolism; released primarily when iron stores are high, so main functions are to reduce both intestinal iron absorption and cellular iron release
220
what is the oxidized form of folate?
5-MTHF
THF
methylcobalamin
folic acid
folic acid
221
which of the following plays a major role in carb metabolism?
pancreas
gallbladder
liver
duodenum
liver
products of carb metabolism like galactose and fructose are converted into glucose in liver cells. The liver stores glucose as glycogen and then sends it to the blood when glucose levels become low. The liver also produces "new" glucose (gluconeogenesis)
pancreas is primarily involved in INSULIN PRODUCTION and regulation of blood glucose
222
for those with Thalassemia who are receiving transfusions w/chelation therapy, which nutrient intake does not typically need to be limited or restricted compared to those who are not receiving transfusions?
zinc
vit A
folate
iron
iron
Thalassemia causes the body to have less of the protein hemoglobin than usual
for those no undergoing blood transfusions, it is advisable to follow a mod low-iron diet
223
which of the following is not a saturated fatty acid?
oleic acid
arachidic acid
stearic acid
palmitic acid
oleic
224
what sex hormone is similar to aldosterone and can cause sodium and water retention?
estrogen
225
vitamin ___ is frequently used to treat nausea and vomiting during pregnancy
b12
b6
b1
b9
B6
226
What nutrients should be emphasized in thalassemia?
Biotin
Iron
Potassium
Folate
Folate d/t needed for cell division and erythropoiesis
Genetic disorder where the body doesn’t produce enough hemoglobin
227
Which of the following nutrients should not be emphasized with thalassemia?
Calcium
Zinc
Vit D
All should be emphasized
228
Which nutrient, present in high amounts in the adrenal glands, if often considered as an MNT therapy intervention for individuals experiencing high stress?
B12
Vit D
Folate
Vit C
Vit C
229
What study design is exclusively prospective in nature?
Meta-analysis
Case-control
Systematic reviews
RTC
RCT
Cohort & cross sectional studies can either be retrospective or prospective, case reports and case control are retrospective, and systematic reviews and meta-analyses are considered retrospective d/t they compile existing evidence
230
What form of niacin primarily exists in animal based foods? Plant based foods?
Animal - Nicotinamide
Plant- Nicotinic acid (better form for high cholesterol)
231
Thiazide diuretics are commonly used in HTN, what other health conditions may benefit from their use?
Hypothyroidism
Epilepsy
Cancer
Osteoporosis
Osteoporosis
232
Which type of breast milk has a high water content, ensuring the baby’s hydration needs are met?
Transitional milk
Hindmilk
Foremilk
Mature milk
Foremilk - the initial milk released during breastfeeding session and has a high water content
233
When does age become an increased risk factor for CV for men?
After 50
After 60
After 45
After 35
After 45
234
Vegetables rich in FODMAPs mannitol and fructans
Mannitol - mushrooms, cauliflower, snow peas
Fructans - artichoke, garlic, leek, onion
235
What’s considered low birth weight, normal, and high birth weight?
Low is under 5 lbs 8 oz
Normal is 5 lbs 8 oz to 8 lbs 13 oz
High birth weight is more than 8 oz 13 oz
236
What can impair folate digestion and absorption?
Zinc deficiency (folate has a zn dependent enzyme
Acidic duodenal pH
Alcohol
Food inhibit is like those found in legumes, lentils, cabbage, oranges
237
Which of the following describes the framework for the development of nutrient recs?
Dietary recommended intake (DRI)
Dietary reference intake (DRI)
Estimated average requirement (EAR)
Recommended dietary allowance (RDA)
Dietary reference intake (DRI) - DRI’s include for reference points…adequate intake, estimate average requirement, RDA, and TUL
238
Who’s at risk for a b6 deficiency?
Older adults (d/t inadequate intake or accelerated hydrolysis of pyridoxal phosphate and oxidative of PL)
Malabsorption conditions (Crohns, celiac)
Excessive alcohol consumption
Systemic inflammation alters distribution of B6 in tissues but also increases its catabolism
Med depletion - penacillamine, oral BC
