Nutrition Therapy and Pathophysiology 3rd Edition By Nelms. Chapter 1-26 | TEST BANK

TEST BANK

Chapter 01 - Role of the Dietitian in the Health Care System True / False 1. The Scope of Practice encompasses the range of roles, activities, and regulations within which nutrition and dietetics practitioners perform. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: The Registered Dietitian in Clinical Practice 2. Hospice facilities focus on integrated, multidisciplinary assistance for recovery from acute or chronic illness and/or surgical procedures. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: The Registered Dietitian in Clinical Practice 3. With a minimum of 1,000 hours of related practice and at least 90 continuing education credits, a registered dietitian may become a lactation consultant. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 4. Medical doctors are commonly responsible for the initial nutrition screening of patients and for notifying the dietitian if a patient’s intake is inadequate. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 5. Some states provide Medicaid benefits for nutrition services, but there is significant variability between states. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 6. To provide optimal nutritional care, all aspects of a patient’s life must be considered. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System REFERENCES: Developing Critical Thinking Skills and Professional Performance 7. Evidence-based practice can best be defined as purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference upon which that judgment is based. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 8. The cognitive processes that a dietitian goes through to make clinical judgments are known as practice standards. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 9. The steps of the decision-making process do not necessarily take place in a particular sequence. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 10. The AND’s Code of Ethics and Standards of Professional Performance requires that outcomes are measurable and evidence-based. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance Multiple Choice 11. A hospital that is owned or managed by the community or a religious organization rather than a group of investors is classified as: a. private profit. b. veterans/military. c. private not for profit. d. public not for profit. e. public for profit.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: The Registered Dietitian in Clinical Practice 12. What is an example of a tool used by a dietitian to track his or her professional progress as part of the Practice Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System Management and Advancement Standard? a. Scope of Practice for the RD and DTR b. CDR Professional Development Portfolio c. Nutrition Care Process Reference Manual d. Scope of Practice Decision Tool e. Dietetics Career Development Guide ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: The Registered Dietitian in Clinical Practice 13. Reviewing productivity reports, hiring and training employees, and developing policies are all major tasks of the: a. clinical nutrition manager. b. dietetic assistant. c. clinical dietitian. d. diet clerk. e. dietetic technician (DTR) ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: The Registered Dietitian in Clinical Practice 14. Processing diet orders, checking menus against standards, and setting up standard nourishment are all major tasks of the: a. dietetic technician (DTR) b. clinical nutrition manager. c. clinical dietitian. d. diet clerk. e. registered dietitian nutritionist.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: The Registered Dietitian in Clinical Practice 15. What is an advantage of working as a registered dietitian in a long-term care facility over other settings? a. Shorter working hours due to decreased need for services b. More leadership positions available among health professionals at the same facility c. More flexibility to take paid holidays and time off on weekends d. More hours available for menu planning e. Greater autonomy and flexibility with scheduling ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 16. One primary role of the pediatric RD is to: a. provide information about community resources for nutrition services. b. educate the child about maintaining an appropriate diet for his age. c. assist pediatric patients with performing activities of daily living.

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Chapter 01 - Role of the Dietitian in the Health Care System d. optimize nutrition while promoting growth and development. e. assess for and prescribe enteral feedings and total parenteral nutrition.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 17. A registered dietitian is assessing a patient who reports that it is challenging to eat because she cannot pick up the fork or knife. Who would the RD consult with regard to this issue? a. physical therapist b. occupational therapist c. nurse d. diet clerk e. social worker ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 18. In a neurological setting where swallowing problems are common, the dietitian would have to work closely with which member of the interdisciplinary team? a. pharmacist b. physical therapist c. speech-language pathologist d. nurse e. social worker ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 19. Which professional would most likely be involved with changing the amount of nutrients delivered via parenteral nutrition support? a. nurse b. occupational therapist c. pharmacist d. social worker e. speech-language pathologist ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 20. A patient needs assistance with buying food after he is discharged from the hospital. Which professional should be consulted? a. pharmacist b. social worker c. medical doctor d. nurse Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System e. speech-language pathologist ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 21. A patient needs a prescription for total parenteral nutrition to ensure adequate electrolyte balance. This is the responsibility of the: a. nurse. b. social worker. c. occupational therapist. d. speech-language pathologist. e. medical doctor.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams 22. Of those insured Americans under age 65, what percent of people have private insurance? a. 15% b. 33% c. 46% d. 64% e. 78% ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 23. Approximately what percentage of the U.S. population did not have health insurance in 2012? a. 4% b. 15% c. 24% d. 39% e. 55% ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 24. Under the Affordable Care Act (ACA), nutrition services are expected to expand. Why is this? a. Dietitians will need to conduct fewer screening exams. b. There will be a decreased need for treatment of malnutrition. c. There will be more requirements for preventative services. d. Families will be required to pay for nutrition services. e. Individual state programs will no longer serve low-income Americans.

ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System 25. The dietitian’s knowledge base: a. is fulfilled upon graduation from an accredited school. b. remains at a level of minimum standards based on the Accreditation Standards for Didactic Programs in Nutrition. c. constantly expands and evolves in order to apply to new practice developments. d. is diminishing due to current evidence-based practices. e. is considered insufficient until s/he has finished a dietetics internship.

ANSWER: c DIFFICULTY: Bloom’s: Analyze REFERENCES: Developing Critical Thinking Skills and Professional Performance 26. One step used in the scientific method competency is to: a. assess all options before collecting data. b. weigh the options against standard sets of criteria. c. consider the consequences of a decision. d. test the hypothesis through experimentation. e. make a final conclusion.

ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance 27. The dietitian’s continuing education and reflection on the practice are examples of which component of critical thinking? a. specific knowledge base b. experience c. competence d. attitudes e. intellectual standards ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 28. Learning from patients, observations, and interactions with other health professionals are examples of which component of critical thinking? a. specific knowledge base b. competence c. experience d. attitudes e. intellectual standards ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 29. The ability to identify problems and make decisions regarding the most appropriate solutions is an example of which component of critical thinking?

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Chapter 01 - Role of the Dietitian in the Health Care System a. specific knowledge base b. competence c. experience d. attitudes e. intellectual standards ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 30. The decision-making process includes: a. identifying a phenomenon. b. formulating a hypothesis. c. weighing each option against a set of criteria. d. testing a hypothesis through experimentation. e. evaluating a hypothesis.

ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance 31. A dietitian has completed an assessment on a patient and determined that he is not meeting his intake needs. The patient is prescribed a nutritional supplement. A few days later, the dietitian visits him to see if he is drinking the provided supplement. During this visit, the dietitian is: a. identifying a phenomenon. b. testing a hypothesis. c. formulating a hypothesis. d. describing a phenomenon. e. evaluating the hypothesis.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance 32. The incorporation of systematically reviewed scientific findings into food and nutrition practice is known as: a. scientific inquiry. b. research methods. c. evidence-based practice. d. continuing education. e. data-driven analysis.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 33. What is a systematically developed statement based on scientific evidence that assists practitioner and patient decisions about appropriate health care for specific clinical circumstances? a. guideline b. diagnostic Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System c. evidence-based rule d. scientific analysis e. decision report ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 34. What term refers to a series of clinical judgments that result in an informal judgment or a formal diagnosis? a. problem solving b. decision making c. diagnostic reasoning d. critical thinking e. evidence-based practice ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 35. A patient has cirrhosis of the liver. The dietitian plans specific nutrition interventions for her, and continues to monitor her and observe for clinical and laboratory values that are consistent with cirrhosis. This type of thinking is most reflective of: a. risk taking. b. diagnostic reasoning. c. problem solving. d. decision making. e. continuing education.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance 36. A clinical dietitian attends a nutrition conference and another dietitian presents her research in a specific area of nutrition science. The clinical dietitian then implements what she has learned into practice at her facility. This is an example of: a. evidence-based practice. b. outcomes research. c. nutritional diagnosis. d. the nutrition coding process. e. the decision-making process.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance 37. The dietitian’s values, fairness, and responsibility in reaching solutions are most indicative of which component of critical thinking? a. specific knowledge base b. attitudes Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System c. experience d. competence e. intellectual standards ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 38. Admitting limitations, rethinking a situation, and seeking additional knowledge illustrate which type of attitude? a. creativity b. risk taking c. fairness d. curiosity e. humility ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 39. Evaluation of care that focuses on the status of participants after receiving care is known as: a. the scientific method. b. outcomes research. c. nutritional diagnosis. d. the nutrition coding process. e. medical problem solving.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 40. Application of intellectual standards focuses on: a. a rigorous approach to critical thinking. b. utilizing personal beliefs to make decisions. c. continuing education to promote effective practice. d. limited use of clinical education and extensive personal knowledge. e. an understanding of values and beliefs.

ANSWER: a DIFFICULTY: Bloom's: Analyze REFERENCES: Developing Critical Thinking Skills and Professional Performance 41. What is one type of intellectual standard that universally applies to critical thinking? a. humility b. confidence c. accuracy d. fairness e. curiosity ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 42. The practice of always asking ―why?‖ and finding out as much information as possible before making a judgment most illustrates which attitude? a. creativity b. curiosity c. discipline d. integrity e. fairness ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 43. An entry-level dietitian’s level of critical thinking will most likely involve: a. following rules set forth by authorities. b. avoiding the use of critical thinking for decision-making. c. assuming that the judgments of more seasoned dietitians are correct. d. disconnecting from authorities and using her own judgment. e. allowing others to make critical decisions until she is in a management position.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance Case Study Multiple Choice Ms. Lopez is a widowed 68-year-old Nicaraguan woman, and an immigrant who has lived in the United States for ten years. She lives in a second-floor walk-up apartment with her daughter and son-in-law and their four children. Ms. Lopez is admitted to the hospital, is diagnosed with a stroke, and has weakness in her left side. She complains of coughing when she drinks and feels that food sometimes gets caught in her throat. She has diabetes and high blood pressure and is on several oral medications. She does not, however, check her sugar because she does not feel comfortable pricking her finger. Her body mass index (BMI) is 33. Ms. Lopez is undocumented and uninsured.

44. Assessing whether Ms. Lopez’s left-sided weakness is affecting her ability to perform activities of daily living is the job of which member of the interdisciplinary team? a. occupational therapist b. nurse c. social worker d. speech-language pathologist e. medical doctor ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams PREFACE NAME: Ms. Lopez 45. Assessing whether Ms. Lopez has any difficulty swallowing is the job of which member of the interdisciplinary team?

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Chapter 01 - Role of the Dietitian in the Health Care System a. pharmacist b. nurse c. social worker d. speech-language pathologist e. medical doctor ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Other Health Professionals—Interdisciplinary Teams PREFACE NAME: Ms. Lopez 46. The dietitian has assessed Ms. Lopez and identified a potential problem with her food and fluid intake because of her stroke. What best describes the next step of the scientific method of problem solving in this situation? a. Formulate a hypothesis. b. Evaluate a hypothesis. c. Collect data about the phenomenon. d. Test the hypothesis. e. Identify the phenomenon.

ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance PREFACE NAME: Ms. Lopez 47. The dietitian recommends a soft food diet and the physician has ordered a swallowing study for Ms. Lopez. After 24 hours on the diet, the dietitian checks with the staff to determine if Ms. Lopez has been finishing her food and contacts the physician to determine the outcome of the swallowing study. This process of monitoring and following up best illustrates: a. evidence-based practice. b. outcomes research. c. medical problem solving. d. scientific reasoning. e. diagnostic reasoning.

ANSWER: e DIFFICULTY: Bloom's: Analyze REFERENCES: Developing Critical Thinking Skills and Professional Performance PREFACE NAME: Ms. Lopez 48. A diabetic educator works with the clinical dietitian to help Ms. Lopez learn to check her blood glucose levels. Ms. Lopez is still unsure about pricking her finger for the glucose test and asks the dietitian to explain why she must be responsible for this. The dietitian explains to Ms. Lopez the importance of blood sugar testing and backs up the information given by the diabetic educator. The response of the dietitian best describes which attitude? a. creativity b. confidence c. perseverance d. risk taking e. precision ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance PREFACE NAME: Ms. Lopez 49. The dietitian should ensure that a nutritional diagnosis is ____ and ____ the assessment data collected. a. error-free; critical of b. open-ended; critical of c. open-ended; consistent with d. plausible; critical of e. plausible; consistent with ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 50. The attitude of thinking independently is best demonstrated by: a. listening to both sides of a discussion. b. admitting limitations. c. asking for help when needed. d. not settling for quick solutions. e. basing decisions on your own conclusions.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance Completion 51. A(n) _______________ health care facility is often owned or managed by the county or state government.

ANSWER: public not for profit DIFFICULTY: Bloom's: Remember REFERENCES: The Registered Dietitian in Clinical Practice 52. The three components of the Scope of Practice are Practice Management and Advancement, Practice Resources, and _______________.

ANSWER: Practice Standards DIFFICULTY: Bloom's: Understand REFERENCES: The Registered Dietitian in Clinical Practice 53. Examples of _______________ include the National Guideline Clearinghouse and the Evidence Analysis Library.

ANSWER: Practice Resources DIFFICULTY: Bloom's: Understand REFERENCES: The Registered Dietitian in Clinical Practice 54. A health professional who requires a four-year post-bachelor degree, an internship and residency, and licensing to practice, is a(n) _______________.

ANSWER: medical doctor, physician DIFFICULTY: Bloom's: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System REFERENCES: Other Health Professionals—Interdisciplinary Teams 55. A licensed health professional who compounds and dispenses medications is called a(n) _______________.

ANSWER: pharmacist DIFFICULTY: Bloom's: Remember REFERENCES: Other Health Professionals—Interdisciplinary Teams 56. Currently, the system of health care in the United States is structured around _______________.

ANSWER: health insurance DIFFICULTY: Bloom's: Understand REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 57. The _______________ extends the availability of health insurance to all Americans.

ANSWER: Affordable Care Act (ACA), ACA, Affordable Care Act DIFFICULTY: Bloom's: Understand REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 58. Individual state _______________ programs are expanding to serve lower-income Americans.

ANSWER: Medicaid DIFFICULTY: Bloom's: Understand REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 59. Under the _______________, children 3–18 years old and their families will be able to see an RD for nutrition counseling.

ANSWER: Alliance Healthcare Initiative DIFFICULTY: Bloom's: Remember REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 60. Nutritional care requires _______________ among members of the entire health care team.

ANSWER: collaboration DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 61. Five components have been identified as essential in critical thinking: specific knowledge base, experience, competencies, attitudes, and _______________.

ANSWER: standards DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 62. The path to becoming an RD requires both _______________ and _______________.

ANSWER: education; practice practice; education DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 63. The dietitian must reflect on her or his practice in order to anticipate and react appropriately to _______________.

ANSWER: change Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 64. Methods used for problem solving that utilize competencies as a component of critical thinking include the scientific method, problem solving, evidence-based practice, diagnostic reasoning, and _______________.

ANSWER: decision making DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 65. Dietetics practice should not be based on tradition but on _______________ research.

ANSWER: evidence-based DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 66. Dietitians continually use the process of _______________ to determine the nutrition diagnosis and monitor a patient’s progress and/or response to nutrition therapy.

ANSWER: diagnostic reasoning DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 67. Listening to both sides of a discussion and weighing all the facts are examples of an attitude of _______________.

ANSWER: fairness DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 68. Being thorough at all times and following established procedures are examples of an attitude of _______________.

ANSWER: discipline DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance 69. The dietitian’s _______________ base is continually changing and expanding.

ANSWER: knowledge DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 70. Attitudes reflect the dietitian’s values and should ensure that clinical judgment is made _______________ and _______________.

ANSWER: fairly; responsibly responsibly; fairly DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance Subjective Short Answer 71. List the three different categories of the dietetics Scope of Practice and give an example of each.

ANSWER: The first area is of the Scope of Practice is Practice Standards; an example would be the Code of Ethics.

Practice Management and Advancement is the second category and an example is the Scope of Practice Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System Decision Tool. Practice Resources is the third component and an example is the National Guideline Clearinghouse.

DIFFICULTY: Bloom's: Apply REFERENCES: The Registered Dietitian in Clinical Practice 72. Describe the major tasks of the clinical dietitian.

ANSWER: The clinical dietitian is responsible for nutritional screening and assessment of patients to determine the presence or risks of developing a nutrition-related problem. The clinical dietitian is also involved with development of nutritional diagnosis, nutrition intervention, and monitoring and evaluation of the nutrition care plan.

DIFFICULTY: Bloom's: Remember REFERENCES: The Registered Dietitian in Clinical Practice 73. Explain the impact of the Affordable Care Act on nutrition services.

ANSWER: The Affordable Care Act will require more preventative services, such as counseling regarding obesity, weight loss, healthy diet, and exercise. It will also expect more services for educating adults about dietary practices to control hyperlipidemia and other known risk factors for cardiovascular and other chronic, diet-related diseases. Under the Affordable Care Act, nutrition services are expected to expand.

DIFFICULTY: Bloom's: Analyze REFERENCES: Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT) 74. Describe the dietitian’s knowledge base as used in clinical practice.

ANSWER: The knowledge base is the dietitian’s knowledge about nutrition and its role in health and disease. It includes information and theories related to communications, physical and biological sciences, research, food science, nutrition, management, informatics, and governance of dietetics practice.

DIFFICULTY: Bloom's: Understand REFERENCES: Developing Critical Thinking Skills and Professional Performance 75. List the basic steps of the scientific method.

ANSWER: The basic steps in the scientific method are to identify the phenomenon, collect data about the phenomenon, formulate a hypothesis to explain the phenomenon, test the hypothesis through experimentation, and evaluate the hypothesis.

DIFFICULTY: Bloom's: Remember REFERENCES: Developing Critical Thinking Skills and Professional Performance Essay 76. Describe a scenario in which a patient is admitted to the hospital for dehydration and pneumonia. List the members of the interdisciplinary healthcare team and describe the potential roles of each member in this patient’s care.

ANSWER: In the health care setting, individuals from different disciplines communicate with each other regularly in order to best care for their patients. Dietitians are integral members of the patient’s health care team and collaborate with physicians, pharmacists, nurses, speech pathologists, occupational therapists, social workers, and many others when providing nutritional treatment. Dietitians must know the roles of the other team members in order to be effective and to ensure optimal patient care.

DIFFICULTY: Bloom's: Apply REFERENCES: Other Health Professionals—Interdisciplinary Teams 77. Explain the importance of experience on critical thinking skills in clinical practice.

ANSWER: The component of critical thinking evolves from experience within dietetic practice. Dietitians do not Copyright Cengage Learning. Powered by Cognero.

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Chapter 01 - Role of the Dietitian in the Health Care System learn from textbooks alone; they also learn by observing, listening to patients, interacting with other health care professionals, reading patients’ medical charts, and reflecting on the situations that arise.

DIFFICULTY: Bloom's: Analyze REFERENCES: Developing Critical Thinking Skills and Professional Performance 78. Describe a situation in which a dietitian would use evidence-based practice to update a facility’s policy regarding total parenteral nutrition.

ANSWER: Changes in nutrition therapy recommendations are inevitable because of new developments in science and medicine, including ongoing research in nutrition therapy. A dietitian must be able to critically review research findings by utilizing the research methodology skills learned during dietetics education.

Dietetics practice should not be based on tradition but on evidenced-based research. A search of medical literature reveals research articles that may support change that could be implemented into facility policy.

DIFFICULTY: Bloom's: Analyze REFERENCES: Developing Critical Thinking Skills and Professional Performance 79. Use the decision-making process to describe an example of making a decision for a patient who needs dietary changes due to celiac disease.

ANSWER: The activities involved in decision making include identifying and defining a problem or situation, assessing all options for solving the problem, weighing each option against a set of criteria, testing possible options, considering the consequences of the decision, and making a final decision.

DIFFICULTY: Bloom's: Apply REFERENCES: Developing Critical Thinking Skills and Professional Performance 80. Describe the application of intellectual standards to determine the suitability of nutrition diagnoses and interventions for a patient with diverticulitis.

ANSWER: In treating a client with diverticulitis, intellectual standards should be used so a nutrition diagnosis can be determined and an intervention plan developed. The RD should seek to ensure that the dietary information obtained is adequate, that any confusing statements made by the client are clarified, and that the nutrition diagnosis is plausible and consistent with the assessment data collected.

DIFFICULTY: Bloom's: Analyze REFERENCES: Developing Critical Thinking Skills and Professional Performance

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Chapter 02 - The Nutrition Care Process True / False 1. Comparing nutrient intake to nutrient requirements alone effectively describes the broad picture of nutritional status. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 2. Providing nutrition care can influence and change the factors that contribute to an imbalance in nutritional status and thus restore nutritional health. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Purpose of Providing Nutrition Care 3. Standardized language refers to a uniform terminology that is used to describe practice. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 4. There are three sets of standardized terminology: nutrition diagnosis; nutrition analysis, and nutrition evaluation. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 5. Central to providing nutrition care is the relationship between the client and the dietetics practitioner or team of dietetics practitioners. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Big Picture of Nutrition Care: The Model 6. The outermost ring of the nutrition care process model recognizes the strengths that dietetics practitioners bring to the nutrition care process. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Big Picture of Nutrition Care: The Model Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process 7. The nutrition diagnosis portion of the NCP model includes planning and documenting interventions. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Apply REFERENCES: Big Picture of Nutrition Care: The Model 8. Both external (environmental) and internal (resources of the dietetics practitioner) factors influence the type of nutrition care provided. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Big Picture of Nutrition Care: The Model 9. A nutrition assessment is a systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 10. A nutrition diagnosis is written in terms of a client problem for which nutrition-related activities provide the primary intervention. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP Multiple Choice 11. Attitudes, knowledge, and behaviors that influence an individual‟s food and physical activity choices are called: a. food and nutrient factors. b. lifestyle factors. c. biological factors. d. environmental factors. e. system factors.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Improving Health and Nutritional Status Through Nutrition Care 12. Social and cultural food preferences and practices are external influences affecting food consumption and are called: a. food and nutrient factors.

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Chapter 02 - The Nutrition Care Process b. lifestyle factors. c. biological factors. d. environmental factors. e. system factors.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Improving Health and Nutritional Status Through Nutrition Care 13. The purpose of nutritional care is to: a. cure the underlying medical problem or disease. b. restore a state of nutritional balance. c. impact all lifestyle, environmental, and food and nutrient factors. d. increase supplementation. e. maintain a focus on important vitamins and nutrients.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Purpose of Providing Nutrition Care 14. Standardized nutrition language consists of: a. concise phrases that are organized into groups. b. broad terms that are categorized into sets. c. a list of words that are available to use in documentation. d. descriptive terms that cannot be used interchangeably. e. a chart that provides terminology to choose for documentation.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: The AND‟s Standardized Nutrition Care Process 15. There are three sets of standardized terminology: nutrition diagnosis, nutrition assessment, and: a. nutrition monitoring. b. nutrition evaluation. c. nutrition analysis. d. nutrition investigation. e. nutrition intervention.

ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 16. The NCP combines the process of care with the: a. analysis of research. b. provision of services. c. content of care. d. diagnosis of problems. e. evaluation of care.

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Chapter 02 - The Nutrition Care Process ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: The AND‟s Standardized Nutrition Care Process 17. Which portion of the nutrition care process requires appropriate data collection? a. Nutrition diagnosis b. Nutrition assessment c. Nutrition collection d. Nutrition intervention e. Nutrition prescription ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: The AND‟s Standardized Nutrition Care Process 18. The nutrition monitoring and evaluation process of the NCP involves: a. finding patterns and relationships among data and possible causes. b. setting and prioritizing goals. c. stating the problem clearly. d. defining the basic plan. e. selecting appropriate indicators or measures.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: The AND‟s Standardized Nutrition Care Process 19. Which element is included in the outermost ring of the nutrition care process model? a. Health care and social systems b. Practical knowledge c. Professional skills d. Collaboration and communication e. Critical thinking skills ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Big Picture of Nutrition Care: The Model 20. Which best describes an aspect of the screening and referral system? a. Monitoring the success of the NCP b. Analyzing causes of sub-optimal performance c. Refining the use of the NCP d. Involving interdisciplinary collaboration e. Identifying diagnostic labels using the PES format ANSWER: d DIFFICULTY: Bloom's: Analyze REFERENCES: Big Picture of Nutrition Care: The Model 21. A(n) ____ identifies those individuals or groups who would benefit from nutrition care provided by dietetics Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process professionals. a. social system b. goal setting system c. screening and referral system d. medical nutrition therapy system e. outcomes management system ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Big Picture of Nutrition Care: The Model 22. Which best describes an example of the nutrition-focused physical findings domain used in the nutrition assessment process? a. Oral health and appetite b. Educational background c. Family and social history d. Medical treatments and therapies e. Eligibility for community programs ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 23. Socioeconomic factors are an example of which type of domain used in the nutrition assessment process? a. Anthropometric measurements b. Nutrition-focused physical findings c. Client history d. Food and nutrition-related history e. Biochemical data ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 24. Nutrition diagnosis is a direct link between ____ and ____. a. nutrition analysis, nutrition evaluation b. nutrition evidence, nutrition factors c. nutrition assessment, nutrition monitoring d. nutrition analysis, nutrition intervention e. nutrition assessment, nutrition intervention ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 25. Which best describes an example of the behavioral-environmental domain used in the nutrition diagnosis process? a. Intake of unsafe food b. Impaired nutrient utilization c. Unintended weight loss Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process d. Malabsorption of fats e. Low blood glucose levels ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 26. Unintended weight loss is an example of which type of domain used in the nutrition diagnosis process? a. Behavioral b. Environmental c. Intake d. Clinical e. Social ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 27. Which aspect of the PES statement is described as the diagnostic label? a. Etiology b. Problem c. Signs d. Possibility e. Symptoms ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Steps of the NCP 28. The ____ step of the PES asks the question “why?” a. possibility b. signs c. problem d. etiology e. symptoms ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 29. Which documentation is most appropriate in a case where a nutrition assessment reveals no nutritional problems? a. “No change” b. “No nutrition diagnosis” c. “No assessment completed” d. “Not applicable” e. “No documentation necessary” ANSWER: b DIFFICULTY: Bloom's: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process REFERENCES: Steps of the NCP 30. Which question is most appropriate when evaluating the “P” in the PES statement? a. Is the etiology truly the root cause? b. Is there an intervention that will cause a positive change? c. Will measuring symptoms resolve the problem? d. Can the dietetics practitioner improve the issue? e. Do the signs and symptoms describe the problem?

ANSWER: d DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP 31. Which best describes an example of objective data obtained from the nutrition assessment? a. “Excessive energy intake” b. “Very little appetite” c. “BMI 28.2” d. “Recent weight gain” e. “Decreased activity levels” ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 32. After prioritizing diagnoses and writing a nutrition prescription, what is the next step for the dietetics practitioner? a. Evaluating the response to interventions b. Identifying ideal goals c. Monitoring for changes in outcomes d. Documenting signs and symptoms e. Labeling the problem ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 33. Which best describes ideal goals? a. Problem labels that classify the facts available b. Identification and analysis of scientific data c. Values used to control specific health conditions d. Data used to make choices about problems e. Evaluation of the entire nutrition care process ANSWER: c DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP 34. The desired changes to be achieved over time as a result of nutrition intervention are called: a. diagnostic indicators. b. nutrition assessments.

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Chapter 02 - The Nutrition Care Process c. screening and referral systems. d. expected outcomes. e. outcomes management systems.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 35. Motivational interviewing is an example of which type of domain used in the nutrition intervention process? a. Nutrition education b. Food and nutrient delivery c. Coordination of nutrition care d. Diagnostic labeling e. Nutrition counseling ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 36. Which best describes an example of the food and nutrient delivery domain used in the nutrition intervention process? a. Modifying the composition of meals b. Referring to community agencies c. Developing skills in dietary preparation d. Consulting with local agencies e. Educating the patient about fat intake ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 37. Which characteristic distinguishes the nutrition diagnosis from any other type of diagnosis? a. It is a diagnosis for which nutrition-related activities provide the primary intervention b. It is written in a specific format c. It is designed to nutritionally cure the underlying disease d. It is a way of measuring positive outcomes e. It involves a care process that leads to formulating the diagnosis ANSWER: a DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP 38. Dietetics practitioners can best arrange problems in order of importance for the client by: a. performing interventions. b. reviewing the goals for the client. c. ranking the diagnoses. d. communicating ideal outcomes to others. e. modifying the NCP on a regular basis.

ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 39. The recommended dietary intake of nutrients based on the nutrition diagnosis and the client‟s current health condition is called the: a. nutrition assessment. b. health and referral system. c. nutrition monitoring system. d. outcomes evaluation. e. nutrition prescription.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 40. The action phase of the nutrition care process is: a. implementation. b. estimation. c. planning. d. assessment. e. diagnosis.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 41. Determining that the goals and outcomes anticipated by the client and the dietitian are being achieved is best completed by: a. planning. b. monitoring. c. diagnosing. d. assessing. e. intervening.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 42. Which best explains the key to measuring outcomes? a. Creating a chart for organization b. Modifying the data to simplify it c. Ranking the diagnoses available d. Knowing what needs to be measured e. Reviewing the goals prior to measurement ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process 43. The NCP provides clear examples of the types of outcomes to be measured. These include clinical and health status outcomes such as: a. blood pressure and sodium levels. b. medication changes. c. offerings for educational opportunities. d. satisfaction and quality of life. e. planned health care visits.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 44. A dietitian is documenting a patient‟s nutrition outcome status as “possible progress toward goal.” This is best described by which term? a. Resolved b. Improvement shown c. Unresolved d. No longer appropriate e. Not applicable ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 45. The “P” in the SOAP format of documentation stands for: a. prescription. b. problem. c. progress. d. plan. e. performance.

ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Documentation Case Study Multiple Choice Ms. S is a 40-year-old female admitted to the hospital with nausea and vomiting. She had a Roux en Y gastric bypass two months ago. She reports that her symptoms have been persistent for two weeks and she cannot keep any food down, not even Gatorade. She reports not taking any vitamin and mineral supplements recommended by the RD because “they taste bad.”

HT: 5‟4”

WT: 200#

Diet: NPO

46. Identifying Ms. S‟s current height and weight is an example from which domain of the nutrition assessment terminology? a. Food and nutrition related history b. Nutrition-focused physical findings c. Anthropometric measurements d. Medical tests and procedures e. Client history Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 47. Ms. S‟s nausea and vomiting are examples from which domain of the nutrition diagnosis process? a. Behavioral b. Clinical c. Environmental d. Biochemical e. Medical tests and procedures ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 48. The dietitian writes a PES statement for Ms. S‟s condition. Which best describes an example of the etiology for this patient? a. Symptoms lasting two weeks b. Inadequate dietary intake c. Roux en Y procedure two months ago d. Potential for electrolyte imbalance e. Decreased vitamin intake ANSWER: c DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 49. Based on Ms. S‟s nutrition profile, the dietitian contacts the physician for recommendations for parenteral feedings.

This action is an example of which domain of the nutrition intervention process? a. Coordination of nutrition care b. Food and nutrient delivery c. Nutrition education d. Anthropometric measurements e. Nutrition counseling ANSWER: a DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 50. The dietitian is documenting Ms. S‟s information using the ADIME method of charting. According to this format, which information is documented under the “A” section? a. “Potential for inadequate fluid intake” b. “Addition of vitamins to IV fluids” c. “Nutrition prescription provided for parenteral feedings” Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process d. “Risk of electrolyte imbalance” e. “Nausea and vomiting for two weeks” ANSWER: e DIFFICULTY: Bloom's: Analyze REFERENCES: Documentation PREFACE NAME: Ms.S Completion 51. Dietitians are uniquely qualified to provide nutrition care to persons in different states of _______________ to improve their nutritional status.

ANSWER: health DIFFICULTY: Bloom's: Understand REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 52. _______________ factors such as social and cultural food preferences and practices are external influences that impact both food consumption and lifestyle choices.

ANSWER: Environmental DIFFICULTY: Bloom's: Understand REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 53. The Institute of Medicine defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current _______________.”

ANSWER: professional knowledge, knowledge DIFFICULTY: Bloom's: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 54. The outermost ring of the model identifies _______________ that can have an impact on the ability of the client to receive and benefit from the interventions of nutrition care.

ANSWER: environmental factors DIFFICULTY: Bloom's: Remember REFERENCES: Big Picture of Nutrition Care: The Model 55. The steps of the nutrition care process are supported by two other systems: the _______________ system and the _______________ system.

ANSWER: screening and referral; outcomes management, outcomes management; screening and referral DIFFICULTY: Bloom's: Understand REFERENCES: Big Picture of Nutrition Care: The Model 56. The inner adjoining ring of the nutrition care model recognizes the _______________ that dietetics practitioners bring to the nutrition care process.

ANSWER: strengths DIFFICULTY: Bloom's: Understand REFERENCES: Big Picture of Nutrition Care: The Model 57. The type of data collected during a nutrition assessment depends on whether a(n) _______________ or a(n) Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process _______________ is being conducted.

ANSWER: initial assessment; reassessment, reassessment; initial assessment DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 58. Nutrition diagnosis is the direct link between nutrition _______________ and nutrition _______________.

ANSWER: assessment; intervention, intervention; assessment DIFFICULTY: Bloom's: Remember REFERENCES: Steps of the NCP 59. The _______________ (S) are the defining characteristics obtained from the subjective and objective nutrition assessment data in the PES statement.

ANSWER: signs and symptoms, symptoms and signs DIFFICULTY: Bloom's: Remember REFERENCES: Steps of the NCP 60. _______________ is a critical component of the NCP that requires collecting data over time.

ANSWER: Measuring outcomes DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 61. _______________ are the desired changes to be achieved over time as a result of nutrition intervention.

ANSWER: Expected outcomes DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 62. The final step of planning the nutrition intervention is the _______________ of the appropriate. intervention.

ANSWER: selection DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 63. Evidence-based guidelines link external _______________ regarding nutrition care to a(n) _______________.

ANSWER: scientific evidence; specific health problem DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 64. First and foremost is the need to prioritize the _______________, before writing a nutrition prescription.

ANSWER: nutrition diagnoses, diagnoses DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 65. Interventions are derived from accurate diagnoses and largely driven by _______________.

ANSWER: client involvement, patient involvement Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process DIFFICULTY: Bloom's: Remember REFERENCES: Steps of the NCP 66. The standardized terms from monitoring and evaluation are combined with nutrition _______________ terms.

ANSWER: assessment DIFFICULTY: Bloom's: Understand REFERENCES: Steps of the NCP 67. Evaluating outcomes requires comparing the current _______________ with the previous _______________.

ANSWER: findings; signs and symptoms, findings; symptoms and signs DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 68. The standardized language that is now part of the NCP improves both the _______________ and _______________ communication among members of the health care team, as well as communication with the patient.

ANSWER: written; oral, oral; written DIFFICULTY: Bloom's: Understand REFERENCES: Documentation 69. Documentation should be relevant, accurate, and _______________.

ANSWER: timely DIFFICULTY: Bloom's: Understand REFERENCES: Documentation 70. A form of charting based on the steps of the NCP, the ADIME stands for assessment, diagnosis, intervention, monitoring and _______________.

ANSWER: evaluation DIFFICULTY: Bloom's: Understand REFERENCES: Documentation Subjective Short Answer 71. List the different factors that impact a person‟s nutritional status and give an example of each.

ANSWER: The factors that impact a person‟s nutritional status include human biological, lifestyle, food and nutrient, environmental, and system factors. Biological factors include age or illness; lifestyle factors are attitudes and behaviors; food and nutrient factors include dietary intake; environmental factors include cultural preferences; and systems factors are health or educational systems.

DIFFICULTY: Bloom's: Apply REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 72. Describe each of the components of the nutrition care process model, including the outermost ring, the inner adjoining ring, and the central core.

ANSWER: The central core of the nutrition care process model is the relationship between the patient and the dietetics professional. The outer ring identifies environmental factors that can have an impact on the ability of the client to receive and benefit from the interventions of nutrition care. The inner adjoining ring recognizes the strengths that dietetics practitioners bring to the nutrition care process.

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Chapter 02 - The Nutrition Care Process DIFFICULTY: Bloom's: Apply REFERENCES: Big Picture of Nutrition Care:The Model 73. Describe the screening and referral system in nutrition care.

ANSWER: A screening and referral system identifies those individuals who would benefit from nutrition care provided by dietetics practitioners. They should evaluate how effectively the screening process identifies the clients who require nutrition care. Screening parameters need to be tailored to the population and to the nutrition care services provided and a referral process may also ensure that clients are reliably connected with dietetics practitioners.

DIFFICULTY: Bloom's: Analyze REFERENCES: Big Picture of Nutrition Care:The Model 74. List the three domains of nutrition diagnostic terms and give an example of each.

ANSWER: Nutrition diagnostic terms are grouped into three domains: intake, clinical, and behavioralenvironmental. Examples from the intake domain include inadequate oral intake or suboptimal fiber intake. Examples from the clinical domain include swallowing difficulties or unintended weight loss, Examples from the behavioral-environmental domain include feeding difficulties of intake of unsafe food.

DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP Essay 75. List the major tasks associated with the nutrition assessment portion of the nutrition care process.

ANSWER: The nutrition assessment involves obtaining and verifying appropriate data, clustering and organizing assessment data according to assessment domains and possible nutrition diagnoses, evaluating the data using reliable standards, and calculating estimated nutrient needs.

DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP 76. Describe, in detail, the benefits of the nutrition care process in terms of outcomes management. Be sure to include benefits relating to the profession as a whole as well.

ANSWER: An outcomes management system is used to evaluate the effectiveness and efficiency of the entire NCP (assessment, diagnosis, interventions, outcomes, costs, and other factors) when nutrition care is provided to a number of patients.

DIFFICULTY: Bloom's: Analyze REFERENCES: Big Picture of Nutrition Care:The Model 77. Describe how the dietitian‟s knowledge, skills, and evidence-based practice impact all aspects of the nutrition care process.

ANSWER: The strengths that dietetics practitioners bring to the nutrition care process include professional knowledge/skills and competencies, code of ethics, evidence-based practice, and skills of critical thinking, collaboration, and communication. These are the knowledge and skills that registered dietitians and dietetic technicians obtain through accredited didactic and supervised practice programs.

DIFFICULTY: Bloom's: Analyze REFERENCES: Big Picture of Nutrition Care:The Model 78. Give an example scenario of a patient who would require nutrition services while in the hospital. Conceptually, go through the 4 NCP steps and describe the information obtained in each step. In addition, provide a nutrition diagnosis for Copyright Cengage Learning. Powered by Cognero.

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Chapter 02 - The Nutrition Care Process this patient with the PES components.

ANSWER: The NCP consists of four distinct, but interrelated and connected steps: nutrition assessment, nutrition diagnosis,nutrition intervention, and nutrition monitoring and evaluation. Nutrition diagnoses are written in a PES (problem, etiology, signs/symptoms) format that lists the problem, its cause, and appropriate defining characteristics. Examples will vary.

DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP 79. Describe the differences between using specific diets („renal‟ diet vs. „diabetic‟ diet, for example) and assessment of individual nutrition status.

ANSWER: Instead of providing nutrition care/education as a result of a diet order for a diabetic or renal diet, the dietitian should carefully assess the nutritional status of each patient to specifically identify what, if any, nutrition problems (diagnoses) exist.

DIFFICULTY: Bloom's: Analyze REFERENCES: Steps of the NCP 80. Explain the four different domains of the nutrition intervention standardized language. Describe an example of using each domain for a patient who was recently diagnosed with gastroparesis and requires enteral feedings.

ANSWER: Like the standardized terms used for nutrition assessment and nutrition diagnosis, intervention terminology is organized into domains: food and/or nutrient delivery, nutrition education, nutrition counseling, and coordination of nutrition care.

DIFFICULTY: Bloom's: Apply REFERENCES: Steps of the NCP

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process 1. Determination of ____ involves an attempt to project potential nutrition problems based on the client’s current health status. a. nutritional risk b. nutritional status c. nutrition screening d. nutritional assessment e. nutrition recall ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Nutritional Status 2. The process of identifying patients who may have a nutrition diagnosis and who would benefit from nutritional assessment and intervention by an RD is defined as: a. nutrition-focused physical examination b. nutrition assessment c. estimating nutrition needs. d. nutrition screening. e. calculating nutritional risk.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: An Overview: Nutrition Assessment and Screening 3. A patient reports that she has nausea after eating and often vomits at least once a day. This type of data is considered to be: a. objective. b. biochemical. c. clinical. d. anthropometric. e. subjective.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: An Overview: Nutrition Assessment and Screening 4. A patient decides that she will eat only while sitting at the kitchen table with family members. This is an example of which component of the subjective food- and nutrition-related history assessment? a. behavior b. food and nutrient intake c. nutrition-related patient measures d. physical activity and function e. knowledge and beliefs ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: An Overview: Nutrition Assessment and Screening 5. In 2012, approximately how many Americans were unable to purchase or acquire enough food to sustain their families?

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process a. 3 million b. 12 million c. 21 million d. 36 million e. 49 million ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: An Overview: Nutrition Assessment and Screening 6. Data collected during the 24-hour recall is gathered: a. retrospectively. b. exponentially. c. prospectively. d. pronominally. e. projectively.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Food- and Nutrition-Related History 7. The USDA Multiple Pass Approach is a nutrition assessment method that is very similar to the: a. food diary. b. 24-hour recall. c. mini nutritional assessment. d. food frequency method. e. calorie count method.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Food- and Nutrition-Related History 8. Which best explains the food frequency data collection method? a. The energy value of foods is calculated and totaled for each day b. The client records the types and amounts of foods eaten each day c. Foods are grouped and classified into a retrospective review of intake d. A clinician reviews the types and amounts of foods a client has eaten in the last 24 hours e. Foods are ranked on a numerical scale and the total numbers are calculated every 24 hours ANSWER: b DIFFICULTY: Bloom's: Analyze REFERENCES: Food- and Nutrition-Related History 9. The ____ were established by the U.S. Food and Drug Administration to assist consumers in interpreting nutrition labeling information. a. Daily Values (DV) b. Dietary Reference Intakes (DRI) c. Adequate Intakes (AI) d. Tolerable Upper Intake Levels (UL) Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process e. Estimated Average Requirements (ERA) ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Evaluation and Interpretation of Dietary Analysis Information 10. Which best describes an advantage of using USDA Food Patterns? a. They are a clear guide for preventing disease through nutrition b. They are comprehensive and contain information about macro- and micronutrients c. They can be paired with exercise analysis to promote weight loss d. They are easy to access and quantify food consumed from each of the major food groups e. They contain exchange lists for people with certain types of illness, such as diabetes ANSWER: d DIFFICULTY: Bloom's: Analyze REFERENCES: Evaluation and Interpretation of Dietary Analysis Information 11. A clinician is calculating height using a knee height caliper. Which equation is most appropriate for use with a 26year-old white male client? a. 73.42 + (1.79 x knee height) b. 95.79 + (1.37 x knee height) c. 71.85 + (1.88 x knee height) d. 58.72 + (1.96 x knee height) e. 59.01 + (2.08 x knee height) ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements 12. What percent of body weight does a clinician need to account for when measuring weight in a client who has had a hand amputation? a. 0.8% b. 1.8% c. 2.6% d. 3.1% e. 3.8% ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements 13. A client weighs 165 lbs. and is 5 feet, 8 inches tall. The BMI for this client is: a. 24.5 b. 25.1 c. 26.0 d. 27.2 e. 28.7 ANSWER: b DIFFICULTY: Bloom's: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process REFERENCES: Anthropometric/Body Composition Measurements 14. Which BMI result is classified as being “overweight?” a. 22.9 b. 23.9 c. 24.1 d. 25.9 e. 30.8 ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 15. The most commonly used site for skin-fold measurements is the: a. abdomen. b. thigh. c. triceps. d. calf. e. neck.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Anthropometric/Body Composition Measurements 16. A dietetic clinician has measured the mid-upper arm muscle area in a 46-year-old female client. The result is 22cm.

This result would be classified as: a. obese. b. adequate. c. marginal. d. depleted. e. wasted.

ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements 17. Which best describes the use of phase angle used in bioelectrical impedance analysis? a. An additional measure of prognosis in many chronic conditions b. The measurement of stature by using a calibrating device c. The calculation of energy requirements from data obtained through skin-fold measurements d. The measurement of oxygen consumed and carbon dioxide expired e. The percentage used to evaluate growth patterns relative to population standards ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements 18. ____ is a test that measures body volume (density) and relies on the assumption that the density of fat mass and components of fat-free mass are constant.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process a. Air displacement plethysmography b. Dual energy x-ray absorptiometry c. Bioelectrical impedance analysis d. Hydrostatic weighing e. Skinfold measurements ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 19. The BOD POD is also known as: a. air displacement plethysmography. b. dual energy x-ray absorptiometry. c. bioelectrical impedance analysis. d. hydrostatic weighing. e. skinfold measurements.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 20. A clinician has calculated a client’s creatinine height index with a result of 78% of the suggested standard. Which description best illustrates these results? a. Sufficient skeletal muscle b. Mild skeletal muscle depletion c. Moderate skeletal muscle depletion d. Severe loss of skeletal muscle e. Muscle exhaustion ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures 21. A client consumed approximately 40 g of protein in the past 24 hours. His 24-hour urine collection indicated a urine urea nitrogen of 12 g. His nitrogen balance would be calculated as: a. 9.6 g b. 4.2 g c. -4.2 g d. -9.6 g e. -12.1 g ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures 22. Which result would be an appropriate amount of fibronectin found in 100 mL of blood? a. 100 mg/dL b. 200 mg/dL c. 300 mg/dL Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process d. 450 mg/dL e. 600 mg/dL ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures 23. A clinician is caring for a client who was recently diagnosed with Hodgkin’s lymphoma. Which type of visceral protein would most likely be elevated in this condition? a. albumin b. transferrin c. retinol-binding protein d. prealbumin e. fibronectin ANSWER: d DIFFICULTY: Bloom's: Analyze REFERENCES: Biochemical Assessment and Medical Tests and Procedures 24. Which best indicates a normal level of retinol-binding protein within 100 mL of blood? a. 1.8 mg/dL b. 3.4 mg/dL c. 7.1 mg/dL d. 9.0 mg/dL e. 12.3 mg/dL ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Biochemical Assessment and Medical Tests and Procedures 25. A client has a white blood cell count of 5,000 with 20% lymphocytes. His total lymphocyte count would be: a. 100 b. 500 c. 1,000 d. 5,000 e. 10,000 ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures 26. The percentage of blood that is composed of red blood cells is called: a. mean corpuscular hemoglobin concentration. b. hematocrit. c. transferrin saturation. d. mean corpuscular volume. e. protoporphyrin.

ANSWER: b DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process REFERENCES: Biochemical Assessment and Medical Tests and Procedures 27. Which laboratory value is normally included as part of a chem-7 panel? a. albumin b. AST (aspartate aminotransferase) c. direct bilirubin d. total cholesterol e. serum chloride ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures 28. ____ is the examination of the body using the sense of touch. a. Percussion b. Palpation c. Auscultation d. Inspection e. Production ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition-Focused Physical Findings 29. Which activity is an example of an instrumental activity of daily living? a. personal hygiene and grooming b. sexual activity c. meal preparation d. sleep e. personal mobility ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Functional Assessment 30. Which best describes the purpose of dynamometry? a. To assess nutrition in relation to skeletal muscle function b. To record an accurate measurement of blood pressure c. To determine total visceral protein requirements d. To assess strength in relation to physical activity e. To compare MCH and MCHC values ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Functional Assessment 31. What percentage of total carbohydrate kcal should be provided as a substrate of 100% RMR? a. 10%-15% b. 20% Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process c. 25%-35% d. 50% e. 55%-65% ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Care Criteria: Energy and Protein Requirements 32. For a patient suffering from a disease, but who is obtaining enough kcal each day, protein requirements should be met by providing ____ g/kg/day. a. 0.8 b. 1.5 c. 1.8 d. 2.0 e. 2.4 ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Care Criteria: Energy and Protein Requirements 33. The total amount of energy required by an individual is the sum of which three components? a. Basal energy expenditure, physical activity, thermic effect of food b. Physical activity, resting energy rate, percentile weight for height c. Basal energy expenditure, protein intake, thermic effect of food d. Protein intake, physical activity, resting energy rate e. Physical activity, adjusted body weight, protein intake ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Care Criteria: Energy and Protein Requirements 34. Which condition is an example of chronic disease-related malnutrition? a. closed head injury b. anorexia nervosa c. major infection d. sarcopenic obesity e. thermal burns ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Interpretation of Assessment Data: Nutrition Diagnosis 35. The guideline used to provide criteria for diagnosing specific types of malnutrition, including kwashiorkor, marasmus, and other severe PEM (protein-energy malnutrition) is called the: a. Health and Wellness Nutrition Handbook. b. Nutrition and Diagnostic Manual of Illness. c. Dietary Reference for Disease Diagnosis. d. Harris-Benedict Manual. e. International Classification of Diseases.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Interpretation of Assessment Data: Nutrition Diagnosis Case Study Multiple Choice Ms. Smith is an 85-year-old female admitted to the hospital with a hip fracture and dehydration. She is awaiting surgery. Her family reports that she lives alone and has been showing signs of dementia in the last month. The medical doctor requests a nutritional consultation because the nurse reports that Ms. Smith is not eating well.

Ht: 5’5’’ Wt: 110# UBW: 125# (6 months ago) Alb 2.8 g/dL Hgb 12 g/dL Prealbumin 14 mg/dL TLC 2500 36. Which type of food- and nutrition-data gathering method would be the most appropriate for Ms. Smith? a. food frequency b. 24-hour recall c. calorie count d. food diary e. carbohydrate exchange list ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Food- and Nutrition-Related History PREFACE NAME: Ms. Smith 37. Depending on Ms. Smith’s physical limitations, the dietitian may need to measure and calculate her height using: a. a stadiometer. b. a knee-height caliper. c. a tape measure. d. a length board. e. a weight-to-height scale.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements PREFACE NAME: Ms. Smith 38. The clinician calculates and interprets Ms. Smith’s percent (%) unintentional weight change. The results are 13.6%.

This is classified as: a. mild. b. moderate. c. significant. d. considerable. e. severe.

ANSWER: e DIFFICULTY: Bloom's: Analyze REFERENCES: Anthropometric/Body Composition Measurements PREFACE NAME: Ms. Smith Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process 39. Which biochemical indicator would be used by the medical doctor to determine Ms. Smith’s inflammatory status? a. IGF-1 b. fibronectin c. CRP d. albumin e. transferrin ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures PREFACE NAME: Ms. Smith 40. The dietitian wants to determine Ms. Smith’s protein status by checking her transferrin levels. Which level of transferrin would be considered within a normal range? a. 108 mg/dL b. 188 mg/dL c. 265 mg/dL d. 391 mg/dL e. 410 mg/dL ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures PREFACE NAME: Ms. Smith 41. Today, in most developed countries, concern for nutritional status focuses on the effect of excessive intake of nutrients and energy. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Nutritional Status 42. The Joint Commission requires that all patients receive nutrition screening within 12 hours of their admission to a hospital. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: An Overview: Nutrition Assessment and Screening 43. Reduced grip strength is an example of anthropometric data measured in the nutrition assessment. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: An Overview: Nutrition Assessment and Screening Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process 44. Advantages of the 24-hour recall method include short administration time, very little cost, and negligible risk for the client. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Food- and Nutrition-Related History 45. When a client is filling out a food diary, he or she should use cups, teaspoons, and tablespoons to provide accurate amounts. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Apply REFERENCES: Food- and Nutrition-Related History 46. It is accepted practice to measure body compartments in order to evaluate infants and children for appropriate growth. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Requirements 47. A limitation of using a stadiometer is that it is an estimation of maximum adult height and not actual, current height. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Requirements 48. When weighing a client, wheelchair and bed scales are not recommended due to problems with calibration. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Anthropometric/Body Composition Requirements 49. One limitation of the creatinine height index is that its accuracy depends on a complete collection of urine for 24 hours. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Biochemical Assessment and Medical Tests and Procedures 50. Even though it is commonly measured, hemoglobin is not the most sensitive or the most specific of hematological Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process assessments of nutritional status. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Biochemical Assessment and Medical Tests and Procedures 51. Just as the physical examination is the cornerstone of medical assessment, _______________ provides the foundation for the nutrition care process.

ANSWER: nutrition assessment, nutritional assessment DIFFICULTY: Bloom's: Remember REFERENCES: Introduction 52. Alterations from normal anatomy and physiology that occur as a result of disease or injury are called _______________.

ANSWER: pathophysiology DIFFICULTY: Bloom's: Understand REFERENCES: Nutritional Status 53. _______________ include(s) information that is obtained directly from the patient, family members, and any other caregivers, usually during interviews.

ANSWER: Subjective data, subjective information DIFFICULTY: Bloom's: Apply REFERENCES: An Overview: Nutritional Assessment and Screening 54. The ability to obtain adequate food to maintain an active, healthy lifestyle is called _______________.

ANSWER: food security DIFFICULTY: Bloom's: Understand REFERENCES: An Overview: Nutritional Assessment and Screening 55. _______________ refers to the likelihood that an individual who does not have a particular condition or disease will be correctly excluded when administered a test designed to detect that condition or disease.

ANSWER: Specificity DIFFICULTY: Bloom's: Understand REFERENCES: An Overview: Nutritional Assessment and Screening 56. Another term for accuracy of data obtained through research and screening is _______________.

ANSWER: validity DIFFICULTY: Bloom's: Understand REFERENCES: Food- and Nutrition-Related History 57. During a 24-hour recall, the information is gathered _______________ from the client about food intake over the last day.

ANSWER: retrospectively DIFFICULTY: Bloom's: Apply REFERENCES: Food- and Nutrition-Related History Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process 58. In general, the _______________ are much more useful to the consumer purchasing groceries than the dietitian performing a nutrition assessment.

ANSWER: daily values, DV, DVs DIFFICULTY: Bloom's: Understand REFERENCES: Food- and Nutrition-Related History 59. _______________ refers to the distribution of body components (e.g., muscle mass and body fat) as part of the total body weight.

ANSWER: Body composition DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 60. A child with a weight-for-height percentage of >95% is classified as _______________.

ANSWER: obese DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements 61. Waist circumference of ≥ _______________ inches for women is considered to be predictive of obesity and chronic disease risk in Caucasian, African-American, Hispanic, and Native-American populations.

ANSWER: 35 DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 62. Equipment needed for skinfold measurement includes a _______________ and a skinfold caliper.

ANSWER: tape measure, measuring tape DIFFICULTY: Bloom's: Remember REFERENCES: Anthropometric/Body Composition Measurements 63. _______________ is generally accepted as the most accurate method of measuring body composition.

ANSWER: Underwater weighing, Hydrostatic weighing DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 64. _______________ involves scanning the body with radiation photons at two different energy levels.

ANSWER: Dual energy x-ray absorptiometry, DXA DIFFICULTY: Bloom's: Understand REFERENCES: Anthropometric/Body Composition Measurements 65. _______________ protein refers to skeletal muscle.

ANSWER: Somatic DIFFICULTY: Bloom's: Remember REFERENCES: Biochemical Assessment and Medical Tests and Procedures 66. A clinical state characterized by edema, albuminuria, and decreased plasma albumin often caused by conditions such as systemic lupus erythematosus, renal vein thrombosis, or hypersensitivity to toxic agents is called _______________.

ANSWER: nephrotic syndrome DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process REFERENCES: Biochemical Assessment and Medical Tests and Procedures 67. In healthy individuals, nitrogen _______________ should be equal to nitrogen intake.

ANSWER: excretion DIFFICULTY: Bloom's: Remember REFERENCES: Biochemical Assessment and Medical Tests and Procedures 68. Increased fecal loss of serum protein, especially albumin, causing hypoproteinemia is called _______________.

ANSWER: protein-losing enteropathy, protein losing enteropathy, protein loss enteropathy DIFFICULTY: Bloom's: Understand REFERENCES: Biochemical Assessment and Medical Tests and Procedures 69. When the term _______________is used, it refers to a measurement of oxygen consumed by a patient who has gone without food for at least 12 hours and has been lying down with little movement in a constant-temperature environment overnight.

ANSWER: basal energy expenditure, BEE DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Care Criteria: Energy and Protein Requirements 70. One MET is equivalent to energy expenditure while sitting quietly, which for the average adult approximates _______________ of oxygen uptake per kilogram of body weight per minute.

ANSWER: 3.5 mL, 3.5 ml, 3.5 milliliters DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Care Criteria: Energy and Protein Requirements 71. List the different categories of subjective information on the food- and nutrition-related assessment and give an example of each.

ANSWER: The categories are food and nutrient intake include: food preparation; medication use, such as reporting prescriptions or use of supplements; knowledge, beliefs, and attitudes, including diet modifications for illness; behavior, such as eating only at certain times of day; access to food and nutrition supplies, including lack of access to an oven or stove; physical activity, such as the amount of exercise performed in a week; and nutrition-related patient-centered measures, such as cooperating with blood tests to check glucose levels.

DIFFICULTY: Bloom's: Apply REFERENCES: An Overview: Nutrition Assessment and Screening 72. Describe the food frequency method of nutrition data collection and list its advantages and disadvantages.

ANSWER: The food frequency data collection method is a retrospective review of specific food intake. Advantages of this methodology are that it is inexpensive and requires minimal time to administer. Disadvantages include a tendency toward lower response rates because the instrument is self-administered.

DIFFICULTY: Bloom's: Analyze REFERENCES: Food- and Nutrition-Related History 73. Describe the formula for calculating adjusted body weight for a client who has had an amputation.

ANSWER: Adjusted body weight = actual measured weight divided by 100 - % amputation. The entire equation then is multiplied by 100.

DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process 74. Give the formula for calculating BMI and list reference ranges.

2 2 ANSWER: weight (kg) / [height (m)] or weight (lbs.) / [height (inches)] x 704.5 Below 18.5 = Underweight 18.5 to 24.9 = Normal 25.0 to 29.9 = Overweight Over 30.0 = Obese DIFFICULTY: Bloom's: Apply REFERENCES: Anthropometric/Body Composition Measurements 75. Give the formula for calculating nitrogen balance.

ANSWER: Nitrogen balance = [dietary protein intake / 6.25] – urine urea nitrogen - 4 DIFFICULTY: Bloom's: Apply REFERENCES: Biochemical Assessment and Medical Tests and Procedures 76. Explain food insecurity and its impact on residents of the United States. List interventions that the clinician can implement to assist patients who have food security issues.

ANSWER: Food security refers to the ability to obtain adequate food to maintain an active, healthy lifestyle. In 2012, 49 million Americans were unable to purchase or acquire enough food to sustain their families Most susceptible to food insecurity are single-parent households in rural or large cities, Black and Hispanic households, and families with incomes below the federal poverty line. Useful approaches and resources for practitioners: obtain thorough family and medical histories to assess risk and identify recent changes in health and/or mental status, health care access and screenings, insurance or employment status; identify at-risk households by utilizing the USDA Food Security Survey Module, or connect food-insecure families with food pantries and existing social services at the local, state, and federal levels.

DIFFICULTY: Bloom's: Evaluate REFERENCES: An Overview: Nutrition Assessment and Screening 77. Imagine you are a dietitian setting a client up with a food diary. Describe the process of collecting information and explaining important instructions needed to accurately complete this assessment.

ANSWER: When using a food diary, the client documents his or her dietary intake as it occurs over a specified period of time. The clinician can go through the directions for using a food diary as outlined in Figure 3.5.

DIFFICULTY: Bloom's: Apply REFERENCES: Food- and Nutrition-Related History 78. Explain how to measure height for a client who is unable to stand up. Describe the pros and cons of the various methods available for measuring height.

ANSWER: One method is arm span: the client extends the arms from the body at a 90-degree angle and distance is measured between the tips of the two middle fingers. A limitation of this method is that it is an estimation of maximum adult height and not actual, current height. Knee height is another method of height estimation. Height may also be recorded from the patient’s memory.

DIFFICULTY: Bloom's: Analyze REFERENCES: Anthropometric/Body Composition Measurements 79. Describe the function of protein and explain each of the following tests for assessing visceral protein in the body: albumin, transferrin, prealbumin, retinol-binding protein.

ANSWER: Protein’s unique function in supporting cellular growth and development elevates its significance in Copyright Cengage Learning. Powered by Cognero.

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Chapter 03 - Nutrition Assessment - Foundation of the Nutrition Care Process nutrition assessment.Visceral protein refers to nonmuscular protein making up the organs, structural components, erythrocytes, granulocytes, and lymphocytes, as well as other proteins found in the blood.

Descriptions of visceral protein tests can be found in Table 3.9.

DIFFICULTY: Bloom's: Analyze REFERENCES: Biochemical Assessment and Medical Tests and Procedures 80. List the equation for calculating total energy expenditure (TEE) and describe each of the three basic components of the formula.

ANSWER: The total amount of energy required by an individual is the sum of three basic components: basal energy expenditure (BEE) or basal metabolic rate (BMR) + energy for physical activity or exercise (PA) + thermic effect of food (TEF) = total energy expenditure (TEE). Basal energy expenditure refers to a measurement of oxygen consumed by a patient who has gone without food for at least 12 hours and has been lying down with little movement in a constant-temperature environment overnight. Physical activity (PA) is the most variable portion of an individual’s energy needs and fluctuates depending on the type, duration, and intensity of physical activity. TEF is estimated to be approximately 10% of an individual’s caloric intake and represents the energy needed for absorption, transport, and metabolism of nutrients.

DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Care Criteria: Energy and Protein Requirements

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation 1. Nutrition intervention comprises which step of the nutrition care process? a. Step one b. Step two c. Step three d. Step four e. Step five ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Introduction 2. Nutrition interventions are intended to positively change: a. food and nutrient delivery and intake. b. the scope of practice for the dietitian. c. the client’s knowledge of vitamins and minerals. d. beliefs surrounding food preparation. e. cultural biases toward meal planning.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Introduction 3. Which two steps make up nutrition intervention? a. Monitoring and evaluation b. Assessing and diagnosing c. Analyzing and discussing d. Planning and implementation e. Prescribing and formulating outcomes ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Prescriptions 4. Which action best demonstrates how a registered dietitian (RD) plans an intervention? a. The RD develops the nutrition prescription b. The RD collaborates with the interdisciplinary team c. The RD coordinates the plan of care d. The RD assigns activities to dietetics personnel e. The RD documents specific treatment goals ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Prescriptions 5. Which is an example of an intervention that would help a client consume adequate food? a. Allow the client to prepare foods in his room b. Arrange for parenteral nutrition until client intake is appropriate c. Perform daily weights d. Measure intake and output weekly Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation e. Organize family-style meals in the facility ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 6. An example of a carbohydrate modular nutrition supplement might be: a. MightyShakes b. Polycose c. Ensure d. ProMod e. Boost ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 7. Which is an example of a factor affecting nutritional intake during illness? a. Nursing care b. Medications c. Accessible menus d. The nutrition prescription e. Obesity ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 8. Which best describes dronabinol? a. An enzyme that supports pancreatic sufficiency b. A steroid that increases feelings of well being c. A derivative of marijuana that may improve appetite d. A protein-inhibitor that is used to combat weight loss e. An antiemetic used to treat gastric stasis ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 9. Acceptable foods that are part of a clear liquid diet include: a. Milk and ice cream b. Broth and bouillon c. Cream of mushroom soup d. Yogurt e. Pudding and sherbet ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation 10. Which liquid has the highest osmolality? a. Mineral water b. Milk c. Fruit punch d. Broth e. Prune juice ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 11. What is the best strategy to increase protein content? a. adding sour cream to a smoothie. b. using whole milk with creamed vegetables. c. including powdered milk with soup. d. adding cream cheese to vegetables. e. using extra butter in casseroles.

ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 12. Which is an example of a nutrition diagnosis for which vitamin and mineral supplements might be appropriate? a. Inadequate fluid intake b. Increased nutrient needs c. Increased energy expenditure d. Food-medication interaction e. Inconsistent carbohydrate intake ANSWER: d DIFFICULTY: Bloom's: Analyze REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 13. Which is an example of a commonly used bioactive substance? a. Medium-chain triglycerides b. Soy protein c. Dry milk powder d. Whey e. Gelatin ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 14. Which would be an example of a non-food cause of poor oral intake? a. Poorly fitting dentures b. Decreased sense of smell c. Use of adaptive equipment d. Lack of access to restaurants Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation e. Hearing loss ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 15. Which best describes the purpose of megestrol acetate? a. Improving appetite and increasing weight b. Reducing inflammation c. Correcting sodium and potassium imbalances d. Regulating blood glucose e. Stimulating production of pancreatic hormones ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 16. Which describes a true statement regarding medical food supplements? a. Supplements typically provide more than 1000kcal. b. Supplements are considered inexpensive to use. c. They are designed to promote weight loss. d. Supplements are convenient and do not require refrigeration. e. They supply 40 g of protein in 250 mL. ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 17. A tip to consider when writing instructional materials for the public might be to: a. put together a plan for organizing information. b. always ask available professionals to give feedback before publishing. c. read over the document once after writing to look for errors or missed information. d. use technical terms to sound professional. e. avoid using bullets and numbers.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Education 18. A basic guideline for providing nutrition education, regardless of the setting includes: a. using technical jargon to sound professional. b. dressing informal so that nobody is intimidated c. describing the job duties of the dietitian. d. explaining the relationship of nutrition to health and disease. e. using body language that creates a sense of power.

ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Education Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation 19. The general purpose of nutrition education is to: a. answer questions about healthcare procedures and practices. b. foster a sense of cooperation between clients and their families. c. empower people to study health and nutrition. d. educate clients about disease processes. e. maintain or improve health.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Education 20. A client is discussing her weight loss efforts with a dietitian. She is complaining that she has only lost 8 pounds in the last several months. The dietitian responds by saying, ―I am impressed that you have managed to change your eating habits, though. That is progress.‖ This response is an example of which type of communication? a. motivational interviewing b. probing c. clarifying d. summarizing e. conveying respect ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 21. Which characteristic of the provider would be most likely support a positive relationship with the client? a. charisma b. wisdom c. flexibility d. insight e. power ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 22. Which action represents using attentive body language while counseling a client? a. Maintaining constant eye contact b. Leaning back while talking c. Interrupting only when necessary d. Leaning forward while talking e. Standing with arms folded ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 23. Which is an example of a closed-ended question? a. ―Are you taking your medication?‖ b. ―When did you start losing weight?‖ Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation c. ―How often do you use nutrition supplements?‖ d. ―Who do you live with?‖ e. ―What types of food do you enjoy?‖ ANSWER: a DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Counseling 24. The concept that behavior is learned and is directly related to both internal and external factors is an assumption of which learning theory? a. Health belief b. Cognitive-behavioral c. Social learning d. Transtheoretical e. Stages of change ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 25. Which best describes a strategy that may be used to facilitate change? a. Self-monitoring b. Competing with others c. Analyzing habits d. Shifting responsibility e. Maintaining routines ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 26. Which intervention would be considered most appropriate when working with a pediatric client to provide nutrition counseling? a. Provide informative, goal-oriented education b. Offer the child educational pamphlets c. Teach concepts using media presentations d. Provide details through storytelling e. Give the patient a list of appropriate foods ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 27. Which best describes the dietitian’s role while developing a relationship with the client during nutrition counseling? a. Sharing personal information b. Demonstrating active listening c. Making choices for the client d. Spending a minimum of 60 minutes with the client e. Directing the client toward behavior change Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 28. Follow-up questions by the nutritionist that stem from information already provided by the client are known as: a. funneling questions. b. closed-ended questions. c. secondary questions. d. open-ended questions. e. double-structure questions.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 29. A nutritionist is providing teaching to a client about making changes in her diet. The client is resistant to change and says, ―I don’t think I could follow that kind of diet.‖ Which response from the nutritionist would be most appropriate to confront this client? a. ―I think you would like help, but you don’t want to do the work to change.‖ b. ―I could help you if you would let me, but you don’t seem to want my help.‖ c. ―You say you want to change, but you are not willing to try.‖ d. ―This is not unreasonable; if you tried harder, it wouldn’t be so bad.‖ e. ―You are saying you would like help and I would like to help you if I can.‖ ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 30. Which example refers to applying social learning theory in nutrition counseling and education? a. Sharing success stories b. Focusing on interventions that will change the environment to support health c. Changing patterns of negative thinking d. Identifying the client’s stages of change e. Explaining pros and cons of a situation ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 31. Which example constitutes coordination of care? a. Asking the client to maintain copies of his records b. Referring to a community agency for access to food sources c. Moving a patient between settings to optimize resources d. Utilizing the family to act as the patient’s advocate e. Requiring that the client document his own nutrition plan for comparison ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Coordination of Nutrition Care Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation 32. The purpose of monitoring and evaluation is: a. to determine the degree of progress being made toward the client’s goals. b. to identify the problem etiology for the PES statement. c. to recognize signs and symptoms that are affecting the client’s health. d. to facilitate interventions that optimize nutrient intake. e. to analyze the client’s health history.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Monitoring and Evaluation 33. Which describes a status term that can be used to report progress toward a nutrition goal? a. ―Out of action‖ b. ―No signs of progress‖ c. ―Improvement shown‖ d. ―Analysis forthcoming‖ e. ―Change for the better‖ ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Monitoring and Evaluation 34. What must first be done before monitoring and evaluating an outcome of nutrition intervention? a. Correct underlying electrolyte imbalances b. Complete a nutrition reassessment c. Perform a physical examination d. Complete a discharge summary e. Copy a list of approved foods and supplements ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Monitoring and Evaluation 35. A nutrition diagnosis includes an etiology of the problem and: a. examples of the effects of the problem. b. a reason for solving the problem. c. a statement describing the problem. d. a plan for changing the problem. e. signs and symptoms describing the problem.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Monitoring and Evaluation Case Study Multiple Choice MT is a 60 yo F admitted into the hospital with a Crohn’s disease exacerbation. After performing a detailed nutrition assessment, you determine that MT has lost more than 10% of her body weight and is experiencing malabsorption.

36. As a result of these findings, what would the dietitian most likely prescribe?

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation a. MCT modular supplement b. vitamin E c. LCFA d. probiotics e. psyllium ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) PREFACE NAME: Crohn's disease 37. The dietitian determines that MT consumes 40 g of protein per day, but she needs 65 g per day. Which is recommended to boost both kcalorie and protein intakes? a. 1 meal replacement plus MCT Oil b. 1 meal replacement plus ProMod c. 1 meal replacement plus vitamin D supplements d. 2 meal replacements plus beta-glucan e. 2 meal replacements plus Polycose ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) PREFACE NAME: Crohn's disease 38. The nutritionist wants to build a relationship with MT during the nutrition counseling sessions. Which best describes the beginning of an open-ended question? a. ―Is…?‖ b. ―Did…?‖ c. ―Are…?‖ d. ―Do…?‖ e. ―How…?‖ ANSWER: e DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Counseling PREFACE NAME: Crohn's disease 39. The dietitian is concerned about MT’s ability to process hyperosmolar liquids while she is transitioning to eating more solid foods. Which liquid should be avoided? a. Milk b. Sherbet c. Broth d. Ice cream e. Fruit punch ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) PREFACE NAME: Crohn's disease Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation 40. Before discharge, the dietitian meets with MT to provide discharge teaching combined with nutrition education materials. What is the most important detail regarding the material provided? a. It is clear b. It provides complete information about Crohn’s disease c. It includes common foods that MT consumes d. It is in large print e. It lists what MT is not allowed to eat ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Education PREFACE NAME: Crohn's disease 41. The AND defines evidence-based dietetics practice as ―the incorporation of systematically reviewed scientific evidence into food and nutrition practice decisions.‖ a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Prescriptions 42. Documenting specific treatment goals and expected outcomes is an example of planning the nutrition intervention. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Prescriptions 43. Modified diets are used to maintain or restore health and nutritional status and to accommodate changes in appetite. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 44. Given adequate appetite along with sufficient resources to purchase and prepare food, most malnourished individuals can be rehabilitated with oral diet alone. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 45. A clear liquid diet should be limited to 5 days unless supplements are added. a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 46. ―Inadequate or excessive vitamin/mineral intake‖ would be a nutrition diagnosis for which medical food supplements might be necessary. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 47. The registered dietitian is not involved in the coordination of medications with meal planning. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 48. Eloquence is an essential component to include when writing nutrition educational materials for the community. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Education 49. Nutrition counseling is not a one-time encounter in which everything important about nutrition can be explained. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 50. Cognitive restructuring during the nutrition counseling session teaches the client appropriate steps in addressing failures in behavior change. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 51. If the etiology of the problem cannot be influenced through nutrition therapy, then the interventions should be directed at changing the _______________ of the nutrition problem.

ANSWER: signs and symptoms, symptoms and signs DIFFICULTY: Bloom's: Understand REFERENCES: Introduction Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation 52. A chemically modified triglyceride in which the fatty acid composition can be manipulated is called a _______________.

ANSWER: structured lipid DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 53. The first step in prevention or treatment of malnutrition is an adequate supply of _______________.

ANSWER: food, nutritious food, meals DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 54. _______________ can be adjusted to alleviate mechanical problems for patients with impaired chewing ability.

ANSWER: Texture, Consistency DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 55. The number of water-attracting particles per weight of water in kilograms is known as _______________.

ANSWER: osmolality DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 56. _______________ are defined as commercial or prepared foods or beverages intended to supplement energy, protein, carbohydrate, fiber, and/or fat intake.

ANSWER: Medical food supplements DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 57. Food substances added to a food product or taken as supplements that have a specific intended health purpose are called _______________.

ANSWER: bioactive substances, bioactive substance supplements DIFFICULTY: Bloom's: Remember REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 58. It is important that the counselor develop a _______________ with the patient that enables careful examination of nutrition problems to establish goals and plans.

ANSWER: relationship, collaborative relationship DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 59. Confirming the accuracy of a client’s statement by asking a question or prompting the client to continue talking is called _______________.

ANSWER: clarifying, probing DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Counseling 60. _______________ are logically arranged so that a broad topic is first introduced and then subsequent questions Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation narrow the subject into more specific information.

ANSWER: Funneling questions DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Counseling 61. Questions designed to obtain either a yes or no response or a very brief answer are known as _______________ questions.

ANSWER: closed-ended , closed ended DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Counseling 62. _______________ is a communication technique that lets clients know the counselor is listening and allows the client to clarify misunderstandings.

ANSWER: Summarizing, Paraphrasing DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Counseling 63. _______________ builds on concepts of modeling through observing others who are doing well.

ANSWER: Social learning theory DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 64. A theoretical basis provides guidance to better understand a person’s motivation and readiness to change, but _______________ are the tools that can help facilitate change.

ANSWER: strategies DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 65. _______________ teaches the client appropriate steps in addressing failures in behavior change.

ANSWER: Cognitive restructuring DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Counseling 66. The fourth and last domain of nutrition interventions is _______________.

ANSWER: coordination of nutrition care, coordinating nutrition care DIFFICULTY: Bloom's: Remember REFERENCES: Coordination of Nutrition Care 67. Nutrition care outcomes that demonstrate improved body composition measures are known as _______________.

ANSWER: anthropometrics DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Monitoring and Evaluation 68. The _______________ should focus on the changes in the factors contributing to and signs and symptoms of the nutrition problem.

ANSWER: reassessment, assessment DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation REFERENCES: Nutrition Monitoring and Evaluation 69. ―Nutrition problem no longer exists‖ would be recorded as ―_______________.‖ ANSWER: resolved, completed DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Monitoring and Evaluation 70. Once nutrition diagnoses are _______________ and prioritized, some of the problems may need to be resolved over a longer period of time, thus benefiting from the coordination of nutrition care.

ANSWER: identified DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Monitoring and Evaluation 71. List the 10 categories in which problem etiologies can be classified.

ANSWER: Etiologies can be classified into one or more of the following categories: (1) beliefs or attitudes, (2) cultural, (3) physical function, (4) knowledge, (5) physiological, (6) psychological, (7) social-personal, (8) treatment, (9) access, or (10) behavioral.

DIFFICULTY: Bloom's: Apply REFERENCES: Introduction 72. Provide three examples of how the registered dietitian might plan the nutrition intervention.

ANSWER: The RD may plan the nutrition intervention through measures such as prioritizing nutrition diagnoses based on problem severity, referring to policies and program standards when planning, basing interventions using the best available evidence; conferring with the patient, family, and members of the interdisciplinary team; determining patient-centered goals and expected outcomes, developing the nutrition prescription, utilizing standardized language for describing interventions, and identifying resources and referrals when needed.

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Prescriptions 73. Describe the limitations associated with clear liquid diets.

ANSWER: Clear liquid diets are not nutritionally adequate and should be limited to 24–48 hours unless supplements are added.

DIFFICULTY: Bloom's: Understand REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 74. List examples of nutrition diagnoses for which nutrition-related medication management might be used.

ANSWER: Examples include altered GI function, impaired nutrient utilization, altered nutrient-related laboratory values, inadequate oral intake, and food–medication interaction.

DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 75. List examples of when open-ended questions and closed-ended questions would be used in a nutrition counseling session.

ANSWER: Open-ended questions should be used when the clinician wants to gain more information from the client and when more than short answers are needed. Open-ended questions are also used to guide clients toward answering secondary or probing questions. Closed-ended questions should be used when only a short answer is needed. Because closed-ended questions are usually answered with only a ―yes‖ or ―no,‖ Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation these types of questions should be limited.

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Counseling 76. Discuss methods the registered dietitian can use to ensure patient satisfaction with meals and provide choice in menu selection.

ANSWER: Offering suggestions and appropriate substitutions can be an efficient method of ensuring that the patient’s diet remains adequate and acceptable. Restaurant-style menus, room service ordering systems, a la carte food carts, and individual-unit kitchens and galleys are all examples of methods to ensure patient satisfaction and choice in menu selection.

DIFFICULTY: Bloom's: Analyze REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 77. Explain the advantages and disadvantages of using commercially-prepared medical food supplements.

ANSWER: Commercial supplements are popular because of their convenience and also because patients and caregivers may be familiar with them due to direct-to-consumer marketing. However, acceptability and intake are highly individual. Patients receiving oral supplements frequently develop ―taste fatigue‖ a few days after supplements are initiated, and supplement intake then decreases. It is also important to remember that merely providing supplemental feedings will not increase appetite.

DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 78. Discuss interventions that can be implemented to improve adequate food consumption through feeding assistance or changing the feeding environment.

ANSWER: Changing the environment to allow for food choice—for instance, organizing family-style meals in a rehabilitation facility—can significantly improve the patient’s ability to eat. Preparing the patient to eat may include helping him or her to sit at the appropriate height and distance from the tray or scheduling appropriate mouth care for the patient prior to the meal. Other nutrition interventions may include recommendations for adaptive equipment and providing assistance with eating. Ensuring an appropriate and conducive environment is a team effort requiring the expertise of occupational and physical therapists, speech-language pathologists, and all levels of nursing care.

DIFFICULTY: Bloom's: Apply REFERENCES: Food and/or Nutrient Delivery (Oral Diets) 79. Describe the similarities and differences between nutrition education and nutrition counseling.

ANSWER: Nutrition education focuses on providing patients/clients with information that improves nutrition knowledge and/or helps develop nutrition-related skills, such as label reading or menu planning.

Nutrition counseling generally involves more in-depth behavior change strategies. Both nutrition education and nutrition counseling are intended to maintain or improve health.

DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Education 80. Describe two different theories that may be utilized in nutrition counseling and list examples of their clinical applications.

ANSWER: Behavior change theories and models provide a research-based rationale for designing and tailoring nutrition interventions to achieve the desired effect. For example, if during a nutrition assessment interview the patient acknowledges that she or he does not believe that making significant behavior changes will result in a better health outcome, principles of the health belief model as well as awareness of the stages of change should influence how the counselor proceeds and what type of information is Copyright Cengage Learning. Powered by Cognero.

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Chapter 04 - Nutrition Intervention and Nutrition Monitoring and Evaluation appropriate to promote a change in belief and movement to the next stage of change. Table 4.7 provides a summary of the major theories that support nutrition education and counseling methods.

DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Counseling

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Chapter 05 - Enteral and Parental Nutrition Support 1. Which example is not considered to be a contraindication to enteral feeding? a. diffuse peritonitis b. intestinal obstruction c. GI bleeding d. impaired swallowing e. intractable vomiting ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 2. Which is an example of a research-supported reason to use enteral nutrition support? a. Decreased risk of respiratory infections b. Improved wound healing c. Increased tolerance of formulas d. Complete nutritional coverage e. Ease of administration ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 3. The means of prescribing a very small rate of enteral nutrition with the goal to minimize villous atrophy is known as: a. parenteral nutrition. b. bolus feedings. c. refeeding. d. intermittent feeding. e. trophic nutrition.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 4. A registered dietitian is assisting with placement of a nasogastric tube in a patient. The patient has just received a dose of metoclopramide (Reglan). What is the next appropriate step in the process? a. Insert the tube in the patient’s nose and advance the tube b. Obtain an abdominal radiograph c. Remove the stylet from the tube d. Measure for gastric placement e. Tape the tube to the patient’s nose ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 5. Which best describes a disadvantage of using a nasogastric tube in a patient? a. Discomfort for the patient b. Formula must be delivered by pump only c. It requires a surgical procedure Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support d. There is a risk of infection at the site e. There is a greater risk of tube clogging ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 6. A surgeon places a feeding tube that provides nutrients directly into the patient’s stomach. This type of tube is called a: a. nasogastric tube. b. jejunostomy c. surgical gastrostomy. d. percutaneous endoscopic gastrostomy. e. surgical gastrectomy.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 7. The thickness of a liquid is known as its: a. osmolality. b. viscosity. c. nutrient density. d. osmolarity. e. coagulation.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 8. The protein component of most enteral formulas comes from: a. lactose. b. monosaccharides. c. dextrin and fatty acids. d. albumin and whey. e. soy or casein.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 9. Which best describes an advantage of a percutaneous endoscopic gastrostomy (PEG) tube? a. The tube can be inserted at the bedside b. The tube is used for short-term feedings c. It allows for bolus feedings d. There is little risk of infection e. The tube can be used for IV fluids ANSWER: c DIFFICULTY: Bloom's: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support REFERENCES: Enteral Nutrition 10. The usual nutrient density of enteral formulas ranges between: a. 0.5 and 1.0 kcal/mL b. 1.0 and 2.0 kcal/mL c. 2.0 and 2.5 kcal/mL d. 3.0 and 3.5 kcal/mL e. 4.0 and 5.5 kcal/mL ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 11. For the critically ill patient in the hospital, enteral feedings should be advanced to meet the nutrition prescription within: a. 12 hours. b. 48 hours. c. 72 hours. d. 1 week. e. 2 weeks.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 12. Which describes a true statement about continuous enteral feedings? a. They are administered several times a day -- every 30 minutes. b. They may be administered by gravity from a container suspended above the patient. c. They consist of the administration of approximately 250 mL of formula at a time. d. They are usually more time consuming for staff to administer. e. They require a pump and other equipment to administer.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 13. The first step in determining the enteral nutrition prescription is to: a. consider electrolyte needs. b. establish a dosing weight. c. determine fluid needs. d. determine a kcal goal. e. consider vitamin and mineral needs.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 14. Which patient is at highest risk of aspiration when receiving an enteral feeding? a. A patient with Crohn’s disease Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support b. A pregnant patient c. A patient with an endotracheal tube d. A patient with celiac disease e. A patient with a concurrent diagnosis of cancer ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 15. A nutritionally unstable patient who is receiving enteral feedings should have fluid status assessed at least: a. every day. b. 3 times per week. c. every week. d. every 1-2 weeks. e. prn.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 16. Which of the following actions is appropriate to prevent a clogged feeding tube? a. Instill heparin into the tubing b. Slow the feeding to run at ½ the normal rate for one hour a day c. Use a small volume syringe and add air into the tube d. Flush with 25 mL of tap water several times a day e. Reinsert the stylet that was used during tube placement ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 17. Which patient is most likely at risk of refeeding syndrome? a. A patient recovering from outpatient surgery b. A patient with gastroesophageal reflux c. A patient with hypermagnesemia d. A patient with osteoporosis e. A patient with a history of long-term inadequate oral intake ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 18. Which of the following nursing interventions is appropriate to reduce the risk of aspiration during enteral feedings? a. Instill blue dye into the feeding b. Check a level of lung aspirate daily c. Elevate the head of the bed at least 30 degrees d. Instill the feeding at a faster rate e. Increase fiber to 8 g in each supplement Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 19. Which is an example of a true statement regarding peripheral parenteral nutrition (PPN)? a. PPN instills small volumes of concentrated fluids. b. PPN requires only small amounts to be nutritionally adequate c. PPN is typically most acceptable for a fluid-restricted patient. d. The high osmolality of PPN may cause small veins to collapse. e. Peripheral access for PPN is easier to maintain than a central line.

ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition 20. In which condition would parenteral nutrition most likely be indicated? a. Short bowel syndrome b. Increased oral fluid intake c. Hyperkalemia d. Severe dysphagia e. Cardiovascular disease ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 21. Which statement regarding an implantable port would be considered true? a. An implantable port may be placed by a surgeon or a specially trained registered nurse. b. An implantable port is usually inserted into the arm and threaded to the vena cava. c. An implantable port must have the catheter changed every few days to reduce the risk of infection. d. An implantable port may be difficult to access by the patient. e. An implantable port is only suitable for short-term access.

ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition 22. Which describes an advantage of compounding parenteral solutions in the hospital pharmacy? a. Cost effectiveness b. Increased patient satisfaction c. Decreased risk of infection d. The ability to combine blood products with the solution, if necessary e. Reduction in nursing requirements ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 23. The primary source of carbohydrate in parenteral nutrition comes from: Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support a. modified food starch. b. maltose oligosaccharides. c. dextrose monohydrate. d. arginine polyesterols. e. high fructose corn syrup.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 24. The minimum amount of carbohydrate found in parenteral nutrition as specified by the DRI is: a. 60 g/day. b. 130 g/day. c. 200 g/day. d. 240 g/day. e. 300 g/day.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 25. Which element is not added routinely to standard parenteral nutrition formulas? a. selenium b. zinc c. iron d. chromium e. copper ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 26. How much folic acid is typically required in an adult preparation of parenteral nutrition?

2 mg a. 250 mcg b. 500 mcg c. 600 mcg d. 1 mg e. 2 mg ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 27. Which condition is an example of a gastrointestinal complication that may develop with parenteral feedings? a. irritable bowel syndrome b. cholestasis c. dumping syndrome Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support d. nausea e. gastroesophageal reflux ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 28. Which situation must be considered when making a decision to start parenteral nutrition? a. The length of time nutrition support is needed b. The patient’s BMI c. The patient’s need for amino acids in solution d. The physician’s ability to obtain an order e. The need for an automated compounder ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition 29. The Hickman® catheter is an example of which type of catheter used for parenteral nutrition? a. peripherally inserted central catheter b. non-tunneled catheter c. implantable port d. tunneled catheter e. Swan-Ganz catheter ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 30. A three-in-one solution of parenteral nutrition prepared by an automated compounder contains: a. fatty acids, iron, and monosaccharides. b. dextrose, amino acids, and lipids. c. omega-3 fatty acids, triglycerides, and commercial amino acids. d. oligosaccharides, leucine, and valine. e. nonessential amino acids, dextrose, and vitamins.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition 31. A lipid-based drug that is often administered to the critically ill patient is called: a. Hydrosol. b. Hepatosol. c. Propofol. d. Aminess. e. Clinisol.

ANSWER: c DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support REFERENCES: Parenteral Nutrition 32. Which type of medication would most likely be added to parenteral nutrition solution for patient care? a. acetaminophen b. keterolac c. fentanyl d. cimetidine e. demerol ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition 33. Which type of complication is most often associated with parenteral nutrition administration? a. rash b. lung damage c. Osteoporosis d. kidney stones e. Infection ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 34. Which best describes a common consequence of malnutrition? a. increased gastric emptying b. delayed wound healing c. Cirrhosis d. atrophic gastritis e. hearing loss ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Introduction 35. Which describes recommended criteria for use of enteral feedings in a pediatric patient? a. Weight loss of 5 pounds in 6 months b. Unable to obtain 20% of caloric needs by mouth c. Requiring over 4 hours a day to eat d. Inadequate oral intake for over 48 hours e. Persistent TSF below the 50th percentile ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition Case Study Multiple Choice You have an 80 yo M patient that has end-stage Alzheimer’s disease and has recently been diagnosed with severe dysphagia. This patient is getting ready for discharge from the hospital. His height is 5’ 9’’ and he weighs 162# with Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support no recent changes in weight.

36. How many grams of protein per kilogram of body weight does this patient need? a. 0.8 b. 1.0 c. 1.2 d. 1.5 e. 2.0 ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition PREFACE NAME: Alzheimer’s disease 37. Calculate the daily fluid requirements for this patient. a. 1000 mL b. 1800 mL c. 2200 mL d. 3100 mL e. 3400 mL ANSWER: c DIFFICULTY: Bloom's: Analyze REFERENCES: Enteral Nutrition PREFACE NAME: Alzheimer’s disease 38. Which is the correct amount of kcalories needed daily for this patient to maintain normal body weight? a. 1110 – 1750 kcal b. 1840 – 2210 kcal c. 2350 – 2380 kcal d. 2900 – 3020 kcal e. 3150 – 3200 kcal ANSWER: b DIFFICULTY: Bloom's: Analyze REFERENCES: Enteral Nutrition PREFACE NAME: Alzheimer’s disease 39. Which method of providing enteral nutrition would be most appropriate for this patient? a. orogastric tube b. nasointestinal feeding tube c. Jejunostomy d. surgical gastrostomy e. nasogastric tube ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition PREFACE NAME: Alzheimer’s disease Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support 40. Which situation would require that the patient change from enteral nutrition to parenteral nutrition? a. The patient loses 5 pounds b. The patient develops a paralytic ileus c. The patient can no longer afford enteral nutrition d. The patient develops sleeping problems e. The protein content of the enteral nutrition needs to be changed ANSWER: b DIFFICULTY: Bloom's: Analyze REFERENCES: Parenteral Nutrition PREFACE NAME: Alzheimer’s disease 41. Up to 40% of nursing home patients exhibit some signs of malnutrition. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Introduction 42. In the geriatric population, nutrition support may not be initiated until oral intake has declined precipitously due to advanced progression of diseases. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 43. The first decision to make when designing the nutrition prescription is how to establish access to the gastrointestinal tract. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 44. Post-pyloric access is most often used when the patient is at high risk of aspiration. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 45. One of the most common disadvantages of surgical gastrostomy tubes is that they become dislodged easily. a. True b. False ANSWER: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 46. Recent research has reexamined the use of blenderized feedings and has demonstrated improved tolerance in some children with feeding disorders. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 47. Benefits attributed to fiber, particularly improved bowel function, have more often been associated with insoluble fiber. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 48. Enteral formulas are often the sole source of water for patients receiving them. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 49. Peripheral parenteral nutrition requires large volumes to meet nutritional needs, which makes this route unacceptable for any fluid-restricted patient. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 50. Parenteral solutions may contain as many as 5 different items when they are initially compounded. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 51. Enteral nutrition refers to delivery of nutrients distal to the oral cavity of the gastrointestinal tract via a tube, catheter, or _______________.

ANSWER: stoma DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support 52. Feeding access is achieved when a feeding tube is placed into the stomach or _______________.

ANSWER: intestine DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 53. _______________ feeding tubes enter the gastrointestinal tract through the nose and reside in the duodenum or jejunum.

ANSWER: Nasointestinal, Small bowel DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 54. Among infants, _______________ or _______________ are typically used for enteral feedings.

ANSWER: breast milk; formula, formula; breast milk DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 55. Short-chain fatty acids are used by the intestinal cells, called _______________, as fuel and play a role in maintaining gastrointestinal integrity.

ANSWER: colonocytes DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 56. _______________ is added to formulas and is generally thought to improve stool consistency and reduce diarrhea.

ANSWER: Fiber DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 57. A substance that is water loving or that attracts water is said to be _______________.

ANSWER: hydrophilic DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 58. The osmolality of body fluids is _______________ mOsm/kg.

ANSWER: 300 DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 59. _______________ feedings consist of the administration of 250–500 mL of formula several times daily.

ANSWER: Bolus DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 60. The outer lumen diameter of a feeding tube is described using a measurement called _______________ size.

ANSWER: French DIFFICULTY: Bloom's: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support REFERENCES: Enteral Nutrition 61. The wire guide within the enteral tube that assists with insertion is called the _______________.

ANSWER: stylet DIFFICULTY: Bloom's: Remember REFERENCES: Enteral Nutrition 62. Providing adequate free _______________ as well as using a fiber-supplemented formula are steps that may be performed to relieve constipation associated with enteral feedings.

ANSWER: water DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 63. _______________ is a term used to describe several common metabolic alterations that may occur during nutritional repletion of patients who are malnourished or in a state of starvation.

ANSWER: Refeeding syndrome DIFFICULTY: Bloom's: Understand REFERENCES: Enteral Nutrition 64. The primary difference between enteral and parenteral feedings is that nutrients are provided via the _______________ rather than the gastrointestinal tract in PN. ANSWER: veins DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 65. The most common type of parenteral access is a(n) _______________.

ANSWER: central venous catheter, CVC, central line DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 66. Parenteral solutions are compounded under the supervision of a licensed _______________.

ANSWER: pharmacist DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 67. Excessive _______________ in parenteral nutrition may contribute to hyperglycemia, hepatic steatosis, and excessive carbon dioxide production.

ANSWER: carbohydrate, carbohydrates DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 68. The lipid in most parenteral solutions available in the United States is an emulsion of _______________.

ANSWER: soybean oil DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 69. Increased permeability to _______________ has been noted when atrophic intestinal cells result from lack of enteral Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support stimulation.

ANSWER: bacteria DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 70. If parenteral nutrition is administered continuously for several weeks, transient elevations in _______________ enzymes may be noted.

ANSWER: liver DIFFICULTY: Bloom's: Remember REFERENCES: Parenteral Nutrition 71. List five examples of nutrition diagnoses that would indicate a need for enteral nutrition.

ANSWER: Examples of nutrition diagnoses that would lead the practitioner to recommend enteral nutrition as an intervention include malnutrition, increased energy expenditure, involuntary weight loss, inadequate oral food/beverage intake, inadequate fluid intake, increased nutrient needs, biting/chewing difficulty, involuntary weight loss, impaired swallowing, and impaired nutrient utilization.

DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 72. List and describe the three different types of enteral feeding methods.

ANSWER: Bolus feedings consist of the administration of 250–500 mL of formula several times daily. A syringe may be used to inject feedings through the tube. Intermittent feedings are also administered several times daily, over 20–30 minutes. A pump is typically used to control the flow rate. Continuous feedings are administered over 8–24 hours daily, using a pump to control the feeding rate.

DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 73. List the steps of determining the nutrition prescription.

ANSWER: To determine the nutrition prescription, the clinician must first calculate the patient’s dosing weight, as well as protein, energy, and fluid requirements. The clinician then identifies the most appropriate type of formula based on the patient’s diagnosis. Total energy needs are calculated and then divided by the caloric density of the formula. To determine the goal rate of administration, the clinician divides the total formula volume by the number of hours administered. The starting rate may be lower and then the rate advanced as tolerated to reach the goal rate.

DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 74. Give two examples of each of the following: short-term venous access, long-term venous access.

ANSWER: Types of short-term venous access include the percutaneous central venous catheter (CVC) and the peripherally inserted central catheter (PICC) line. Types of long-term venous access include the tunneled catheter (Hickman®, Broviac®) and implantable ports.

DIFFICULTY: Bloom's: Understand REFERENCES: Parenteral Nutrition 75. List four examples of potential complications associated with parenteral nutrition.

ANSWER: Complications of parenteral nutrition include electrolyte imbalance, under- or over-feeding, hyperglycemia, refeeding syndrome, cholestasis, increased permeability to bacteria in the intestinal tract, elevations in liver enzymes, and increased rates of infection.

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Chapter 05 - Enteral and Parental Nutrition Support DIFFICULTY: Bloom's: Apply REFERENCES: Parenteral Nutrition 76. Describe the procedure for inserting a nasogastric feeding tube.

ANSWER: Registered dietitians (RDs) may be responsible for insertion of nasogastric or nasointestinal feeding tubes for adults in some institutions. A recent review of this practice found a 66% reduction of hospital costs associated with tube insertion along with a shorter time for insertion and a shorter time for feeding initiation in institutions where the RD is responsible for bedside placement of postpyloric feeding tubes.

Box 5.3 summarizes the protocol for the insertion of tubes in adults. (See the ―Equipment‖ section later in the chapter for more information about the tubes and other supplies involved.)

DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 77. Describe indications, advantages, and disadvantages of the following types of enteral feeding tubes: nasogastric tubes, orogastric tubes, gastrostomy tubes, PEG tubes.

ANSWER: Nasogastric tubes are indicated in cases of normal GI function; they stimulate digestive function, are easy to insert and maintain, and they allow for medication administration. Disadvantages of nasogastric tubes include patient discomfort, increased risk of aspiration, irritation of the nasal passages, and the potential for tube displacement. Orogastric tubes are used with normal GI function but when a nasogastric tube is not feasible. Advantages include normal stimulation of gut function, they are easy to insert and maintain, and medications can be placed in the tube. Disadvantages include tube displacement, increased risk of aspiration, and discomfort for the patient. Gastrostomy and PEG tubes bypass the upper GI tract and are used for long-term feedings. Gastrostomy tubes allow for boluses, they are used long term, and there is less risk of aspiration or tube displacement, but they require surgery for placement and the patient can develop skin irritation at the insertion site. PEG tubes can be inserted on an outpatient basis, they allow for bolus feedings, and there is little risk of tube displacement but there is a greater risk of skin irritation at the insertion site.

DIFFICULTY: Bloom's: Analyze REFERENCES: Enteral Nutrition 78. List and describe four examples of complications associated with enteral feedings.

ANSWER: Enteral feeding is not a simple procedure. Patients who receive enteral feedings may experience a variety of complications, and some of these—such as aspiration or tube misplacement—are serious.

Complications of enteral feedings may develop at any point during a course of therapy. High-risk patients who have concurrent illnesses require an experienced dietitian to successfully manage enteral feedings. Information about the tube-related and gastrointestinal complications, as well as other issues, can be found in the section Monitoring and Evaluation: Complications.

DIFFICULTY: Bloom's: Apply REFERENCES: Enteral Nutrition 79. Explain indications for using parenteral nutrition and list several conditions that would require parenteral nutrition instead of enteral nutrition.

ANSWER: Parenteral nutrition is indicated in those clinical situations where the patient is unable to meet nutritional needs either by an oral diet or through the use of enteral nutrition. The clinical conditions that may require parenteral nutrition include an inability to digest and absorb nutrients, such as in massive bowel resection or short bowel syndrome; intractable vomiting, as in hyperemesis gravidarum; GI tract obstruction;impaired GI motility; and abdominal trauma, injury, or infection. Nutrition diagnoses associated with candidates for PN are the same as those for EN. DIFFICULTY: Bloom's: Analyze REFERENCES: Parenteral Nutrition Copyright Cengage Learning. Powered by Cognero.

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Chapter 05 - Enteral and Parental Nutrition Support 80. Describe the use of a pharmacy compounder with the nutrition prescription and list advantages as well as disadvantages.

ANSWER: Automated compounders can be used to manufacture nutrient solutions that combine dextrose and amino acids (two-in-one formulas) or dextrose, amino acids, and lipids (three-in-one formulas). PN can be provided in either a two-in-one or three-in-one system, and each system has both advantages and disadvantages. In the two-in-one, lipids are added separately based on the available container sizes (100 mL, 250 mL, or 500 mL). This system provides a greater degree of flexibility in the amounts of dextrose and amino acids that can be given. A disadvantage of the two-in-one system is the need for an additional administration set (intravenous tubing and other devices required for the delivery of parenteral nutrition) for the lipids. The three-in-one system requires a single administration set, which saves nursing time and reduces costs. On the other hand, the addition of lipids with the three-in-one system results in an opaque solution, which obscures precipitate and increases the risk of particulate being infused into the patient.

Addition of lipid into the three-in-one solution limits the electrolytes and final concentration of amino acids in solution.

DIFFICULTY: Bloom's: Analyze REFERENCES: Parenteral Nutrition

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Chapter 06 - Documentation of the Nutrition Care Process 1. The nutrition care process consists of four steps: nutrition assessment, intervention, evaluation/monitoring, and: a. diagnosis. b. judgment. c. analysis. d. conclusion. e. investigation.

ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Introduction 2. Which describes a function of the patient’s medical chart? a. Communicating information between medical professionals and the public b. Evaluating medical care for the client’s family c. Upholding the Joint Commission’s standards d. Keeping a record of what has been done for the patient e. Supporting the need for funding the non-profit facility ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 3. The patient’s medical record contains CPT codes for documentation. CPT stands for: a. Computerized Policies and Training b. Current Procedural Terminology c. Calculated Programs and Technology d. Consistent Prospective Testing e. Copied Preferences and Testimonies ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 4. A record of an individual’s care that provides health information from all clinicians that provide care and is designed to follow the patient wherever they receive health care is known as the: a. electronic medical record (EMR). b. medical chart. c. electronic health record (EHR). d. patient register. e. personal health record (PHR).

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 5. Which describes a section of the problem-oriented medical record (POMR)? a. progress notes b. research results c. billing statements Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process d. reimbursement policies e. facility medical procedures ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 6. Which type of information would be documented under the “S” portion of the SOAP format? a. the patient’s age b. medical diagnosis c. nutrition therapy recommendations d. the patient’s vital signs e. psychosocial factors affecting care ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 7. The “I” in ADIME charting stands for: a. ideal. b. impaired. c. identification. d. intervention e. interaction.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 8. Which abbreviation is on the Joint Commission’s official “Do Not Use” list? a. mg b. IU c. mL d. mEq e. kg ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 9. A dietitian is documenting a list of the patient’s medications and supplements using the ADIME format. Which section of the charting would this information fall under? a. Assessment b. Diagnosis c. Monitoring d. Evaluation e. Inference ANSWER: a DIFFICULTY: Bloom's: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process REFERENCES: Charting: Documentation of the Nutrition Care Process 10. Which charting format consists of a combination and reduction of the SOAP and IER formats? a. ADIME b. IEP c. PIE notes d. ISFP e. Focus notes ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 11. Which information is included in the charting by exception (CBE) method? a. the patient’s height, weight, and BMI b. estimated energy requirements c. the nutritional care plan d. dietary assessment data e. results of the physical exam ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 12. When charting about a procedure performed on a patient, when should the nutrition practitioner chart the information? a. just before the procedure b. just after the procedure c. the day after the procedure d. only when there are significant results e. before the patient is discharged ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 13. Which action would be involved with bracketing biases when charting? a. Getting rid of personal preferences and values b. Describing information that is subjective to self c. Imagining how an unbiased professional would respond d. Recording feelings and responses to the patient’s behavior e. Documenting personal discussions by placing a bracket around the words ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 14. A nutrition practitioner has just made an error while writing in a chart. Which is the best method of correcting the situation? a. Remove the page from the chart and start over Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process b. Draw a line through the error and initial it c. Use correction fluid and write over it d. Scribble through the error and initial it e. Use red ink to write “error” and initial it ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 15. Which information would go under the “I” section of an IER note? a. laboratory data b. record of intake and output c. dietary assessment data d. plans for follow-up e. nutrition education ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 16. A patient reports that he is nauseated and has vomited two times. This information would be included in which part of the SOAP note? a. Subjective b. Objective c. Assessment d. Analysis e. Plan ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 17. Which would be considered an acceptable medical abbreviation? a. QD b. U c. cc d. mmHg e. IU ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 18. A physician has ordered 6U of insulin for a patient. Which would be the correct method of writing this order instead? a. 6 Un b. Six U c. Six units d. 6 units e. 6 ut Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 19. One of the most important goals of documentation in the medical record is: a. to be clear and concise. b. to follow ADA format. c. to develop a new method of charting. d. to use medical abbreviations. e. to demonstrate knowledge of medicine and dietetics.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 20. The organizational structure or format in which the nutrition diagnosis is written is called the: a. SOAP note. b. PES. c. focus notes. d. nutrition diagnosis. e. progress notes.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 21. After interviewing a patient, the dietitian describes why he is at nutritional risk. This information should be recorded in which part of ADIME charting? a. Assessment b. Diagnosis c. Intervention d. Monitoring e. Evaluation ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 22. A patient has developed a pressure ulcer from lying in bed. This information should be documented in which part of ADIME charting? a. Assessment b. Diagnosis c. Intervention d. Monitoring e. Evaluation ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process 23. Which situation would be considered a violation of a patient’s right to confidentiality? a. Reviewing the patient’s care plan with his physician b. Discussing the patient’s condition with the physical therapist involved in the case c. Talking about medications while the patient’s spouse is in the room d. Discussing the patient’s status with a local pharmacist e. Explaining the goals of treatment for the patient with his nurse ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 24. A dietitian is documenting information in a patient’s chart. She writes an asterisk and then explains the information further in the comments section of the chart. Which type of documentation format is the dietitian most likely using? a. SOAP format b. PIE notes c. charting by exception d. focus notes e. ADIME format ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 25. A dietitian must record a patient’s nutrition information in his chart, and she is waiting for the nurse to finish her notes. What guideline must the dietitian consider when she gets the chart and starts her own documentation? a. Review what the nurse wrote and write the same information in her own words b. Leave a small amount of white space after the nurse’s writing to add information later c. Ask the nurse to document the nutrition information as well d. Write a signature after the nursing information and the nutrition information e. Write clearly so that the nurse or anyone else reading the chart can understand the information ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 26. Which factor is essential to keep in mind while documenting in a patient’s chart? a. Include less information, rather than too much b. Only record assumptions at the end of documentation c. Add a signature only with written documentation, not electronic d. Avoid abbreviations unless it is clear that anyone can understand them e. Only chart what others see as significant ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 27. Which constitutes a goal of the Health Insurance Portability and Accountability Act (HIPAA)? a. Prevent the inappropriate use of protected health information Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process b. Prevent communication between financial institutions related to patient billing c. Ensure that insurance companies are reimbursing appropriate amounts d. Guarantee the safety of the patient’s chart between admission and discharge e. Ensure that the patient’s chart is correctly transcribed into an electronic health record ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 28. Each context of writing contains four elements: the subject matter, the ethos, the purpose, and: a. the language. b. the publication. c. the cognitive response. d. the objective information. e. the audience.

ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Beyond Charting: An Overview of Writing in the Profession 29. The personality or voice that comes through the text and characterizes the writer for the reader is known as the: a. spirit. b. nature. c. ethos. d. temperament. e. philosophy.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Beyond Charting: An Overview of Writing in the Profession 30. Which best describes writing processes? a. A universal contextual framework b. Different levels on which to focus attention c. The organization of different sections of written work d. The cognitive processes and stages of writing e. An ability to choose the appropriate words ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 31. Levels of discourse are generally described as: a. the reasons for writing the text. b. norms, ideas, organization, and grammar. c. the readers to whom the writing is directed. d. styles, lettering, and fonts. e. the characters and settings the writing is about.

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Chapter 06 - Documentation of the Nutrition Care Process ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 32. When describing the steps of the writing process, which would be considered the first step? a. invention b. editing c. drafting d. sentence generation e. revision ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Beyond Charting: An Overview of Writing in the Profession 33. Which best describes the process of pre-writing? a. recalibrating thinking b. setting goals c. planning the text d. making minor corrections e. eliminating unnecessary material ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 34. Which genre written by a clinical dietitian would most likely be viewed by other members of the interdisciplinary team? a. brochures b. memos c. charts d. handouts e. pamphlets ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 35. The ethos is an important component of writing because: a. it allows the reader to understand the text more fully. b. it establishes the nutrition professional as the expert. c. it describes the focus of the writing. d. it considers the education level of the audience. e. it documents information for legal purposes.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Conclusion: Your Ethos—Establishing Experience Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process Case Study Multiple Choice A healthcare facility has recently adopted a new method of documenting in the medical record. The dietitian was trained using the SOAP method, but now needs to transition to understanding different methods of charting to ensure that transition to new documentation is smooth.

36. The information written in the “S” portion of the SOAP format would now be written in which portion of the ADIME note? a. A b. D c. I d. M e. E ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process PREFACE NAME: healthcare

37. The information contained in the “O” portion of the SOAP note would now be written in which part of the ADIME note? a. A b. D c. I d. M e. E ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process PREFACE NAME: healthcare 38. The information from the SOAP note is consolidated into three sections: writing the patient’s data, the nutritionist’s interventions, and the patient’s response to the interventions. This process most likely reflects which type of charting? a. CBE b. PIE notes c. IER format d. focus notes e. IEP format ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process PREFACE NAME: healthcare 39. The “P” in PIE notes stands for: a. procedure. b. plan. c. policy.

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Chapter 06 - Documentation of the Nutrition Care Process d. problem e. patient.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process PREFACE NAME: healthcare 40. The overall movement in charting over the last decade has been toward: a. increasing the size of the medical record. b. changing charting from SOAP format to ADIME. c. decreasing the size of the medical record. d. requiring workers to document more information. e. eliminating the need for the medical record.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process PREFACE NAME: healthcare 41. Health professionals probably ought to write even more than they do because keeping personal notes in addition to required documentation of nutrition care provides greater opportunities for insights. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Introduction 42. The driving forces that impact medical record keeping include accrediting agencies for health care facilities, continuous quality improvement programs, and insurance reimbursement for medical care. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 43. Each state’s licensing agency requires that all health care facilities monitor, evaluate, and seek ways to improve the quality of care for their patients. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 44. Clients frequently request copies of their medical records, but they do not have the right to read those records. a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 45. The data in the EMR is the legal record of what happened to the patient during his or her encounter with the care delivery organization and is owned by the patient. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 46. Steps to ensure accuracy of the medical record include the use of standard language and medical abbreviations. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 47. The data portion of problem-oriented medical record is a list of expected outcomes and plans for further data collection. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 48. The rhetorical norms of writing are the different levels of writing on which one can focus attention. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 49. The actual process of writing is usually always linear. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Beyond Charting: An Overview of Writing in the Profession 50. While editing, successful writers wait to make editing changes to a text until revision is complete. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process REFERENCES: Beyond Charting: An Overview of Writing in the Profession 51. Clear, concise wording in the medical record, using terminology consistent with the _______________, will facilitate reimbursement for services.

ANSWER: prospective payment system DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 52. Each state’s licensing agency, as well as _______________, requires that all health care facilities monitor, evaluate, and seek ways to improve the quality of care for their patients.

ANSWER: the Joint Commission, JCAHO DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 53. The _______________ is defined as: “an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications.”

ANSWER: electronic medical record, EMR DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 54. A record of an individual’s care that provides health information from all clinicians that provide care for that individual and is designed to follow the patient wherever they receive health care is known as the _______________ ANSWER: electronic health record, EHR DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 55. The Joint Commission recommends that certain abbreviations not be used because they are more likely to contribute to _______________.

ANSWER: errors, patient care errors, mistakes DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 56. The POMR is divided into five parts: data, problem list, care plan, progress notes, and _______________.

ANSWER: discharge summary DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 57. The Academy of Nutrition and Dietetics has promoted the use of the _______________ format because it mirrors the steps of the nutrition care process.

ANSWER: ADIME DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 58. The label “SOAP” refers to the four sections of each entry in the medical chart: subjective data, _______________, assessment, and plan.

ANSWER: objective data Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 59. _______________ include patient information or data collected from the patient or caregiver.

ANSWER: Subjective data DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 60. The _______________ section of ADIME charting is where the actual PES statements are listed and prioritized.

ANSWER: diagnosis, D DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 61. Using IER notes, _______________ refers to the assessment part of SOAP, the diagnosis and evaluation based on the data gathered.

ANSWER: evaluation DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 62. When using the charting by exception method, a(n) _______________ indicates an abnormal finding on an assessment or an abnormal response to an intervention.

ANSWER: asterisk DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 63. When charting, remember that medical charts are _______________ documents as well as medical documents.

ANSWER: legal DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 64. The federal U.S. law that assures patients of the confidentiality of their medical information is the Health Insurance Portability and _______________ Act of 1996, or HIPAA. ANSWER: Accountability DIFFICULTY: Bloom's: Remember REFERENCES: Charting: Documentation of the Nutrition Care Process 65. When referring to a patient while charting, use the term “patient” or “_______________,” and not his or her name.

ANSWER: client DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 66. The levels of _______________ include the different levels of writing on which one can focus attention.

ANSWER: discourse DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 67. A set of readers to whom the text is directed is known as the _______________.

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Chapter 06 - Documentation of the Nutrition Care Process ANSWER: audience DIFFICULTY: Bloom's: Remember REFERENCES: Beyond Charting: An Overview of Writing in the Profession 68. _______________ involves whatever it is that the writer does before actually writing.

ANSWER: Prewriting, invention DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 69. All writing involves subject matter, a purpose, an audience, and the writer’s _______________.

ANSWER: ethos DIFFICULTY: Bloom's: Remember REFERENCES: Beyond Charting: An Overview of Writing in the Profession 70. Differences in the writing of different communities --different disciplines, different workplaces -- coalesce into what are referred to as _______________.

ANSWER: genres DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 71. List each component of the following acronyms: SOAP, ADIME, IER. ANSWER: SOAP: subjective data, objective data, assessment, plan ADIME: assessment, diagnosis, intervention, monitoring, evaluation IER: intervention, evaluation, revision DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 72. List three examples of guidelines for charting that were stated in the text.

ANSWER: Examples of guidelines for charting include recognizing the significance of charting, including the dietitian’s full name and status when signing charts, being timely with charting, never charting for someone else, avoiding documenting procedures until after they have been completed, remembering that medical charts are legal documents and should be treated as such, using only black ink and writing legibly, using clear language while writing and avoiding unfamiliar abbreviations, and avoiding white space. Further, the clinician should document only information that has been observed with objective notes and avoid assumptions.

DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 73. List the basic functions of writing for both personal and professional situations.

ANSWER: The basic functions are to record information, to inform or disseminate information, to persuade, and to entertain.

DIFFICULTY: Bloom's: Understand REFERENCES: Charting: Documentation of the Nutrition Care Process 74. Name the elements involved with every rhetorical norm.

ANSWER: Subject matter: what the text is about Purpose: a reason for writing the text Audience: a set of readers to whom the text is directed Copyright Cengage Learning. Powered by Cognero.

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Chapter 06 - Documentation of the Nutrition Care Process Ethos: the personality or voice that comes through the text and characterizes the writer for the reader DIFFICULTY: Bloom's: Understand REFERENCES: Beyond Charting: An Overview of Writing in the Profession 75. List the three important areas of writing that are necessary for communication that must be understood for all writers.

ANSWER: Three important areas of writing need to be understood: (1) the rhetorical norms--that is, the universal contextual framework within which all communication exists; (2) the levels of discourse--that is, the different levels of writing on which one can focus attention; and (3) writing processes--that is, the cognitive processes and stages of writing.

DIFFICULTY: Bloom's: Apply REFERENCES: Beyond Charting: An Overview of Writing in the Profession 76. Discuss the purpose and give an example of charting by exception in the patient’s medical record.

ANSWER: Charting by exception (CBE) is an abbreviated approach to medical charting that involves recording only unusual or out-of-the-ordinary events. The CBE format includes a standardized nutritional care plan. After the initial charting of the care plan, only significant data and/or unanticipated responses to the proposed plan should be included in the record. In most CBE formats, a flowchart is used to document assessments and interventions. An asterisk (*) indicates an abnormal finding on an assessment or an abnormal response to an intervention. The findings are explained in the comments section of the form.

An example of CBE might be documenting on a patient who has been vomiting; the dietitian fills out the flow chart and then writes an asterisk in the GI section. In the notes, the dietitian may then write: * “Pt. has vomited three times this morning…” and go on to explain the cause and effects of the situation.

DIFFICULTY: Bloom's: Analyze REFERENCES: Charting: Documentation of the Nutrition Care Process 77. Describe the importance of developing a personal medical notebook and note its use, advantages, and disadvantages.

ANSWER: Health professionals should consider keeping a personal medical notebook where they can chart everything involved with each patient’s treatment, where they can brainstorm problems, and where they can include their subjective experiences and express their own emotional and intellectual responses. A personal notebook may help the dietitian to cope with some stress and anxiety of the job as well as remember important information that needs to be included when charting. A disadvantage is that the notebook may contain personal information and the clinician must keep it safe to protect patient confidentiality.

DIFFICULTY: Bloom's: Analyze REFERENCES: Charting: Documentation of the Nutrition Care Process 78. Describe the parameters of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

ANSWER: The federal U.S. law that assures patients of the confidentiality of their medical information is the Health Insurance Portability and Accountability Act of 1996. HIPAA protects information about clients that is gathered by examination, observation, conversation, or treatment. A dietitian cannot discuss a client’s status with other clients or staff who are uninvolved in the client’s care. A legal suit can be brought against a dietitian who has disclosed information about clients without their consent. Dietitians and other health care professionals use records not only to provide care for individual patients, but also as an information source for continuous quality improvement, data gathering, research, or continuing education. This is not a breach of confidentiality as long as the records are used as specified and permission is granted from the institution’s internal review board.

DIFFICULTY: Bloom's: Apply REFERENCES: Charting: Documentation of the Nutrition Care Process 79. Discuss each of the following steps in the writing process: prewriting, drafting, revision, editing.

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Chapter 06 - Documentation of the Nutrition Care Process ANSWER:

Prewriting is whatever it is that the writer does before actually writing. For longer pieces of writing, successful writers tend to spend time planning a text before beginning to write it. They develop their ideas about the subject matter and identify their purpose and audience. They produce a rough plan for how the text is to be organized. Drafting, or actual sentence generation involves setting goals and subgoals and recalibrating one’s thinking as more and more text is produced. In addition to revising while drafting, successful writers virtually always make revisions to their text after it has been completely drafted. Successful writers then spend time making minor corrections at the sentence and subsentence levels of discourse. This is when proofreading takes place; these writers make their changes based on errors they identify during the proofing of their manuscripts.

DIFFICULTY: Bloom's: Apply REFERENCES: Beyond Charting: An Overview of Writing in the Profession 80. Discuss possible options for research and publication for the nutrition professional beyond writing patient instructions.

ANSWER: There are a number of options for research and publication for the dietetics professional. The dietitian may want to do original research and report the findings of that research either in professional journals and books or at professional conferences. Reporting research results is considerably more formal than writing instructions for patients, in the sense that there are certain organizational and stylistic conventions that must be adopted when reporting research. Other ideas and options include dietetic teaching and medical journalism.

DIFFICULTY: Bloom's: Analyze REFERENCES: Beyond Charting: An Overview of Writing in the Profession

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Chapter 07 - Fluid and Electrolyte Balance 1. What percentage of a typical adult male’s body is comprised of water? a. 40% b. 50% c. 60% d. 70% e. 80% ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 2. What kind of tissue has the lowest percentage of water in the body? a. muscle b. fat c. skin d. connective e. epithelial ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 3. How much of the body’s water is found within cells (intracellular fluid)? a. 1/4 b. 1/3 c. 1/2 d. 2/3 e. 3/4 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 4. What is the best definition of diuresis? a. the production of excessive amounts of urine b. accumulation of edema within a joint c. accumulation of edema within the abdomen d. dehydration caused from excessive bleeding e. kidney pain caused by stones ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. What does hypokalemia mean? a. high serum potassium b. high serum calcium c. low lymph calcium d. low serum calcium Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance e. low serum potassium ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 6. What is the term for abnormal fluid accumulation in the peritoneal cavity (often due to liver disease)? a. diuresis b. ascites c. hypernatremia d. water intoxication e. edema ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 7. The force that pulls water across membranes is referred to as: a. edema force b. diffusion force c. electrolyte force d. osmotic pressure e. gradient pressure ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 8. What percentage of bodyfluid is in plasma? a. 0.05% b. 1% c. 6.6% d. 9% e. 14% ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 9. What is the normal range of osmolality for the blood? a. 280 to 320 mOsm/kg H2O b. 325 to 375 mOsm/kg H2O c. 380 to 420 mOsm/kg H2O d. 425 to 475 mOsm/kg H2O e. 580 to 620 mOsm/kg H2O ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance 10. What is likely to occur when cells are exposed to a hypertonic solution? a. dehydration b. swelling c. edema d. destruction e. equilibrium ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 11. Precise determination of metabolic water is: a. calculated by using osmolarity b. calculated by using osmolality c. calculated using urine output d. constant from hour to hour e. not possible ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 12. What route of fluid loss is the most variable and will accommodate changes in dietary fluid intake? a. feces b. respiration c. urine d. perspiration e. metabolism ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 13. What is the specific gravity of water? a. 0.25 b. 0.5 c. 0.75 d. 1.0 e. 2.0 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 14. How much fluid should an average adult consume each day under normal circumstances? a. 20–25 mL/kg b. 30–35 mL/kg c. 40–45 mL/kg d. 50–55 mL/kg Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance e. 60–65 mL/kg ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 15. Ions with a positive charge are referred to as: a. electrolytes b. cations c. anions d. molecules e. particles ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Body Solutes 16. What is the major cation in the ECF (extracellular fluid)? a. sodium b. calcium c. chloride d. potassium e. glucose ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Body Solutes 17. How much sodium does 1 tsp of table salt contain? a. 900 mg b. 1,300 mg c. 1,800 mg d. 2,300 mg e. 3,000 mg ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Body Solutes 18. Baroreceptors within blood vessels are stimulated by: a. high osmolarity b. low osmolarity c. high glucose concentration d. high hydrostatic pressure e. low hydrostatic pressure ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance 19. What hormone is released from the kidney and stimulates conversion of angiotensinogen to angiotensin I? a. arginine vasopressin b. antidiuretic hormone c. renin d. pepsin e. aldosterone ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 20. Serum calcium exists in a reciprocal relationship with what other electrolyte? a. magnesium b. potassium c. phosphorus d. chloride e. sodium ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 21. What is hypovolemia? a. ascites within joints b. extracellular fluid deficit c. intracellular fluid deficit d. blood that’s too acidic e. blood that’s too alkaline ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 22. What color of urine reflects dehydration? a. clear and colorless b. light yellow c. red d. dark amber e. green ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 23. What is the most common cause of hypervolemia? a. decrease in urinary output b. diarrhea c. chronic vomiting d. water intoxication Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance e. low salt diet ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 24. The pitting depth of edema is based on what numerical scale? a. 1 to 3 b. 0 to 3 c. 0 to 4 d. 1 to 5 e. 1 to 10 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 25. What is the least likely (but possible) cause of hyponatremia? a. alcoholism b. use of diuretics c. too little water consumption d. IV therapy without electrolytes e. lack of dietary sodium ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 26. Hypernatremia can theoretically be caused by either an increase in sodium or a: a. increase in potassium consumption b. decrease in potassium consumption c. decrease in blood glucose d. increase in water consumption e. decrease in water consumption ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 27. Loss of gastric acids through vomiting can lead to: a. metabolic alkalosis b. metabolic acidosis c. diabetes insipidus d. hyponatremia e. hypernatremia ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance 28. What is the most common cause of hyperkalemia? a. liver cirrhosis b. inadequate excretion of potassium from renal failure c. inadequate excretion of sodium from renal failure d. high blood cholesterol levels e. chronically low blood pressure ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 29. How much of the body’s calcium is found in body fluids? a. 20% b. 12% c. 9% d. 5% e. 1% ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 30. Malignant tumors that metastasize to bone can lead to: a. hypocalcemia b. hyperkalemia c. hypercalcemia d. hypernatremia e. hyperkalemia ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 31. How much of the body’s magnesium is within bone? a. 5-6% b. 25% c. 35-40% d. 50-60% e. 85% ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 32. The medication cyclosporine can cause excessive urinary loss of what electrolyte? a. calcium b. magnesium c. potassium d. phosphorus Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance e. sodium ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 33. Magnesium is used to treat what high-risk condition of pregnancy ? a. preeclampsia b. spina bifida c. Downs’ syndrome d. leukocytosis e. thrombocytosis ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 34. Hypophosphatemia is defined as a serum phosphate level: a. <0.3 mg/dL b. <1.3 mg/dL c. <2.3 mg/dL d. <3.3 mg/dL e. <4.3 mg/dL ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 35. Hypercalcemia is defined as a serum calcium level: a. >15 mg/dL b. >11 mg/dL c. >8 mg/dL d. >5 mg/dL e. >1 mg/dL ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance Case Study Multiple Choice Mr. M has been diagnosed with chronic kidney disease Stage 5, requiring dialysis. His initial chemistries panel indicates he has low sodium, chloride and calcium levels as well as high potassium and phosphorus levels. The physician has put him on a fluid restriction, a potassium restriction, and a phosphorus restriction.

36. Which of the following is contributing to Mr. M’s fluid imbalance? a. kidney disease b. liver disease c. aldosterone secretion exceeding production d. excessive thirst Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance e. poor diet ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance PREFACE NAME: chronic kidney disease 37. The type of fluid involved in Mr. M’s imbalance is: a. intracellular b. transcellular c. extracellular d. pericardial e. ascites ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance PREFACE NAME: chronic kidney disease 38. What is one reason that a physician might order a potassium restriction? a. potassium interacting with kidney disease medications b. high potassium levels stimulating the secretion of aldosterone by the adrenal glands c. high potassium levels causing the retention of vasopressin d. potassium directly interacting with calcium e. diet containing very high levels of potassium ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance PREFACE NAME: chronic kidney disease 39. One of the reasons for his high phosphorus could be: a. the P restriction is altering the levels in the blood b. hypoglycemia c. low magnesium d. high potassium e. low calcium ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance PREFACE NAME: chronic kidney disease 40. The physician has placed Mr. M on a diuretic. A good measure of how he is responding to this medication would be: a. serum PTH concentration b. serum albumin concentration c. serum phosphorus concentration d. fluid inputs and outputs Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance e. serum calcium concentration ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance PREFACE NAME: chronic kidney disease 41. At birth, total body water accounts for approximately 75% of the infant’s weight. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 42. Extracellular fluid is divided into three compartments: interstitial, intravascular, and transcellular (or transitional). a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 43. Osmotic pressure can be expressed as either osmolarity or hydraulic force. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 44. Total urine output is the sum of obligatory urine and facultative urine. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 45. In the ECF, the major cation is magnesium, and major anions are chloride and calcium. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Body Solutes 46. In older adults, thirst sensation increases. a. True b. False ANSWER: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 47. Decreasing hydrostatic pressure stimulates the renin– angiotensin–aldosterone system regulation of fluids and electrolytes. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 48. Medications such as diuretics are often prescribed to purposefully increase ECF volume. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 49. The most common cause of hypovolemia is a decrease in urinary output such as that seen in acute liver failure. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 50. Elevated concentrations of potassium in the ECF can occur when hemolysis of red blood cells increases, such as with leukocytosis or thrombocytosis. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 51. Maintenance of fluid balance is significantly integrated with maintenance of _______________ balance.

ANSWER: electrolyte DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction 52. Body water content declines throughout the life span and often falls below _______________ percent in adults older than 65 years old.

ANSWER: 50 DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 53. Transcellular fluids are those fluids found in secretions within _______________.

ANSWER: organs Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 54. Solutes that do not disperse in fluid, such as large protein molecules, are called _______________.

ANSWER: colloids DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 55. Osmotic pressure can be expressed as either osmolarity or _______________.

ANSWER: osmolality DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 56. Precise determination of _______________ water is not possible; it is thus usually estimated by using intakes of carbohydrate, protein, and _______________ as variables.

ANSWER: metabolic; fat DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 57. The solute concentration in the urine is determined by measuring its _______________.

ANSWER: specific gravity DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 58. Beverages range between 84% and 100% water, with _______________ being at the lower end of the range.

ANSWER: fruit juices DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 59. Negatively charged ions are called _______________.

ANSWER: anions DIFFICULTY: Bloom’s: Remember REFERENCES: Body Solutes 60. The major cation in the ICF is _______________.

ANSWER: potassium DIFFICULTY: Bloom’s: Remember REFERENCES: Body Solutes 61. The mechanism of thirst is regulated in the _______________.

ANSWER: hypothalamus DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 62. When blood volume increases, hydrostatic pressure _______________.

ANSWER: increases Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 63. Increasing amounts of angiotensin II stimulate release of the hormone _______________ from the adrenal cortex.

ANSWER: aldosterone DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 64. Vasopressin causes fluid to be reabsorbed in the tubules of the _______________.

ANSWER: kidney DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 65. Vitamin D increases absorption of _______________ in the small intestine.

ANSWER: calcium DIFFICULTY: Bloom’s: Remember REFERENCES: Physiological Regulation of Fluid and Electrolytes 66. Natural licorice and chewing tobacco, if swallowed, contain an _______________ compound that will also stimulate increases in urinary _______________ excretion.

ANSWER: aldosterone; potassium DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 67. Hypocalcemia most commonly results from a deficit of _______________ or from abnormal vitamin _______________ metabolism.

ANSWER: PTH; D DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 68. Hypophosphatemia can result from vitamin _______________ deficiency.

ANSWER: D DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 69. Hypomagnesemia occurs during withdrawal from _______________.

ANSWER: alcohol DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 70. Calcium gluconate, given intravenously, can reverse the effects of _______________.

ANSWER: hypermagnesemia DIFFICULTY: Bloom’s: Remember REFERENCES: Disorders of Fluid Balance 71. Describe the functions of water in the body.

ANSWER: The functions of water in the body include transporting nutrients, transporting and excreting metabolic Copyright Cengage Learning. Powered by Cognero.

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Chapter 07 - Fluid and Electrolyte Balance waste, supporting cell shape and structure, lubricating friction generating surfaces, and sustaining normal body temperature.

DIFFICULTY: Bloom’s: Apply REFERENCES: Introduction 72. Explain the role of arginine vasopressin in fluid balance.

ANSWER: Arginine vasopressin (AVP) -- previously known as antidiuretic hormone, acts on the renal tubules to reduce urine output in response to dehydration and hyperosmolality.

DIFFICULTY: Bloom’s: Apply REFERENCES: Glossary 73. Describe insensible fluid loss.

ANSWER: Insensible loss is fluid loss that cannot be easily measured (usually refers to fluid lost via sweat and respirations).

DIFFICULTY: Bloom’s: Apply REFERENCES: Glossary 74. Explain what factors influence movement of solutes.

ANSWER: Factors influencing movement of solutes include molecular size (smaller molecules move more easily), electrical charge of the molecule, hydrostatic pressure, and method of solute transport.

DIFFICULTY: Bloom’s: Apply REFERENCES: Body Solutes 75. List the three general categories of alterations in fluid balance.

ANSWER: 1) Changes in fluid volume; 2) changes in fluid concentration or osmolality; 3) changes in fluid composition.

DIFFICULTY: Bloom’s: Apply REFERENCES: Disorders of Fluid Balance 76. Describe the “third spaces”.

ANSWER: Fluids can accumulate within body cavities in spaces between organs. These are often called the “third spaces” and include peritoneal, pericardial, and thoracic cavities as well as the joints and bursae. For the normal healthy individual, these spaces hold insignificant amounts of fluid. However, in illness or injury, fluid accumulation in these spaces may become significant. For example, fluid may accumulate in the peritoneal cavity with liver disease, causing the condition known as ascites.

DIFFICULTY: Bloom’s: Apply REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes 77. Explain the types of solutes in the body, including the major electrolytes.

ANSWER: Solutes in body fluids include both electrolytes (ions) and other molecules. Electrolytes dissociate in fluid to form one or more charged particles. Other molecules, such as glucose, protein, urea, lactate, and other organic acids, remain stable in solution. The major electrolytes in the body are sodium, potassium, calcium, magnesium, chloride, bicarbonate, phosphate, and sulfate. Ions with a positive charge are referred to as cations, and negatively charged ions are called anions.

DIFFICULTY: Bloom’s: Apply REFERENCES: Body Solutes 78. Describe the thirst mechanism.

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Chapter 07 - Fluid and Electrolyte Balance ANSWER:

Cellular sensors within the interstitial fluid are affected by changes in the fluid around them. They trigger the hypothalamus to interpret these signals as thirst and as a result, the individual will be stimulated to increase his or her fluid intake. This thirst mechanism cannot always be relied on, however.

In older adults, thirst sensation decreases. In the trained, elite athlete, thirst sensation may not be a valid indication of need for additional fluid.

DIFFICULTY: Bloom’s: Apply REFERENCES: Physiological Regulation of Fluid and Electrolytes 79. Describe the clinical manifestations of hyponatremia.

ANSWER: Often, clinical manifestations of hyponatremia do not appear until levels of sodium fall below 120 mEq/L. Signs and symptoms that do occur are consistent with changes in osmolality. As serum osmolality falls, water enters the brain cells. Nausea, vomiting, lethargy, confusion, and even seizures can result. All signs and symptoms are more pronounced if hyponatremia occurs rapidly. Laboratory measurements will confirm a serum sodium of <136 mEq/L. Plasma osmolality will be <285 mOsm/kg.

DIFFICULTY: Bloom’s: Apply REFERENCES: Disorders of Fluid Balance 80. Describe the treatment for hyperkalemia.

ANSWER: Treatment of the underlying cause is crucial in correcting hyperkalemia. In a short-term emergency situation, calcium gluconate can be given intravenously to decrease the abnormalities in cardiac cells that could lead to cardiac arrest. Additionally, both glucose and insulin can be used to shift potassium from the ECF to the ICF. Correction of any acid-base imbalance also results in potassium movement into the ICF. Cation exchange resins such as Kayexalate can be given to allow the exchange of sodium for potassium in the large intestine. For long-term treatment, dialysis and a potassium-restricted diet are primary interventions to control hyperkalemia. It is also crucial to prevent malnutrition through adequate nutrition support.

DIFFICULTY: Bloom’s: Apply REFERENCES: Disorders of Fluid Balance

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Chapter 08 - Acid Base Balance 1. Changes in respiration result in rapid changes in CO2 levels in infants due to their: a. under-developed kidneys b. immature immune systems c. small livers d. small lung capacities e. tiny mouths ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction 2. What do acidic substances “donate” in chemical reactions? a. oxygen atoms b. hydrogen ions c. protons d. carbon atoms e. chloride ions ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 3. In human physiology, which two groups of acids are most important? a. acidic and alkaline b. gastric and intestinal c. volatile and nonvolatile d. reactive and nonreactive e. digestive and enzymatic ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 4. The lungs are unable to eliminate which types of acids? a. nonvolatile acids b. volatile acids c. reactive acids d. nonreactive acids e. enzymatic acids ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 5. What is the most biochemically important volatile acid in the body? a. hydrochloric acid b. acetic acid c. phosphoric acid Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance d. nitric acid e. carbonic acid ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 6. Fixed acids are categorized as: a. stable or unstable b. organic or inorganic c. reactive or unreactive d. endocrine or exocrine e. donating or accepting ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 7. The term hypercapnia indicates that there is ____. a. too much calcium in the blood b. a lack of the blood gas carbon dioxide c. a lack of the blood gas oxygen d. an excess of the blood gas carbon dioxide e. an excess of the blood gas oxygen ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 8. What is the best definition of metabolic alkalosis? a. condition resulting from either retention of cations or loss of nonvolatile acid b. condition resulting from either retention of bicarbonate or calcium c. condition resulting from either retention of bicarbonate or loss of nonvolatile acids d. a kidney disease resulting in hyperventilation e. a liver disease resulting in reduced respiration ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 9. What is the most predominant base involved in human acid-base balance? a. bicarbonate b. alkaline water c. calcium carbonate d. magnesium citrate e. ammonia ANSWER: a DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance REFERENCES: Basic Concepts: Acids, Bases, and Buffers 10. What is the normal pH range of blood serum in humans? a. 7.35 – 7.45 b. 7.15 – 7.75 c. 7.4 – 7.6 d. 7.55 – 7.59 e. 7.0 – 8.0 ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 11. Acidemia is the actual decrease in pH within the body to: a. <7.75 b. <7.6 c. <7.55 d. <7.45 e. <7.35 ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 12. What does the hemoglobin buffer system primarily buffer against? a. uric acid changes b. kidney phosphate changes c. carbonic acid changes d. blood oxygen changes e. excess red blood cell production ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 13. Which fluid is most likely to be buffered by the phosphate buffer system? a. blood b. saliva c. extracellular fluid d. urine e. lymph ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 14. The protein buffer system acts in the same fashion as what other buffer system? a. phosphate buffer system b. bicarbonate–carbonic acid buffer system Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance c. hemoglobin buffer system d. monosodium buffer system e. disodium buffer system ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 15. What ions do NOT cross the blood-brain barrier? a. H+ and Ca2+ b. H+ and HCO3c. HCO3- and Cld. Na+ and Cle. Na+ and Ca2+ ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 16. Within the bloodstream where is hemoglobin present? a. red blood cells b. serum c. lymph d. endothelium e. white blood cells ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 17. What happens to ventilation when acidosis occurs and the buffer system is not adequate to control the acidosis? a. not affected b. becomes erratic c. suddenly stops d. hyperventilation e. hypoventilation ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 18. To maintain pH, a healthy, normal functioning kidney will reabsorb the majority of: a. H+ b. H2O c. nitrogen d. phosphate e. HCO3Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 19. What is the minimum pH of urine in humans? a. 3.9 b. 4.2 c. 4.5 d. 4.8 e. 5.1 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 20. Ammonia is best classified as a(n) ____. a. buffer b. acid c. base d. electrolyte e. hydrogen donator ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 21. What does the anion gap measure? a. the total quantity of anions b. the difference between unmeasured anions and cations c. the ratio of different anions d. the effect of anions on the blood e. the effect of anions on the kidneys ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Assessment of Acid-Base Balance 22. What is the reference range for the calculated anion gap? a. 0.1–0.9 mEq/L b. 1.0–2.9 mEq/L c. 5.0–6.5 mEq/L d. 8–16 mEq/L e. 10–25 mEq/L ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Assessment of Acid-Base Balance 23. What is the normal value for oxygen saturation in the blood?

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Chapter 08 - Acid Base Balance a. 95% or higher b. between 94-96% c. 97% or higher d. between 97-99% e. 99.1% or higher ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Assessment of Acid-Base Balance 24. How many major types of simple acid-base disorders exist? a. two b. three c. four d. five e. six ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 25. What condition occurs when the retention of carbon dioxide causes an excess of acid in relationship to base? a. metabolic alkalosis b. metabolic acidosis c. increase in blood pH d. respiratory alkalosis e. respiratory acidosis ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 26. Where is the respiratory center in the brain located? a. pineal gland b. pituitary gland c. posterior cerebrum d. pons e. medulla ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 27. Pickwickian syndrome is characterized by. a. morbid obesity, breathing problems, respiratory acidosis b. morbid obesity, breathing problems, respiratory alkalosis c. liver disease, circulation problems, respiratory acidosis d. kidney disease, circulation problems, respiratory alkalosis Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance e. anorexia nervosa, breathing problems, respiratory alkalosis ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 28. Sleep apnea can potentially cause which acid-base disorder? a. respiratory alkalosis b. respiratory acidosis c. metabolic alkalosis d. metabolic acidosis e. kidney disease ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 29. Respiratory alkalosis is generally a result of conditions that cause ____. a. hypoglycemia b. decreased heart rate c. hyperventilation d. hypoventilation e. kidney disease ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 30. Catecholamines are drugs that can cause what type of acid-base imbalance? a. lactic acidosis b. metabolic acidosis c. metabolic alkalosis d. respiratory acidosis e. respiratory alkalosis ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 31. What is the most common cause of metabolic acidosis? a. asthma b. morbid obesity c. intestinal fistulas d. excessive diarrhea e. over-consumption of coffee ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance 32. Poisoning from the consumption of ethylene glycol (antifreeze) leads to: a. metabolic alkalosis b. metabolic acidosis c. respiratory alkalosis d. respiratory acidosis e. lactic acidosis ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 33. With diabetic ketoacidosis, metabolic acidosis occurs due to an inability to metabolize: a. ketones b. lactate c. bicarbonate d. water e. ammonia ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 34. Prolonged vomiting is likely to lead to what type of acid-base imbalance? a. respiratory alkalosis b. respiratory acidosis c. metabolic alkalosis d. metabolic acidosis e. lactic acidosis ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 35. In terms of mixed acid-base disorders, which of the following is NOT possible? a. metabolic acidosis and respiratory acidosis b. respiratory acidosis and respiratory alkalosis c. metabolic alkalosis and respiratory alkalosis d. metabolic acidosis and respiratory alkalosis e. metabolic alkalosis and respiratory acidosis ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders Case Study Multiple Choice Mr. X is a 56-year-old male admitted 2° c/o shortness of breath and difficulty breathing and is diagnosed with pneumonia. He has a history of congestive heart failure, osteoarthritis, hypertension, gout, and coronary artery disease.

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Chapter 08 - Acid Base Balance LABS: Na = 133 Cl = 103 K = 4.1 Glucose = 207 BUN = 25 Creatinine = 1.5 Albumin 3.2 Cholesterol = 320

Normal Values (135-147) (95-107) (3.5-5.2) (up to 140) (7-20) (0.5-1.4) (3.2-5) (< 200)

Arterial BGs: ph = 7.49 pCO2 = 30 pO2 = 96 HCO3 = 26

Normal values (7.35-7.45) (35-45) (70-100) (19-25)

36. What is the primary indication that Mr. X has an acid-base disorder? a. mildly elevated creatinine b. mildly low sodium c. borderline low albumin d. high blood pH e. borderline high bicarbonate ANSWER: d DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders PREFACE NAME: Mr. X 37. Mr. X is likely to have which acid-base disorder? a. lactic acidosis b. respiratory acidosis c. respiratory alkalosis d. metabolic acidosis e. metabolic alkalosis ANSWER: c DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders PREFACE NAME: Mr. X 38. What factor is contributing most to his acid-base disorder? a. gout b. high cholesterol c. pneumonia / shortness of breath d. osteoarthritis e. hypertension ANSWER: c DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders PREFACE NAME: Mr. X 39. What compensatory disorder could Mr. X develop? a. metabolic alkalosis b. metabolic acidosis Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance c. respiratory alkalosis d. respiratory acidosis e. lactic acidosis ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders PREFACE NAME: Mr. X 40. What treatment would be the most effective for his acid-base disorder? a. treat pneumonia and lose weight b. control blood pressure and reduce blood cholesterol c. anti-inflammatories for osteoarthritis and lose weight d. insulin therapy and control blood pressure e. manage heart condition and reduce blood cholesterol ANSWER: a DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders PREFACE NAME: Mr. X 41. Nonvolatile acids include those inorganic acids that are formed during metabolism of carbohydrate, protein, and lipid. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 42. Bases are substances that can accept or receive a hydrogen ion. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 43. The pH of a substance is measured in a range from 1 to 12. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 44. Buffers are present in all body fluids -- both extracellular and intracellular. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance REFERENCES: Regulation of Acid-Base Balance 45. The Henderson-Hasselbach equation has been used to explain the interrelationships between H2O, HCO3-, and pH. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 46. An important buffer system within red blood cells and tubules of the kidney is the ammonium buffer. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 47. Assessment of acid-base balance requires more than simply examining laboratory values. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Assessment of Acid-Base Balance 48. In respiratory alkalosis, the major cellular buffering defense available is inspiration of CO2 by the lungs. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 49. Metabolic acidosis refers to all types of acidosis that are not caused by excessive ammonia. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 50. Lactic acidosis occurs as a result of increased production of lactate or ketoacids. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 51. _______________ acids are those that can be converted to a gaseous form and eliminated by the lungs.

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Chapter 08 - Acid Base Balance ANSWER: Volatile DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 52. Nonvolatile or _______________ acids are produced as end products of carbohydrate, protein, and lipid metabolism.

ANSWER: fixed, inorganic DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 53. The concentration of _______________ is used to measure acidity.

ANSWER: H+ DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 54. Water is considered neutral pH at _______________.

ANSWER: 7.0 DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 55. _______________ is the actual decrease in pH within the body to <7.35.

ANSWER: Acidemia DIFFICULTY: Bloom’s: Remember REFERENCES: Basic Concepts: Acids, Bases, and Buffers 56. The primary buffer in extracellular fluid (ECF) is the _______________ buffer system.

ANSWER: bicarbonate–carbonic acid DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 57. _______________ present in the plasma can act as buffers; their contribution is most important intracellularly.

ANSWER: Proteins DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 58. The _______________ role in controlling both H+ and HCO3- is a critical component for the maintenance of pH homeostasis.

ANSWER: kidney’s DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 59. The kidney uses _______________ and _______________ as buffers because it cannot excrete bicarbonate at the same time as hydrogen ions.

ANSWER: dibasic phosphate, ammonium DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 60. Free hydrogen ions combine with _______________ to form ammonium.

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Chapter 08 - Acid Base Balance ANSWER: ammonia DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 61. When assessing acid-base balance, the _______________ response is determined first, but an investigation of the _______________ response or compensation as well allows for a complete assessment.

ANSWER: primary; secondary DIFFICULTY: Bloom’s: Remember REFERENCES: Assessment of Acid-Base Balance 62. _______________ is the ion that moves in the opposite direction of HCO3-.

ANSWER: Chloride (Cl-) DIFFICULTY: Bloom’s: Remember REFERENCES: Regulation of Acid-Base Balance 63. The _______________ represents the difference between unmeasured anions and cations.

ANSWER: anion gap DIFFICULTY: Bloom’s: Remember REFERENCES: Assessment of Acid-Base Balance 64. Respiratory diseases, such as chronic obstructive pulmonary disease, result in inability to maintain adequate oxygenation or release of _______________.

ANSWER: carbon dioxide DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 65. The acute response to respiratory alkalosis (within the first 24 hours) is a shift of acid from the _______________ to the _______________.

ANSWER: ICF; ECF DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 66. Carbonic _______________ inhibitors such as the drug acetazolamide can result in excessive loss of base while inhibiting production of carbonic acid in the kidney.

ANSWER: anhydrase DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 67. Symptoms of metabolic acidosis may include changes in respiration, such as _______________ breathing.

ANSWER: Kussmaul DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 68. An example of alkalosis without fluid imbalance is in the condition of primary or secondary _______________.

ANSWER: hyperaldosteronism DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance 69. There are no specific signs and symptoms for metabolic _______________.

ANSWER: alkalosis DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 70. Metabolic alkalosis and respiratory acidosis may occur when a patient with chronic obstructive pulmonary disease receives _______________.

ANSWER: diuretics DIFFICULTY: Bloom’s: Remember REFERENCES: Acid-Base Disorders 71. Explain Kussmaul breathing.

ANSWER: Rapid, deep, and labored breathing commonly seen in people who have ketoacidosis or who are in a diabetic coma. Kussmaul breathing is a compensatory mechanism used to increase expiration of CO2, thereby decreasing pH to normal. Kussmaul breathing is named for Adolph Kussmaul, the 19th century German doctor who first noted it.

DIFFICULTY: Bloom’s: Apply REFERENCES: Glossary 72. Describe the abbreviation pK. ANSWER: pK is the constant degree of dissociation (the ability of an acid to release its hydrogen ions) for a given solution; this is a constant amount for any given solution.

DIFFICULTY: Bloom’s: Apply REFERENCES: Glossary 73. Explain buffers.

ANSWER: A buffer is a substance or a group of substances that reacts with either acid or base in order to decrease the effect of acid or base on the pH of a solution.

DIFFICULTY: Bloom’s: Apply REFERENCES: Basic Concepts: Acids, Bases, and Buffers 74. List the 3 ways the body accommodates all the hydrogen ions it produces.

ANSWER: 1) chemical buffers, 2) the respiratory regulation of pH, and 3) the kidney regulation of pH. DIFFICULTY: Bloom’s: Apply REFERENCES: Regulation of Acid-Base Balance 75. List the 4 types of acid-base disorders.

ANSWER: 1) respiratory acidosis, 2) respiratory alkalosis, 3) metabolic acidosis, and 4) metabolic alkalosis.

DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders 76. Describe the role of acids in the human body.

ANSWER: Substances that can donate or give up hydrogen ions (H+) are considered to be acids. In human physiology, two groups of acids are important: volatile and nonvolatile. Volatile acids are those that can be converted to a gaseous form and eliminated by the lungs. Nonvolatile acids include those inorganic acids that are formed during metabolism of carbohydrate, protein, and lipid. The lungs cannot eliminate nonvolatile acids. Carbonic acid is the most important volatile acid because it is produced in the largest Copyright Cengage Learning. Powered by Cognero.

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Chapter 08 - Acid Base Balance amount and provides the major source of H+.

DIFFICULTY: Bloom’s: Apply REFERENCES: Basic Concepts: Acids, Bases, and Buffers 77. Explain the pH scale.

ANSWER: The unit for measuring relative acidity or alkalinity of a fluid is called pH. Simply stated, pH is the ratio of acids to bases. Hydrogen ion concentration (H+) is the negative logarithm of hydrogen ions in solution. Because the scale of H+ is logarithmic, in order for the pH to change by one unit (e.g., changing from 3 to 4), there must be a 10-fold change in H+. The pH of a substance is measured in a range from 1 to 14. A 1 on the pH scale indicates the most acidic, and 14 indicates the most alkaline.

Water is considered neutral at 7.0.

DIFFICULTY: Bloom’s: Apply REFERENCES: Basic Concepts: Acids, Bases, and Buffers 78. Discuss the effect of acid and base shifts on electrolyte balance.

ANSWER: Hydrogen ions and bicarbonate are both electrolytes. Acid-base changes will therefore affect concentrations of other electrolytes in both ECF and intracellular fluid (ICF). For example, movement of HCO3- to the plasma requires the exchange of another negatively charged ion so that electroneutrality is maintained. Chloride is the ion that moves in the opposite direction of HCO3-. Changes in potassium, chloride, and sodium may accompany acid-base disorders.

DIFFICULTY: Bloom’s: Apply REFERENCES: Regulation of Acid-Base Balance 79. Describe the clinical manifestations of respiratory acidosis.

ANSWER: Laboratory values in acute respiratory failure will indicate a decreased pH and an elevated pCO2.

Bicarbonate levels will be slightly elevated if renal compensation has begun. Compensatory mechanisms or secondary responses allow the pH to remain normal but serum bicarbonate and arterial pCO2 are elevated. Serum electrolytes will show an increase in serum Ca+, K+, and possibly Cl- due to changes in renal controls.

DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders 80. Discuss the etiology of metabolic alkalosis.

ANSWER: Clinical situations resulting in alkalosis can be categorized as either those conditions involving fluid imbalance (alkalosis with volume decrease) or those without fluid imbalances (alkalosis without volume contraction). Conditions that involve fluid imbalance include prolonged vomiting and/or nasogastric suction or use of diuretics. Conditions leading to alkalosis that do not involve fluid imbalance would include hyperaldosteronism, excessive use of corticosteroids, blood transfusions, chronic use of antacids, and excessive administration of sodium bicarbonate.

DIFFICULTY: Bloom’s: Apply REFERENCES: Acid-Base Disorders

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System 1. What is the study of the disruption of normal physiologic processes called? a. epidemiology b. pathogenesis c. physiology d. pathophysiology e. pathology ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: The Disease Process 2. What is the study of the distribution of disease within populations? a. epidemiology b. pathogenesis c. physiology d. pathophysiology e. morbidity ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: The Disease Process 3. What is the term for immunity produced due to exposure to an antigen (infection or vaccination)? a. enhanced immunity b. boosted immunity c. inherited immunity d. passive immunity e. active immunity ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 4. What is amyloid? a. connective tissue associated with cancer b. diseased connective tissue c. starch-like substance present in diseased tissues d. scar tissue associated with the liver e. an enzyme that digests scar tissue ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. What does the term apoptosis mean? a. spread of cancer cells b. genetically programmed cell death c. an antibody to an exotoxin d. antigen-specific non-responsiveness by a T or B cell Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System e. reduction in size of muscle cells ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 6. What’s the name of the disease that results from prolonged exposure to high levels of glucocorticoid hormones? a. anaphylactic shock b. Cushing’s syndrome c. hyperemia d. severe combined immune deficiency e. serum sickness ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 7. What does the prognosis of a disease refer to? a. the mortality rates of the disease b. the degree of infectiousness c. the ability for the disease to spread d. the expected or usual outcome e. the cause of the disease ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: The Disease Process 8. An insufficient oxygen supply (ischemia) interferes with cellular: a. apoptosis b. mitosis c. metabolism d. differentiation e. membrane integrity ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 9. Free radicals are chemically unstable and searching for additional: a. electrons b. hydrogen ions c. protons d. neutrons e. carbon atoms ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System 10. Hyaline deposits are a mixture of what types of compounds? a. collagen, fibrin, amyloid b. fatty acids, connective tissue, epithelium c. connective tissue, scar tissue, cholesterol d. scar tissue, fibrin, fatty acids e. collagen, cholesterol, epithelium ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 11. An increase in cell size is termed: a. atrophy b. hyperplasia c. apoptosis d. metaplasia e. hypertrophy ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 12. Necrosis refers to the cellular changes that occur during: a. metaplasia b. dysplasia c. cell death d. cell growth e. metastasis ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 13. What kills surface microbes on inanimate objects? a. antiseptics b. antibiotics c. betadine d. disinfectants e. detergents ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Preventing Transmission of Infection 14. The immune system is typically divided into what two major categories? a. effective and non-effective b. innate and acquired c. mature and immature d. natural and artificial Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System e. normal and auto-immune ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 15. What are the two central organs of the immune system? a. spleen and tonsils b. bone marrow and thymus gland c. gut-associated lymphatic tissue and bronchial-associated lymphatic tissue d. appendix and spleen e. bone marrow and lymph nodes ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 16. What organ is responsible for destruction of old RBCs and is a major site for the initiation of the immune response? a. spleen b. liver c. bone marrow d. tonsils e. thymus ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 17. Where are Peyer’s patches located? a. spleen b. throat c. stomach d. small intestine e. large intestine ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 18. Where do all cells of the immune system originate? a. lymph glands b. the liver c. Peyer’s patches d. stem cells within the spleen e. stem cells within bone marrow ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System 19. Which of the following are chemical mediators that direct vasodilation and vascular permeability? a. prostaglandins and bicarbonate b. thromboxanes and fibrinogen c. histamine and nitric oxide d. leukotrienes and ammonia e. chemotaxins and interleukins ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 20. What do chemotaxins attract to the site of injury? a. interleukins and thromboxanes b. prostaglandins and histamines c. neutrophils and monocytes d. T cells and B-lymphocytes e. COX-1 and COX-2 enzymes ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 21. What does lactoferrin do? a. destroys toxic microbes b. binds iron, thus preventing use by bacteria c. triggers blood clotting d. increases vascular permeability e. releases prostaglandins ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 22. In liver disease, the blood concentration of what enzymes is elevated? a. COX-1 and COX-2 b. prostaglandinase and glucokinase c. glucose-6-phosphotase and pyruvate dehydrogenase d. alanine transferase and aspartate amino transferase e. phenylalanine hydroxylaseand transaminase ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 23. What vitamin is needed to make collagen during wound repair? a. vitamin A b. vitamin B5 c. vitamin C Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System d. vitamin D e. vitamin E ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 24. What is the preferred fuel for enterocytes, lymphocytes, and macrophages? a. glutamine b. glucose c. ascorbic acid d. omega-3 fatty acids e. omega-6 fatty acids ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 25. According to the National Pressure Ulcer Advisory Panel, how many stages are there for pressure ulcers? a. 1 b. 2 c. 3 d. 4 e. 5 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 26. What is the term for ineffective wound healing? a. epithelial dissonance b. coagulation c. apoptosis d. eschar e. dehiscence ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 27. What is the most common cause of adhesions? a. abdominal surgery b. pneumonia c. obesity d. diabetes e. rheumatoid arthritis ANSWER: a DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System REFERENCES: The Immune Response 28. What is the percentage of European and North American adults who suffer from autoimmune diseases? a. 3% b. 5-7% c. 9% d. 10-12% e. 14% ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Autoimmunity 29. What gland(s) does Addison’s autoimmune disease target? a. thyroid b. thymus c. pancreas d. pituitary e. adrenals ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Autoimmunity 30. What are transplants between identical twins called? a. allografts b. xenografts c. halografts d. autografts e. isografts ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Attacking Altered and Foreign Cells: Tumors and Transplants 31. What kind of transplant rejection occurs in bone marrow, but not heart or kidney transplants? a. host-versus-host (HVH) b. host-versus-graft (HVG) c. second-set rejection d. graft-versus-host (GVH) e. graft-versus-graft (GVG) ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Attacking Altered and Foreign Cells: Tumors and Transplants 32. What is the chief drawback of attenuated vaccines? a. immunosuppression b. reversion to the pathogenic form Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System c. death d. autoimmune disease e. chronic inflammatory response ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Immunization 33. In developing (Third World) countries, what is the greatest cause of immunodeficiency? a. malnutrition b. genetic disorders c. infectious disease d. diabetes e. medications ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Immunodeficiency 34. Approximately how many Americans suffer from allergic diseases? a. between 8-12 million b. between 20-25 million c. at least 50 million d. between 80-90 million e. between 100-120 million ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Hypersensitivity (Allergy) 35. What type of hypersensitivity reaction involves B-lymphocytes? a. delayed hypersensitivity reactions b. immediate hypersensitivity reactions c. acquired hypersensitivity reactions d. external hypersensitivity reactions e. internal hypersensitivity reactions ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Hypersensitivity (Allergy) Case Study Multiple Choice Mrs. P is an 85-year-old female who is a resident of a long-term care facility. The wound nurse was doing her rounds and noticed that Mrs. P had developed an open ulcer with a partial thickness loss of dermis and a red-pink wound bed on the side of her hip. She is 5’2” and weighs 52 kilograms with no known gastrointestinal or autoimmune issues. The wound nurse schedules a nutrition consultation for Mrs. P and discusses her findings with you.

36. How many grams of protein per kilogram of bodyweight does she need for wound healing? a. 0.5 Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System b. 0.8 c. 1.0 d. 1.3 e. 2.0 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response PREFACE NAME: Mrs. P 37. How many kilocalories per kilogram of bodyweight does she need to properly heal? a. about 10 b. about 15 c. about 19 d. about 23 e. about 30 ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response PREFACE NAME: Mrs. P 38. How much water should Mrs. P drink each day to give her the best opportunity to heal? a. at least 10 mL/kg b. about 20 mL/kg c. at least 30 mL/kg d. about 50 mL/kg e. at least 75 mL/kg ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response PREFACE NAME: Mrs. P 39. What type of wound has Mrs. P likely developed? a. Stage I pressure ulcer b. Stage II pressure ulcer c. Stage III pressure ulcer d. Stage IV peptic ulcer e. Stage I gangrenous ulcer ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response PREFACE NAME: Mrs. P 40. What supplement could benefit wound healing by increasing collagen deposition, improving nitrogen balance, and enhancing several parameters of immune function? a. arginine Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System b. lysine c. vitamin E d. vitamin K e. iron ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response PREFACE NAME: Mrs. P 41. Epidemiology provides data for outcome measures such as morbidity and mortality, and identifies risk factors associated with disease. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: The Disease Process 42. A common cellular response to injury and disease is deposition of a substance called hyaline within and between the cells. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 43. Immune cells are often referred to as white blood cells or erythrocytes. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 44. Material that accumulates in tissue spaces is called exudate. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 45. Cardiac, skeletal, and neurological cells can be restored after injury if optimal conditions are maintained. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System 46. The primary immune response normally begins with the proliferation of memory cells, which can be sufficient to block infection if virulence of the pathogens is low. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 47. Autoimmune diseases have a strong tendency to run in families, with a 40% chance that a family with one affected adult will have another. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Autoimmunity 48. Most vaccines are made from killed microorganisms and are not attenuated. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Immunization 49. Females are more likely to have immune-deficiencies because many such deficiencies involve recessive genes, often on the Y chromosome. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Immunodeficiency 50. Sensitization is the production of IgE antibodies after exposure to an allergen. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Hypersensitivity (Allergy) 51. The clinical course or _______________ includes impact and duration of the disease.

ANSWER: pathogenesis DIFFICULTY: Bloom’s: Remember REFERENCES: The Disease Process 52. The usual outcome of disease is sometimes referred to as the _______________.

ANSWER: prognosis DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System REFERENCES: The Disease Process 53. Pigment accumulation after cell injury can include _______________ and derivatives of _______________.

ANSWER: melanin; hemoproteins DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 54. _______________ is deranged cellular growth and can result in abnormalities of size, shape, or function.

ANSWER: Dysplasia DIFFICULTY: Bloom’s: Remember REFERENCES: Cellular Injury 55. Sterilization is accomplished by use of heat, chemicals, or _______________.

ANSWER: radiation DIFFICULTY: Bloom’s: Remember REFERENCES: Preventing Transmission of Infection 56. Monocytes and macrophages are highly specialized cells that ingest and destroy cells and microbes via _______________.

ANSWER: phagocytosis DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 57. T lymphocytes were named for the _______________, the site where they mature and differentiate.

ANSWER: thymus gland DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 58. Initially, _______________ were called lymphokines because the first ones discovered were produced by lymphocytes.

ANSWER: cytokines DIFFICULTY: Bloom’s: Remember REFERENCES: Foundations of the Immune System 59. The body reacts to injury with both a _______________ and a cellular response.

ANSWER: vasomotor DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 60. When fibrinogen increases, clotting of erythrocytes _______________, which affect the rate of _______________.

ANSWER: increases; sedimentation DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 61. Long term use of _______________ is associated with many possible side effects, including hyperglycemia, osteoporosis, and protein loss/muscle wasting.

ANSWER: glucocorticoids or steroids Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 62. Healing of burns often results in development of _______________.

ANSWER: contractures DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 63. Plasma cells are _______________ than B cells and packed full of endoplasmic reticulum to produce _______________ at a rate of 30,000 Ig/sec.

ANSWER: larger; antibodies or immunoglobulins DIFFICULTY: Bloom’s: Remember REFERENCES: The Immune Response 64. Perniciuos anemia develops when a(n) _______________ reacts with intrinsic factor, resulting in decreased _______________ absorption.

ANSWER: autoantibody, B12 DIFFICULTY: Bloom’s: Remember REFERENCES: Autoimmunity 65. In _______________ syndrome, WBCs invade and destroy glands that produce moisture, resulting in dry mouth and dry eyes.

ANSWER: Sjögren’s DIFFICULTY: Bloom’s: Remember REFERENCES: Autoimmunity 66. With _______________ bone marrow transplants, the recipient is also the donor.

ANSWER: autologous DIFFICULTY: Bloom’s: Remember REFERENCES: Attacking Altered and Foreign Cells: Tumors and Transplants 67. _______________ vaccines are live mutants that have lost their pathogenicity while retaining immunogenicity, and provide more natural protection.

ANSWER: Attenuated DIFFICULTY: Bloom’s: Remember REFERENCES: Immunization 68. Protein-energy malnutrition in infancy and early childhood has adverse effects on the _______________.

ANSWER: thymus gland DIFFICULTY: Bloom’s: Remember REFERENCES: Immunodeficiency 69. _______________ occurs when a lymphocyte fails to respond when stimulated by its antigen-specific receptor.

ANSWER: Anergy DIFFICULTY: Bloom’s: Remember REFERENCES: Hypersensitivity (Allergy) Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System 70. The most severe allergic reaction is _______________.

ANSWER: anaphylactic shock (anaphylaxis) DIFFICULTY: Bloom’s: Remember REFERENCES: Hypersensitivity (Allergy) 71. Define the term metaplasia.

ANSWER: Metaplasia occurs when disease or injury results in displacement of one cell type by another that may be less mature. This is classically seen in vitamin A deficiency and H. pylori infection.

DIFFICULTY: Bloom’s: Apply REFERENCES: Cellular Injury 72. Describe the difference between an antigen and an immunogen.

ANSWER: An antigen is a substance that is bound by an antibody. The key difference between an antigen and an immunogen is that the immunogen is an antigen that is capable of inducing an immune response because it is foreign to the host.

DIFFICULTY: Bloom’s: Apply REFERENCES: Foundations of the Immune System 73. List the different classes of interferons.

ANSWER: Three classes of interferons have been distinguished: 1) alpha, 2) beta, and 3) gamma.

DIFFICULTY: Bloom’s: Apply REFERENCES: Foundations of the Immune System 74. Describe the signs and symptoms of inflammation.

ANSWER: The cardinal or classic signs of inflammation are redness, warmth, swelling, and pain resulting from hyperemia and vascular permeability.

DIFFICULTY: Bloom’s: Apply REFERENCES: The Immune Response 75. Explain how accurate skin prick tests are for diagnosing allergies.

ANSWER: Skin prick tests are used as a preliminary test to narrow the list of potential problem substances, since the negative predictive value is >95%. However, positive predictive value is about 50%, so it may not be sufficient to establish a diagnosis.

DIFFICULTY: Bloom’s: Apply REFERENCES: Hypersensitivity (Allergy) 76. Explain etiology of disease.

ANSWER: Etiology is the description and identification of the cause of disease. Etiology can be narrowed to a specific causative agent or may be a combination of factors that influence or change disease development. Influential factors could be age, nutritional status, or other coexisting diseases. Etiology of disease can be categorized as genetic, acquired, multifactorial, idiopathic, or iatrogenic.

DIFFICULTY: Bloom’s: Apply REFERENCES: The Disease Process 77. Outline the four basic requirements of an effective immune system.

ANSWER: There are four basic requirements of an effective immune system: 1) specificity, the ability to react with one and only one antigen, which lowers the chance that a reaction to a pathogen will also harm the person; 2) diversity, so it can respond to many pathogens; 3) adaptivity, the ability to pick the best Copyright Cengage Learning. Powered by Cognero.

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Chapter 09 - Cellular and Physiological Response to Injury - The Role of the Immune System response to counter the pathogen; and 4) the ability to respond to stimuli not encountered previously.

DIFFICULTY: Bloom’s: Apply REFERENCES: Foundations of the Immune System 78. Explain the innate immune response.

ANSWER: Cells of the innate immune system (macrophages, monocytes, natural killer cells, and leukocytes) react with any antigen; they can thus react immediately. Innate immunity involves inflammation, interferon, natural killer cells, and complement. This initial innate immune response is quite often sufficient to eliminate the pathogen or reduce its numbers enough to prevent initiation of a disease process. This type of immune response does not increase or improve with repeated exposures.

DIFFICULTY: Bloom’s: Apply REFERENCES: The Immune Response 79. Describe active immunization.

ANSWER: In active immunization, the individual is exposed to an antigen in a harmless form and produces antibodies as well as activated T and B cells and memory cells. The memory immune response, initiated upon exposure to the pathogen or a booster, prevents infection and provides additional antibodies and memory cells. In some cases, such as influenza, the residual antibodies are more important than the memory response due to the short incubation period of the disease, and more frequent vaccinations are often required to maintain the antibody level.

DIFFICULTY: Bloom’s: Apply REFERENCES: Immunization 80. Discuss the most common food allergies in the United States.

ANSWER: The American Academy of Allergy, Asthma & Immunology states that approximately 3 million adults in the United States report allergy to peanuts and tree nuts (almonds, Brazil nuts, hazelnuts, and walnuts).

Another 6 million report an allergy to fish and shellfish. The most common food allergens in infants and children are cow’s milk, eggs, peanuts, tree nuts, wheat, soy, fish, and shellfish.

DIFFICULTY: Bloom’s: Apply REFERENCES: Hypersensitivity (Allergy)

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Chapter 10 - Nutritional Genomics 1. In what year did the International Human Genome Sequencing Consortium publish the finished version of the human genome sequence? a. 1995 b. 1999 c. 2003 d. 2007 e. 2011 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction 2. What year did Gregor Mendel discover the laws of genetics? a. 1820 b. 1865 c. 1888 d. 1905 e. 1927 ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 3. A copy of a specific gene situated in a given locus on a chromosome is called a(n): a. allele b. codon c. chromatin d. intron e. exon ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 4. A group of gene variants that occur together is called: a. polygenic b. translation c. genotype d. phenotype e. haplotype ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. The production of RNA from DNA is accomplished by what process? a. reduction b. expression c. subscription Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics d. transcription e. translation ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 6. When did James Watson and Francis Crick describe the double-helical structure of DNA? a. 1945 b. 1953 c. 1965 d. 1972 e. 1980 ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 7. When was the Huntington’s disease gene mapped with DNA markers? a. 2003 b. 1999 c. 1990 d. 1983 e. 1971 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 8. The interaction between drugs and an individual’s genome is referred to as: a. nutrigenetics b. nutrigenomics c. pharmacogenomics d. pharmacology e. epigenomics ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 9. What type of cell does NOT contain nuclei? a. red blood cells b. nerve cells c. heart muscle cells d. skeletal muscle cells e. epithelium ANSWER: a DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics REFERENCES: An Overview of the Structure and Function of Genetic Material 10. How many pairs of chromosomes comprise the human genome? a. 23 b. 22 c. 21 d. 20 e. 19 ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 11. What chromosomes do human males have? a. A and B b. A and A c. X and X d. Y and Y e. X and Y ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 12. Nucleotides have how many primary components? a. one b. two c. three d. four e. five ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 13. How many nitrogenous bases are in human DNA? a. 1 b. 2 c. 3 d. 4 e. 5 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 14. What is a series of three nucleotide bases that encodes a specific amino acid called? a. a gene b. a codon Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics c. a protein d. an allele e. an autosome ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 15. What chromosome number is linked to various disease states with nutritional implications including several cancers, type 1 diabetes, and Crohn’s disease? a. 7 b. 10 c. 12 d. 15 e. 20 ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 16. What percentage of human DNA is non-coding DNA? a. 95% b. 90% c. 85% d. 80% e. 75% ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 17. What is the nitrogenous base that pairs with adenine,in human DNA? a. guanine b. cytosine c. arginine d. thymine e. lysine ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 18. What enzyme is responsible for Transcription? a. DNA polymerase b. DNA activase c. DNA transcriptase d. RNA transcriptase e. RNA polymerase ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 19. In humans, the inheritance of blue eyes is classified as: a. X-linked dominant b. X-linked recessive c. autosomal recessive d. autosomal dominant e. Y-linked ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 20. What kind of hereditary disease is cystic fibrosis? a. X-linked dominant b. X-linked recessive c. autosomal recessive d. autosomal dominant e. Y-linked ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 21. In mammalian DNA, approximately what percentage of cytosines are methylated? a. 1% b. 2-5% c. 6-8% d. 10% e. 12-15% ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 22. Low intake of what nutrient (particularly when combined with high alcohol intake) is associated with increased colon cancer risk? a. thymine b. riboflavin c. niacin d. folate e. biotin ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 23. What nutrient in fruits and vegetables is likely the most important in reducing the risk of cancer?

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Chapter 10 - Nutritional Genomics a. antioxidants b. fatty acids c. amino acids d. sugars e. minerals ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 24. What likely underlies the abnormalities associated with metabolic syndrome and predisposition to diabetes and cardiovascular disease? a. highly acidic blood b. highly alkaline blood c. a pro-inflammatory state d. poor digestion e. a lack of excitatory neurotransmitters ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 25. Where do the peroxisome proliferator-activated receptors (PPARs) reside in cells? a. mitochondria b. endoplasmic reticulum c. plasma membrane d. cytoplasm e. nucleus ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 26. What gene mutation is responsible for familial hypercholesterolemia? a. cholesterol generating gene b. fatty acid assimilating gene c. HDL-receptor gene d. VLDL-receptor gene e. LDL-receptor gene ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 27. What type of fatty acids reduce apolipoprotein C-III levels? a. long-chain omega-3 PUFAs b. short-chain omega-3 PUFAs c. long-chain omega-3 MUFAs d. short-chain omega-6 MUFAs Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics e. long-chain omega-6 MUFAs ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 28. What gene associated with cardiovascular disease risk has been the most studied? a. the gene coding for apolipoprotein G b. the gene coding for apolipoprotein E c. the gene coding for apolipoprotein C d. the gene coding for apolipoprotein B e. the gene coding for apolipoprotein A ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 29. What gender and genotype is most likely to be responsive to dietary and other lifestyle interventions to minimize cardiovascular disease risk? a. male APOE ε3 carriers b. female APOE ε3 carriers c. male APOE ε4 carriers d. female APOE ε4 carriers e. male APOE ε5 carriers ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 30. In general, a diet high in saturated fat has been linked to: a. improved insulin sensitivity b. improved glucose metabolism c. reduced insulin synthesis d. reduced insulin secretion e. insulin resistance ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 31. How many genes are in the human genome? a. 111, 500 b. 80,000 plus c. 55,644 d. 20,000 plus e. 5,644 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics 32. What initiative was formed to establish a coordinated evidence-based process for evaluating genetic tests and translating genomic applications that are in transition from research to both clinical and public health applications? a. The Human Genome Project b. The Evaluation of Genomic Applications in Practice and Prevention c. The Accountability of Clinical and Public Health Applications d. Health Insurance Portability and Accountability Act e. The Dietitians in Integrative and Functional Medicine ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 33. The APOE gene variant that puts an individual at risk for CVD is also associated with a high risk of what other disease? a. Alzheimer’s disease b. Crohn’s disease c. cystic fibrosis d. type 1 diabetes e. phenylketonuria ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 34. Companies such as 23andMe, deCODEme, and Navigenics are conducting what type of business? a. nutritional consulting b. dietetic research c. direct-to-consumer genetic testing d. licensing nutritionists e. assessing cardiovascular risk ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 35. “Junk DNA” appears to play an important role in: a. stimulating cognitive awareness b. regulating gene expression c. enhancing reproductive fitness d. modulating lifespan e. triggering psychic phenomena ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics Case Study Multiple Choice Mr. and Mrs. G are a late-30s married couple who come into an outpatient nutritional counseling center due to a Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics referral from their physician who takes a special interest in genetics. They have both been tested for several genetic conditions due to their family history and concern over developing various chronic diseases. Mrs. G is particularly concerned due to the history of cancer and dementia in her family, whereas obesity runs in Mr. G’s family.

36. The registered dietitian reads the genetic report and finds that Mrs. G has a polymorphism in the methylene tetrahydrofolate reductase gene, which is linked to an increased risk of: a. Alzheimer’s disease b. diabetes c. hyperlipidemia d. colon cancer e. obesity ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease PREFACE NAME: multiple 37. What nutrient should the registered dietician counsel Mrs. G on how to achieve optimal levels in her diet or via supplementation to reduce her risk of such a disease? a. omega-3 fatty acids b. arginine c. vitamin A d. biotin e. folate ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease PREFACE NAME: multiple 38. A diet high in what foods can potentially lower Mrs. G’s risk of this genetically linked disease? a. red beets and apples b. strawberries and kiwis c. cauliflower and carrots d. celery and onions e. watermelon and pineapple ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease PREFACE NAME: multiple 39. In addition to advice on specific nutrients and foods, what should the registered dietician tell Mrs. G to avoid or limit in order to lower her risk of this specific polymorphism? a. physical exercise b. alcohol c. polyunsaturated fat d. fructose e. sucrose Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease PREFACE NAME: multiple 40. Mr. G’s genetic profile shows that he has a variation in the gene code for apolipoprotein E, which puts him at higher risk for: a. hyperlipidemia b. cystic fibrosis c. prostate cancer d. diabetes e. Alzheimer’s disease ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 41. The Human Genome Project was launched in the United States in 1990. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 42. Attention to nutritional genomics and pharmacogenomics has been escalating and this trend is likely to continue in the coming years. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 43. Each gene is a linear sequence of nucleotides that are actually responsible for encoding fatty acids. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 44. Epigenetics relates not to the genome sequence itself, but to the inherited pattern of gene expression regulated by modifications to DNA. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics 45. When the alleles from each parent differ, an individual is homozygous for that gene. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 46. Like DNA methylation, histone modification is a form of epigenetic regulation. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 47. Several cancers have a clearly established genetic inheritance based on mutations in a single gene. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 48. Colon cancer risk reduction in humans via intake of cruciferous vegetables is linked to glutathione S-transferase genotype. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 49. The recommendation of one diet intervention in response to one polymorphism is likely to be effective. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 50. Much remains unknown about the interaction between genes. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 51. _______________ is a technology used to measure expression of thousands of genes simultaneously.

ANSWER: Microarray DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics REFERENCES: Glossary 52. _______________ DNA technology was developed in 1972 by Stanley Cohen and Herbert Boyer.

ANSWER: Recombinant DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 53. One of the hottest areas of debate regarding the interplay between ethics and genetics has to do with direct-toconsumer marketing of _______________.

ANSWER: genetic tests DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 54. Deoxyribonucleic acid (DNA) was identified as the blueprint of life in _______________.

ANSWER: 1944 DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 55. The nitrogenous bases include adenine and _______________ (both purines), as well as thymine and _______________.

ANSWER: guanine; cytosine DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 56. DNA contains non-coding regulatory sequences called _______________ to which molecules can bind in order to signal unwinding of a specific region of DNA for creation of a needed protein.

ANSWER: promoter regions DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 57. The coding strand of DNA that serves as the template for mRNA synthesis is known as the _______________ strand.

ANSWER: sense DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 58. The complement of RNA transcripts produced when genes are “expressed” is referred to as the _______________.

ANSWER: transcriptome DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 59. _______________ determine which patients will benefit or fail to benefit from specific diet prescriptions.

ANSWER: Polymorphisms DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 60. As opposed to monogenic diseases, complex diseases such as obesity, diabetes, cancer, and cardiovascular disease are _______________.

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Chapter 10 - Nutritional Genomics ANSWER: polygenic DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 61. There are predicted to be a few hundred _______________ genes in humans.

ANSWER: imprinted DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 62. Environmental factors play a large role in regulating gene _______________.

ANSWER: expression DIFFICULTY: Bloom’s: Remember REFERENCES: An Overview of the Structure and Function of Genetic Material 63. Epidemiological research has linked cooked meats to increased risk of _______________ cancer.

ANSWER: colon DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 64. Cancer can result from genome-wide _______________ due to inappropriate gene activation and chromosomal instability.

ANSWER: hypomethylation DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 65. The interaction of folate status and MTHFR genotype with _______________ appears to be of critical importance.

ANSWER: alcohol DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 66. Dietary modification, such as avoidance of phenylalanine, is effective for _______________ diseases, such as PKU. ANSWER: monogenic DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 67. Dietary fats interact with various _______________ to influence outcomes.

ANSWER: genotypes DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 68. Since oxidative DNA damage is thought to play a role in carcinogenesis, adequacy of _______________ is suggested to be anti-carcinogenic.

ANSWER: antioxidants DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics in Disease 69. The Evaluation of Genomic Applications in Practice and Prevention initiative was developed by the Office of Public Copyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics Health Genomics of the _______________.

ANSWER: Centers for Disease Control and Prevention DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 70. In addition to the genome sequence, the role of _______________, the microbiome, and modulation of gene expression by dietary factors must also be considered in the overall scope of genome–nutrient interactions.

ANSWER: epigenetics DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Genomics and the Practice of Dietetics 71. Briefly outline the psychosocial and ethical issues in genomics research.

ANSWER: This area includes issues related to protection of human research participants (i.e., privacy and identifiability of genetic information), recruitment of more diverse participants in genomics research, community engagement, and other related areas.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutritional Genomics: Nutrigenetics, Nutrigenomics, and Nutritional Epigenomics 72. Discuss the sex chromosomes.

ANSWER: Of the 23 pairs of chromosomes, 22 are autosomes and one pair is comprised of the sex chromosomes.

Males have one X and one Y chromosome, while females have two X chromosomes, so the gender of offspring is determined by the male parent.

DIFFICULTY: Bloom’s: Apply REFERENCES: An Overview of the Structure and Function of Genetic Material 73. List the classifications of inherited genes.

ANSWER: Inheritance of specific genes can be classified as autosomal dominant, autosomal recessive, X-linked dominant, X-linked recessive, or Y-linked.

DIFFICULTY: Bloom’s: Apply REFERENCES: An Overview of the Structure and Function of Genetic Material 74. Describe familial hypercholesterolemia.

ANSWER: Familial hypercholesterolemia is an autosomal dominant disorder characterized by absence or mutation of LDL receptors leading to severely elevated LDL-cholesterol levels and risk of early myocardial infarction and death.

DIFFICULTY: Bloom’s: Apply REFERENCES: An Overview of the Structure and Function of Genetic Material 75. Briefly discuss the connection between folate intake and cancer risk.

ANSWER: Low intakes of folate have a long association with cancer risk, including cancer of the colon, and this risk appears to escalate in the presence of high alcohol intake.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutritional Genomics in Disease 76. Outline the differences between nutrigenetics and nutrigenomics.

ANSWER: Nutrigenetics is the interaction between an individual’s genetic profile (i.e., genotypes of specific genes and the function of proteins encoded by those genes) with nutrients and other bioactive food components. In contrast, nutrigenomics is the study of mechanisms by which nutrients and other foodCopyright Cengage Learning. Powered by Cognero.

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Chapter 10 - Nutritional Genomics derived bioactive substances interact with the genome to influence gene expression.

DIFFICULTY: Bloom’s: Apply REFERENCES: Glossary 77. Discuss what happens after transcription is complete.

ANSWER: Once transcription is complete, mRNA undergoes post-transcriptional processing. Enzymes in the nucleus excise segments of the mRNA known as introns, while leaving the segments known as exons.

Thus, only exons are ultimately translated into the final protein product. While DNA remains in the nucleus, the messenger RNA carries the code out of the nucleus into the cytosol, where ribosomes on the rough endoplasmic reticulum are prepared for protein assembly. The complement of RNA transcripts produced when genes are “expressed” is referred to as the transcriptome.

DIFFICULTY: Bloom’s: Apply REFERENCES: An Overview of the Structure and Function of Genetic Material 78. Give examples of an autosomal recessive trait and an autosomal dominant disorder.

ANSWER: An example of an autosomal recessive trait is phenylketonuria, in which affected individuals inherit one mutated copy of the phenylalanine hydroxylase gene from each parent (homozygous). The resulting inability to convert phenylalanine to tyrosine requires lifelong phenylalanine restriction to prevent mental retardation. Familial hypercholesterolemia is an example of an autosomal dominant disorder and characterized by absence or mutation of LDL receptors leading to severely elevated LDL-cholesterol levels and risk of early myocardial infarction and death.

DIFFICULTY: Bloom’s: Apply REFERENCES: An Overview of the Structure and Function of Genetic Material 79. Discuss the regulation of gene expression.

ANSWER: Gene expression is regulated in many ways, including DNA methylation; histone methylation, acetylation, or phosphorylation; and transcription factors. More recently, non-coding RNAs, such as the miRNAs, have been identified as playing a regulatory role as well. All of these regulatory mechanisms can be influenced by early programming in response to nutrition and other environmental factors in fetal life or infancy, as well as throughout the lifespan.

DIFFICULTY: Bloom’s: Apply REFERENCES: An Overview of the Structure and Function of Genetic Material 80. Discuss the link between genetics and obesity.

ANSWER: Obesity has a clear link to genetics, demonstrated by numerous studies showing that obesity does persist in families even where food intake and physical activity patterns differ. However, the escalating obesity epidemic in recent decades supports the idea that, while susceptibility to obesity is genetically and epigenetically determined, the development of obesity itself is the result of a susceptible genome in the presence of a conducive environment. In other words, placing susceptible individuals in an obesigenic environment -- one characterized by plentiful energy-dense, high-fat foods and technological advances requiring little in the way of physical activity -- results in obesity.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutritional Genomics in Disease

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Chapter 11 - Pharmacology 1. In the United States, what proportion of physician visits includes a written prescription? a. 1/5 b. 1/3 c. 2/3 d. 3/4 e. 7/8 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 2. How much did spending on prescription drugs increase between the years 1990 and 2011 in the United States? a. two-fold b. three-fold c. four-fold d. six-fold e. eight-fold ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 3. What is the study of drug absorption, distribution, metabolism, and excretion called? a. pharmacokinetics b. pharmacology c. pharmacotherapy d. pathophysiology e. biokinetics ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 4. What is the name of the cardiac glycoside that is prescribed to alter the contractions of the heart? a. creatinine b. digoxin c. omeprazole d. gentamycin e. creatine ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. What is a type of medication that is used to treat hyperlipidemia? a. MAOIs b. creatinines c. prokinetics d. excipients Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology e. statins ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 6. What term refers to the placement of a drug inside the cheek? a. otic b. buccal c. ophthalmic d. parenteral e. sublingual ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 7. What is the effect of ACE (angiotensin-converting enzyme) inhibitors? a. increase blood pH levels b. decrease blood pH levels c. increase calcium absorption rates d. vasodilation of blood vessels e. vasoconstriction of blood vessels ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Drug Mechanisms 8. What method of administering drugs requires an injection? a. buccal b. subcutaneous c. enteral d. sublingual e. topical ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Administration of Drugs 9. What has to happen to the medication before absorption is successful? a. dissolution b. oxidation c. reduction d. ionization e. hyperemia ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology 10. What type of excipients are added to medications to increase dissolution? a. disintegrants b. antioxidants c. expectorants d. lubricants e. binders ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 11. What parts of the body have the largest surface areas for drug absorption? a. mouth and throat b. mouth and stomach c. large intestine and bowel d. small and large intestines e. small intestine and lungs ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 12. What kind of drugs are quickly absorbed across cell membranes? a. protein-based b. sugar-based c. lipid-based d. carbohydrate-based e. vitamin analogues ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 13. What occurs immediately after a drug is absorbed in the body? a. ionization of the drug b. dissolution of the drug c. reduction of the drug d. distribution of the drug e. oxidation of the drug ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 14. Most drug biotransformation in the liver is accomplished by an enzyme called: a. cytochrome P500 b. cytochrome P450 c. cytochrome R200 d. alpha-lipase R200 Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology e. alpha-lipase R450 ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 15. What kind of meal increases gastric emptying time (i.e., slow emptying rate) the most? a. fruit and yogurt snack b. high-fat meal c. spinach salad d. egg salad sandwich e. vegetable stir fry with rice ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 16. The binding of a nutrient or food component with a drug (making it unabsorbable) is called: a. chelation b. dissolution c. oxidation d. reduction e. phagocytosis ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 17. St. John’s wort (herbal supplement) impacts the metabolism of drugs because it significantly induces the activity of: a. proton-pump inhibitors b. CYP 2B6 c. MAOIs d. CYP 3A4 e. H2 blockers ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 18. What vitamin is an antagonist of the drug warfarin (Coumadin)? a. vitamin A b. vitamin B2 c. vitamin B6 d. vitamin C e. vitamin K ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology 19. Long-term use of St. John’s wort may result in diminished clinical effectiveness or increased dosage requirements for at least what percentage of all marketed medications? a. 10% b. 25% c. 50% d. 70% e. 90% ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 20. What fruit significantly impacts the actions of drugs such as statins and cyclosporines? a. prunes b. grapes c. grapefruit d. watermelon e. raspberries ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 21. When MAO is blocked by MAO inhibitors, what amine is affected (levels rise)? a. lysine b. tyramine c. arginine d. glycine e. glutamine ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 22. What’s a common side effect of the drug Prozac? a. reduced saliva production b. altered taste sensations c. bloating d. decreased appetite and weight loss e. heartburn ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 23. What class of meds results in decreased absorption of calcium as well as increased urinary loss of calcium -- creating high risk for bone fracture and osteoporosis? a. corticosteroids Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology b. NSAIDs c. cyclosporins d. statins e. H2 blockers ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 24. What immunosuppressant medications have been associated with large amounts of magnesium loss in the urine? a. corticosteroids b. NSAIDs c. cyclosporins d. statins e. H2 blockers ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 25. What B-vitamin supplement interferes with the metabolism of blood glucose? a. riboflavin b. biotin c. pantothenic acid d. folic acid e. niacin ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 26. NSAIDs increase the secretion of what vitamin? a. A b. B1 c. B2 d. B3 e. C ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 27. What common drug causes insomnia? a. pseudoephedrine b. tramadol c. ibuprofen prednisone d. prednisone e. diazepam Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 28. What criteria is used to identify the medications most likely to result in adverse effects? a. Adams criteria b. Beers criteria c. Collins criteria d. DuPont criteria e. Elliot criteria ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 29. What is the primary risk of taking COX-2 inhibitors (anti-inflammatory)? a. Crohn’s disease b. breast cancer c. heart failure d. hyperlipidemia e. rheumatoid arthritis ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 30. What is the risk to the elderly of taking benzodiazapines? a. stomach ulcers b. constipation c. kidney failure d. hypertension e. cognitive impairment ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 31. What route of drug administration is absorbed at a slower rate? a. buccal b. sublingual c. inhalation d. oral e. topical ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Administration of Drugs 32. Adverse drug effects happen more often within what age group?

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Chapter 11 - Pharmacology a. the elderly b. middle-age people c. young adults d. teenagers e. children ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 33. What are two blood thinners that should never be taken together? a. warfarin and digoxin b. warfarin and NSAIDs c. lithium and ACE inhibitors d. digoxin and clarithromycin e. lithium and NSAIDs ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 34. When doing a nutrient assessment of drug–nutrient interactions, which primary organs are assessed? a. kidneys, small intestine, spleen b. liver, spleen, pancreas c. kidneys, liver, heart d. liver, heart, small intestine e. kidneys, spleen, pancreas ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy 35. What are the three main biomarkers used to assess liver function? a. ALT, ALA, creatinine b. ALT, AST, bilirubin c. bilirubin, glucose, creatinine d. ALA, glucose, serum potassium e. AST, ALA, creatinine ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy Case Study Multiple Choice Mrs. Z is a 76 year old female who is seen by the internal medicine physician because she has been feeling very depressed. She also gets chronic migraines. The physician takes a full history from Mrs. Z, which reveals that several medications have been prescribed to her by a variety of specialists. It seems that each specialist neglected to pay attention to the meds that Mrs. Z was prescribed by her other doctors and the potential drug-nutrient interactions. She also takes some daily health supplements.

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Chapter 11 - Pharmacology The physician’s notes are as follows: Current Meds / Supplements Reason for Prescribing / Taking St. John’s wort ............................... she read in a magazine that this helps with depression Slow Fe (iron supplement) ............ for prior anemia Warfarin ......................................... history of embolic stroke Omeprazole ................................... history of peptic ulcer Tums ............................................. chronic upset stomach Amoxicillin ................................... recent respiratory infection Doxazosin ..................................... incontinence Allegra .......................................... seasonal allergies Lipitor ........................................... high cholesterol Vitamin E ...................................... she heard it was good for heart disease Typical Daily Diet Breakfast: eggs, bacon, ½ grapefruit, fresh orange juice Lunch: hotdogs, sausages, or pepperoni sub, sliced tomatoes, cold tea Dinner: cooked spinach, chicken breast, mashed potatoes, hot tea 36. Considering Mrs. Z is taking Allegra and Lipitor, which element of her diet is a concern for a negative drug-nutrient interaction? a. hot tea b. eggs c. deli meats d. grapefruit e. spinach ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact PREFACE NAME: Mrs. Z 37. What current med / supplement is Mrs. Z taking that likely results in diminished clinical effectiveness or increased dosage requirements for her other medications? a. Tums b. vitamin E c. St. John’s wort d. slow iron e. tea ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact PREFACE NAME: Mrs. Z 38. Considering Mrs. Z is takingwarfarin, which element in her diet is a concern for a negative drug-nutrient interaction? a. cold tea b. orange juice c. eggs d. bacon Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology e. spinach ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact PREFACE NAME: Mrs. Z 39. Because of the connection between increased levels of tyrosine and migraine headaches, what dietary changes should Mrs. Z make? a. eliminate grapefruit b. eliminate deli (cured) meats c. eliminate orange juice d. eliminate eggs e. eliminate fresh tomatoes ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact PREFACE NAME: Mrs. Z 40. With no fever, shortness of breath or rales, which medication should likely be discontinued for Mrs. Z? a. amoxicillin b. warfarin c. doxazosin d. Lipitor e. omeprazole ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact PREFACE NAME: Mrs. Z 41. Complementary and alternative medicine (CAM) includes the use of herbs, botanicals, and megadoses of nutrients. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 42. There is no official definition for the term “megavitamin therapy,” but it usually encompasses amounts of over 10 times the RDA. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 43. When an individual takes nitroglycerin for angina, it is usually administerd via the sublingual route.

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Chapter 11 - Pharmacology a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Administration of Drugs 44. The pH at the absorption site can alter ionization of the drug, which may change the speed and effectiveness of absorption. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 45. Circulation within the liver decreases by approximately 65% by age 65 years with concurrent decreases in liver mass. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 46. The most important chemical properties of medications related to drug absorption include the solubility of the drug in lipid or water and the ionization of the medication. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 47. Monoamine oxidase (MAO) is an intricate enzyme system distributed predominantly in nervous tissue, the heart, and the small intestine. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 48. The older adult population represents a group of individuals with an exceptionally low risk for drug–nutrient interactions. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 49. Natural products do not cause adverse alterations in glucose metabolism.

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Chapter 11 - Pharmacology a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Drug Mechanisms 50. People with allergies to shellfish should not take glucosamine supplements. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy 51. _______________ is defined as the use of drugs for treatment of disease and health maintenance.

ANSWER: Pharmacotherapy DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 52. The top selling dietary product in the Natural and Health Food Market is _______________.

ANSWER: flax seed / oil DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 53. Chromium picolinate is a supplement taken to improve _______________ sensitivity.

ANSWER: insulin DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction to Pharmacology 54. _______________ are medications that specifically interrupt the production of acid in the stomach.

ANSWER: H2 blockers DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 55. Some drug effects are _______________ of cellular receptors and are called nonspecific cellular responses.

ANSWER: independent DIFFICULTY: Bloom’s: Remember REFERENCES: Drug Mechanisms 56. Medications placed directly into the spinal canal are called _______________ or intrathecal.

ANSWER: epidural DIFFICULTY: Bloom’s: Remember REFERENCES: Administration of Drugs 57. Suppository medications can be administered via the _______________ or the vagina.

ANSWER: rectum DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology REFERENCES: Administration of Drugs 58. Binders, lubricants, and coating agents _______________ dissolution, whereas disintegrants _______________ dissolution.

ANSWER: decrease; increase DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 59. Aspirin is a good example of a medication that is absorbed in the _______________, but can also damage the gastric mucosa.

ANSWER: stomach DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 60. A(n) _______________ works to stimulate synthesis of the cytochrome P450 enzymes, increasing action potential.

ANSWER: inducer DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 61. Most drugs of low molecular weight are filtered out of the blood in the _______________ unless they are bound to large molecules such as proteins or to erythrocytes.

ANSWER: glomerulus DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 62. Many medications are bound to a protein carrier called _______________.

ANSWER: albumin DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 63. Medications that affect gastric emptying time include _______________ such as metoclopramide.

ANSWER: prokinetics DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 64. One of the most common mechanisms for alteration of drug metabolism is concurrent use of _______________.

ANSWER: other medications DIFFICULTY: Bloom’s: Remember REFERENCES: Pharmacokinetics 65. Amitriptyline, a common antidepressant, may cause a decrease in _______________ production.

ANSWER: saliva DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 66. Calcium supplements are absorbed best in an _______________ environment.

ANSWER: acidic Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 67. An example of a tubular reabsorption deficit involves the use of immunosuppressant medications called _______________.

ANSWER: cyclosporins DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 68. _______________ medication formulations should be used, when available, for administration via enteral feeding tubes.

ANSWER: Liquid DIFFICULTY: Bloom’s: Remember REFERENCES: How Foods and Drugs Interact 69. Willow bark acts like the common drug _______________.

ANSWER: aspirin (ASA) DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy 70. Black _______________ extract is used to treat menstrual problems and ameliorate menopause symptoms.

ANSWER: cohosh DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy 71. Explain what DASH stands for and what it is used for.

ANSWER: DASH stands for: Dietary Approaches to Stop Hypertension and is a type of low-sodium diet for people with high blood pressure.

DIFFICULTY: Bloom’s: Apply REFERENCES: Introduction to Pharmacology 72. What is parental administration and list the possible routes for parental administration of drugs.

ANSWER: Parenteral administration requires an injection into the body, possible routes are: subcutaneous, intradermal, intramuscular, intraperitoneal, or intravenous.

DIFFICULTY: Bloom’s: Apply REFERENCES: Administration of Drugs 73. Describe what excipients are. List some examples and what they do.

ANSWER: Excipients are substances added to formulations of medications that affect dissolution. Binders, lubricants, and coating agents decrease dissolution, whereas disintegrants increase dissolution.

DIFFICULTY: Bloom’s: Apply REFERENCES: Pharmacokinetics 74. Give an example of a negative drug-nutrient interaction involving MAOIs. ANSWER: A classic example of a drug–nutrient interaction resulting in harmful side effects is the interaction between pressor agents in foods (tyramine, dopamine, histamine, phenylethylamine) and monoamine oxidase inhibitors (MAOIs). This interaction can result in sudden increases in blood pressure with Copyright Cengage Learning. Powered by Cognero.

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Chapter 11 - Pharmacology resulting complications.

DIFFICULTY: Bloom’s: Apply REFERENCES: How Foods and Drugs Interact 75. List the common CAM use for licorice root.

ANSWER: Licorice root is a traditional remedy for stomach ulcers, bronchitis, and sore throat, as well as infections caused by viruses, such as hepatitis.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutrition Therapy 76. Discuss the role of nutrition therapy in pharmacotherapy and provide an example of a drug-nutrient interaction.

ANSWER: The role of nutrition therapy in pharmacotherapy is to highlight the effect of nutrition on the action of the prescribed medication or the effect of the medication on an aspect of nutrition. Drug–nutrient interactions are undesirable/harmful interaction(s) between food and over-the-counter medications, prescribed medications, herbals, botanicals, and/or dietary supplements that diminishes, enhances, or alters effect of nutrients and/or medications. The Academy of Nutrition and Dietetics emphasizes a collaborative model of health care that allows maximum benefit from the use of both pharmacotherapy and nutrition therapy. For example, grapefruit interferes with absorption of Zocor and could significantly change availability of this medication.

DIFFICULTY: Bloom’s: Apply REFERENCES: Introduction to Pharmacology 77. Describe the different routes the body uses to excrete drugs. Give an example of a consequence of a specific route of excretion.

ANSWER: Most drugs are removed by either urinary or biliary excretion, but some can be excreted via the lungs, bowel, and/or glands, depending on the chemical structure of the metabolite. Some drugs can be excreted in breast milk, which means that a nursing infant will be exposed to them. In addition, patients who are taking drugs excreted via the salivary glands may complain of taste changes.

DIFFICULTY: Bloom’s: Apply REFERENCES: Pharmacokinetics 78. Describe factors that affect drug dissolution.

ANSWER: The pH of the stomach and the gastric emptying rate are two of the most important nutrition-related factors impacting drug dissolution. Medications may require an acidic environment for dissolution.

Achlorhydria, which is decreased production of hydrochloric acid, occurs in aging as well as some medical conditions such as HIV and AIDS. Medications that could affect gastric acidity include H2 blockers, proton-pump inhibitors, and antacids. Gastric emptying rate influences the amount of time in which dissolution can occur; medications that affect gastric emptying time include prokinetics, such as metoclopramide.

DIFFICULTY: Bloom’s: Apply REFERENCES: How Foods and Drugs Interact 79. Give an example of the effect of drugs on nutrient metabolism.

ANSWER: Drugs can interfere with macronutrient, vitamin, and mineral metabolism. For example, corticosteroids increase the rate of gluconeogenesis, resulting in hyperglycemia and increased nitrogen loss. Numerous medications interfere with vitamin and mineral metabolism. Phenytoin (Dilantin), used for treatment of seizures, inhibits both vitamin D and folate metabolism. Long-term use may result in megaloblastic anemia secondary to folate deficiency.

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Chapter 11 - Pharmacology REFERENCES: How Foods and Drugs Interact 80. Discuss the drug-nutrient interactions in the elderly.

ANSWER: The older adult population represents one group with an exceptionally high risk for drug–nutrient interactions. There are several reasons. First, older individuals generally have the highest rate of chronic disease and are therefore prescribed the largest number of medications; this sheer volume increases risk.

Furthermore, the use of over-the-counter and complementary medications compounds the incidence of interactions. In addition, drug pharmacokinetics is affected by physiological changes that occur with aging. Decreased muscle mass and impaired cardiac, liver, and renal function all are common in older adults and can change how a drug is absorbed, metabolized, and excreted. Finally, compliance with drug regimens can be an important issue for this population. Financial burdens, complex regimens, or lack of proper drug education can lead to inappropriate drug dosing.

DIFFICULTY: Bloom’s: Apply REFERENCES: How Foods and Drugs Interact

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Chapter 12 - Diseases and Disorders of Energy Imbalance 1. The resting energy expenditure (REE), the thermic effect of food (TEF), and physical activity-related energy expenditure all make up the: a. basal energy expenditure (BEE). b. 24-hour energy expenditure. c. estimated energy requirements (EER). d. Non-exercise activity thermogenesis (NEAT). e. iatrogenic body density measurement.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Energy Balance 2. For the average North American, resting energy expenditure accounts for how much of total 24-hour energy expenditure? a. 5-10% b. 10-25% c. 25-50% d. 60-75% e. 80-90% ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Energy Balance 3. Alcohol contains how many kcalories per gram? a. 3 b. 4 c. 7 d. 9 e. 10 ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Energy Balance 4. Which factor influences the thermic effect of food (TEF) during a meal? a. The macronutrient composition of the meal b. The setting in which the meal is consumed c. The position of the person eating the meal d. The total energy expenditure of the individual e. The thermoregulation of the room where the meal is served ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Energy Balance 5. Which is considered a factor affecting resting energy expenditure (REE)? a. Height b. BMI Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance c. Age d. Heart rate e. Blood pressure ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Energy Balance 6. The most accurate approach for measuring energy requirements in critically ill patients is: a. doubly labeled water. b. direct calorimetry. c. The Mifflin–St. Jeor formula. d. The Harris-Benedict equations. e. indirect calorimetry.

ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Energy Balance 7. Which is a peptide hormone that is produced in the stomach and stimulates appetite? a. ghrelin b. lignin c. cholecystokinin d. amylin e. peptide YY ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Regulation of Energy Balance and Body Weight 8. Which best describes the difference between white adipose tissue (WAT) and brown adipose tissue (BAT)? a. The cells of BAT store triglycerides from food while the cells of WAT store LDL cholesterol b. As humans age, the amount of WAT diminishes and the amount of BAT increases c. In WAT, triglyceride is stored as one single molecule, while in BAT, there are multiple smaller droplets d. WAT is the primary fat found in infants and children, while BAT is primarily found in adults e. WAT derives its color from a large number of mitochondria while BAT derives its color from carotenoids ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Regulation of Energy Balance and Body Weight 9. Two hormones produced by adipose tissue that are involved in energy balance and fat storage are: a. interleukin-6 and c-reactive protein. b. adiponectin and leptin. c. insulin and ghrelin. d. glycogen and amylin. e. calcitonin and endothelin.

ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance DIFFICULTY: Bloom's: Understand REFERENCES: Regulation of Energy Balance and Body Weight 10. Which is considered a true statement regarding central body fat distribution? a. It is more commonly seen in females. b. It is also referred to as a gynoid body shape. c. It gives the body a shape resembling a pear. d. It refers to excess fat located on the hips and thighs. e. It may include visceral fat and subcutaneous fat.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 11. Which is identified as a high-risk waist circumference for males? a. > 33 inches b. > 35 inches c. > 38 inches d. > 40 inches e. > 44 inches ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 12. Obesity is men is most likely associated with which condition? a. cancer of the esophagus b. bradycardia c. hepatitis C d. cancer of the gallbladder e. diabetes insipidus ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 13. Which is considered a congenital cause of obesity? a. Cushing syndrome b. congenital adrenal hyperplasia c. Prader-Willi syndrome d. Goldenhar syndrome e. polycystic ovary syndrome ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 14. Which describes an obesogenic environmental influence on eating habits? a. An increase in the proportion of disposable income spent on food Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance b. Increased availability of foods with low energy density c. Increased access to supermarkets and food stores d. Increased amounts of snack and convenience foods e. The increased cost of energy-dense foods compared to low-energy foods ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 15. Which best describes night eating syndrome? a. Consuming at least 25% of total energy intake between the evening meal and the next morning. b. Eating excess foods during the night while still asleep. c. Eating non-food items as extra intake after the evening meal. d. Consuming at least 75% of total energy intake between midnight and 6 am. e. Consuming all calories in a 24-hour period between 6 pm and 6 am.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 16. Which is an example of an obesogenic environmental influence on physical activity habits? a. An increase in sports requirements in school b. A lack of safe sidewalks in neighborhoods c. A workplace that is historically less automated d. Household chores that are completed by hand e. An increase in urban sprawl that has created more walking and bicycle trails ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 17. Which describes an example of a lipase inhibitor used in the treatment of obesity? a. phentermine b. topiramate c. sibutramine d. phendimetrazine e. orlistat ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 18. Which describes the most appropriate initial treatment for a patient with a BMI between 25 and 29.9 who has comorbidities? a. Avoid additional weight gain and increase activity b. Reduce calories, increase activity, and add behavioral therapy c. Consider pharmacological therapy combined with diet and weight loss d. Institute a very low calorie diet (VLCD) combined with increased activity e. Consider bariatric surgery combined with pharmacological therapy Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 19. The most common type of bariatric surgery performed in the United States is: a. laparoscopic adjustable gastric banding. b. open adjustable gastric banding. c. laparoscopic vertical sleeve gastrectomy. d. Roux-en-Y gastric bypass. e. the duodenal switch with biliopancreatic diversion.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 20. Which type of bariatric surgery is considered the simplest and least invasive? a. laparoscopic adjustable gastric banding b. open adjustable gastric banding c. laparoscopic vertical sleeve gastrectomy d. Roux-en-Y gastric bypass e. duodenal switch with biliopancreatic diversion ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 21. Which is classified as a risk factor that would place a patient at high priority for treatment of overweight and obesity? a. Increased high-density lipoprotein cholesterol b. Family history of polycystic kidney disease c. Alcohol consumption of more than 2 drinks per day d. Impaired fasting glucose e. Decreased low-density lipoprotein cholesterol ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Overweight and Obesity 22. According to an observational study of successful weight losers in the National Weight Control Registry (NWCR), which is most important for weight maintenance? a. Eating a diet low in carbohydrates b. Having snack foods readily available c. Managing emotional eating d. Eating a diet high in protein e. Skipping meals when necessary ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance 23. Current guidelines for weight loss goals among patients are: a. 5-10% of baseline weight loss in 3 months. b. 5-10% of baseline weight loss in 6 months. c. 5-10% of baseline weight loss in 12 months. d. 25% of baseline weight loss in 6 months. e. 25% of baseline weight loss in 12 months.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Overweight and Obesity 24. Successful weight maintenance is defined as a regain of weight that is less than ____ in 2 years. a. 3.4 pounds b. 6.6 pounds c. 10 pounds d. 12.4 pounds e. 15.2 pounds ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 25. Which information is part of the food and nutrition-related history during the nutrition assessment for overweight and obese clients? a. usual body weight b. blood pressure c. visceral protein assessment d. current weight e. food allergies and intolerances ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 26. The best method of achieving a desired energy deficit for many people is by: a. eliminating carbohydrate intake. b. avoiding vitamins A and E. c. restricting fat intake. d. limiting protein intake. e. avoiding alcohol.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 27. Which is an example of the most appropriate educational topic that could be used with an overweight or obese patient? a. Purchasing more high-energy density foods b. Limiting caffeine consumption c. Adding high kcalorie ingredients during cooking Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance d. Decreasing water intake e. Reducing portion sizes ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Overweight and Obesity 28. A minimum initial physical activity goal for adults is ____ per week of moderate-intensity physical activity. a. 60 minutes b. 100 minutes c. 150 minutes d. 200 minutes e. 300 minutes ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 29. Which activity would be considered most vigorous and require the least amount of time to derive benefits? a. washing windows b. stair walking c. gardening d. pushing a stroller e. raking leaves ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 30. Which is an example of a risk factor for weight loss and malnutrition in older adults? a. decreased nutrient needs b. vision changes c. increased food access from supermarkets and convenience stores d. missed meals due to medical tests e. cardiovascular disease ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Underweight 31. Which indicates a measurement that contributes to failure to thrive (FTT) among infants and children? a. Length for age < 85th percentile b. BMI < 10th percentile c. Weight < 75% of median weight for age d. Weight < 50% of median weight for height e. Head circumference less than 15th percentile ANSWER: c DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance REFERENCES: Underweight 32. An example of a binge-eating behavior associated with eating disorders would be: a. consuming little variety in foods. b. avoiding social eating occasions. c. purchasing and preparing foods ritualistically. d. eating more rapidly than usual. e. eating small amounts when not hungry.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Eating Disorders 33. A risk factor that is particularly relevant in developing bulimia nervosa would be: a. perfectionism. b. obsessive-compulsive disorder. c. parental alcoholism. d. late menarche. e. childhood failure to thrive.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Eating Disorders 34. Which physical finding may be associated with anorexia nervosa? a. lanugo b. hirsutism c. diarrhea d. tachycardia e. elevated plasma glucose ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Eating Disorders 35. Which type of treatment is most appropriate for a patient with bulimia nervosa? a. inpatient hospitalization b. enteral feedings c. physical rehabilitation training d. cognitive-behavioral therapy e. lipase inhibitor medications ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Eating Disorders Case Study Multiple Choice CP is a 30 yo female who is meeting with a physician to consider Roux-en-Y gastric bypass surgery.

HT: 5’3” WT: 234# UBW: 201# (2 years ago) Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance 36. The type of surgery that CP is considering is most accurately described as: a. banding. b. restrictive. c. restrictive-malabsorptive. d. malabsorptive. e. high volume.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity PREFACE NAME: gastric bypass surgery.

37. Calculate CP’s BMI. a. 34.4 b. 36.5 c. 39.2 d. 40.7 e. 41.6 ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity PREFACE NAME: gastric bypass surgery.

38. If CP’s BMI were above 50, she would most likely be a candidate for which type of bariatric surgery? a. adjustable gastric banding b. non-adjustable gastric banding c. Roux-en-Y gastric bypass d. vertical sleeve gastrectomy e. duodenal switch with biliopancreatic diversion ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity PREFACE NAME: gastric bypass surgery.

39. If CP has the Roux-en-Y procedure, which type of nutrient malabsorption is she at highest risk for? a. vitamin B6 b. potassium c. iron d. niacin e. riboflavin ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity PREFACE NAME: gastric bypass surgery.

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Chapter 12 - Diseases and Disorders of Energy Imbalance 40. If CP should elect not to have bariatric surgery, she should work with the registered dietitian to change her intake by: a. eliminating 250-500 kcal per day. b. reducing intake by 500-1000 kcal per day. c. eliminating 1000-1500 kcal per day. d. losing 3 to 5 pounds per week. e. losing 20 pounds per year.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity PREFACE NAME: gastric bypass surgery.

41. Basal energy expenditure is the energy necessary to sustain life and to keep such vital organs as the heart, lungs, brain, liver, and kidneys functioning. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Energy Balance 42. When found in large aggregations in conjunction with fibrous connective tissue, adipocytes form adipose tissue, which serves as the storage site for approximately 10% of the body’s energy reserves. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Regulation of Energy Balance and Body Weight 43. The adipocyte is a metabolically active endocrine cell that releases numerous hormones involved in regulating appetite, energy balance, body fat content, and reproduction. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Regulation of Energy Balance and Body Weight 44. The “two compartment model” of body composition analysis views the body as two different compartments: liquids and solids. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 45. Children and adolescents having a BMI-for-age >85th percentile, but <95th percentile are considered overweight. a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 46. Excessive adipose tissue located in the hips and thighs is associated with increased risk of type 2 diabetes, hypertension, and coronary heart disease, even when BMI is within the healthy weight range. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 47. Mexican-American men with higher incomes are more likely to be obese than those with lower incomes. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 48. Once a person reaches his or her healthy adult weight, the desired goal is to avoid additional weight gain with age. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Overweight and Obesity 49. There is scientific evidence that physical activity helps people maintain a stable weight over time, but the optimal amount of activity for weight maintenance is not always clear. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 50. Most patients with anorexia nervosa lose their desire for food and do not experience hunger. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Eating Disorders 51. Internationally, the most commonly used unit of measurement of food energy is the _______________.

ANSWER: kilojoule, kJ DIFFICULTY: Bloom's: Remember REFERENCES: Energy Balance Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance 52. A(n) _______________ is a nation that is generally regarded as one with a high standard of living, a high per capita income, and a well-developed infrastructure.

ANSWER: developed nation DIFFICULTY: Bloom's: Remember REFERENCES: Energy Balance 53. The _______________ is defined as the average dietary energy intake that is predicted to maintain energy balance in a healthy person of a defined age, gender, weight, height, and level of physical activity consistent with good health.

ANSWER: estimated energy requirement, EER DIFFICULTY: Bloom's: Remember REFERENCES: Energy Balance 54. As plasma glucose level rises following a meal, the beta cells of the pancreas release insulin and _______________.

ANSWER: amylin DIFFICULTY: Bloom's: Remember REFERENCES: Regulation of Energy Balance and Body Weight 55. Overweight and moderate obesity are characterized by _______________ of adipocytes.

ANSWER: hypertrophy, enlargement DIFFICULTY: Bloom's: Understand REFERENCES: Regulation of Energy Balance and Body Weight 56. _______________, a hormone produced by adipose tissue that is involved in energy balance and fat storage, appears to signal that ample fat has been stored.

ANSWER: Leptin DIFFICULTY: Bloom's: Understand REFERENCES: Regulation of Energy Balance and Body Weight 57. Lower body fat distribution is more often seen in females and is sometimes referred to as _______________.

ANSWER: gynoid DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 58. The _______________is calculated by dividing the waist circumference measurement by the hip circumference measurement.

ANSWER: waist-to-hip ratio, waist to hip ratio, WHR DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 59. Central or abdominal obesity is a major risk factor for _______________, considered the most common chronic liver condition in the Western world.

ANSWER: non-alcoholic fatty liver disease, NAFLD DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 60. The term _______________ has been coined to refer to those environments that both promote weight gain and act as barriers to weight loss.

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Chapter 12 - Diseases and Disorders of Energy Imbalance ANSWER: obesogenic environment DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 61. _______________ are medications that promote weight loss by acting on the central nervous system to decrease appetite and increase satiety, thus reducing food consumption and energy intake.

ANSWER: Appetite suppressants, anorectics DIFFICULTY: Bloom's: Remember REFERENCES: Overweight and Obesity 62. Of the four bariatric procedures, _______________is the most complicated and the least frequently performed, but also results in the greatest amount of weight loss.

ANSWER: DS-BPD, duodenal switch with biliopancreatic diversion DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 63. In general, complications of bariatric surgery are more likely to result from the _______________ procedures than from the restrictive procedures.

ANSWER: restrictive-malabsorptive, malabsorptive-restrictive DIFFICULTY: Bloom's: Understand REFERENCES: Overweight and Obesity 64. BMI and _______________ are used to initially assess the degree of obesity and for monitoring the patient’s response to obesity treatment.

ANSWER: waist circumference DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Overweight and Obesity 65. A compensatory survival mechanism intended to conserve energy in the face of starvation is known as _______________.

ANSWER: adaptive thermogenesis DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Overweight and Obesity 66. Although greater energy deficits may be useful to provide needed motivation during the period of weight loss, a(n) _______________ providing less than 800 kcal per day should not be used for routine weight loss.

ANSWER: very-low-calorie diet, VLCD DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 67. _______________ are low in energy while high in weight, and include such foods as high-water vegetables and fruits, and broth-based soups.

ANSWER: Low-energy-density foods DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Overweight and Obesity 68. _______________ is primarily caused by catabolism as a result of increased metabolic rate and protein breakdown Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance and results in wasting of muscle mass.

ANSWER: Cachexia DIFFICULTY: Bloom's: Understand REFERENCES: Underweight 69. Patients with _______________ exhibit a severe and selective restriction of food intake, particularly of those foods that are perceived as fattening, resulting in a marked weight loss.

ANSWER: anorexia nervosa, AN DIFFICULTY: Bloom's: Remember REFERENCES: Eating Disorders 70. _______________ is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat, with episodes marked by feelings of lack of control.

ANSWER: Binge eating disorder, BED DIFFICULTY: Bloom's: Remember REFERENCES: Eating Disorders 71. List the components of 24-hour energy expenditure and the approximate percentage of total energy used by each.

ANSWER: The components are resting energy expenditure: 67%; physical activity energy expenditure: 23%; and thermic effect of food: 10%.

DIFFICULTY: Bloom's: Apply REFERENCES: Eating Disorders 72. Describe the basic formula for calculating BMI in adults.

2 ANSWER: The formula to calculate BMI is: weight in kilograms (height in meters) . The clinician may need to convert pounds to kilograms by dividing the number of pounds by 2.2. To convert inches to meters to calculate the height, the provider takes the number of inches x 0.0254 to get the number of meters.

DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 73. Explain the purpose of waist circumference measurement and define high-risk results for both males and females.

ANSWER: A practical approach to quantifying abdominal fat is to measure waist circumference (WC), which is useful in assessing the disease risk of patients who are categorized as having a healthy body weight, who are considered overweight, or who are mildly obese. Risk of disease increases when the waist circumference exceeds 40 inches in males and 35 inches in females.

DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 74. Name five examples of health consequences that can develop from overweight and obesity.

ANSWER: Adverse health consequences that can develop from overweight and obesity include premature death, increased risk of heart disease, diabetes; an increased risk of some types of cancer, such as endometrial, colon, kidney, or breast cancer; sleep apnea, asthma, polycystic ovary syndrome, arthritis, and infertility.

DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 75. List three examples of possible nutrition diagnoses appropriate for patients who are overweight or obese.

ANSWER: The following nutrition diagnoses are common among patients who are overweight or obese: excessive energy intake, excessive fat intake, less than optimal intake of types of carbohydrates, food- and Copyright Cengage Learning. Powered by Cognero.

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Chapter 12 - Diseases and Disorders of Energy Imbalance nutrition-related knowledge deficit, disordered eating pattern, undesirable food choices, overweight/obesity, unintended weight gain, self-monitoring deficit, and physical inactivity.

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Overweight and Obesity 76. Define and discuss the role of adipocytes in the body in relation to their storage capacities and metabolic activity.

ANSWER: The adipocyte is a large, rounded cell primarily filled with a droplet of triglyceride. The adipocyte is metabolically active in the uptake, synthesis, storage, and mobilization of triglycerides. There is a constant turnover of triglycerides in the adipocyte as new triglycerides are synthesized and stored and older triglycerides are hydrolyzed and released from the adipocyte into the circulation. Research has shown the adipocyte to be a metabolically active endocrine cell releasing numerous hormones involved in regulating appetite, energy balance, body fat content, and reproduction. In addition, adipocytes release numerous molecules that influence blood pressure, blood coagulation, insulin sensitivity, lipid oxidation, and serum lipid levels.

DIFFICULTY: Bloom's: Apply REFERENCES: Regulation of Energy Balance and Body Weight 77. List the two different types of body fat distribution, their characteristics, and the risks of complications associated with each.

ANSWER: Abdominal or central fat placement refers to fat located primarily within the abdominal region of the body, both surrounding the organs of the abdomen and located just under the skin around the waist.

Abdominal fat distribution is more often seen in males, tends to give the body a shape resembling that of an apple, and is sometimes referred to as android. Lower body fat placement refers to fat located primarily in the lower region of the body, and tends to give the body a shape resembling a pear. Lower body fat distribution is more often seen in females and is sometimes referred to as gynoid. Abdominal obesity is associated with increased risk of type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, and metabolic syndrome. Adipose tissue located within the lower body is inversely related to cardiovascular disease and diabetes mellitus.

DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 78. Discuss the physiological consequences of obesity in the following areas: type 2 diabetes, hepatobiliary disorders, cancer, reproductive disorders.

ANSWER: Type 2 diabetes is three times as prevalent among the obese as compared with normal-weight persons.

Excess body fat, especially if located within the abdominal region, elevates fasting and post-prandial levels of plasma free fatty acids and is a major risk factor for metabolic syndrome. The risk of gallstones increases with adult weight. Central or abdominal obesity is a major risk factor for non-alcoholic fatty liver disease (NAFLD). Although generally asymptomatic, NAFLD can range from simple steatosis to non-alcoholic steatohepatitis and eventual liver failure. Studies have confirmed that obesity is a significant risk factor for death from cancer generally and from cancer in several specific sites. Obesity in males is associated with increased death from cancer of the esophagus, rectum, pancreas, liver, and prostate. In females, obesity increases risk of death from cancer of the gallbladder, bile duct, breast, endometrium, cervix, and ovaries. Obesity is associated with reproductive disorders in both sexes. In males, obesity is associated with gynecomastia, hypogonadism, reduced testosterone levels, and elevated estrogen levels. In females, it is associated with menstrual abnormalities and polycystic ovarian syndrome (PCOS).

DIFFICULTY: Bloom's: Analyze REFERENCES: Overweight and Obesity 79. Describe the process of each of the four types of bariatric surgery and list an advantage and disadvantage of each.

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Chapter 12 - Diseases and Disorders of Energy Imbalance ANSWER:

In laparoscopic adjustable gastric banding (LAGB), an inflatable silicone ring is secured around the upper part of the stomach to create a small pouch with a narrow opening at the bottom. The pouch restricts the amount of food that can be consumed at one time. LAGB is the simplest and least invasive because it does not require any stapling of the stomach, but those receiving LAGB lose weight at a slower rate. In laparoscopic vertical sleeve gastrectomy, (LVSG), up to 85% of the stomach is surgically removed, leaving a narrow, tubular, banana-shaped portion of the stomach between the esophagus and the duodenum. Because the detached section of the stomach is primarily responsible for the production of the hormone ghrelin, weight loss is further enhanced by the markedly lower serum levels of ghrelin seen in patients who have had LVSG. The Roux-en-Y procedure creates a small pouch at the top of the stomach, restricting food intake and quickly inducing satiety. The jejunum is cut and the distal end (“roux limb”) is surgically connected to the pouch. The Roux-en-Y is the most common bariatric surgery and is highly effective and long lasting. The duodenal switch with biliopancreatic diversion (DS-BPD) is the most complicated and the least frequently performed, but also results in the greatest amount of weight loss. The first part of the procedure is a laparoscopically performed vertical sleeve gastrectomy; the second stage reroutes food from the stomach past most of the small intestine.

DIFFICULTY: Bloom's: Apply REFERENCES: Overweight and Obesity 80. Describe the behavioral manifestations associated with each of the following: anorexia nervosa, bulimia nervosa, binge eating disorder.

ANSWER: Anorexia nervosa is characterized by excessive dieting, severe weight loss, and distorted body image with a pathological fear of being fat. Fear of gaining weight or becoming fat is an important criterion, as is persistent behavior that interferes with weight gain; another key criterion is “restriction of energy intake relative to requirements leading to a significantly low body weight (less than minimally normal or less than that expected).”Bulimia nervosa is characterized by frequent episodes of binge eating followed by inappropriate behaviors such as self-induced vomiting to avoid weight gain. Binge eating disorder is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat, with episodes marked by feelings of lack of control.

DIFFICULTY: Bloom's: Analyze REFERENCES: Eating Disorders

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Chapter 13 - Diseases of the Cardiovascular System 1. The right atria and the right ventricle make up the right heart and pump blood to: a. the left heart. b. the pulmonary circulation. c. the superior vena cava. d. the aortic artery. e. the inferior vena cava.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Cardiovascular System 2. The repeating contraction and relaxation of the heart is termed the: a. ejection fraction. b. end diastolic volume. c. stroke volume. d. cardiac output. e. cardiac cycle.

ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Cardiovascular System 3. Which best describes mean arterial pressure (MAP)? a. The amount of end diastolic volume that is ejected from the heart by contraction of the left ventricle b. The force exerted by the blood on the walls of blood vessels during the contraction of the ventricles c. The resistance against which the ventricles must contract in order to eject blood into systemic circulation d. The depolarization of the AV node that is carried into the ventricles by the atrioventricular bundle e. The volume of blood ejected with each contraction of the left ventricle ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Cardiovascular System 4. Which condition has been a factor associated with primary hypertension? a. Decreased secretion of vasopressin b. Differences in genes that affect sodium retention c. Increased levels of nitrous oxide in the bloodstream d. Decreased production of angiotensinogen e. Type 1 diabetes and diminished insulin production ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Hypertension 5. Which is an example of a loop diuretic used in the treatment of hypertension? a. furosemide b. hydrochlorothiazide c. acetazolamide d. spironolactone Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System e. methazolamide ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Hypertension 6. What best describes how ACE inhibitors work to control hypertension? a. Decreasing blood volume by increasing urinary output b. Blocking beta-receptors in the heart to decrease heart rate and cardiac output c. Decreasing peripheral vascular resistance by interfering with the production of angiotensin II from angiotensin I d. Reducing stroke volume e. Affecting the movement of calcium, which causes the blood vessels to relax ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Hypertension 7. Which describes a recommendation for lifestyle changes that may be made to control hypertension? a. Engage in 30 minutes of physical activity per week b. Avoid alcohol completely c. Consume no more than 3400 mg of sodium per day d. Increase fruits, vegetables, and low-fat dairy in the diet e. Maintain a BMI between 25 and 29.9 ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Hypertension 8. The DASH eating plan recommends daily servings of various foods, including: a. 1-2 servings of vegetables daily. b. 4-5 servings of fruits daily. c. 4-5 servings of low-fat dairy products daily. d. 4-5 servings of nuts and seeds daily. e. 2-3 servings of sweets daily.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Hypertension 9. A dietitian is helping a client with determining sodium content of food to manage her hypertension. The label on a product reads, ―140 mg or less of sodium per serving.‖ This product would be classified as: a. sodium free. b. very low sodium. c. low sodium. d. unsalted. e. high in sodium.

ANSWER: c DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System REFERENCES: Nutrition Therapy for Hypertension 10. During the development of atherosclerosis, as platelets adhere to the sub-endothelial surfaces, they begin to secrete both adenosine diphosphate (ADP) and: a. nitric oxide. b. platelet-derived growth factor. c. C-reactive protein. d. plasminogen activator inhibitor. e. thromboxane A2.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 11. The protein portion of the lipoprotein that provides structural integrity and allows for receptors to recognize the lipoprotein particle is called: a. a chylomicron. b. an amino acid receptor. c. bradykinin. d. fibrinolytic factor. e. an apolipoprotein.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 12. A dietitian is reviewing the laboratory results of a client’s total cholesterol levels. The results are 210 mg/dL. These results would be classified as: a. desirable. b. normal. c. borderline high. d. high. e. excessive.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 13. The components of metabolic syndrome include elevated triglycerides, low HDL cholesterol, insulin resistance, elevated blood pressure, and: a. abdominal obesity. b. cerebral edema. c. low exercise tolerance. d. muscle tetany. e. early-onset dementia.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System 14. Gemfibrozil is a type of medication used to control high cholesterol and is classified as a(n): a. nicotinic acid. b. bile acid sequestrant. c. HMG-CoA reductase inhibitor. d. fibric acid. e. statin.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 15. A dietitian is using the CAGE questions to assess for intakes of saturated fat and cholesterol in a client’s diet. The ―C‖ in CAGE stands for: a. convenience. b. calories. c. calcium. d. caffeine. e. cheese.

ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Atherosclerosis 16. Research recommends how much daily intake from saturated fat food sources? a. No more than 15% of total kcal b. No more than 12% of total kcal c. No more than 10% of total kcal d. No more than 7% of total kcal e. 0% to no more than 5% of total kcal ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Atherosclerosis 17. A dietitian is counseling a client with atherosclerosis about how to make therapeutic lifestyle changes. Which food item should the dietitian advise the client to choose less often? a. soft or liquid margarine b. buttermilk c. whole eggs d. cottage cheese e. pasta ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Atherosclerosis 18. Which is an example of a polyunsaturated fat source? a. butter b. corn oil Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System c. lard d. coconut oil e. palm oil ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Atherosclerosis 19. Uncontrolled contractions of the heart ventricle that are often associated with myocardial infarction are known as: a. ventricular tachycardia. b. ventricular fibrillation. c. ventricular shock arrhythmias. d. atrial fibrillation. e. complete heart block.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease 20. Symptoms of angina may include nausea, pain in the arm and neck, sweating, and: a. hemorrhage. b. chills. c. edema. d. rash. e. shortness of breath.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease 21. Which best describes an echocardiogram, which may be used to diagnose heart disease? a. Radionucleotides attached to red blood cells allow for visualization of the heart while beating b. Vital signs are measured after a session of prescribed exercise on a treadmill c. A technician takes a graphic recording of the heart’s electrical activity d. A catheter is inserted from an appropriate artery or vein into the ventricle e. Sound waves are used to document anatomy and function of the heart ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease 22. Which describes a non-invasive test used in patients with symptoms of PAD that measures the blood pressure in the upper and lower extremities at rest and after exercise? a. magnetic resonance angiography b. radionucleotide imaging c. positron emission tomography d. ankle-brachial index e. CT angiography ANSWER: d Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System DIFFICULTY: Bloom's: Understand REFERENCES: Peripheral Arterial Disease 23. The most common cause of heart failure in women is: a. hypertension. b. ischemic heart disease. c. peripheral arterial disease. d. myocardial infarction. e. acute coronary syndrome ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Heart Failure 24. Patients who have structural heart disease but demonstrate no symptoms of heart failure are classified as having which stage of the disease? a. A b. B c. C d. D e. E ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Heart Failure 25. Signs of right-sided heart failure include distended neck veins, flushing, and: a. dry mouth. b. ascites. c. sunken eyes. d. decreased urine output. e. constipation.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Heart Failure 26. Which is an example of a high-sodium product that should be limited in a patient with heart failure? a. edamame b. flour tortillas c. chocolate milk d. tuna e. eggnog ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Heart Failure 27. Which information is essential as part of educating a client with heart failure about fluid restriction?

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Chapter 13 - Diseases of the Cardiovascular System a. Increase sodium intake to offset fluid loss b. Count all beverages and foods such as soups, sherbet, and gelatin within the fluid allowance c. Use warm or hot foods to control thirst d. Check body weight 3 times daily e. Limit fluid intake to 4 quarts per day ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Heart Failure 28. Which best describes surgical ventricular restoration? a. An implant is placed in the chest to use when the right and left side of the heart do not contract at the same time b. A device mechanically pumps blood from the left side of the heart to the rest of the body c. A procedure is performed that restores the normal geometry of the left ventricle by removing scarred areas of heart tissue d. A person’s failing heart is replaced with a healthy heart from a suitable deceased donor e. Sensors are placed in the ventricles to regulate electrical impulses coming from the SA node ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Medical Procedures for Cardiac Failure 29. Which is a true statement regarding a heart transplant? a. Most transplant surgeries are performed on patients younger than 40 years old. b. A heart-lung bypass machine is hooked up in order to provide blood to the patient’s body after surgery. c. The aorta and pulmonary arteries are not replaced as part of the surgery. d. Aldosterone antagonists and immunosuppressant medications are administered after surgery to prevent rejection. e. Recovery often involves 3 months in the hospital and 6 months of monitoring by the transplant team for organ rejection.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Medical Procedures for Cardiac Failure 30. A long-term complication of heart transplant might be: a. osteoporosis. b. hypokalemia. c. weight gain. d. migraine headaches. e. hyponatremia.

ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Medical Procedures for Cardiac Failure 31. Immediate nutrition goals after a heart transplant are to supply adequate nutrients so the body can heal and to: a. reduce fluid buildup.

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Chapter 13 - Diseases of the Cardiovascular System b. prevent potassium loss. c. increase energy intake. d. prepare for cardiac rehabilitation. e. fight infections.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Heart Transplant 32. The four basic steps of food safety are: clean, separate, cook, and: a. eat. b. dispose. c. chill. d. store. e. consume.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Heart Transplant 33. A dietitian is educating a client about how to prevent infection after a heart transplant. Which foods would the dietitian counsel the client to avoid? a. pasteurized milk b. homemade eggnog c. canned fish d. cooked sprouts e. hard cheese ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Heart Transplant 34. What is the recommended amount of protein intake during the initial phase after heart transplant? a. 0.8 – 1.0 g/kg b. 1.0 – 1.5 g/kg c. 1.5 – 2.0 g/kg d. 2.0 – 2.4 g/kg e. 2.5 – 3.0 g/kg ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Heart Transplant 35. Which medication is recommended for a low-risk patient with atrial fibrillation? a. warfarin b. vitamin K c. dabigatran d. aspirin e. rivaroxaban Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Atrial Fibrillation PT is a 65 yo M who comes to the emergency room complaining of chest pain. Several diagnostic tests conclude that he has suffered an MI. The registered dietitian is consulted for nutrition education. PT reports that he has gained 30 pounds in the previous year due to his hectic work schedule, which forces him to eat out often. In addition, he is physically inactive. PT also reports that he has a family history of heart disease and his father died of an MI. HT: 5’9 WT: 190# Waist Circumference: 105 cm BP: 140/93 Cholesterol: 259 LDL: 180 HDL: 58 TG: 234 Diet Hx: B Egg and sausage muffin Coffee L Ham and cheese sandwich on white bread Potato chips Soda D Chicken breast Mashed potatoes Iced tea Cheesecake 36. Which is an example of a modifiable risk factor that contributed to PT’s condition? a. obesity b. family history c. ethnicity d. gender e. age ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease PREFACE NAME: case 37. Based on the available clinical data, what additional diagnosis might be made in this case? a. hyperhomocysteinemia b. heart failure c. peripheral vascular disease d. metabolic syndrome e. atrial fibrillation ANSWER: d DIFFICULTY: Bloom's: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System REFERENCES: Atherosclerosis PREFACE NAME: case 38. PT’s diet is high in which element? a. polyunsaturated fat b. saturated fat c. vitamin D d. monounsaturated fat e. potassium ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Atherosclerosis PREFACE NAME: case 39. The registered dietitian may recommend which of the following additions to PT’s diet to help decrease the absorption of lipids? a. nuts b. magnesium c. folate d. soluble fiber e. protein ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Atherosclerosis PREFACE NAME: case 40. Which compound, when consumed twice daily, can have therapeutic effects on cholesterol? a. nuts b. folate c. vitamin B6 d. plant stanols e. vitamin B12 ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Atherosclerosis PREFACE NAME: case 41. Though many myocardial cells have the capability of generating spontaneous electrical activity, electrical activity is initiated at the atrioventricular (AV) node. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Cardiovascular System Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System 42. An individual who is currently taking antihypertensive medication is not considered to have hypertension if the blood pressure normalizes as a result of the medication. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Hypertension 43. A comprehensive approach that addresses multiple lifestyle factors has the most significant effect on blood pressure control for hypertensive individuals. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Hypertension 44. The prevailing theory for the pathophysiology of atherosclerosis is that the disease begins as a response to injury that results in hemorrhage. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 45. Hypothyroidism leading to obesity has also been identified as a risk factor for coronary atherosclerosis. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Atherosclerosis 46. Current recommendations include maintenance of dietary fat intake within 10%-15% of total caloric intake for patients with atherosclerosis. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Atherosclerosis 47. The causes of an acute MI or unstable angina are plaque erosion, rupture of a plaque resulting in formation of a thrombus, and vasoconstriction. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Ischemic Heart Disease Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System 48. Ischemic heart disease (IHD) is often misdiagnosed or undiagnosed in females because they tend to experience angina pain differently than men. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease 49. Since the intakes of magnesium and calcium can directly impact the progression and management of HF, accurate assessment of both of these nutrients is essential. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Heart Failure 50. Clients with atrial fibrillation should be educated on foods that are high in vitamin K and how to check product labels for vitamin K contents. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Atrial Fibrillation 51. The veins from the upper part of the body drain into the _______________ vena cava.

ANSWER: superior DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Cardiovascular System 52. The force exerted by the blood on the walls of blood vessels during the contraction of the ventricles is termed _______________.

ANSWER: systolic blood pressure DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Cardiovascular System 53. _______________ hypertension occurs as a result of another primary problem, such as kidney disease, other cardiovascular diseases, endocrine disorders, or neurogenic disorders.

ANSWER: Secondary DIFFICULTY: Bloom's: Understand REFERENCES: Hypertension 54. _______________ are medications that affect the movement of calcium, which causes the blood vessels to relax and therefore reduces vasoconstriction.

ANSWER: Calcium channel blocking agents, calcium channel blockers DIFFICULTY: Bloom's: Understand REFERENCES: Hypertension Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System 55. When assessing hypertension, it is not necessary to measure waist circumference for those patients with a BMI >_______________, because it adds no additional predictive power.

ANSWER: 35 DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Hypertension 56. One tsp of table salt is equivalent to _______________ mg sodium.

ANSWER: 2300 DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Hypertension 57. _______________ produced in the endothelial cells controls the normal relaxation of smooth muscle in the arteries and arterioles.

ANSWER: Nitric oxide, NO DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 58. At the onset of atherosclerotic lesion formation, the damage to the endothelial layer attracts platelets to the area, which attach to the endothelium and form a small clot termed a _______________.

ANSWER: mural thrombus DIFFICULTY: Bloom's: Remember REFERENCES: Atherosclerosis 59. A surgical procedure that typically uses the saphenous vein or internal mammary artery to ―bypass‖ the blocked vessel is known as a(n) _______________.

ANSWER: coronary artery bypass graft, CABG DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Atherosclerosis 60. In the diet, _______________ appear to behave similarly to saturated fatty acids in that they increase total cholesterol and LDL levels and perhaps lower HDL levels.

ANSWER: trans fatty acids, trans fats DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Atherosclerosis 61. _______________ is a term used to describe the condition of persons who present with either an acute MI or unstable angina.

ANSWER: Acute coronary syndrome, ACS DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease 62. It is not unusual for individuals to experience episodes of _______________ in response to an increase in cardiac workload.

ANSWER: angina DIFFICULTY: Bloom's: Understand REFERENCES: Ischemic Heart Disease Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System 63. During the immediate post-MI period, oral intake may be _______________ due to pain, anxiety, fatigue, and shortness of breath.

ANSWER: decreased DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Ischemic Heart Disease 64. A(n) _______________ is defined as a non-healing break in the skin. Inadequate perfusion to the tissues (i.e., lack of oxygen) is the primary etiology for skin breakdown.

ANSWER: ulceration DIFFICULTY: Bloom's: Remember REFERENCES: Peripheral Arterial Disease 65. Typically, heart failure begins with the _______________, the heart’s primary pumping chamber.

ANSWER: left ventricle DIFFICULTY: Bloom's: Remember REFERENCES: Heart Failure 66. A _______________ mg sodium diet is a standard initial recommendation for individuals with heart failure.

ANSWER: 2000 DIFFICULTY: Bloom's: Remember REFERENCES: Nutrition Therapy for Heart Failure 67. A(n) _______________ is a medical procedure used for heart failure that mechanically pumps blood from the left side of the heart to the rest of the body.

ANSWER: left ventricular assist device, LVAD, left VAD DIFFICULTY: Bloom's: Understand REFERENCES: Medical Procedures for Cardiac Failure 68. A(n) _______________ is a surgical procedure in which a person’s failing heart is replaced with a healthy heart from a suitable deceased donor.

ANSWER: heart transplant DIFFICULTY: Bloom's: Remember REFERENCES: Medical Procedures for Cardiac Failure 69. Post-surgery education on basic food safety after heart transplant should be provided since transplant patients are more susceptible to _______________ due to immunosuppressant therapy.

ANSWER: infection, infections DIFFICULTY: Bloom's: Understand REFERENCES: Nutrition Therapy for Heart Transplant 70. _______________ is used to determine the dosage of anticoagulant medication for patients with atrial fibrillation.

ANSWER: Clotting rate, international normalized ratio, INR, DIFFICULTY: Bloom's: Understand REFERENCES: Atrial Fibrillation 71. Describe the formula used for calculating blood flow and vessel resistance.

ANSWER: Flow = Δ pressure / resistance Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System Resistance = (length of vessel x viscosity of the blood)/(radius) DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Cardiovascular System 72. List risk factors that are common to the development of coronary heart disease, peripheral vascular disease, and cerebrovascular accidents.

ANSWER: Long-term studies have allowed researchers to identify risk factors linked to development of CHD, PVD, and CVA, including family medical history, age, sex, obesity, dyslipidemia, hypertension, diabetes, physical inactivity, and cigarette smoking.

DIFFICULTY: Bloom's: Understand REFERENCES: Atherosclerosis 73. List examples of foods to choose and foods to avoid when decreasing saturated fat and increasing unsaturated fats in the following categories: dairy products, fats and oils, breads and cereals.

ANSWER: Dairy products: Choose low-fat cheese, ice milk, frozen yogurt, low-fat coffee creamer, low-fat or nonfat sour cream; avoid regular cheeses (American, Colby, mozzarella), cream cheese, ice cream, half & half, non-dairy creamer, whipped topping, regular sour cream. Fats and oils: Choose unsaturated oils, margarines, and salad dressings; seeds, nuts, and cocoa powder. Avoid soybean, corn, coconut, and palm oils; butter, lard, bacon fat, trans fats, coconut, and milk chocolate.

Breads and cereals: Choose whole grain breads, cereals, rice, pasta, and crackers; dry beans, and peas.

Avoid breads in which eggs, fat, or butter are major ingredients; granola, high-fat crackers, commercially prepared pastries and baked goods.

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Atherosclerosis 74. List the classifications of complications that can occur after a myocardial infarction.

ANSWER: Complications may include disturbances of cardiac rhythm, heart failure, intracardial thrombi, pericarditis, cardiac rupture, papillary muscle dysfunction, and ventricular aneurysm.

DIFFICULTY: Bloom's: Apply REFERENCES: Ischemic Heart Disease 75. Name and briefly describe the stages of heart failure.

ANSWER: Stage A: Patients who are at high risk for developing heart failure but have no structural abnormalities.

Stage B: Patients who have structural heart disease but demonstrate no symptoms of heart failure. Stage C: Patients with past or current symptoms of heart failure who have underlying structural heart disease.

Stage D: Patients with end-stage disease requiring specialized treatment, such as mechanical circulatory support, procedures to facilitate fluid removal.

DIFFICULTY: Bloom's: Apply REFERENCES: Heart Failure 76. Discuss each of the following components when evaluating clinical hypertension: classification of blood pressure, major cardiovascular disease risk factors, identifiable causes of hypertension.

ANSWER: Normal blood pressure is classified as <120 mmHg systolic and <80 mmHg diastolic. Stage 1 hypertension is classified as a systolic reading between 140 and 159 mmHg for people age 18-79 and a systolic reading over 150 mmHg for people over 80 years old; and as a diastolic reading between 90 and 99 mmHg. Stage II hypertension is classified as a systolic measurement over 160 mmHg and a diastolic measurement over 100 mmHg. Major cardiovascular risk factors include hypertension, obesity, dyslipidemia, diabetes mellitus, cigarette smoking, physical inactivity, microalbuminuria, eGFR < 60 mL/min, increased age, and a family history of CVD. Identifiable causes of hypertension include sleep Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System apnea, drug-induced states, chronic kidney disease, primary aldosteronism, renovascular disease, Cushing’s syndrome, steroid use, pheochromocytoma, coarctation of the aorta, and thyroid disease.

DIFFICULTY: Bloom's: Apply REFERENCES: Hypertension 77. Describe the ―5 A’s‖ of nutrition counseling for hypertension, including examples of interventions from the dietitian.

ANSWER: Assess: Check food intake, dietary habits, physical activity and readiness to change behavior. The dietitian may assess according to the WAVE tool (weight, activity, variety, excess).

Advise: Give clear, specific, and personalized behavior change advice. Say, ―Diet changes, exercise, and weight loss can reduce your blood pressure as much as medicine.‖ Agree: Collaborate with the patient, base goals on readiness to change, keep food and exercise records.

Assist: Help the patient acquire knowledge, skills, and support; provide resources, lists, and recommendations for community groups and clubs.

Arrange: Make and schedule follow-up appointments with the patient.

DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Therapy for Hypertension 78. Describe the components of the rapid eating assessment for patients (REAP) and give an example of a question applicable to each category of the assessment.

ANSWER: The client is asked a question regarding various types of food categories; the client should answer each question as ―usually/often,‖ ―sometimes,‖ ―rarely/never,‖ or ―does not apply to me.‖ The categories and sample questions are posed as ―In an average week, how often do you:‖ Meals: skip breakfast?

Grains: eat less than 3 servings of whole-grain products a day?

Fruits and vegetables: eat less than 2–3 servings of fruit a day?

Dairy: eat or drink less than 2–3 servings of milk, yogurt, or cheese a day?

Meats/chicken/turkey: eat beef, pork, or dark-meat chicken more than two times a week?

Fried foods: eat fried foods such as fried chicken, fried fish, or French fries?

Snacks: eat regular potato chips, nacho chips, corn chips, crackers, regular popcorn, nuts instead of pretzels, low-fat chips or low-fat crackers, air-popped popcorn?

Fats and oils: use regular salad dressing and mayonnaise instead of low-fat or fat-free salad dressing and mayonnaise?

Sweets: eat sweets such as cake, cookies, pastries, donuts, muffins, chocolate, and candies more than two times per day?

Soft drinks: drink 16 oz or more of non-diet soda, fruit drink/punch, or Kool-Aid a day?

Sodium: add salt to foods during cooking or at the table?

Alcohol: drink more than 1–2 alcoholic drinks a day?

Activity: watch more than 2 hours of television or videos a day?

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Atherosclerosis 79. Explain the components of the guide to therapeutic lifestyle changes (TLC), listing examples from each of the segments.

ANSWER: Foods to choose more often: Increase servings of whole grain breads/cereals, vegetables, and fruits; eat 2-3 servings of low-fat dairy, <2 egg yolks per week, <5 oz. of meat per day, choose unsaturated fats.

Food items to choose less often: doughnuts, biscuits, butter rolls, croissants, sweet rolls, fried vegetables, cream sauces, whole-fat dairy, cream cheese, high-fat cuts of meat, egg yolks, butter, shortening, chocolate, coconut.

Recommendations for weight reduction: weigh regularly, lose weight gradually, limit the number of eating occasions, choose portions carefully, avoid second helpings, read food labels.

Recommendations for increased physical activity: make physical activity part of daily routine, make Copyright Cengage Learning. Powered by Cognero.

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Chapter 13 - Diseases of the Cardiovascular System physical activity part of recreational activities.

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Therapy for Atherosclerosis 80. Describe each of the components of nutrition intervention for heart failure, including sodium restriction, energy and protein requirements, fluid intake, and drug-nutrient interactions.

ANSWER: A 2000-mg sodium diet is a standard initial recommendation for individuals with HF. Adjustments to levels of 2000 mg, 1000 mg, or 500 mg may be prescribed depending on the patient’s individual medical condition—specifically, fluid and volume states as well as overall oral intake. Energy needs should be determined by indirect calorimetry. Daily protein intake should be 1.13 g/kg of body weight for patients in a nourished state or 1.37 g/kg for those in a stable malnourished state. Fluid requirements are typically calculated at 1mL/kcal or 35 mL/kg. For HF, fluid is restricted to less than 2000 mL/day for a serum sodium below 130 mEq/L. The use of multiple diuretics in the medical treatment of HF may lead to losses of multiple water-soluble nutrients, including potassium, magnesium, thiamin, riboflavin, folate, and vitamin B12.

DIFFICULTY: Bloom's: Analyze REFERENCES: Nutrition Therapy for Heart Failure

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract 1. The innermost layer of the esophagus is called the: a. muscle layer. b. mucosa. c. adventitia. d. secretory layer. e. submucosa.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 2. Food storage occurs primarily in which part of the stomach? a. corpus b. antrum c. fundus d. pyloric canal e. cardia ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 3. Control of gastric secretions is accomplished through complementary actions of the nervous and endocrine systems, and involves four major chemical messengers: acetylcholine, histamine, gastrin, and: a. serotonin. b. nitric oxide. c. somatostatin. d. substance P. e. neuropeptide Y. ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 4. Saliva is produced in the mouth by three pairs of salivary glands: the parotid, submandibular, and: a. occipital. b. sublingual. c. supramandibular. d. lingual. e. maxillary.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 5. Which best describes the pharyngeal phase of swallowing? a. The involuntary swallowing reflux begins and the bolus is carried through the throat to the top of the esophagus b. There is rapid passage of large amounts of food into the small intestine Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract c. Esophageal peristalsis carries the bolus through the esophagus and LES and into the stomach d. The tongue moves the bolus to the back of the throat e. The food is chewed and prepared as a bolus by the tongue, teeth, and mandible ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 6. Hydrochloric acid and intrinsic factor are secreted in the stomach by: a. the pylorus. b. histamine. c. somatostatin. d. parietal cells. e. mucous cells.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 7. Which activity may increase the risk of development of dental caries? a. drinking liquid while eating b. eating whole grain bread c. chewing sugarless gum d. sipping sugared beverages for prolonged periods e. consuming extra fruit ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 8. Inflammation of the oral mucosa that is often associated with fungal infections or with herpes-like viruses is called: a. stomatitis. b. gingivitis. c. cheilosis. d. glossitis. e. xerostomia.

ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Oral Cavity 9. A dietitian is providing nutrition information to a patient with a jaw fracture who has had a maxillomandibular fixation.

Which type of food would the dietitian most likely tell the client to avoid? a. rye bread b. 2% milk c. bananas d. pasta e. soft-cooked eggs Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Oral Cavity 10. What is an example of a nutrition intervention recommended for stomatitis? a. Increase intake of carbonated beverages b. Consume no more than 2 alcoholic drinks per day c. Avoid extremes of hot or cold food temperatures d. Use alcohol-based mouth rinses to keep the mouth clean e. Avoid oral topical anesthetics ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 11. What is an example of a change in gastrointestinal physiology that occurs with aging? a. Increased upper esophageal pressure b. Atrophy of the small intestine mucosa c. Enhanced excretion of hydrochloric acid in the stomach d. Increased incidences of diarrhea e. Overproduction of saliva in the mouth ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 12. Which intervention is most appropriate for preventing “baby bottle tooth decay?” a. Taking a child to the dentist by the time he is 6 months old b. Weaning a child from the bottle by 24 months of age c. Removing a bottle from the child’s mouth during sleep d. Brushing the baby’s teeth at least once per week e. Offering juice instead of formula ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 13. A jaw fracture that results in multiple pieces of bone is called a: a. comminuted fracture. b. open fracture. c. closed fracture. d. incomplete fracture. e. complete fracture.

ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Oral Cavity 14. What best describes a nutrition intervention for xerostomia?

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract a. Using a de-humidifier at bedtime b. Avoiding sour and tart foods c. Adding extra sauces and gravies to foods d. Increasing intake of hot foods and fluids e. Limiting caffeine to 3 servings per day ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Oral Cavity 15. Which is an example of a factor that contributes to lower esophageal sphincter incompetence? a. renal artery stenosis b. increased secretion of aldosterone c. cardiomyopathy d. cigarette smoking e. increased secretion of cortisol ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 16. Which medication is classified as a proton pump inhibitor? a. Mylanta b. Gaviscon c. Pepcid AC d. Nexium e. Reglan ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 17. Which complication is most likely associated with Barrett’s esophagus? a. irritable bowel syndrome b. esophageal cancer c. diverticulitis d. pyloric stenosis e. atrophic gastritis ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 18. A patient with dysphagia aspirates food approximately 10% of the time while eating and has no cough reflex.

According to the Dysphagia Severity Scale, which level of severity would this patient be classified as having? a. 2 b. 3 c. 4 d. 5 Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract e. 6 ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Esophagus 19. Which is considered a true statement regarding hiatal hernia? a. Most cases of hiatal hernia are considered type 2 (rolling). b. Symptoms of hiatal hernia are similar to those of Crohn’s disease. c. Incidence of hiatal hernia decreases with age. d. Pregnancy may increase the risk of hiatal hernia. e. Surgery for hiatal hernia involves Roux-en-Y gastric bypass.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 20. Which is a true statement regarding eosinophilic esophagitis? a. EoE has only been recognized within the past 20 years. b. Immune cells involved with EoE include B cells and white blood cells. c. EoE has no connection to food intake. d. Symptoms of EoE in adults include nausea, vomiting, and abdominal pain. e. Metoclopramide is the standard form of treatment for EoE. ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 21. Which is considered a symptom of gastroesophageal reflux in infants? a. constipation b. increased food intake c. dry mucous membranes d. irritability e. diarrhea ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 22. Which gastrointestinal condition is not associated with dysphagia? a. dumping syndrome b. achalasia c. hiatal hernia d. gastroparesis e. GERD ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract 23. Which complication would most commonly be associated with dysphagia? a. ageusia b. eructation c. syncope d. flatulence e. aspiration ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 24. The most common symptoms of gastroparesis are: a. abdominal pain and hematemesis. b. nausea, vomiting, and postprandial fullness. c. abdominal distention, nausea, and flatulence. d. epigastric pain and blood in the stool. e. heartburn and food impaction.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 25. A patient is having a procedure that involves passing a tube through the oral pharynx into the stomach and recording barometric pressure through a transducer. This procedure most accurately describes a(n): a. endoscopy. b. barium radiology study. c. esophageal manometry study. d. Bernstein test. e. urea breath test.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 26. What describes the mechanism of action of metoclopramide in managing nausea? a. Blocking dopamine, which affects the vomiting center in the brain b. Increasing the effectiveness of other antiemetics c. Strengthening the pyloric sphincter to increase gastric emptying d. Reducing the effect of prostaglandins e. Blocking substance P in the brain, which has a direct effect on the vomiting center ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach 27. The most common symptom related to peptic ulcer disease is: a. nausea. b. belching. c. epigastric pain.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract d. anorexia. e. vomiting.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach 28. Which is a component of nutrition therapy for peptic ulcer disease? a. Lying down after eating b. Restricting acidic juices c. Increasing sodium intake d. Drinking extra milk e. Eating small, frequent meals ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Stomach 29. Which describes the purpose of vagotomy? a. To enlarge the pyloric sphincter b. To eliminate cholinergic stimulation of the stomach c. To anastomose the jejunum to the stomach d. To lower the pressure on the lower esophageal sphincter e. To prevent dumping syndrome ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach 30. Which is a correct statement regarding late dumping syndrome? a. It occurs 30-60 minutes after a meal. b. It is especially common after eating protein. c. It increases the risk of hypoglycemia. d. It causes gas, cramping, and diarrhea. e. It results in sweating, flushing, and dizziness.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach 31. What describes an appropriate nutrition intervention for a patient following gastric surgery? a. Instruct the patient to lie down after eating b. Increase progression to solid food to avoid dumping syndrome c. Reduce intake from six meals per day to three d. Supplement with folate and vitamin B6 e. Advise the patient to consume liquids with meals ANSWER: a DIFFICULTY: Bloom's: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract REFERENCES: Pathophysiology of the Stomach 32. Which type of food would most likely be recommended during the recovery period after gastric surgery? a. whole grains b. potatoes without the skin c. lunch meat d. chocolate milk e. fruit juice ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Stomach 33. The gold standard for diagnosis of gastroparesis is the: a. upper GI endoscopy. b. endoscopic retrograde cholangiopancreatography (ERCP). c. endoscopic ultrasound. d. esophagography test. e. scintigraphic gastric emptying test.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach 34. The most common surgical procedure used for refractory GERD is: a. a videofluoroscopy swallowing procedure. b. the Roux-en-Y procedure. c. agastroduodenostomy. d. the Nissen fundoplication. e. a partial gastrectomy with a reconstruction.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach LK is a 40 yo F s/p gastric resection 2 weeks ago due to a perforated ulcer from complicated PUD. Prior to her surgery, she was experiencing severe pain and upset stomach. She is now complaining of persistent diarrhea after she eats.

HT: 5’4” WT: 170# Usual intake: Diet: NPO AM juice and fruit Snack toast with butter Noon half a tuna sandwich Snack granola bar, Gatorade PM mashed potatoes with gravy Snack ice cream 35. What is the most likely cause of LK’s persistent diarrhea? a. hiatal hernia Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract b. dumping syndrome c. dehydration d. gastroesophageal reflux e. gastroparesis ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach PREFACE NAME: case 36. Which nutritional recommendation would be most appropriate for LK? a. Restricting foods that irritate the gastric mucosa b. Allowing plenty of fluids with meals c. Eating 1-3 large meals each day d. Supplementing with folate and magnesium e. Avoiding all desserts and sweets ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Stomach PREFACE NAME: case 37. LK would most likely be at risk of which nutrient deficiency? a. vitamin B6 b. niacin c. iron d. potassium e. phosphorus ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach PREFACE NAME: case 38. Which medication would most likely be prescribed for LK’s condition? a. clarithromycin b. atorvastatin calcium c. niacin d. bevacizumab e. amlodipine ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach PREFACE NAME: case 39. Which foods would the dietitian most likely recommend for LK? a. scrambled eggs Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract b. ham c. 2% milk d. red wine e. peanut butter ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Stomach PREFACE NAME: case 40. Major innervation for the enteric nervous system is supplied by parasympathetic and sympathetic fibers of the autonomic nervous system. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 41. Pharyngeal and esophageal phases of swallowing take only 3-5 minutes under normal conditions. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 42. Several different types of bacteria commonly found in the mouth colonize the surface of the tooth to form plaque. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Oral Cavity 43. Medicines for high blood pressure and depression often are causes of xerostomia. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Oral Cavity 44. Dysgeusia is the complete inability to taste; it is also called “mouth blindness.” a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Oral Cavity Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract 45. There is a strong association between obesity and gastroesophageal reflux disease. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Esophagus 46. The symptoms of eosinophilic esophagitis experienced by a patient depend on the phase of swallowing that is impaired. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 47. The description called “spoon-thick liquids” by the National Dysphagia Diet Task Force allows all liquids, including water, ice, milk, juice, coffee, tea, frozen desserts, and gelatin. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 48. The post-gastrectomy diet encourages a well-balanced diet slightly higher in protein and fat than what is recommended by the U.S. Dietary Guidelines. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach 49. Zollinger-Ellison (ZE) syndrome is similar in symptoms to PUD, but is typically unresponsive to standard therapy. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach 50. Major innervation for the enteric nervous system is supplied by parasympathetic and sympathetic fibers of the autonomic nervous system. Parasympathetic impulses are carried by the _______________.

ANSWER: vagus nerve DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 51. The outer layer, or _______________, of tissue for the esophagus is connective tissue and has no additional outer covering.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract ANSWER: adventitia DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 52. Control of gastric secretions is accomplished through complementary actions of the nervous and _______________ systems.

ANSWER: endocrine DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 53. Partially digested food in a semi-fluid state that enters the stomach and small intestine is called _______________.

ANSWER: chyme DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 54. Most medications are absorbed in the _______________.

ANSWER: small intestine DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 55. The term _______________ refers to an individual without any teeth.

ANSWER: edentulous DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Oral Cavity 56. _______________ is fissuring and scaling at the corners or angles of the mouth that may be a sign/symptom of riboflavin, folate, niacin, pyridoxine, vitamin B12, or iron deficiency.

ANSWER: Cheilosis DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 57. Medications called _______________, which act to block the effect of acetylcholine, reduce the amount of saliva production as a major side effect.

ANSWER: anticholinergics DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 58. _______________ ingested when teeth are developing is incorporated into the structure of the enamel and protects it against the action of acids.

ANSWER: Fluoride DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Oral Cavity 59. For the patient with maxillomandibular fixation, all foods must be prepared so that each easily moves through a _______________.

ANSWER: straw, syringe DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract REFERENCES: Pathophysiology of the Oral Cavity 60. The Nissen fundoplication for treatment of GERD involves taking the fundus of the _______________ and wrapping it around the lower esophagus.

ANSWER: stomach DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 61. Meals of _______________ quantity tend to stimulate more acid production, delay gastric emptying, and increase the risk of reflux with GERD. ANSWER: large, larger, greater DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 62. The dysplastic cellular changes associated with Barrett’s esophagus are considered to be a precursor to _______________.

ANSWER: cancer, esophageal cancer, malignancy DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 63. _______________ is an inflammatory condition characterized by infiltration of eosinophils within the esophageal mucosa.

ANSWER: Eosinophilic esophagitis, EoE DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Esophagus 64. For those individuals who are unable to safely swallow or to consume adequate nutrition orally because of dysphagia, _______________ feedings should be considered.

ANSWER: enteral DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 65. _______________, or dyspepsia, is not considered to be a specific condition but may involve symptoms of abdominal pain, gas, bloating, nausea, or gastroesophageal reflux.

ANSWER: Indigestion DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach 66. Forceful vomiting can either rupture the esophagus, called _______________, or tear the lower esophageal sphincter, called a Mallory-Weiss tear.

ANSWER: Boerhaave’s syndrome DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach 67. A(n) _______________ occurs when a negative consequence is linked to a particular food and a person chooses to avoid eating that food.

ANSWER: learned food aversion Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach 68. Type A gastritis is a condition most often related to _______________.

ANSWER: pernicious anemia DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Stomach 69. Selective _______________ is a surgical procedure that eliminates innervations from the vagus nerve to parietal cells, resulting in decreased acid production and a decreased response to gastrin.

ANSWER: vagotomy DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Stomach 70. List the seven functions of saliva in the oral cavity.

ANSWER: Functions of saliva include: (1) moistening and lubricating food to facilitate swallowing; (2) initiating digestion of carbohydrate; (3) providing antibacterial protection with lysozyme; (4) enhancing taste; (5) serving as a buffer; (6) promoting oral hygiene by dissolving food, dead cells, and foreign substances; and (7) assisting speech by allowing free movement of the lips and tongue.

DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 71. Name the four chemical messengers in the stomach that are used to control gastric secretions.

ANSWER: Control of gastric secretions is accomplished through complementary actions of the nervous and endocrine systems, and involves four major chemical messengers: acetylcholine, histamine, and gastrin, which stimulates gastric secretions, and somatostatin, which inhibits gastric secretions.

DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 72. List three examples each of dietary factors that increase risk of dental caries and those that decrease risk of dental caries.

ANSWER: Dietary factors that increase risk: sugar sweetened liquids, sticky foods, slowly dissolving candies, starchy snacks; simple sugars such as sucrose, honey, or molasses.

Dietary factors that decrease risk: sugar-free gum and candy, fresh fruits and vegetables, high quality protein, whole grain, low-sugar breads and cereals.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Oral Cavity 73. Describe clinical manifestations of GERD. ANSWER: Symptoms of GERD may include dysphagia, heartburn, increased salivation, and belching. In some situations, pain is severe and may radiate to the back, neck, or jaw. Pain from GERD can be confused with pain that is cardiac in origin because of the diffuse spread of pain into these other areas.

DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 74. Name four different types of diagnostic procedures that may be used in identifying upper GI pathology.

ANSWER: Examples include endoscopy, barium radiology studies, 24-hour pH monitoring, esophageal manometry, the Bernstein test, urea breath test, electrogastrography, antroduodenal manometry, gastric analysis, or Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract gastric scintigraphy.

DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Esophagus 75. Describe the process of swallowing as food moves from the oral cavity to the stomach; include the processes of the four phases of swallowing.

ANSWER: The first phase is the oral preparatory phase where food is chewed and mixed with saliva. The second phase, the oral transit phase, consists of voluntary movement of the bolus of food from the front of the oral cavity to the back. The third phase of swallowing is known as the pharyngeal phase. The most important part of this phase is to ensure the bolus is directed into the esophagus and is prevented from entering the trachea. This is initially accomplished when the uvula seals off the nasal passage so food does not leak into the nose. Next, laryngeal muscles contract and seal off the glottis. The epiglottis also tilts upward to assist in preventing food from entering the larynx. The final phase of swallowing is the esophageal phase. The upper esophageal sphincter (UES), when open, allows the bolus to enter the esophagus. When the sphincter is closed, it prevents air from entering the GI tract during breathing.

After the bolus of food moves through the UES into the esophagus, the sphincter closes and normal breathing will resume.

DIFFICULTY: Bloom's: Apply REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract 76. Discuss nutrition therapy used for jaw fracture; include examples of recommended foods.

ANSWER: Foods should be prepared to a very smooth and thin consistency; commercially prepared baby food is available to use or food can be placed in a food processor. To add extra protein, include dry milk powder, double strength milk, cottage cheese or yogurt. To add extra k calories, use whole milk, extra butter, sugar, or honey. Examples of recommended foods include milk and milk products, meat, poultry, fish, eggs, rice, pasta, fruits, vegetables, margarine, oils, and liquid nutrition supplements.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Oral Cavity 77. Describe the process of a focused assessment of the upper gastrointestinal tract for a client, including relevant measurements and subjective data.

ANSWER: Assess the client’s history: socioeconomic status, education, food security, support systems, medical and health history for the client and family.

Anthropometric measurements: include height, weight, highest weight, BMI. Biochemical data: protein levels, electrolytes, hemoglobin, BUN/creatinine.

Nutrition-focused physical findings: head and neck physical assessment, signs of malnutrition, dehydration, or other illnesses affecting nutrition.

Food-nutrition related history: changes in intake, ability to chew, nausea/vomiting, difficulties with feeding self, food allergies and preferences, cultural practices, eating patterns, previous nutrition education.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Oral Cavity 78. Explain manifestations, clinical diagnosis, and treatment interventions of gastroesophageal reflux among infants.

ANSWER: Gastrointestinal reflux (GER) occurs in approximately 2%–7% of young infants but generally resolves before 1 year of age in children without other medical problems. The signs and symptoms associated with GER include regurgitation, vomiting, coughing, irritability, and difficulty feeding. The specific etiology for GER may be related to overfeeding, poor positioning, food allergy, eosinophilic esophagitis, decreased LES pressure, delayed gastric emptying, or excessive acid production. Nutrition diagnoses Copyright Cengage Learning. Powered by Cognero.

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Chapter 14 - Diseases of the Upper Gastrointestinal Tract associated with GER include malnutrition, inadequate protein-energy intake, underweight, altered GI function, and swallowing difficulty. Infants diagnosed with a specific food allergy will be treated by excluding the antigen, such as cow’s-milk protein, from the diet. H2-receptor agonists and proton pump inhibitors are also prescribed for infants with GER. Nutrition interventions include caregiver education to address positioning of the baby for feeding; modifying formula choice; adding rice cereal to thicken the formula; providing more frequent, lower-volume feedings; and elevating the head of the crib or bassinet.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Esophagus 79. Describe the purpose of the National Dysphagia Diet and list examples of foods to include from each level.

ANSWER: The National Dysphagia Diet was developed as standard definitions for foods, liquids, and levels of nutrition intervention for people with difficulties with swallowing. Foods to include at the pureed level (National Dysphagia Diet 1) are foods of “pudding-like” consistency that are smooth or pureed with no lumps; foods allowed at level 2 are foods that are moist and soft textured such as tender ground or finely diced meats, soft cooked vegetables, soft ripe or canned fruit, and some moistened cereals. The advanced level (National Dysphagia Diet 3) includes most regular foods except very hard, sticky, or crunchy items. Bread, rice, cake, shredded lettuce, and tender, moist meats are allowed.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Esophagus 80. The purposes of mastication are to break food down into smaller pieces, to mix food with saliva, and: a. to move food from the front of the mouth to the pharynx. b. to regulate speech patterns. c. to facilitate an immune reaction. d. to provide antibacterial protection. e. to stimulate taste buds.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Upper Gastrointestinal Tract

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 1. Which describes the correct location of stem cells and enterocytes of the small intestine? a. Within the folds of Keckring b. On the outside of the villi c. On the surface of the brush border d. In the crypts between the villi e. Within the cells of the microvilli ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 2. Which sphincter or valve protects the small intestine from bacteria translocation from the large intestine? a. pyloric sphincter b. ileocecal valve c. sphincter of Oddi d. lower esophageal sphincter e. internal anal sphincter ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 3. Which best describes the migrating motility complex (MMC)? a. Weak contractions that rid the small intestine of leftover bacteria or waste b. Segmentation motility that mixes chyme with digestive secretions c. A hormone called gastrin that stimulates the onset of segmental contractions d. A muscular valve that controls the rate of movement of food from the ileum e. A substance that neutralizes the very acidic chyme as it enters from the stomach ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 4. The primary enzyme involved in starch digestion is: a. motilin. b. pancreatic amylase. c. vasoactive intestinal polypeptide. d. substance P. e. cholecystokinin.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 5. The most likely cause of steatorrhea is: a. increased levels of pancreatic lipase. b. too little vitamin B12 absorbed in the ileum. c. the excretion of bile acids. d. low-density lipoproteins broken down into the stool.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract e. lipids that are not digested or absorbed correctly.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 6. Which substances are released in the large intestine and play a role in electrolyte and fluid absorption? a. Bile salts and pancreatic lipase b. Triglycerides and chylomicrons c. Potassium and bicarbonate d. Hydrogen and sodium e. Aminopeptidases and chloride ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 7. The primary function of the large intestine is to: a. inhibit gastric emptying and post-prandial glucagon release. b. provide a site for reabsorption of water, electrolytes, and some vitamins. c. stimulate acid secretion and pancreatic HCO3 secretion. d. provide enzymatic digestion before defecation. e. provide sodium, iron, and water for chyme production.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 8. What is an example of a resistant starch? a. yogurt b. bread c. potatoes d. hot dogs e. dried fruit ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 9. Which is an example of a true statement regarding osmotic diarrhea? a. It is typically caused by lack of dietary fiber. b. It often occurs from endotoxins released by bacteria. c. Its most common type is traveler’s diarrhea. d. It develops from an underlying disease. e. It stops when the causative agent is removed.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 10. Bright red blood on the surface of the stool is called: a. melena. b. occult blood. c. hematochezia. d. steatorrhea. e. exudate.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 11. Recommendations for the prevention of diarrhea worldwide include strategies such as: a. washing hands with soap after touching food. b. promoting hygiene education. c. exclusive formula feeding for infants. d. preventing weaning practices. e. immunizing all adults.

ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 12. Which medication would be classified as an anticholinergic anti-diarrheal medication? a. hyoscyamine b. pectin c. kaolin d. metronidazole e. olsazine ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 13. What best describes the action of opiate anti-diarrheal medications? a. They enter bacteria and destroy DNA b. They decrease fluid secretions and reduce stool output c. They decrease intestinal muscle tone and peristalsis of the GI tract d. They inhibit acetylcholine and decrease peristalsis e. They work as anti-inflammatory and immune suppressant agents in the colon ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 14. Current practice of nutrition therapy for diarrhea involves: a. making the patient NPO. b. feeding clear liquids. c. enteral nutrition for 3 days. d. parenteral nutrition until diarrhea resolves.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract e. feeding a normal diet of tolerable foods.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 15. Which foods would be most appropriate for an infant with diarrhea who has started on solids? a. fish b. carrots c. bananas d. strained peas e. beef broth ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 16. What symptom is included as part of the Rome III Criteria for diagnosing constipation? a. blood in the stools b. abdominal pain c. sensation of incomplete evacuation d. fewer than 6 defecations per week e. flatulence ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 17. How much fiber is recommended for adults daily? a. 10-15 g b. 20-25 g c. 25-35 g d. 40-50 g e. 50-60 g ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 18. A dietitian is working with a client to help her improve her fiber intake. Which recommendation would the dietitian most likely give? a. Use white flour for baking and cooking b. Increase fiber intake by 20 g per day until tolerated c. Avoid dried beans and peas d. Choose fruit and vegetable juices over fresh produce e. Use brown or wild rice instead of white rice or potatoes ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 19. Which condition would most likely be a possible cause of malabsorption? a. glomerulosclerosis b. amyloidosis c. appendicitis d. albuminuria e. colon polyps ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 20. The standard first step in reducing symptoms of fat malabsorption would be to: a. increase intake of fat-soluble vitamins. b. restrict carbohydrate intake. c. limit fluids. d. restrict fat intake. e. decrease protein intake.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 21. Damage to intestinal mucosa through celiac disease occurs with exposure to which substance? a. gliadin b. lactate dehydrogenase c. glycophorin d. fibronectin e. selectin ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 22. Which is the most appropriate treatment of celiac disease? a. Symptomatic management with anti-diarrheal medications b. Supplementation with probiotics c. Lifelong adherence to a gluten-free diet d. Antibiotics and immunomodulator medications e. Total colectomy ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 23. Which food would a patient with celiac disease most likely need to avoid? a. popcorn b. chicken tenders c. butter Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract d. white rice e. processed cheese ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 24. Which condition is associated with irritable bowel syndrome? a. pernicious anemia b. Graves’ disease c. systemic lupus erythematosus d. type 1 diabetes e. temporomandibular joint (TMJ) syndrome ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 25. What food should be included in a low-FODMAP diet? a. apples b. ice cream c. sweet potatoes d. eggs e. baked beans ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 26. A dietitian is counseling a client with irritable bowel syndrome about how best to avoid gas-producing foods. Which food would the dietitian most likely suggest that the client avoid? a. beets b. artichokes c. mushrooms d. okra e. green peas ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 27. Which symptoms are most indicative of ulcerative colitis? a. nausea and vomiting, and headache b. epigastric pain and abdominal fullness c. nausea, bloating, and steatorrhea d. abdominal pain, bloody diarrhea, and tenesmus e. nausea,constipation, and flatulence ANSWER: d DIFFICULTY: Bloom's: Understand Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 28. A patient with Crohn’s disease is undergoing a sigmoidoscopy. Which best describes this procedure? a. Imaging of the stomach, liver, and pancreas b. Evaluation of the colon and distal ileum c. Assessment of the small intestine d. Imaging of the colon up to the splenic fixture e. Evaluation of the esophagus, stomach, and duodenum ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 29. A patient with inflammatory bowel disease is taking medication to manage his acute symptoms. What must the dietitian consider when planning nutrition interventions for this patient? a. The patient may have increased nutrient requirements. b. The patient should remain NPO during periods of exacerbation of symptoms. c. The patient will need parenteral nutrition in addition to medication. d. The patient will have decreased fluid requirements. e. The patient will experience nausea, which will impact food intake.

ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 30. Which is a true statement regarding diverticulosis? a. Diverticulosis most commonly begins in adolescence and progresses into adulthood. b. Diverticulosis is asymptomatic for most people. c. Factors associated with diverticulosis include lactose and gluten intolerance. d. Diverticulosis develops because of low fiber intake. e. People with a history of constipation are more likely to develop diverticulosis.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 31. What recommendations should the dietitian make for the client with a newly placed ostomy? a. Eat the largest meal of the day in the evening to reduce output overnight. b. Limit dairy products to reduce odor in output. c. Drink at least 4-5 cups of fluid every day. d. Choose foods that can thicken stools, such as peanut butter, margarine, and yogurt. e. Avoid spicy or fried foods, which can cause diarrhea.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 32. Following surgery that results in short bowel syndrome, what should be the first items offered for the patient to eat or drink?

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract a. low-residue full liquids b. hypotonic clear liquids c. lactose-free milk or dairy d. isotonic clear liquids e. yogurt with probiotics ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 33. Which best describes bacterial overgrowth syndrome? a. The patient is exposed to contaminated instruments during surgery b. Cross-contamination of bacteria occurs between the colon and the small intestine c. The colon is perforated and bacteria enter the peritoneum d. The surgical incision becomes infected with overgrowth of bacteria e. The patient passes excess bacteria from the stomach into the small intestine ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 34. Which condition is most likely a cause of short bowel syndrome among children? a. obesity treatment b. necrotizing enterocolitis c. volvulus d. strangulated hernia e. surgical bypass ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 35. A patient has just undergone surgical removal of the colon and rectum. This would most likely result in a(n): a. gastrostomy. b. jejunostomy. c. colostomy. d. urostomy. e. ileostomy.

ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract RD is a 29 yo F admitted with intractable diarrhea and abdominal pain. She has a PMH of Crohn’s disease and has had two previous resections of the small bowel. She frequently has pain in the RLQ after eating. She claims the pain often gets so bad that she is afraid to eat and has been progressively consuming below her caloric needs. She currently takes Asacol and Lomotil to manage the symptoms of Crohn’s disease. After undergoing a colonoscopy, an obstruction resulting from stricture in the terminal ileum was discovered. Emergency surgery was performed to remove the obstruction and a resection was done with the remaining intestine. RD’s gastroenterologist recommends bowel rest and expects her to have a full recovery.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract HT: 5’4” WT: 110# UBW: 122# Diet: NPO Meds: Asacol, Lomotil Alb. 2.7 Pre-Alb. 17 Na: 138 Cl: 98 BUN: 5 Glucose: 80 K: 3.6 CO2: 25 Cr: 0.8 36. What is a common complication of Crohn’s disease that may require surgery? a. weight loss b. diarrhea c. perforation d. tenesmus e. muscle wasting ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract PREFACE NAME: case 37. Which type of medication would most likely be prescribed for RD during the acute phase of Crohn’s disease? a. proton pump inhibitors b. biologic therapies c. corticosteroids d. purine antagonists e. H2 receptor agonists ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract PREFACE NAME: case 38. RD’s frequent diarrhea most likely puts her at risk of which nutrient deficiency? a. calcium b. iron c. vitamin D d. vitamin B12 e. magnesium ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract PREFACE NAME: case 39. Which condition would most likely place RD at risk of folate deficiency? a. anorexia b. healing after surgery c. medication use d. high-volume diarrhea e. blood loss Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract PREFACE NAME: case 40. Which types of foods would the nutritionist suggest for RD in rehabilitation during a period of remission? a. foods high in oxalate b. low-residue foods c. foods that contain antioxidants d. lactose-free foods e. foods without glutamine ANSWER: c DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract PREFACE NAME: case 41. More than 50% of the small intestine has to be removed before any significant reduction in its capability is observed. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 42. Gastric juices provide the primary digestive enzymes in the small intestine. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 43. Haustration in the large intestine is accomplished by alternating waves of relaxation and con- traction of smooth muscle lasting for several minutes. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 44. When defecation relieves cramping, diarrhea is generally from the small intestine. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 45. Consumption of fructans or fructooligosaccharides (FOS) has been shown to soften feces and to assist in relieving constipation. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 46. Damage to the anatomy and physiology of the small intestine due to disease is the most common cause of malabsorption. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 47. Celiac disease is often associated with other chronic, infectious diseases, including hepatitis, varicella, and cytomegalovirus. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 48. At least two-thirds of IBS patients associate the signs and symptoms they experience with characteristics of the foods that they eat. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 49. Approximately 95% of patients with ulcerative colitis have disease only involving the rectum. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 50. Treatment for diverticulosis involves only nutrition therapy, with a specific focus on fiber intake. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 51. _______________ is a hormone secreted by the small intestine that assists in the control of the migrating motility complex.

ANSWER: Motilin DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 52. _______________ absorption is much more difficult due to its insolubility in water.

ANSWER: Lipid, fat DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 53. The _______________ is the primary site for reabsorption of bile acids.

ANSWER: ileum DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 54. The _______________ colon ends in the rectum where another sphincter (the anal sphincter) controls voluntary release of intestinal contents.

ANSWER: sigmoid DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 55. _______________ starch is defined as starch components that enter the large intestine undigested.

ANSWER: Resistant DIFFICULTY: Bloom's: Remember REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 56. Normal osmolality of the gastrointestinal tract is approximately _______________ mOsm/L. ANSWER: 300 DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 57. _______________ is a dark stool caused by contamination with blood from the upper GI tract.

ANSWER: Melena DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 58. During a fecal microbiota transplantation, stool is obtained from a healthy donor and is infused into the patient, usually via _______________.

ANSWER: colonoscopy DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 59. Substances in food that stimulate the beneficial flora of the large intestine are called _______________.

ANSWER: prebiotics DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 60. The _______________ absorption test assists in distinguishing between pancreatic dysfunction and small bowel malabsorption.

ANSWER: D-xylose DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 61. _______________ supplements, which are triglycerides that contain primarily caprylic (C8) and capric (C10) fatty acids, can be used to increase caloric intake.

ANSWER: Medium-chain triglyceride, MCT DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 62. _______________ symptoms that can occur in the absence of GI problems of a person with celiac disease include bone and joint pain, muscle cramping, fatigue, and peripheral neuropathy.

ANSWER: Extraintestinal DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 63. One nutritional intervention for treating IBS is the use of a traditional _______________ diet, which eliminates all possible foods related to the patient’s symptoms.

ANSWER: exclusion, elimination DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 64. The only current recommendation for fiber supplementation in IBS patients is the use of ispaghula husk, which is more commonly known as _______________.

ANSWER: psyllium DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 65. With chronic ulcerative colitis, the intestinal wall can become so thin that the mucosa is ulcerated, which is referred to as _______________.

ANSWER: toxic megacolon DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 66. The most common surgical procedure in ulcerative colitis is a _______________.

ANSWER: total colectomy DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 67. A(n) _______________ is a surgically created artificial opening into the abdomenfrom which waste products can be excreted.

ANSWER: stoma DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract 68. Absorption of _______________ is of specific concern with short bowel syndrome because it requires adequate ileal receptors and a normal transit time.

ANSWER: vitamin B12 DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 69. Bacterial overgrowth syndrome is treated by both correcting the underlying cause and administering medications such as _______________.

ANSWER: broad-spectrum antibiotics, antibiotics DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 70. It is understood that approximately 50% of the duodenum and jejunum can be resected without significant nutrition deficits. If less than _______________ cm of the small intestine is left, malabsorption is inevitable.

ANSWER: 100 DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 71. Briefly describe segmentation associated with digestion in the small intestine.

ANSWER: Segmentation consists of ring-like contractions along the length of the small intestine. Within a matter of seconds, the contracted segments relax and the previously relaxed areas contract. The oscillating contractions thoroughly mix chyme within the small intestine lumen.

DIFFICULTY: Bloom's: Apply REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 72. Define each of the four components currently under investigation to maintain health of the colon: resistant starches, prebiotics, probiotics, and synbiotics.

ANSWER: Resistant starch is defined as starch components that enter the large intestine undigested. Prebiotics are substances in food that stimulate the beneficial flora of the large intestine. Probiotics are products containing live microorganisms that are sold as foods and supplements. Synbiotics are those products that contain both prebiotics and probiotics.

DIFFICULTY: Bloom's: Understand REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 73. List four components of the Rome III Consensus Criteria for diagnosing constipation.

ANSWER: The Rome III Criteria classifies constipation as at least two of the following symptoms in the previous year for at least 12 non-consecutive weeks: straining during at least 25% of defecations; lumpy or hard stools in at least 25% of defecations; sensation of incomplete evacuation for at least 25% of defecations; sensation of anorectal obstruction for at least 25% of defecations; manual maneuvers to facilitate at least 25% of defecations; fewer than three defecations per week; and loose stools are rarely present without the use of laxatives.

DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 74. Briefly describe the process of restriction and reintroduction of dairy products in clients with lactose malabsorption.

ANSWER: Individuals vary in the amounts of lactose they can tolerate; if the lactose intolerance is secondary to another condition or due to acute illness, lactose exclusion is recommended for approximately 4 weeks.

Then small amounts of lactose can be reintroduced. Dairy products such as cheese and yogurt have smaller amounts of lactose and may be adequately tolerated; up to 1 cup of milk can be introduced in Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract small increments throughout a 24-hour period.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 75. Describe the FODMAP diet and give examples of foods included in a low-FODMAP diet plan.

ANSWER: FODMAP foods (those containing fermentable oligo-, di-, and monosaccharides and polyols) are not easily digested and absorbed; patients with digestive difficulties should avoid these types of foods, as they can cause abdominal pain, nausea, bloating, and fullness. Alternatively, examples of foods to include are blueberries, cantaloupe, honeydew melon, cranberries, green beans, lettuce, yellow summer squash, red bell peppers, potato, tomato, rice, oats, quinoa, tapioca, rice milk, soy milk, hard cheeses; lactose-free yogurt; and ice cream substitutes (gelatin and sorbet).

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 76. Describe the process of lipid digestion and absorption in the small intestine.

ANSWER: Dietary fat in the form of large fat globules composed of triglycerides is emulsified by the detergent action of bile salts into a suspension of smaller fat droplets. This lipid emulsion prevents the fat droplets from coalescing and thereby increases the surface area available for attack by pancreatic lipase. Lipase hydrolyzes the triglycerides into monoglycerides and free fatty acids. These water-insoluble products are carried to the luminal surface of the small-intestine epithelial cells within water-soluble micelles, which are formed by bile salts and other bile constituents. When a micelle approaches the absorptive epithelial surface, the monoglycerides and fatty acids leave the micelle and passively diffuse through the lipid bilayer of the luminal membranes.

DIFFICULTY: Bloom's: Analyze REFERENCES: Normal Anatomy and Physiology of the Lower Gastrointestinal Tract 77. Explain the nutrition assessment for the lower gastrointestinal tract, including the components of client history, anthropometric measurements, and biochemical data, and giving examples of each component.

ANSWER: Client history: includes personal, patient, family, social, and medical histories, such as previous medical conditions or surgeries, medications, support systems, and education.

Anthropometric measurements: includes height, weight, weight history, BMI. Biochemical data: includes visceral protein assessment, inflammation assessment, hematologic assessment, lipid assessment, and lower GI specific tests.

DIFFICULTY: Bloom's: Apply REFERENCES: Nutrition Assessment for Lower Gastrointestinal Tract Conditions 78. Describe how a dietitian would teach a client to increase fiber in his diet, listing examples of foods to include.

ANSWER: The dietitian should recommend slowly increasing daily fiber to 25–35 g per day, eating whole-grain breads and cereals, eating a variety of grains, such as barley, oats, farro, kamut, and quinoa; eating baked beans more often, adding dried beans and peas to casseroles or soups, choosing fresh fruit and vegetables instead of juices, eating fruits and vegetables with peels or skins on, comparing food labels of similar foods to find higher-fiber choices, checking the Nutrition Facts labels, and drinking plenty of fluids.

Foods to include might be dried beans, peas, fruits, vegetables, whole grains, and nuts.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 79. Explain etiological factors that have been associated with the development of IBS, including communication between body systems, GI tract function and environment, and GI symptoms.

ANSWER: Communication between body systems: central-enteric nervous system dysregulation, psychological Copyright Cengage Learning. Powered by Cognero.

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Chapter 15 - Diseases of the Lower Gastrointenstinal Tract factors, sex hormones, and abnormal communication between the gastrointestinal tract and the muscle.

GI tract function and environment: altered mobility, mucosal immune activation, altered gut flora, and abnormal visceral reflexes.

GI symptoms: food sensitivity or intolerance, excessive gas production, and constipation.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract 80. Explain the differences between ulcerative colitis and Crohn’s disease in terms of clinical manifestations and medical treatment.

ANSWER: Inflammatory bowel disease is characterized as an autoimmune, chronic inflammatory condition of the gastrointestinal tract. IBD is actually the general term for either of two diagnoses: ulcerative colitis (UC) and Crohn’s disease. Patients with UC present with signs and symptoms including abdominal pain, bloody diarrhea, and tenesmus. Patients with severe disease often are febrile, are tachycardic, and have diarrhea that contains pus and mucus. Patients with Crohn’s disease experience abdominal pain, diarrhea, and tenesmus. They are much less likely to have blood in their stool but usually experience more abdominal pain and cramping than patients with UC. Treatments for both UC and Crohn’s disease include anti-inflammatory medications, antibiotics, immunosuppressive medications, immunomodulators, and biologic therapies as well as surgical intervention.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Lower Gastrointestinal Tract

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas 1. Bile salts aid in the absorption of fatty acids through the formation of which substance? a. micelles b. chylomicrons c. acetyl CoA d. prothrombin e. mucoproteins ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 2. Which organ stores bile that is produced in the liver? a. pancreas b. kidney c. spleen d. gallbladder e. stomach ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Hepatobiliary System 3. Delta cells of the pancreas are responsible for secreting: a. glucagon. b. insulin. c. somatostatin. d. amylase. e. cholecystokinin.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Hepatobiliary System 4. Increased destruction of red blood cells with rapid release of bilirubin into the blood is known as: a. obstructive jaundice. b. bilirubin conjugation. c. post-hepatic jaundice. d. hemolytic jaundice. e. bilirubin dissection.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 5. At which level of serum bilirubin does the skin begin to appear jaundiced? a. 1.0-1.1 mg/dL b. 1.5-1.9 mg/dL c. 2.1-2.4 mg/dL d. 2.5-3.0 mg/dL Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas e. 3.3-3.5 mg/dL ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 6. When ascites is present, which nutrition modification is typically necessary? a. low sodium b. decreased fluid intake c. increased vitamin K d. low fiber e. decreased protein ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 7. A syndrome of impaired mental status and abnormal neuromuscular function that results from liver failure is known as: a. hepatic stenosis. b. jaundice. c. hepatic encephalopathy. d. fulminant hepatitis. e. hepatomegaly.

ANSWER: c DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 8. A patient with hepatic encephalopathy is being assessed according to the Adapted West Haven Criteria. The patient has marked somnolence, psychomotor agitation, and his speech is difficult to understand. In which stage would this patient be classified? a. 0 b. 1 c. 2 d. 3 e. 4 ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 9. Ammonia is absorbed and transported in the intestinal venous blood to the liver, where it is metabolized into what substance? a. amino acids b. urea c. fatty acids d. glucose e. glycogen ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 10. What medication is most commonly used in the treatment of hepatic encephalopathy? a. manganese b. tyramine c. lactulose d. octopamine e. phenylethanolamine ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 11. Which type of hepatitis is most commonly transmitted through the fecal-oral route? a. hepatitis A b. hepatitis B c. hepatitis C d. hepatitis D e. hepatitis E ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 12. Hepatitis C is most commonly transmitted through which route? a. exposure to blood or body fluids from an infected person b. the fecal-oral route c. excessive alcohol intake d. contaminated drinking water e. sewage ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 13. Common manifestations of all types of hepatitis include jaundice, fatigue, vomiting, and: a. epigastric pain. b. dark urine. c. diarrhea. d. generalized rash. e. dilated pupils.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 14. The most common nutrient-drug interactions that occur with antiviral medications are: a. high cholesterol and hypertriglyceridemia.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas b. dyspepsia, abdominal pain, and diarrhea. c. hematochezia and iron deficiency anemia. d. muscle cramps, joint pain, and fever. e. headache, dizziness, and confusion.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 15. What treatment is used in the management of both hepatitis B and hepatitis C? a. neomycin b. spironolactone c. prednisone d. interferon e. famotidine ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 16. Which is a true statement regarding alcoholism in older adults? a. Approximately 20% of people over 65 abuse alcohol. b. Most adults become addicted to alcohol later in life in response to problems. c. Older adults are even more susceptible to nutrient deficiencies when they abuse alcohol. d. Most primary care providers identify alcohol abuse in older adults because of routine assessments. e. Alcohol abuse among older adults is one of the most commonly identified problems of aging.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 17. What laboratory level is most likely to be elevated in a patient with fatty liver? a. serum albumin b. glucose c. red blood cells d. cortisol e. serum transaminase ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 18. Which condition is most commonly associated with non-alcoholic steatohepatitis (NASH)? a. obesity b. high blood glucose c. celiac disease d. hypothyroidism e. anorexia Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas ANSWER: a DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 19. The cause of fatty liver after alcohol ingestion is: a. greater amounts of glucagon secretion and enhanced gluconeogenesis from amino acids. b. elevated tryptophan levels and the formation of serotonin. c. increased availability of fatty acids in the liver. d. esterification of fatty acids. e. increased production and absorption of ammonia.

ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 20. Which best describes hepatobiliary scintigraphy? a. A non-invasive test produces cross-section images of parts of the body. b. A gamma camera takes pictures of a radioactive compound as the bile moves through the liver, bile ducts, and gallbladder. c. An endoscope is inserted down the throat, through the stomach, and into the small intestine to view internal structures. d. A non-invasive X-ray produces three-dimensional pictures of parts of the body. e. The patient is injected with a small amount of radioactive material that is absorbed by the gallbladder, which stimulates it to contract.

ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 21. Cystic fibrosis is an inherited disorder of epithelial transport and is one of the most common lethal inherited disorders of which ethnic group? a. Asians b. African Americans c. Caucasians d. Pacific Islanders e. Native Americans ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 22. Alcohol causes increased urinary excretion of which nutrient? a. folate b. vitamin B12 c. magnesium d. chloride e. sodium ANSWER: a Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 23. What complication most commonly occurs with folate deficiency? a. reduced bone formation and mineralization b. villous shortening in the intestine c. retrograde amnesia d. ataxia and sensory neuropathy e. pancreatic insufficiency ANSWER: b DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 24. Wernicke-Korsakoff syndrome is associated with excessive alcohol intake and a deficiency of which nutrient? a. thiamin b. vitamin B12 c. vitamin D d. folate e. vitamin B6 ANSWER: a DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Liver 25. Nutrition interventions for a client with alcoholic hepatitis include a diet that is: a. low in carbohydrates. b. high in saturated fat. c. low in artificial sugars. d. low in protein. e. high in carbohydrates.

ANSWER: e DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Liver 26. The recommended daily protein intake for a patient with alcoholic hepatitis would be: a. 0.5-0.8 grams/kilogram b. 0.8-1.0 grams/kilogram c. 1.0-1.5 grams/kilogram d. 1.5-2.0 grams/kilogram e. 2.5-3.0 grams/kilogram ANSWER: d DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Liver 27. The most common cause of cirrhosis in the United States is: a. alcohol abuse.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas b. hepatitis B. c. non-alcoholic fatty liver disease. d. hepatitis C. e. biliary colic.

ANSWER: d DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Liver 28. There are three types of gallstones: cholesterol, pigment, and: a. bile. b. mixed. c. ammonia. d. inflammatory. e. phospholipid.

ANSWER: b DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Biliary System 29. Which intervention is appropriate for a patient with an acute attack of cholangitis? a. A low-fat diet b. Decreased fluid intake c. Supplementation with vitamin B6 d. Enteral nutrition e. Increased carbohydrate intake ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Biliary System 30. The most common cause of chronic pancreatitis in children is: a. phenylketonuria. b. sickle cell anemia. c. necrotizing enterocolitis. d. cystic fibrosis. e. hypothyroidism.

ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Exocrine Pancreas 31. Symptoms associated with acute pancreatitis include: a. diarrhea, bloody stools, and abdominal cramping. b. epigastric pain and ascites. c. flatulence, diarrhea, and abdominal distention. d. fever and headache. e. abdominal pain, nausea, vomiting.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Exocrine Pancreas 32. Which condition is commonly associated with chronic pancreatitis? a. celiac disease b. anorexia c. diabetes d. renal failure e. atrial fibrillation ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Exocrine Pancreas 33. When steatorrhea associated with pancreatitis occurs, what intervention should follow? a. Administration of pancreatic digestive enzymes b. Early initiation (within 48 hours) of enteral nutrition c. A low-carbohydrate nutrition prescription with modest protein d. Calcium supplements along with a multivitamin e. Fluid and sodium restriction ANSWER: a DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Exocrine Pancreas JB is a 53 yo male who was recently divorced. He has experienced periods of depression and decreased appetite. Family reports history of heavy drinking habits and 15# weight lost. He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed. Mr. JB’s condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. Mr. JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight. Mr. JB also c/o pain when swallowing food. Because of JB’s persistent symptoms, he’s been admitted to the hospital.

A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended. By day 2 Mr. JB still c/o of nausea and no po intake has been reported. The MD prescribed dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO. Ht: 5’11’’ Wt: 145 # UBW: 163# Dx: End-stage liver cirrhosis, dysphagia PMH: alcoholic cirrhosis, portal hypertension Labs: Na: 134 53 K: 5.2

Cl: 101 Glu: 139 CO2: 25

BUN: 4 AST: 45 Cr: 1.8

Alb: 2.3 ALT 48 H/H: 11/35

TG: 305 Alk Phos: 40

Transferrin: 101 Bilirubin: 2.1

NH4:

Diet: NPO Meds: Neomycin, Aldactone, Lasix, Reglan 34. Following the paracentesis, the nutritionist might recommend what component to the nutrition prescription? a. vitamin B12 b. protein Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas c. hypertonic fluid d. vitamin D e. potassium ANSWER: b DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology Common to the Hepatobiliary Tract PREFACE NAME: case 35. How would the registered dietitian determine JB’s caloric needs in this situation? a. 15-20 kcal/kg IBW b. 20-25 kcal/kg IBW c. 25-30 kcal/kg IBW d. 30-35 kcal/kg current body weight e. 35-40 kcal/kg current body weight ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver PREFACE NAME: case 36. How will the registered dietitian determine JB’s protein needs? a. 0.8-1.0 g/kg b. 1.0-1.2 g/kg c. 1.4-1.6 g/kg d. 1.8-2.0 g/kg e. > 2 g/kg ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver PREFACE NAME: case 37. The RD recommends sodium restriction because of JB’s ascites. How much sodium should the RD initially recommend for JB each day? a. 500 mg/day b. 1000 mg/day c. 2000 mg/day d. 3000 mg/day e. 3500 mg/day ANSWER: c DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver PREFACE NAME: case 38. Because of JB’s history of alcohol abuse, he is most likely at risk of which nutrient deficiency? a. potassium b. vitamin A Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas c. sodium d. vitamin B6 e. vitamin E ANSWER: d DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver PREFACE NAME: case 39. The liver receives blood from two sources: the hepatic portal vein and the hepatic artery. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Hepatobiliary System 40. Bile (or gall) is a bitter yellow, blue, and green fluid secreted by the liver and stored in the pancreas. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 41. Autodigestion of the pancreas is prevented by storing the digestive enzymes in their inactive forms, as zymogens. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 42. Medical treatment for hepatoencephalopathy is primarily directed at reducing the amount of circulating ammonia. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 43. Red blood cells, alkaline phosphatase, and serum glucose are generally elevated with hepatitis. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 44. The hepatotoxic alcohol threshold at which ALD may develop is 20 g (two drinks) daily for men. a. True Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 45. Alcohol and acetaldehyde have a hepatotoxic effect that interferes with metabolism and activation of vitamins by liver cells. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 46. The most common causes of cirrhosis are chronic HCV and alcoholism, and 95% of heavy drinkers develop the disease. a. True b. False ANSWER: False DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 47. Prolonged parenteral nutrition and short bowel syndrome can cause biliary stasis and therefore increase risk of gallstones. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology the Biliary System 48. Forty percent of acute pancreatitis cases are due to a gallstone passing into the bile duct and temporarily lodging at the sphincter of Oddi. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Exocrine Pancreas 49. The basic functional unit of the liver is the _______________, which is a cylindrical structure several millimeters in length. lobule ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 50. The hepatic duct descends to the right for a few inches and is then joined by the cystic duct from the gallbladder to form the _______________. common bile duct ANSWER: Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 51. The pancreas is the only organ of the body that has both _______________ and endocrine functions. exocrine ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Anatomy and Physiology of the Hepatobiliary System 52. Withdrawal of fluid from the abdomen via a catheter, often used as treatment for ascites, is called _______________. paracentesis ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 53. _______________ presents as small, brief, intermittent movements of individual fingers and may be seen in patients with hepatic encephalopathy.

Asterixis ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 54. _______________ is a liver disorder that uncommon in the United States and requires HBV to replicate.

Hepatitis D, HDV ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 55. _______________ or steatosis occurs in about 25% of the general U.S. population and 90% of chronic alcohol abusers.

Fatty liver, Fatty liver disease ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 56. The most common clinical sign of fatty liver is _______________. hepatomegaly ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 57. The most deleterious complication of cystic fibrosis with cirrhosis is _______________. portal hypertension ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 58. _______________ is a form of toxic liver injury associated with chronic ethanol consumption.

Alcoholic hepatitis ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Liver 59. _______________ is a manifestation of thiamin deficiency usually seen in individuals suffering from alcoholism.

Wernicke-Korsakoff syndrome ANSWER: Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Liver 60. _______________ is the development of renal failure in patients with advanced chronic liver disease.

Hepatorenal syndrome, HRS ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Liver 61. A patient’s eligibility to be placed on the waiting list for a liver transplant is determined based on the _______________ scoring system.

Model for End-Stage Liver Disease, MELD ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 62. The liver is the source of bile, but bile’s composition is further modified by the _______________. gallbladder ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Biliary System 63. When a gallstone passes from the gallbladder through the cystic duct and lodges in the common bile duct or in the head of the pancreas, the condition is called _______________. choledocholithiasis ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Biliary System 64. _______________ is an inflammation of the biliary ducts, usually secondary to obstruction of the common bile duct leading to infection.

Cholangitis ANSWER: DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology of the Biliary System 65. Small crystals of cholesterol on the surface of the inflamed mucosa of the gallbladder act as _______________ (points of origin) for further precipitation of cholesterol, and the crystals grow larger and larger. nidi ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Biliary System 66. Thirty percent of _______________ pancreatitis is of unknown origin, but it is now thought that up to 15% of cases are due to genetic defects. chronic ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Exocrine Pancreas 67. An estimated dosage range would be _______________ IU of lipase per meal for the patient with acute pancreatitis.

40,000-50,000 ANSWER: DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Exocrine Pancreas Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas 68. Fat malabsorption with chronic pancreatitis results in _______________. steatorrhea ANSWER: DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Exocrine Pancreas 69. Define the functions of the gallbladder.

Gallbladder functions include removal of water and some inorganic electrolytes from the bile, which ANSWER: increases the concentration of larger organic solutes; storage of bile; and control of the delivery of bile salts to the duodenum.

DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 70. Describe the major functions of the pancreas.

The pancreas has two major functions: exocrine function, which produces enzymes and bicarbonate ANSWER: necessary for digestion; and endocrine function, which produces hormones to regulate the use of body fuels.

DIFFICULTY: Bloom's: Understand REFERENCES: Anatomy and Physiology of the Hepatobiliary System 71. Give three examples of possible nutrition diagnoses associated with acute hepatitis.

Common nutrition diagnoses that may be associated with acute hepatitis include inadequate oral ANSWER: food/beverage intake; inadequate protein and calorie intake; food–medication interaction; and impaired nutrient utilization.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Liver 72. List three different causes of cirrhosis found in the United States.

The most common causes of cirrhosis in the United States are hepatitis C, alcoholic liver disease, ANSWER: hepatitis B, and miscellaneous factors, such as autoimmune hepatitis, biliary cirrhosis, primary sclerosing cholangitis, hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, granulomatous disease, drug-induced liver disease, and chronic right-sided heart failure.

DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver 73. Describe a basic nutrition assessment for a patient with gallbladder disease.

For the patient with gallbladder disorders, weight and weight history should be obtained, and a 24-hour ANSWER: recall, diet history, or food diary should be used to determine intake and tolerance of specific foods or nutrients. Albumin and prealbumin levels should be assessed if the patient is NPO and/or has a concurrent infection. Medications for treatment of gallstones, infection, and pain should be noted.

DIFFICULTY: Bloom's: Apply REFERENCES: Pathophysiology of the Biliary System 74. Briefly describe the three major hypotheses that explain the impairment of neurotransmission involved with hepatic encephalopathy.

Hepatic encephalopathy (HE) is a syndrome of impaired mental status and abnormal neuromuscular ANSWER: function that results from liver failure. The ammonia hypothesis states that liver disease interferes with ammonia detoxification and shifts ammonia metabolism to skeletal muscle, where it is used in the conversion of glutamate to glutamine. Ammonia levels increase in the blood and the brain because of Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas muscle wasting. The ammonia is detoxified via the conversion of glutamate to glutamine; the depletion of glutamate and accumulation of glutamine in the brain contributes to hepatic encephalopathy. The synergistic neurotoxin hypothesis proposes that neurotoxins, many of which are produced by intestinal bacteria, are involved in hepatic encephalopathy. Hyperammonemia is thought to stimulate glucagon secretion and enhance gluconeogenesis from amino acids. The resulting hyperglycemia stimulates hyperinsulinemia, enhancing the uptake of branched-chain amino acids (BCAA) by muscle and lowering the plasma levels of BCAA relative to aromatic amino acids (AAA) that accumulate in the brain. The subsequent rise in tryptophan level leads to the formation of the inhibitory neurotransmitter serotonin, and the raised phenylalanine level leads to the inhibition of dihydroxyphenylalanine (DOPA) production and formation of so-called “false neurotransmitters.” The false neurotransmitter hypothesis suggests that these false transmitters may displace catecholamines from their receptors.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 75. Describe the differences between hepatitis A, B, and C, including their methods of transmission, clinical manifestations, and modes of treatment.

Hepatitis is an inflammation of the liver caused by a virus, bacteria, toxins, obstruction, parasites, or ANSWER: chemicals. Hepatitis A is generally transmitted via the oral-fecal route. Sources of contamination include drinking water, food, and sewage. Symptoms are typically nausea, vomiting and fatigue. There are no special treatments for hepatitis A except rest, adequate nutrition, and fluids. Hepatitis B (HBV) is transmitted through transfusions of blood or through improperly sterilized medical instruments or other skin-puncturing instruments that have come in contact with contaminated blood. Acute hepatitis B virus infection is a short-term illness, much like HAV infection. Chronic hepatitis B may cause cirrhosis or liver cancer. For acute infection, no medication is available; treatment is supportive, much like that for HAV. For chronic infection, two oral medications, tenofovir and entecavir, and an injected drug, pegylated interferon, are considered first-line options. Hepatitis C (HCV) transmission occurs when an individual is exposed to blood or body fluids from an infected person. Hepatitis C is often asymptomatic but may cause jaundice, abdominal pain, dark urine, and fatigue. The therapy for chronic hepatitis C has become more effective over the 10 years since alpha interferon was first approved for use. Recently, a new oral, non-interferon medication, sofosbuvir, was approved by the FDA for the treatment of chronic hepatitis C. DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Liver 76. Explain why malnutrition is prominent in the patient with alcoholism or alcoholic hepatitis.

Alcohol often replaces food in the diet. Though it is possible to meet maintenance energy needs from ANSWER: the energy in the alcohol consumed, malnourishment results because of an inadequate intake of nutrients; though high in calories, alcohol contains no protein, vitamins, or minerals. Alcohol is also preferentially metabolized over whatever nutrients are obtained through food. Alcohol causes inflammation of the stomach, pancreas, and intestine, interfering with the normal processes of digestion and absorption and resulting in secondary malnutrition. The subsequent decrease in pancreatic enzyme secretion, intestinal transporters, and micelle formation results in altered absorption of fat-soluble vitamins, thiamin, and folic acid. The metabolism of alcohol increases the need for certain nutrients, particularly the B vitamins and magnesium. Alcohol causes increased urinary excretion of folate and pyridoxine (B6), as well as increased retinoid metabolism.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Liver 77. Describe possible complications associated with thiamin deficiency in the patient with alcohol dependency.

The most common cause of thiamin deficiency in the United States is alcoholism. Alcohol affects ANSWER: Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas thiamin uptake and other aspects of thiamin utilization, and these effects may contribute to the prevalence of thiamin deficiency in alcoholics. The major manifestations of thiamin deficiency in humans involve the cardiovascular and nervous systems. The Wernicke-Korsakoff syndrome is characterized by weakness of eye movements, gait disturbance (ataxia), and confusion. Korsakoff’s psychosis is characterized initially by anterograde amnesia, retrograde amnesia to a lesser extent, a disordered time sense, and often confabulation of the acute senses. Cognitive deficits have also been observed. Ophthalmoplegia in Wernicke’s encephalopathy responds rapidly to thiamin administration, while the ataxia and confusion respond more slowly. The rapidity of response depends on the conversion of thiamin to its active form in the liver; patients with advanced liver disease such as cirrhosis may therefore have a delayed response.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Liver 78. Describe the differences between acute and chronic pancreatitis, including causes, manifestations, and nutrition intervention.

Pancreatitis, an inflammation of the pancreas, can be either acute or chronic. The disease is ANSWER: characterized by edema, autodigestion, fat necrosis, and hemorrhage of pancreatic tissue. Acute pancreatitis causes nausea, vomiting, abdominal distention, and steatorrhea. The exact mechanisms that lead to pancreatic injury are not fully understood. However, a common characteristic seems to be premature activation of trypsin within the pancreas, resulting in autodigestion of the pancreatic cells.

For the mild form of acute pancreatitis, research supports feeding patients without delay, as tolerated.

Research indicates that a low-fat solid diet is tolerated as well as a clear liquid diet. Chronic pancreatitis is a chronic, irreversible inflammatory condition that leads to fibrosis with tissue calcification. Signs and symptoms include chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels. If the pancreas loses its endocrine and exocrine functions, weight loss, malnutrition, and/or steatorrhea will be present. For chronic pancreatitis, the nutritional status of the patient will depend on the underlying etiology of the disease and level of endocrine and exocrine function.

DIFFICULTY: Bloom's: Analyze REFERENCES: Pathophysiology of the Exocrine Pancreas 79. There are three major hypotheses that try to explain the impairment of neurotransmission during hepatic encephalopathy: the ammonia hypothesis, the synergistic neurotoxin hypothesis, and: a. the protein and pyramidine hypothesis. b. the amino acid transamination hypothesis. c. the detoxification hypothesis. d. the neurosteroid hypothesis. e. the false neurotransmitter hypothesis.

ANSWER: e DIFFICULTY: Bloom's: Remember REFERENCES: Pathophysiology Common to the Hepatobiliary Tract 80. Which people group is most commonly infected with chronic hepatitis B virus in the United States? a. Native Americans b. Hispanic/Latinos c. Caucasians d. African Americans e. Pacific Islanders Copyright Cengage Learning. Powered by Cognero.

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Chapter 16 - Diseases of the Liver - Gallbladder - and Exocrine Pancreas ANSWER: e DIFFICULTY: Bloom's: Understand REFERENCES: Pathophysiology of the Liver

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Chapter 17 - Diseases of the Endocrine System 1. How many hormones does the anterior pituitary gland secrete? a. two b. three c. four d. five e. six ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction 2. Which glands secrete somatostatin? a. pituitary and thalamus b. hypothalamus and pancreas c. pancreas and adrenals d. hypothalamus and pineal e. pituitary and adrenals ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction 3. What is the common name for chronic adrenal insufficiency? a. Crohn’s disease b. Parkinson’s disease c. Addison’s disease d. Lou Gehrig’s disease e. Marfan’s syndrome ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 4. What adrenal medulla hormone regulates arterial blood pressure and prepares the body for “fight or flight” responses? a. oxytocin b. serotonin c. cortisol d. epinephrine e. norepinephrine ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. What hormone stimulates contraction of the uterus during childbirth and promotes ejection of milk from mammary glands during breastfeeding? a. oxytocin b. serotonin c. cortisol Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System d. epinephrine e. norepinephrine ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 6. What is the term for inadequate glucose supply to the brain? a. neuropathy b. neuroglycopenia c. glycosuria d. achlorhydria e. ketoacidosis ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 7. There are how many functional groups or categories of endocrine hormones? a. 2 b. 3 c. 4 d. 5 e. 6 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 8. What chemical class of hormones do the majority of endocrine hormones fall into? a. steroid hormones b. amine hormones c. neurohormones d. peptide hormones e. sugar-based hormones ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 9. Amines are derivatives of what amino acid? a. tyrosine b. lysine c. arginine d. serotonin e. thyroxin ANSWER: a DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System REFERENCES: Normal Anatomy and Physiology of the Endocrine System 10. What is the pituitary gland attached to via the pituitary stalk? a. hypothalamus b. thalamus c. pineal d. medulla e. pons ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 11. What hormones are synthesized by the hypothalamus, but released by the posterior pituitary? a. epinephrine and norepinephrine b. serotonin and dopamineserotonin and dopamine c. vasopressin and oxytocin d. thyroid stimulating hormone and growth hormone e. thyroxin and triiodothyrone ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 12. How many adrenocortical hormones are produced in the adrenal cortex? a. 3 b. 4 c. 6 d. 12 e. over 50 ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 13. What are the endocrine cells of the pancreas that secrete glucagon? a. cortical cells b. alpha cells c. beta cells d. delta cells e. medullar cells ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 14. Insufficient secretion of a tropic hormone leads to: a. primary hyposecretion b. secondary hyposecretion Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System c. tertiary hyposecretion d. cellular hypersecretion e. ductal hypersecretion ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Pathophysiology of the Endocrine System 15. What percentage of the U.S. population has been diagnosed with diabetes? a. 1% b. 3% c. 5% d. 8% e. 12% ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 16. What is the primary characteristic of all types of diabetes? a. hyperglycemia b. hypoglycemia c. kidney disease d. liver disease e. hypertension ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 17. What percentage of all diagnosed cases of diabetes does type 1 diabetes account for? a. 90-95% b. about 75% c. about 50% d. 5-10% e. 1-3% ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 18. Type 2 diabetes occurs most frequently in: a. newborns b. infants c. children d. adolescents e. adults ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 19. What ethnic group is affected most by diabetes in the U.S.? a. Hispanic / Latinos b. Asian Americans c. African Americans d. Native Americans e. Caucasians (European ancestry) ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 20. What is likely the biggest risk factor for developing type 2 diabetes? a. high blood pressure b. cigarette smoking c. obesity d. drinking alcohol e. stress ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 21. How many ways are there to diagnose diabetes? a. 5 b. 4 c. 3 d. 2 e. 1 ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 22. What is the fasting plasma glucose diagnostic criterion for diabetes? a. greater than or equal to 95 mg/dL b. greater than or equal to 106 mg/dL c. greater than or equal to 116 mg/dL d. greater than or equal to 126 mg/dL e. greater than or equal to 145 mg/dL ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 23. What is the lifespan of a red blood cell? a. 120 days Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System b. 100 days c. 75 days d. 45 days e. 12 days ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 24. What are three common complications from long-term diabetes? a. kidney disease, liver disease, central neuropathy b. lung disease, retinopathy, liver disease c. retinopathy, peripheral neuropathy, heart disease d. kidney disease, peripheral neuropathy, lung disease e. central neuropathy, heart disease, lung disease ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 25. What kind of insulin is used to treat diabetes? a. recombinant bovine insulin b. insulin derived from plants c. recombinant porcine insulin d. insulin derived from bacteria e. recombinant human insulin ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 26. What is the preferred initial drug to treat type 2 diabetes while using monotherapy? a. DPP-4 inhibitors b. alpha-glucosidase inhibitors c. glucagon d. glulisine e. metformin ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 27. What category of nutrient has the biggest impact on glycemic response? a. carbohydrates b. fats c. proteins d. vitamins e. minerals Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 28. Hypoglycemia occurs when plasma glucose levels fall to: a. 50 mg/dL b. 70 mg/dL c. 90 mg/dL d. 110 mg/dL e. 125 mg/dL ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Hypoglycemia 29. What type of pharmaceutical agents are commonly used in treatment of reactive hypoglycemia in order to slow gastric emptying and intestinal motility and inhibit vagal stimulation of insulin release? a. insulin secretagogues b. amylin analogs c. anticholinergic agents d. incretin mimetics e. meglitinides ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Hypoglycemia 30. Grave’s disease is a type of: a. pancreatic disorder b. pituitary disorder c. liver disorder d. hypothyroidism e. hyperthyroidism ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 31. What percentage of the U.S. population suffers from hypothyroidism? a. about 25% b. about 20% c. about 10% d. about 5% e. about 1% ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System 32. What is the most common cause of hypothyroidism in developing countries? a. autoimmune reaction b. lack of dietary iodine c. hyperthyroidism treatment d. lack of dietary iron e. viral infections ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 33. What is an inherited autoimmune disease that causes hypothyroidism and is 5-10 times more common in women? a. Hashimoto’s thyroiditis b. Grave’s disease c. lymphocytic thyroiditis d. lymphoma e. goiter ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 34. A well-known visible sign of Graves’ disease, but not other types of hyperthyroidism, is: a. goiter b. hypertension c. exophthalmos d. deformed fingernails e. blue-colored lips ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 35. What causes acromegaly? a. thyroxin hypersecretion b. growth hormone hypersecretion c. testosterone hypersecretion d. serotonin hyposecretion e. epinephrine hyposecretion ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders JK is a 19-year-old male college student with T1DM. He is away from home and is reportedly drinking and eating poorly. His school schedule is erratic so he eats at all different times of the day. He currently takes extended longacting analogue insulin once per day. Around 8 pm, his blood sugars are falling very low.

HT: 5’10”

WT: 175 pounds

Hemoglobin A1C 9%

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Chapter 17 - Diseases of the Endocrine System 36. What range did the M.D. likely use to calculate JK’s initial insulin regimen? a. 0.2-0.5 units/kg b. 0.5-0.8 units/kg c. 0.8-1.1 units/kg d. 1.1-1.4 units/kg e. 1.4-1.7 units/kg ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus PREFACE NAME: case study 37. What is likely the cause of JK’s low blood sugar at 8 pm? a. his insulin dosage is too high b. he is eating too much c. he is exercising too much d. he is not exercising enough e. timing and peak of his insulin are not matching his intake ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus PREFACE NAME: case study 38. Given his schedule, what may work better for JK? a. conventional therapy b. split-dose insulin c. multiple daily injections d. single-dose insulin e. not taking any insulin ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus PREFACE NAME: case study 39. If JK and his M.D. decide to change to multiple daily injections, what’s the most important thing JK should learn from his dietitian? a. how to become a vegan b. carbohydrate counting c. how to make protein-rich smoothies d. fatty acid avoidance e. how to avoid artificial sweeteners ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus PREFACE NAME: case study Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System 40. What would be an optimal hemoglobin A1C for JK once he begins his new insulin regimen? a. 10% b. 8% c. 7% d. 6% e. 4% ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus PREFACE NAME: case study 41. The pituitary gland is located in the bony cavity at the base of the brain just below the hypothalamus. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 42. The thyroid hormones are two iodine-containing hormones derived from the amino acid tyrosine: thyroxine and triiodothyrone. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 43. Insulin is a catabolic hormone that controls the metabolic fate of carbohydrate, protein, and lipid. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 44. Over 25.6 million individuals in the United States, or 8% of the population, have been diagnosed with diabetes. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 45. Some forms of T1DM have no known cause and are referred to as fulminant T1DM. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System REFERENCES: Diabetes Mellitus 46. Islet cell autoantibodies serve as indicators of the body’s destructive immune response against its own delta-cells. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 47. T2DM is caused by a combination of abnormal insulin secretion and insulin resistance. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 48. Reactive hypoglycemia may occur in individuals with diabetes due to administration of insufficient insulin or oral diabetes medications. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Hypoglycemia 49. Symptoms of hypothyroidism are generally quite significant and severe. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 50. Pituitary tumors are the most common cause of hypopituitarism. a. True b. False ANSWER: True DIFFICULTY: Bloom's: Remember REFERENCES: Other Endocrine Disorders 51. _______________ is the hormone released from alpha cells of the pancreas when blood glucose levels fall below the normal range.

ANSWER: Glucagon DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 52. Aldosterone directly influences the kidney to retain _______________.

ANSWER: sodium Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 53. Active insulin enters the blood via the _______________ vein and has an approximate half-life of _______________ minutes.

ANSWER: portal; 5 DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 54. The anabolic effect of insulin on protein metabolism produces a positive _______________ balance.

ANSWER: nitrogen DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 55. In its active form, insulin consists of two _______________ chains linked by _______________ bridges.

ANSWER: polypeptide; disulfide DIFFICULTY: Bloom’s: Remember REFERENCES: Normal Anatomy and Physiology of the Endocrine System 56. Secondary hyposecretion occurs when secretion of a _______________ hormone is inadequate to cause an endocrine organ to secrete adequate amounts of a hormone.

ANSWER: tropic DIFFICULTY: Bloom’s: Remember REFERENCES: Pathophysiology of the Endocrine System 57. The varieties of insulin available are made by genetically modifying the _______________ sequence so that there are varying pharmacokinetics.

ANSWER: amino acid DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 58. Individuals using conventional therapy to treat diabetes mellitus must synchronize administration of their insulin and food intake to avoid _______________.

ANSWER: hypoglycemia DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 59. Intensive insulin therapy requires multiple _______________ injections of rapid-acting insulin.

ANSWER: daily DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 60. Current estimates using standard criteria indicate that approximately one in five people over the age of _______________ have elevated fasting blood glucose and/or elevated glycosylated hemoglobin.

ANSWER: 65 DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System 61. Of the four meal planning approaches used in the Diabetes Control and Complications Trial (DCCT), the most successful was _______________counting.

ANSWER: carbohydrate DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 62. _______________ control is fundamental to the management of diabetes and provides the basis for monitoring and evaluation of the condition.

ANSWER: Glycemic or blood glucose DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 63. Continuous glucose monitoring uses a device that communicates with a sensor placed under the _______________.

ANSWER: skin DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 64. Severe hypoglycemia is defined as blood glucose level of _______________ mg/dL. ANSWER: 51-70 DIFFICULTY: Bloom’s: Remember REFERENCES: Diabetes Mellitus 65. _______________ hypoglycemia usually results from excess insulin or insulin-like substances that are secreted as a result of external factors such as alcohol or drug ingestion.

ANSWER: Fasting DIFFICULTY: Bloom’s: Remember REFERENCES: Hypoglycemia 66. A primary cause of fasting hypoglycemia is hyperinsulinism due to pancreatic _______________.

ANSWER: “beta-cell tumors” or just “tumors” DIFFICULTY: Bloom’s: Remember REFERENCES: Hypoglycemia 67. Thyroid disorders are common _______________ disorders and fall into two major categories: hypothyroidism and _______________.

ANSWER: endocrine; hyperthyroidism DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 68. The most common cause of hyperthyroidism is _______________, which accounts for approximately 60-80% of cases.

ANSWER: Graves’ disease DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 69. _______________ syndrome, also called hypercortisolism, is a rare disorder caused by chronic exposure to excessive Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System circulating cortisol.

ANSWER: Cushing’s DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 70. Diabetes _______________ results from insufficient production of vasopressin by the hypothalamus.

ANSWER: insipidus DIFFICULTY: Bloom’s: Remember REFERENCES: Other Endocrine Disorders 71. List the four categories of hormones based on function.

ANSWER: 1) Reproduction and sexual differentiation, 2) growth and development, 3) homeostasis, and 4) regulation of metabolism and nutrient supply.

DIFFICULTY: Bloom’s: Apply REFERENCES: Normal Anatomy and Physiology of the Endocrine System 72. Discuss nephropathy in regards to diabetes.

ANSWER: Nephropathy occurs in 20-40% of individuals with diabetes and is the single leading cause of chronic kidney disease (CKD) -- kidney failure that must be treated with dialysis or transplantation. Diabetes is the cause of 44% of new cases of CKD. DIFFICULTY: Bloom’s: Apply REFERENCES: Diabetes Mellitus 73. List the basic types of insulin delivery regimens.

ANSWER: There are three basic types of insulin delivery regimens: fixed (conventional), flexible (intensive insulin therapy), and continuous subcutaneous insulin infusion.

DIFFICULTY: Bloom’s: Apply REFERENCES: Diabetes Mellitus 74. Define hypoglycemia.

ANSWER: Hypoglycemia is an abnormally low blood glucose level. It occurs when glucose is utilized too rapidly, glucose release rate falls behind tissue demands, or excess insulin enters the bloodstream.

DIFFICULTY: Bloom’s: Apply REFERENCES: Hypoglycemia 75. Discuss the etiology of hypothyroidism throughout the world.

ANSWER: Worldwide, the most frequent cause of hypothyroidism is iodine deficiency. In the United States and other areas where iodine intake is adequate, autoimmune thyroid disease and previous treatment for hyperthyroidism are the most common causes.

DIFFICULTY: Bloom’s: Apply REFERENCES: Other Endocrine Disorders 76. Describe the endocrine cells of the pancreas.

ANSWER: The endocrine cells of the pancreas include the alpha cells, which secrete glucagon and GLP-1 (glucagon-like-peptide); beta cells, which secrete insulin; delta cells, which secrete somatostatin; and the F cells, which secrete pancreatic polypeptide. These cells make up an anatomically small portion of the pancreas, but the hormones they secrete play a vital role in energy regulation and fuel homeostasis.

DIFFICULTY: Bloom’s: Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 17 - Diseases of the Endocrine System REFERENCES: Normal Anatomy and Physiology of the Endocrine System 77. Explain the “dawn phenomenon.”

ANSWER: The dawn phenomenon results from the effect of hormones involved in controlling circadian rhythms.

Cortisol and growth hormone stimulate gluconeogenesis. This causes hyperglycemia between 5:00 a.m. and 9:00 a.m. (“dawn”). Examination of blood glucose records for individuals who have high glucose levels at awakening may identify this event. It will need to be distinguished from another condition, referred to as rebound effect. This refers to an elevation in blood glucose as a reaction to previous low blood glucose levels during the night. To correct these events, bedtime snacks or insulin regimens will be adjusted. These conditions may occur in either T1 or T2DM. DIFFICULTY: Bloom’s: Apply REFERENCES: Diabetes Mellitus 78. Discuss metabolic syndrome in relation to diabetes.

ANSWER: A condition related to insulin resistance is metabolic syndrome, which shares some characteristics with T2DM. Central obesity and insulin resistance are significant contributing features, along with atherosclerotic risk factors including dyslipidemia and hypertension. Metabolic syndrome places individuals at increased risk for coronary artery disease. Treatment of metabolic syndrome is multifaceted and includes diet, exercise, and pharmacologic therapy including statins, fibrates, angiotensin-converting enzyme (ACE) inhibitors, and thiazolidinediones. Over one-third of the U.S. population over age 20 meets the criteria for metabolic syndrome.

DIFFICULTY: Bloom’s: Apply REFERENCES: Diabetes Mellitus 79. Define polycystic ovarian syndrome and list the common characteristics.

ANSWER: Polycystic ovarian syndrome (PCOS) is an endocrine problem affecting approximately 10% of women during their reproductive years. PCOS can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics: high levels of male hormones, also called androgens -- this may cause excessive facial and body hair growth; an irregular or no menstrual cycle; and in some cases, many small cysts (fluid-filled sacs) on their ovaries. PCOS is the most common hormonal reproductive problem in women of childbearing age.

DIFFICULTY: Bloom’s: Apply REFERENCES: Diabetes Mellitus 80. Discuss pituitary tumors.

ANSWER: Pituitary tumors are adenomas found in the pituitary gland. They are slow growing and most are benign.

Autopsy data from the National Institute of Diabetes and Digestive and Kidney Diseases indicates that 25% of the U.S. population has some form of small pituitary tumor. Pituitary tumors often present with signs and symptoms related to hypofunction or hyperfunction. Tumors that produce hormones are called functioning tumors, whereas those that do not produce hormones are called nonfunctioning tumors.

DIFFICULTY: Bloom’s: Apply REFERENCES: Other Endocrine Disorders

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Chapter 18 - Diseases of the Renal System 1. What percentage of American adults have physiological evidence of chronic kidney disease? a. 5% b. 10% c. 15% d. 20% e. 25% ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Introduction 2. What is the functioning unit of the kidney called? a. tubule b. cortex c. nephron d. medulla e. glomerulus ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 3. What is a build-up of nitrogenous waste products (such as urea) in the blood and body fluids called? a. anemia b. proteinuria c. oliguria d. azotemia e. hematuria ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 4. What is the term for blood in the urine? a. anemia b. proteinuria c. oliguria d. azotemia e. hematuria ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. What hormone influences the reabsorption of sodium within the kidneys? a. aldosterone b. vasopressin c. cortisol d. testosterone Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System e. epinephrine ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 6. What pituitary hormone works at the level of the collecting duct to either increase or decrease absorption of water in order to maintain plasma volume and thus blood pressure? a. aldosterone b. vasopressin c. cortisol d. testosterone e. epinephrine ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 7. What structure in the kidney collects the glomerular filtrate? a. loop of Henle b. efferent tubule c. afferent tubule d. Bowman’s capsule e. distal tubule ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 8. What is often one of the first signs of renal insufficiency? a. kidney pain b. hematuria c. microalbuminuria d. increased urine output e. low blood pressure ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 9. The onset of renal failure is not usually apparent until what percentage of renal function is lost? a. 50-70% b. about 40% c. 20-30% d. about 15% e. 5-10% ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System 10. What is the leading cause of kidney failure? a. diabetes b. hypotension c. kidney trauma d. heart disease e. bacterial infection ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 11. What is the GFR in patients with Stage 5 kidney disease? a. less than 90 mL /min/1.73 m2 b. about 70 mL /min/1.73 m2 c. less than 45 mL /min/1.73 m2 d. about 25 mL /min/1.73 m2 e. less than 15 mL /min/1.73 m2 ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 12. How long does the typical hemodialysis treatments take on average? a. 30 minutes b. 2 hours c. 4 hours d. 8 hours e. 12 hours ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 13. Corticosteroids, cyclosporine, tacrolimus, mycophenolate mofetil, and sirolimus are all examples of what type of medication? a. NSAIDs b. analgesics c. antibacterials d. immunosuppressive e. antivirals ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 14. What is a measure of both visceral protein status and acute-phase inflammatory response? a. plasma protein b. serum albumin Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System c. blood sugar levels d. percentage of hematocrit e. blood creatinine levels ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 15. What vitamin supplements are typically indicated for people with chronic kidney disease (HD and PD patients)? a. A, B6, E b. B-complex, C and D c. A, B9, K d. B-complex, D, E e. A, C, K ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 16. What mineral supplements might be beneficial for people with chronic kidney disease (HD and PD patients)? a. iron and zinc b. calcium and magnesium c. calcium and boron d. boron and zinc e. iron and magnesium ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 17. How many grams per serving of animal protein does the National Renal Diet recommend for people on kidney dialysis? a. 16-20 b. 12-15 c. 9-11 d. 6-8 e. 3-5 ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 18. What is the recommended daily potassium intake for hemodialysis patients? a. 10-11 g/day b. 8-9 g/day c. 6-7 g/day d. 4-5 g/day e. 2-3 g/day ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 19. What fruits are low in potassium? a. banana, cantaloupe, figs b. oranges, papayas, prunes c. apples, grapes, raspberries d. kiwis, mangos, nectarines e. avocados, pomegranates, raisins ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 20. What vegetables are low in potassium? a. beans, artichokes, beets b. squash, broccoli, Brussels sprouts c. cucumbers, celery, onions d. carrots, lentils, parsnips e. potatoes, pumpkin, legumes ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 21. The interdialytic weight gain goal in HD patients should not exceed what percentage of body weight? a. 2% b. 5% c. 9% d. 12% e. 15% ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 22. Albumin is a primary carrier for what mineral? a. boron b. iron c. zinc d. calcium e. magnesium ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 23. What vegetable is considered a high-sodium food? a. olives Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System b. zucchini c. broccoli d. cucumbers e. cabbage ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 24. What meat is considered a high-sodium food? a. chicken b. turkey c. pepperoni d. steak e. filet of salmon ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 25. What percentage of HD patients develops ischemic heart disease? a. 5% b. 10% c. 20% d. 30% e. 40% ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 26. Prolonged exposure to elevations of PTH causes the development of what bone disease (characterized by rapid bone turnover with an excess of collagen production)? a. rickets b. osteomalacia c. osteopenia d. osteosarcoma e. osteitis fibrosa cystica ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 27. What type of oral iron supplement causes less GI distress? a. heme iron polypeptides b. ferrous gluconate c. ferrous fumarate d. ferrous sulfate e. polysaccharides Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 28. After kidney transplant, the intake of what dietary factor should be strictly limited to reduce the risk of cardiovascular disease and infection? a. lactose b. simple carbohydrates c. gluten d. alcohol e. protein ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 29. What food enhances the bioavailability of tacrolimus and cyclosporine? a. spinach b. legumes c. grapefruit d. chocolate e. tomatoes ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 30. What percentage of kidney transplant patients display dyslipidemia? a. 10% b. 25% c. 40% d. 55% e. 70% ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 31. What is the prevalence of acute kidney injury in all hospitalized patients in the U.S.? a. 1% b. 3% c. 5% d. 7% e. 10% ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Acute Kidney Injury Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System 32. Medical and nutritional management of acute kidney injury typically aim to maintain BUN (blood urea nitrogen) in the range of: a. 60-100 mg/dL b. 80-100 mg/dL c. 100-120 mg/dL d. 120-130 mg/dL e. 130-150 mg/dL ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Acute Kidney Injury 33. Patients with acute kidney injury are prone to loss of what type of amino acids? a. leucine and isoleucine b. only essential amino acids c. only non-essential amino acids d. all essential and non-essential amino acids e. only branched-chain amino acids ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury 34. What is a more common term for nephrolithiasis? a. kidney necrosis b. kidney cancer c. kidney stones d. viral kidney infection e. bacterial kidney infection ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nephrolithiasis 35. For kidney stones that are composed of uric acid, avoidance of what kind of food is recommended? a. foods high in calcium b. foods high in purines c. foods high in vitamin C d. foods low in magnesium e. foods low in oxalates ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Nephrolithiasis Case Study Multiple Choice KL is a 45-year-old male admitted to the hospital with an infection. He is on PD secondary to congenital disease of the kidney. He does not have diabetes.

HT: 6’ WT: 170 pounds (77 kg) Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System 36. Approximately how many grams of protein does KL require each day? a. 66 g b. 78 g c. 87 g d. 93 g e. 110 g ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury PREFACE NAME: KL 37. Approximately how many kilocalories does KL require daily? a. 1,840 kcal b. 1,930 kcal c. 2,050 kcal d. 2,200 kcal e. 2,700 kcal ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury PREFACE NAME: KL 38. What is the most likely source of his infection? a. fistula b. UTI c. catheter d. AV graft e. prostate ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury PREFACE NAME: KL 39. Which of the following is likely true about KL’s situation? a. He goes to a dialysis center 3x per week. b. His caloric intake needs to be adjusted to account for calories in dialysate. c. He will have to wait 6 weeks for the fistula to mature. d. His prostate infection needs antibiotic therapy. e. He is not a candidate for a kidney transplant.

ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury PREFACE NAME: KL Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System 40. KL visits the dietitian. What information will the dietician most likely share with him? a. He has less of a dietary potassium restriction than he would on HD. b. His dietary phosphorus is unrestricted. c. His fluid intake must be output + 1,000 cc. d. He needs to limit protein of high biological value. e. He cannot consume any sweet fruits.

ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury PREFACE NAME: KL 41. The kidneys are two retroperitoneal organs the size of a fist. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 42. The kidney’s role in controlling both hydrogen and bicarbonate ions is a critical component of the maintenance of pH homeostasis. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 43. Diabetes, hypotension, and heart disease are the leading causes of kidney failure. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 44. African Americans are nearly four times as likely to develop kidney failure as white Americans. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 45. The protein requirements for HD are slightly higher than for PD. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System REFERENCES: Nutrition Therapy for Chronic Kidney Disease 46. Triglyceride levels are particularly reduced in PD patients due to the absorption of glucose from the dialysate. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 47. In general, the hemodialysis diet is high in protein and controls intakes of potassium, phosphorus, fluids, and sodium. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 48. The use of active vitamin D sterols decreases calcium absorption in the intestines. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 49. Acute kidney injury is a disorder characterized by an abrupt increase in GFR that results in failure to maintain fluid, electrolyte, and acid-base balance. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Acute Kidney Injury 50. Kidney stones typically consist of calcium salts, cystine, uric acid, or struvite. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nephrolithiasis 51. The _______________ tubule of the kidney contains cells with a complex brush border, tight intercellular junctions, and large numbers of mitochondria.

ANSWER: proximal DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 52. The enzyme _______________ is produced by the kidney and is necessary for the initiation of the renin-angiotensin control of fluid balance.

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Chapter 18 - Diseases of the Renal System ANSWER: renin DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 53. Most commonly, kidney function is measured by the _______________.

ANSWER: glomerular filtration rate (GFR) DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 54. Deficiency of the active form of vitamin D is associated with impaired intestinal calcium absorption and secondary _______________.

ANSWER: hyperparathyroidism DIFFICULTY: Bloom’s: Remember REFERENCES: The Kidneys 55. _______________ nephropathy is the most common cause of CKD in the United States.

ANSWER: Diabetic DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 56. _______________ is a renal replacement procedure that removes excessive and toxic by-products of metabolism from the blood, thus replacing the filtering function of healthy kidneys.

ANSWER: Dialysis DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 57. Waste products and excess fluids are removed from the body by the actions of diffusion, ultrafiltration, and _______________.

ANSWER: osmosis DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 58. The dialysate for PD is available with a range of _______________ concentrations that alter its osmolality and assist in fluid removal.

ANSWER: dextrose DIFFICULTY: Bloom’s: Remember REFERENCES: Chronic Kidney Disease 59. Secondary hyperparathyroidism in dialysis patients can progress to severe, intractable forms of _______________ disease.

ANSWER: bone or osteodystrophy DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 60. CKD patients are unable to synthesize adequate amounts of endogenous _______________, a hormone that is made by renal tubular cells and important for production of red blood cells.

ANSWER: erythropoietin or EPO Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 61. In addition to restriction of dietary phosphorus, most patients use phosphate _______________ to prevent gastrointestinal absorption of dietary phosphorus.

ANSWER: binders DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 62. Low serum calcium levels often accompany CKD due to alterations in vitamin _______________ metabolism.

ANSWER: D DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 63. _______________ carbonate is a phosphate-binder.

ANSWER: Magnesium or Calcium DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 64. Supplementation of _______________ soluble vitamins is typically indicated for HD and PD patients due to increased losses during dialysis, anorexia, and poor dietary intake.

ANSWER: water DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 65. Because serum vitamin _______________ levels are elevated in HD and PD patients, supplementation is not necessary.

ANSWER: A DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 66. Since most HD patients receive anticoagulation therapy, caution must be taken if supplementing with vitamin _______________ due to its role in promoting clot formation.

ANSWER: K DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Chronic Kidney Disease 67. Etiology of acute kidney injury is classified as pre-renal, intrinsic, or _______________.

ANSWER: post-renal DIFFICULTY: Bloom’s: Remember REFERENCES: Acute Kidney Injury 68. It is common for the nutritional status of patients with acute kidney injury to decline within a short period of time, owing to _______________ losses.

ANSWER: nitrogen DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Acute Kidney Injury Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System 69. _______________, the cause of more than 50% of all kidney stones, is defined as urinary calcium excretion greater than 300 mg per 24 hours in men or 250 mg per 24 hours in women.

ANSWER: Hypercalciuria DIFFICULTY: Bloom’s: Remember REFERENCES: Nephrolithiasis 70. It has been demonstrated that foods high in _______________, including dairy products, can actually prevent the formation of kidney stones.

ANSWER: calcium DIFFICULTY: Bloom’s: Remember REFERENCES: Nutrition Therapy for Nephrolithiasis 71. Outline the primary functions of the kidney.

ANSWER: The primary functions of the kidney include maintenance of homeostasis through control of fluid, pH, and electrolyte balance and blood pressure; excretion of metabolic end products and foreign substances; and production of enzymes and hormones.

DIFFICULTY: Bloom’s: Apply REFERENCES: The Kidneys 72. List the types of renal replacement therapy for CKD stage 5.

ANSWER: Currently two major types of renal replacement therapy are used for patients with CKD stage 5: hemodialysis (HD) and peritoneal dialysis (PD).

DIFFICULTY: Bloom’s: Apply REFERENCES: Chronic Kidney Disease 73. List the factors that increase protein requirements for people with chronic kidney disease.

ANSWER: Factors that increase protein requirements include 1) losses of approximately 10–12 grams of free amino acids per day and 5–15 grams of albumin per day; 2) altered albumin turnover; 3) metabolic acidosis, which increases amino acid degradation; 4) inflammation; and 5) infection.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutrition Therapy for Chronic Kidney Disease 74. List the common sources of oral iron supplements.

ANSWER: Ferrous gluconate, ferrous sulfate, ferrous fumarate, polysaccharide-iron complex, and a heme iron polypeptide are common sources of iron in oral supplements.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutrition Therapy for Chronic Kidney Disease 75. Explain why kidney stones form.

ANSWER: Kidney stones (nephrolithiasis) form as a result of abnormal crystallization of calcium, oxalate, struvite, cystine, hydroxyapatite, or uric acid that is not excreted normally in the urine.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nephrolithiasis 76. Describe the signs and symptoms associated with inadequate kidney function..

ANSWER: Signs and symptoms associated with inadequate kidney function are directly related to the kidney’s inability to perform the normal homeostatic control functions. Advanced impairment of kidney function Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System results in edema, metabolic acidosis, hyperkalemia, anemia, uremia, azotemia, hyperphosphatemia, oliguria, hypertension, and bone and mineral disorders.

DIFFICULTY: Bloom’s: Apply REFERENCES: The Kidneys 77. Describe the procedure of hemodialysis.

ANSWER: Since dialysis therapy requires access to the circulatory system, patients receiving hemodialysis need to undergo a procedure that allows continual access to the bloodstream. Dialysis access is usually a permanent access site called an arteriovenous fistula (AVF), created surgically by fashioning in the forearm a subcutaneous joining of the radial artery and the cephalic vein or a tunneled catheter. If the patient’s veins are not adequate for this procedure, an arteriovenous graft (AVG) can be created with a catheter. The AV fistula requires 4-6 weeks to become fully functional. A subclavian port is used temporarily if HD is required before the AV fistula is ready for use.

DIFFICULTY: Bloom’s: Apply REFERENCES: Chronic Kidney Disease 78. Describe the nutrition diagnoses that might coincide with CKD. ANSWER: Given the complexity of the nutritional implications of CKD, many nutrition diagnoses may be present.

The following is a list of possible nutrition diagnoses for patients with CKD: inadequate energy intake, inadequate oral intake, excessive fluid intake, malnutrition, inadequate protein intake, excessive mineral intake (potassium, phosphorus, sodium), altered GI function, altered nutrition-related laboratory values, food–medication interaction, unintended weight loss, food- and nutrition-related knowledge deficit, disordered eating pattern, undesirable food choices, impaired ability to prepare foods/meals, poor nutrition quality of life, and limited access to food.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutrition Therapy for Chronic Kidney Disease 79. Describe the use of immunosuppressants for kidney transplants.

ANSWER: Immunosuppressant medications such as corticosteroids, cyclosporine, mycophenolate and tacrolimus are used to prevent acute rejection and maintain long-term survival of the transplanted kidney. Multiple drugs are used in an attempt to lower levels of certain agents and decrease unwanted side effects. Some foods may alter the action and/or effectiveness of these immunosuppressants. Patients are provided detailed instructions on when to take their medications in order to guarantee adequate drug absorption.

Grapefruit and grapefruit juice enhance the bioavailability of tacrolimus and cyclosporine. Consequently, patients are advised to avoid these foods while taking these agents.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutrition Therapy for Chronic Kidney Disease 80. Discuss the etiology of acute kidney injury.

ANSWER: Acute kidney injury is classified based on etiology as pre-renal, intrinsic, or post-renal. Pre-renal AKI results from conditions that reduce perfusion and cause ischemic damage to the kidney. Potential causes include severe dehydration, circulatory collapse, or fluid losses from the GI tract or from extensive wounds. Intrinsic (parenchymal) AKI refers to damage within the kidney cells. This could occur after exposure to toxins such as antibiotics, chemotherapy, or contrast dyes, or with systemic inflammatory conditions such as sepsis. Other causes of intrinsic AKI include acute infections such as glomerulonephritis or inflammation from conditions such as Sgöjren’s syndrome. Post-renal (obstructive) AKI results from a blockage of the ureter or neck of the bladder. Possible causes of obstruction include kidney stones, blood clots, and tumors.

DIFFICULTY: Bloom’s: Apply REFERENCES: Acute Kidney Injury Copyright Cengage Learning. Powered by Cognero.

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Chapter 18 - Diseases of the Renal System

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Chapter 19 - Diseases of the Hematological System 1. What body parts are involved in hematopoiesis? a. lungs and heart b. bone marrow and spleen c. veins and arteries d. liver and pancreas e. lymph nodes and adrenal glands ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Overview of the Hematological System 2. What is the densest or heaviest component of the blood, evidenced by centrifuging? a. serum b. plasma c. erythrocytes d. leukocytes e. electrolytes ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Overview of the Hematological System 3. What is the product of heme metabolism that is excreted with bile? a. thrombopoietin b. ferritin c. uric acid d. bilirubin e. hepcidin ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 4. What is the hormone that regulates iron homeostasis? a. thrombopoietin b. ferritin c. vasopressin d. vasopressin e. hepcidin ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 5. What is the group of inherited blood disorders involving abnormal globin subunits in the hemoglobin molecule called? a. thalassemia b. lupus c. sickle cell anemia d. hemophilia Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System e. chronic myeloproliferative disease ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Glossary 6. Hemoglobin binds to what type of cell? a. white blood cells b. red blood cells c. iron d. oxygen e. platelets ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 7. What minerals are closely tied to normal hematopoiesis? a. calcium, magnesium, iron b. lead, zinc, aluminum c. phosphorus, potassium, cooper d. iron, zinc, copper e. calcium, potassium, magnesium ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 8. What are immature red blood cells called? a. platelets b. lymphocytes c. reticulocytes d. thrombocytes e. leukocytes ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 9. What part of long bones contain the red marrow? a. spongy bone b. compact bone c. medullary cavity d. diaphysis e. endosteum ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System 10. What is arachidonic acid? a. an amino acid b. a polysaccharide c. an omega-3 fatty acid d. an omega-6 fatty acid e. an omega-9 fatty acid ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Homeostatic Control of the Hematological System 11. What percent of total blood volume do white blood cells comprise? a. 1% b. 5% c. 8% d. 12% e. 18% ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 12. What is the main vitamin and mineral involved with the clotting process? a. vitamin K and magnesium b. vitamin C and copper c. vitamin K and calcium d. vitamin A and copper e. vitamin C and calcium ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Homeostatic Control of the Hematological System 13. What are the three major categories of nutritional anemias? a. mild, moderate, severe b. vitamin deficiency, mineral deficiency, genetic c. acute, chronic, fatal d. macrocytic, microcytic, hemolytic e. megaloblastic, microblastic, hypochromic ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 14. What kind of anemia develops from a folate deficiency? a. microcytic b. macrocytic c. hemolytic d. hypochromic Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System e. microblastic ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 15. What kind of anemia develops from lead toxicity? a. microcytic b. macrocytic c. hemolytic d. hypochromic e. microblastic ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 16. What is the most likely cause of the anemia if it’s microcytic and hypochromic? a. vitamin E toxicity b. iron deficiency c. thiamin deficiency d. selenium overdose e. vitamin E deficiency ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 17. What is the most common cause of a nutritional anemia? a. protein deficiency b. vitamin E toxicity c. lead toxicity d. iron deficiency e. thiamin deficiency ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 18. What is the most bioavailable source of iron? a. milk b. spinach c. kidney beans d. seaweed e. clams ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System 19. What vitamin enhances the absorption of iron? a. vitamin B1 b. vitamin B12 c. vitamin C d. vitamin D e. vitamin E ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 20. What is the term used to describe eating non-nutritive substances such as lead paint chips or clay? a. bulimia b. metallothionein c. pica d. hypovitaminosis e. hypochromic disorder ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 21. What mineral deficiency is linked to restless leg syndrome? a. calcium b. iron c. copper d. lithium e. boron ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 22. What is the upper intake level of iron, established for the United States? a. 15 mg/day b. 25 mg/day c. 35 mg/day d. 45 mg/day e. 55 mg/day ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 23. What is the iron rich compound found in breast milk? a. lactoferrin b. ferrous glycinate c. ferric glycinate d. phytase Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System e. ferrous fumarate ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 24. What vitamin deficiency causes pernicious anemia? a. B2 b. B5 c. B12 d. B7 e. B3 ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 25. What compound, released by stomach parietal cells, is needed to properly absorb vitamin B12? a. hydrochloric acid b. phytase c. ferrous fumarate d. pepsin e. intrinsic factor ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 26. Which of the following is the richest source of folate? a. strawberries b. blueberries c. flour tortillas d. corn tortillas e. asparagus ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 27. What causes primary hemochromatosis? a. genetics b. inadequate diet c. iron supplements d. severe blood loss e. repeated blood transfusions ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Hemochromatosis Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System 28. What is the treatment for hemochromatosis? a. megadosing of vitamin C b. phlebotomy c. use of proton pump inhibitors d. use of H2 blockers e. bone marrow transplant ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Hemochromatosis 29. What percent of people with hemochromatosis develop cardiomyopathy? a. 10% b. 30% c. 50% d. 70% e. 90% ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Hemochromatosis 30. Sickle cell anemia is a structural defect in what cells? a. platelets b. thrombocytes c. lymphocytes d. leukocytes e. erythrocytes ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias 31. What is a result of impaired globin synthesis? a. reduced erythrocyte production b. increased leukocyte production c. increased iron absorption d. decreased hemoglobin synthesis e. increased mineral absorption ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias 32. When does Erythroblastosis fetalis occur? a. when Rh- infants are born to Rh+ mothers b. when Rh+ infants are born to Rh- mothers c. when infants are born to folate deficient mothers d. when infants are born to iron deficient mothers Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System e. when a fetus experiences lead poisoning in the womb ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias 33. What plasma protein factor is deficient in hemophilia A? a. VIII b. X c. VI d. V e. IV ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Clotting and Bleeding Disorders 34. What plasma protein factor is deficient in hemophilia B? a. XI b. X c. IX d. VIII e. VII ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Clotting and Bleeding Disorders 35. Vitamin K is a fat-soluble compound that can be stored in the adult liver for approximately how many days? a. 45 b. 30 c. 20 d. 10 e. 3 ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Clotting and Bleeding Disorders Case Study Multiple Choice PS is an 87-year-old male admitted to the hospital for stomach pain. He has mild breathing problems and complains of fatigue and chronic stomach upset, for which he takes daily antacid. While hospitalized, a physician has determined that PS has megaloblastic anemia.

36. Which of the following is least likely to cause PS’s anemia? a. reduced intrinsic factor production b. lack of dietary folate intake c. lack of dietary B12 intake d. lack of dietary iron intake Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System e. GI malabsorption ANSWER: d DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias PREFACE NAME: PS 37. Given PS’s age and symptoms, what is a likely cause of the megaloblastic anemia? a. excessive loss of blood from stomach ulcer b. lack of folate from poor dietary habits c. liver disease d. lead poisoning e. reduced B12 absorption due to inadequate intrinsic factor ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias PREFACE NAME: PS 38. What lab values would be altered given the likely cause of PS’s problem? a. low folate b. low creatinine c. low cyanocobalamin d. high serum ferritin e. high leukocytes ANSWER: c DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias PREFACE NAME: PS 39. What should PS consider adding to his diet to potentially help with his condition? a. asparagus b. beef liver c. kidney beans d. citrus fruits e. broccoli ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias PREFACE NAME: PS 40. If the MD were to prescribe folate for PS which of the following is a potential concern? a. folate could mask a B12 deficiency b. folate is very expensive and hard to find c. folate is a blood thinner d. folate negatively interacts with his iron supplement Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System e. folate could promote growth of H. pylori ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias PREFACE NAME: PS 41. Hematocrit is expressed as the percent of packed red blood cell volume within whole blood. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Overview of the Hematological System 42. Erythropoiesis involves the incorporation of hemoglobin into a RBC. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 43. There are two sets of globin protein chains, delta and gamma. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 44. The von Willebrand factor is a protein on the cell surface that causes platelets to become sticky and adhere to other platelets. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Homeostatic Control of the Hematological System 45. Hemolytic anemia may be due to deficiencies or excesses of vitamin D. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 46. Plant sources of iron are the most bioavailable because they don’t contain compounds that bind iron and render it less absorbable. a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 47. Folate and B12 deficiencies result in specific forms of anemia, where the red blood cells are megaloblastic and macrocytic. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 48. Hemochromatosis is a condition in which a number of regulatory mechanisms for vitamin B12 are inoperative. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Hemochromatosis 49. The five major classes of hemoglobinopathy are: structural, thalassemias, thalassemic hemoglobin variants, hereditary persistence of fetal hemoglobin, and acquired hemoglobinopathy. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias 50. Hemophilia, an inherited disorder, results in insufficient factors for ferritin synthesis. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: Clotting and Bleeding Disorders 51. The hematological system involves the bone marrow and _______________ for hematopoiesis.

ANSWER: spleen DIFFICULTY: Bloom’s: Remember REFERENCES: Overview of the Hematological System 52. All blood components are generated from the _______________ stem cells, which have the capability of differentiating into various cell types.

ANSWER: bone marrow DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 53. Hemoglobin is a four-subunit metalloprotein containing _______________ at the center of each subunit.

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Chapter 19 - Diseases of the Hematological System ANSWER: iron OR heme DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 54. Disorders of porphyrin metabolism include the porphyria syndromes, where one or more of the intermediates for _______________ synthesis are abnormal or the enzymes for the steps are inactive.

ANSWER: heme DIFFICULTY: Bloom’s: Remember REFERENCES: Anatomy and Physiology of the Hematological System 55. The inflammatory signals act on red marrow to increase _______________, which regulates platelet production.

ANSWER: thrombopoietin DIFFICULTY: Bloom’s: Remember REFERENCES: Homeostatic Control of the Hematological System 56. The coagulation proteins are vitamin _______________-dependent and are synthesized in the liver.

ANSWER: K DIFFICULTY: Bloom’s: Remember REFERENCES: Homeostatic Control of the Hematological System 57. Antiretroviral therapy for HIV and AIDS patients causes abnormal clotting by decreasing the red bone marrow’s ability to produce _______________.

ANSWER: platelets DIFFICULTY: Bloom’s: Remember REFERENCES: Homeostatic Control of the Hematological System 58. Both anemia and lead poisoning are associated with impaired _______________ function and neurological damage in children.

ANSWER: brain/cognitive DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 59. Supplemental iron should be given as ferrous _______________ or ferrous _______________, which are better absorbed and tolerated than other iron chelates.

ANSWER: sulfate; gluconate DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 60. Megaloblastic anemia may result from an inadequate intake of vitamin _______________.

ANSWER: B12 or folate or B9 DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 61. Vitamin B12 is recycled and/or stored in the _______________.

ANSWER: liver DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System 62. _______________ levels are thought to be the best markers of vitamin B12 status.

ANSWER: Holotranscobalamin II DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 63. Vitamin B12 supplements are best taken _______________ or via injection.

ANSWER: sublingually DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 64. Vitamin B12 or Folate deficiencies increases risk for elevated _______________ in children as well as in adults.

ANSWER: homocysteine DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 65. Cirrhosis leads to the decreased production of transferrin and _______________ for iron mobilization.

ANSWER: ferritin DIFFICULTY: Bloom’s: Remember REFERENCES: Nutritional Anemias 66. Secondary hemochromatosis is caused by other _______________ disorders or repeated blood transfusions.

ANSWER: blood-related DIFFICULTY: Bloom’s: Remember REFERENCES: Hemochromatosis 67. Chronic toxicity from iron overload leads to functional _______________, hepatomegaly, and eventually cirrhosis.

ANSWER: diabetes DIFFICULTY: Bloom’s: Remember REFERENCES: Hemochromatosis 68. The _______________ are inherited disorders of abnormal alpha or beta globin synthesis.

ANSWER: thalassemias DIFFICULTY: Bloom’s: Remember REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias 69. True primary _______________ anemia is also known as Fanconi’s anemia.

ANSWER: aplastic DIFFICULTY: Bloom’s: Remember REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias 70. Hemorrhagic disease of the newborn is characterized by clotting deficiencies due to insufficient amounts of _______________ available to the neonate.

ANSWER: vitamin K DIFFICULTY: Bloom’s: Remember REFERENCES: Clotting and Bleeding Disorders Copyright Cengage Learning. Powered by Cognero.

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Chapter 19 - Diseases of the Hematological System 71. List the subunits of the hemoglobin molecule.

ANSWER: The subunits of hemoglobin are comprised of globin (a protein moiety) and heme, a porphyrin ring that carries the iron.

DIFFICULTY: Bloom’s: Apply REFERENCES: Anatomy and Physiology of the Hematological System 72. Describe the dietary factors that regulate hemostasis.

ANSWER: Under normal circumstances, hemostasis is tightly regulated, and dietary factors play a central role in hemostasis. Vitamin K; dietary fats; antioxidants such as vitamin C, vitamin E, and selenium; prooxidants such as iron and copper; and cell signals such as the presence of calcium ions are all integral to normal clotting, bleeding, and blood flow.

DIFFICULTY: Bloom’s: Apply REFERENCES: Homeostatic Control of the Hematological System 73. Explain how hepcidin controls the level of plasma iron.

ANSWER: Hepcidin controls the level of plasma iron by regulating 1) intestinal absorption of dietary iron, 2) release of iron from macrophages, and 3) transfer of iron stored in the hepatocytes.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutritional Anemias 74. Describe the main purpose of nutritional therapy for hemochromatosis.

ANSWER: The purpose of nutrition therapy in patients with hemochromatosis is to minimize the risk of excess iron intake.

DIFFICULTY: Bloom’s: Apply REFERENCES: Hemochromatosis 75. List the plasma protein factors that are linked to hemophilia.

ANSWER: A deficiency in plasma protein factor VIII is classified as hemophilia A; a deficiency in plasma protein factor IX is classified as hemophilia B. DIFFICULTY: Bloom’s: Apply REFERENCES: Clotting and Bleeding Disorders 76. Describe side roblastic anemia.

ANSWER: Sideroblastic anemia is a form of anemia characterized by the appearance of sideroblasts, immature ferritin-containing blast marrow cells in circulation. Sideroblastic anemia presents clinically as iron overload due to adjustments for poor oxygenation. Iron absorption and RBC production are increased to compensate for ineffective oxygen transport. There are presently eight characterized forms of sideroblastic anemia identified by the genetic mutation that is present, and all have characteristic mitochondrial iron overloading.

DIFFICULTY: Bloom’s: Apply REFERENCES: Anatomy and Physiology of the Hematological System 77. Discuss how aspirin impacts hemostasis.

ANSWER: The most familiar compound affecting bleeding through platelet function is salicylic acid or aspirin.

Aspirin affects the cyclooxygenase enzyme systems that produce thromboxanes from arachidonic acid. It is common knowledge that daily aspirin dosing for the prevention of heart attacks or for chronic pain can lead to gastrointestinal bleeding and substantial blood losses. Anemia can be seen as a result of prolonged occult (hidden) bleeding.

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Chapter 19 - Diseases of the Hematological System DIFFICULTY: Bloom’s: Apply REFERENCES: Homeostatic Control of the Hematological System 78. Describe how iron-deficiency anemia and impaired thyroid function are related.

ANSWER: Worldwide, thyroid impairment occurs alongside iron-deficiency anemia. Intakes of both and iodine among low-income persons isolated from coastal waters rich in these minerals are usually poor. Iron deficiency also disrupts thyroid peroxidase, contributing to adverse effects. Iron is an important cofactor for energy regulation, thermoregulation (control of body temperature), and metabolic rate, and thus exerts depressive systemic effects when deficient. Thermoregulation, metabolism, and thyroid function are intertwined; they are dependent on iodine, iron, and selenium, another important component of deiodinase enzymes in thyroxine metabolism.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutritional Anemias 79. Discuss how the feedback mechanism for iron absorption is altered in iron-deficiency anemia.

ANSWER: Persons with uncomplicated deficiencies of iron already have up-regulated proteins for enhancing iron absorption from the digestive tract. One such protein (hepcidin) communicates iron status and erythropoietic demands to the small intestine and modulates absorption. This feedback mechanism allows deficient individuals to enhance their absorption of available heme and non-heme iron. Irondeficiency anemia can be corrected through continued iron-dense, nutrient-dense dietary intake, supplementation, and correction of any underlying conditions that may be contributing to the deficit.

Increasing the nutrient density of foods over the long term is the best strategy.

DIFFICULTY: Bloom’s: Apply REFERENCES: Nutritional Anemias 80. Define sickle cell anemia and describe the role of nutrition therapy in sickle cell anemia.

ANSWER: Sickle cell anemia is the most common structural hemoglobinopathy, defined as homozygous abnormal hemoglobin polymerization resulting in a sickling of RBCs in symptomatic individuals. The crescentshaped cell morphology is obvious when stained and magnified. Nutrition therapy for an acute sickle cell crisis should include increased macronutrients because this condition increases energy expenditure, protein and bone turnover, risk of pulmonary disease, chronic inflammation, frequency of infections, and cardiac output.

DIFFICULTY: Bloom’s: Apply REFERENCES: Hemoglobinopathies: Non-Nutritional Anemias

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Chapter 20 - Diseases and Disorders of the Neurological System 1. What are the two major divisions of the nervous system? a. endocrine and exocrine nervous systems b. upper and lower nervous systems c. spinal and extremity nervous systems d. central and peripheral nervous systems e. cerebral and autonomic nervous systems ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 2. What are the two branches of the autonomic nervous system? a. endocrine and exocrine b. upper and lower c. sympathetic and parasympathetic d. central and peripheral e. voluntary and involuntary ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 3. What functional cell of the nervous system is responsible for transmission of information from one cell to another? a. nerves b. neurons c. ganglions d. glial cells e. lymphocytes ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 4. What is the term for a loss of voluntary movement? a. akinesia b. aneurysm c. paraplegia d. epilepsy e. bradykinesia ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 5. What is the term for delayed or slowed body movements? a. akinesia b. aneurysm c. paraplegia d. epilepsy Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System e. bradykinesia ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 6. What disease or disorder is characterized by demyelination of cells within the CNS, inflammation, and development of scar tissue? a. Parkinson’s b. multiple sclerosis c. Alzheimer’s d. myasthenia gravis e. amyotrophic lateral sclerosis ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 7. What is the term for the body of a neuron? a. dendrite b. axon c. filament d. soma e. myelin ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 8. What inhibitory neurotransmitter controls body posture and movement? a. acetylcholine b. glutamate c. dopamine d. serotonin e. norepinephrine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 9. Epilepsy is considered as a diagnosis when there are how many unprovoked seizures? a. 2 b. 3 c. 4 d. 5 e. 6 ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Epilepsy and Seizure Disorders Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System 10. What percentage of the population can expect to have a seizure within their lifetime? a. 5% b. 10% c. 20% d. 30% e. 50% ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Epilepsy and Seizure Disorders 11. Extended seizure activity lasting over 5 minutes is called: a. grand-mal b. petit-mal c. tonic-clonic d. epilepsy e. status epilepticus ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Epilepsy and Seizure Disorders 12. What type of diets are recommended for people with seizures / epilepsy? a. high carbohydrate diets b. fruit-only diets c. ketogenic diets d. low-fat diets e. dense protein diets ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Epilepsy and Seizure Disorders 13. What drug for epilepsy inhibits both vitamin D and folate metabolism? a. valproate b. carbamazepine c. gabapentin d. phenytoin e. topiramate ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Epilepsy and Seizure Disorders 14. The classic ketogenic diet is typically initiated with what macronutrient ratio? a. 4 fat to 1 protein and carbohydrate b. 4 carbohydrate to 1 protein c. 4 protein to 1 carbohydrate Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System d. 4 protein to 1 fat e. 4 carbohydrate to 1 fat ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Epilepsy and Seizure Disorders 15. In the United States, what demographic is at highest risk of stroke? a. Asian Americans b. African Americans c. Caucasians (European ancestry) d. Native Americans e. Hispanics ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Stroke and Aneurysm 16. What lifestyle factor is the strongest predictor of stroke risk? a. cigarette smoking b. alcohol consumption c. taking illicit drugs d. obesity e. drinking soda pop ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Stroke and Aneurysm 17. Within what approximate time frame does necrosis (cell death) occur due to lack of blood, oxygen and glucose supplied to the brain? a. at least 30 minutes b. 20-25 minutes c. 12-18 minutes d. 4-10 minutes e. 1-3 minutes ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Stroke and Aneurysm 18. What is the primary issue with attempting to feed stroke patients? a. loss of taste sensation b. reduced saliva production c. loss of appetite d. potential for weight gain e. dysphagia ANSWER: e DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System REFERENCES: Nutrition Therapy for Stroke and Aneurysm 19. Where is the neurotransmitter dopamine produced within the brain? a. pons b. occipital lobe c. substantia nigra d. thalamus e. hypothalamus ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 20. What symptom, visible in the hands, is characteristic of Parkinson’s disease? a. blue discolor b. red discolor c. tremor d. severe edema e. swollen joints ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 21. What is the chemical precursor to dopamine? a. retrodopa b. levodopa c. monoamine oxidase d. carbidopa e. benserazide ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 22. What medications act to reduce the breakdown of L-dopa outside the blood–brain barrier? a. COMT inhibitors b. dopamine agonists c. MAO-B inhibitors d. decarboxylase inhibitors e. anticholinergic meds ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 23. What is the only current medicinal treatment for ALS, which appears to affect the release of the neurotransmitter glutamate? a. riluzole Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System b. benserazide c. carbidopa d. levodopa e. immunoglobulin ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 24. What is the primary medicinal treatment for Guillain-Barré syndrome (GBS)? a. oral anticholinesterase drugs b. retrodopa c. high-dose intravenous immunoglobulin d. high-dose intravenous vitamin C e. riluzole ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 25. What percentage of patients with GBS completely recover within 18 months of onset? a. 15% b. 25% c. 40% d. 60% e. 85% ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 26. In myasthenia gravis, an autoimmune reaction damages or destroys the cellular receptors for what neurotransmitter? a. dopamine b. serotonin c. epinephrine d. norepinephrine e. acetylcholine ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 27. Which gland is often abnormal in patients with myasthenia gravis? a. thymus gland b. thyroid gland c. adrenal glands d. pituitary gland e. pineal gland Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 28. How many distinct types of multiple sclerosis (MS) are there? a. 6 b. 5 c. 4 d. 3 e. 2 ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 29. What is the strongest known risk factor for MS? a. cigarette smoking b. genetics c. obesity d. living in northern climates e. vegetarian diet ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 30. What are the two major physical changes in the brain that are characteristic of Alzheimer’s disease? a. aluminum deposition and edema b. amyloid plaques and neurofibrillary tangles c. amyloid plaques and hypertrophy d. calcification and hypertrophy e. aluminum deposition and neurofibrillary tangles ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 31. The first stage of Alzheimer’s disease is characterized by: a. depression and anger b. hand tremors and confusion c. headaches and depression d. memory loss and confusion e. memory loss and muscle weakness ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 32. What age group has the highest rate of traumatic brain injuries due to motor vehicle accidents?

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Chapter 20 - Diseases and Disorders of the Neurological System a. young adults 18-25 b. middle-aged adults c. children under 5 d. elderly e. adolescents ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 33. Quadriplegia or tetraplegia refers to paralysis involving what part(s) of the body? a. all four limbs b. the entire body c. the legs and feet d. the arms and hands e. hands and fingers ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 34. What amino acids are needed in higher amounts in patients with pressure ulcers? a. lysine and tyrosine b. tyrosine and valine c. arginine and glutamine d. valine and cysteine e. lysine and cysteine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 35. Injury to what segment of the spine results in damage to the chest and abdominal muscles? a. cervical b. thoracic c. lumbar d. sacral e. coccyx ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury KL is a 34-year-old male admitted to the hospital (large trauma center) after suffering a traumatic brain injury (TBI) secondary to a serious motor vehicle accident. He was in excellent health prior to the accident.

HT: 6’2”

WT: 190 pounds (86 kg)

36. What is the best means of determining KL’s caloric needs while in the hospital?

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Chapter 20 - Diseases and Disorders of the Neurological System a. Mifflin-St Jeor equation b. Harris-Benedict equation c. WHO standards d. indirect calorimetry e. Glasgow coma scale ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury PREFACE NAME: Case20 37. What level of energy intake per day is the most appropriate for KL? a. 1,800 kcal b. 2,100 kcal c. 2,400 kcal d. 2,700 kcal e. 3,000 kcal ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury PREFACE NAME: Case20 38. What is the best estimate for KL’s protein needs? a. 0.6-0.9 g/kg b. 0.9-1.1 g/kg c. 1.15 g/kg d. 1.2-1.5 g/kg e. 1.5-2.0 g/kg ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury PREFACE NAME: Case20 39. What is likely the best way to feed KL while he is in the hospital? a. nasogastric tube b. nasoenteric tube c. parenteral nutrients d. baby food orally e. keep NPO (withhold oral food & fluids) ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury PREFACE NAME: Case20 40. Which of the following might reduce KL’s metabolic requirements?

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Chapter 20 - Diseases and Disorders of the Neurological System a. use of paralytic drugs b. use of appetite stimulant c. use of morphine d. KL’s gender e. KL’s race ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury PREFACE NAME: Case20 41. The somatic division of the PNS carries messages forward to the CNS from the sensory organs, and outward from the CNS to the muscles for action. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 42. Partial seizures can be further classified as simple partial or complex partial. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Epilepsy and Seizure Disorders 43. The term developmental delay is a catch-all phrase used to describe any lag in reaching age-appropriate developmental milestones. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Epilepsy and Seizure Disorders 44. Ischemic strokes are the least most common form, accounting for about 10% of all strokes. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Stroke and Aneurysm 45. For most stroke patients, evidence supports delayed initiation (2 weeks) of nutrition support due to risk of weight gain. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System REFERENCES: Nutrition Therapy for Stroke and Aneurysm 46. Although the exact cause of Parkinson’s disease is unclear, it results in the loss of serotonin-producing cells in the thalamus portion of the brain. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 47. A high protein intake interferes with optimal levels of L-dopa due to competition for protein carriers. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 48. ALS affects involuntary types of neurons, such as those involved in memory, reasoning, vision, and hearing, as well as muscular processes such as heartbeat and digestion. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 49. Most inflammatory conditions of the spinal cord are treated with NSAIDs. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 50. Traumatic brain injuries are classified as either penetrating brain injuries or closed-head injuries. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 51. The components of a neuron are the soma, _______________, axon, and axon terminals.

ANSWER: dendrites DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 52. Endorphins are _______________ that naturally occur in the brain.

ANSWER: neuropeptides Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Nervous System 53. The percentage of individuals relieved from seizures with anti-epileptic drugs is around _______________ percent.

ANSWER: 70 DIFFICULTY: Bloom’s Remember REFERENCES: Epilepsy and Seizure Disorders 54. Febrile seizures are triggered by high _______________.

ANSWER: fever (temperature) DIFFICULTY: Bloom’s Remember REFERENCES: Epilepsy and Seizure Disorders 55. Because the ketogenic diet is low in fiber and _______________ and insufficient in other nutrients, supplementation is recommended to avoid deficiencies.

ANSWER: calcium DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Epilepsy and Seizure Disorders 56. The major variations of ketogenic diets in use today include the classic ketogenic diet, the _______________ triglyceride diet, the low-glycemic-index treatment, and the modified Atkins diet.

ANSWER: medium-chain DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Epilepsy and Seizure Disorders 57. A(n) _______________ stroke occurs as a neurological dysfunction caused by focal cerebral, spinal, or retinal infarction.

ANSWER: ischemic DIFFICULTY: Bloom’s Remember REFERENCES: Stroke and Aneurysm 58. _______________ are not considered to be a stroke, but are episodes of ischemia that lead to momentary symptoms consistent with the loss of oxygen to the brain.

ANSWER: Transient ischemic attacks (TIAs) DIFFICULTY: Bloom’s Remember REFERENCES: Stroke and Aneurysm 59. Individuals with stroke do not experience the _______________ phase that is seen in the acute period after traumatic brain injury.

ANSWER: hypermetabolic DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Stroke and Aneurysm 60. The _______________ status of patients at the onset of the injury is an important consideration for a successful recovery.

ANSWER: nutritional DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System REFERENCES: Nutrition Therapy for Stroke and Aneurysm 61. _______________ is a term used to describe a cluster of symptoms including bradykinesia with rigidity and/or tremor.

ANSWER: Parkinsonism DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 62. Vitamin _______________ is required as a cofactor for one of the enzymes needed for the conversion of L-dopa to dopamine.

ANSWER: B6 DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 63. Amyotrophic lateral sclerosis, commonly known as _______________ disease, is a progressive neurological disease that affects the motor neurons of the nervous system.

ANSWER: Lou Gehrig’s DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 64. Approximately _______________ percent of Guillain-Barré syndrome (GBS) patients report onset of symptoms 1-3 weeks after an infection.

ANSWER: 60 DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 65. Approximately 30 percent of patients with GBS require mechanical _______________.

ANSWER: ventilation DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 66. Myasthenia gravis is a(n) _______________ neuromuscular disease that affects the skeletal muscles and results in varying levels of weakness and fatigue.

ANSWER: autoimmune DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 67. Multiple sclerosis is an immune-mediated disease characterized by destruction of the _______________ and the formation of scar tissue.

ANSWER: myelin sheath DIFFICULTY: Bloom’s Remember REFERENCES: Progressive Neurological Disorders 68. Many patients with severe head injuries require surgery for removal or repair of _______________ and contusions.

ANSWER: hematomas DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System 69. Paraplegia is defined as paralysis involving the lower body below the _______________.

ANSWER: umbilicu DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 70. Because spinal cord injury patients have lower metabolic rates, preventing excessive _______________ is crucial.

ANSWER: weight gain DIFFICULTY: Bloom’s Remember REFERENCES: Neurotrauma and Spinal Cord Injury 71. Explain the primary roles of the parietal lobe.

ANSWER: The parietal lobe is responsible for the sensations of pain, touch, taste, temperature, and pressure; it is also related to mathematical and logical thinking.

DIFFICULTY: Bloom’s Apply REFERENCES: Normal Anatomy and Physiology of the Nervous System 72. Define the term stroke.

ANSWER: The American Heart Association and American Stroke Society states that stroke can include any of the following: CNS infarction, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and cerebral venous thrombosis.

DIFFICULTY: Bloom’s Apply REFERENCES: Stroke and Aneurysm 73. List the two forms of amyotrophic lateral sclerosis (ALS).

ANSWER: Two distinct forms of ALS exist: bulbar and spinal. Initial presentation is due to the differences in where the neuron deterioration begins.

DIFFICULTY: Bloom’s Apply REFERENCES: Progressive Neurological Disorders 74. Define Guillain-Barré syndrome.

ANSWER: Guillain-Barré syndrome (GBS) is defined as an acute peripheral nervous system syndrome characterized by progressive paralysis that is mediated by an autoimmune response.

DIFFICULTY: Bloom’s Apply REFERENCES: Progressive Neurological Disorders 75. Distinguish between complete and partial spinal cord injuries.

ANSWER: A complete injury indicates that there is no function below the point of the spinal cord injury, and can result in paraplegia or quadriplegia. A partial injury indicates that the individual can experience sensation and may have voluntary movement.

DIFFICULTY: Bloom’s Apply REFERENCES: Neurotrauma and Spinal Cord Injury 76. Describe how a neuron passes its message on to another neuron and how this model ensures specificity.

ANSWER: A neuron passes its message on to another neuron by releasing chemical neurotransmitters into the space between the two neurons, called the synapse. A presynaptic neuron sends the specific information, or impulse, and a postsynaptic neuron receives it. A neurotransmitter can stimulate a postsynaptic neuron only at specific receptor sites on its dendrites and soma. Receptor sites respond to only one type of Copyright Cengage Learning. Powered by Cognero.

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Chapter 20 - Diseases and Disorders of the Neurological System neurotransmitter. This lock and key model ensures that specific neurotransmitters work only at specific kinds of synapses.

DIFFICULTY: Bloom’s Apply REFERENCES: Normal Anatomy and Physiology of the Nervous System 77. Discuss the prevention of stroke and acute care following stroke.

ANSWER: Prevention of stroke through lifestyle changes and use of medications to lower cholesterol and blood pressure, and thereby minimize atherosclerosis, is an important measure. Aspirin, warfarin, and other anticoagulant or antiplatelet medications can also reduce risk of ischemic stroke in those at risk.

However, when prevention fails, other measures must be taken quickly for optimal outcome. The longer the blood supply to the brain is impaired, the more extensive the damage. Thus, the first priority in acute care following ischemic stroke is to eliminate the clot and restore blood flow.

DIFFICULTY: Bloom’s Apply REFERENCES: Stroke and Aneurysm 78. Discuss the etiology and pathophysiology of Parkinson’s disease (PD).

ANSWER: The etiology of PD remains unclear, but proposed contributing factors include genetics, environmental toxins, prions (protein malformations), oxidative stress, imbalance of neurotransmitters leading to excitotoxicity, mitochondrial dysfunction, loss of ability to reproduce dopamine-producing cells (including the loss that occurs with aging), abnormal inflammatory response within certain cells of the brain, improper response to dopamine within the brain, and increased rate of cell death. Twin and family studies indicate that genetics may certainly contribute to early-onset Parkinson’s, but genetic testing is not currently routine and is used only in research settings. Over 16 mutations have been noted on multiple chromosomes that are linked to PD. DIFFICULTY: Bloom’s Apply REFERENCES: Progressive Neurological Disorders 79. Explain the clinical manifestations of ALS. ANSWER: Classic signs and symptoms of ALS include asymmetric muscle weakness and atrophy, hyperreflexia (hyper-stiffening of the muscles), and fasciculations (uncontrolled twitching of the muscles). The manner in which these signs and symptoms manifest in the patient depend on the area of neuron destruction. There may be difficulty with gross motor actions such as walking, or in fine motor actions such as grasping an object. Swallowing and chewing skills decline as the neurons controlling these skills weaken. As the disease progresses, the extensive muscle atrophy lead to increasing paralysis, requiring mechanical ventilation and nutrition support.

DIFFICULTY: Bloom’s Apply REFERENCES: Progressive Neurological Disorders 80. Describe the pathophysiology of primary and secondary traumatic brain injury.

ANSWER: TBI-related injuries to the brain have been classified as primary and secondary. The primary brain injury results from the initial penetration or mechanical thrashing of the brain against the interior of the skull, leading to lacerations and crushing of brain tissue. Secondary injuries are those occurring due to the physiological changes that occur during the aftermath of the initial injury. These often include cerebral edema, hemorrhage, hematoma, and infection. These changes can adversely affect brain function by leading to rising intracranial pressure and impaired blood flow. Ultimately, it is the secondary injuries that can lead to destruction of neurons, glia, and axons.

DIFFICULTY: Bloom’s Apply REFERENCES: Neurotrauma and Spinal Cord Injury

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Chapter 21 - Diseases of the Respiratory System 1. At what age is the male respiratory system fully mature? a. 2 months b. 14 years c. 17 years d. 20 years e. 25 years ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 2. At what age is the female respiratory system fully mature? a. 2 months b. 14 years c. 17 years d. 20 years e. 25 years ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 3. What is the term for an increase in size of the right ventricle of the heart caused by resistance to the passage of blood through the lungs? a. aerophagia b. emphysema c. cor pulmonale d. pulmonary consolidation e. orthopnea ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 4. What is the term for an accumulation of fluid between the two outer membranes surrounding the lungs? a. emphysema b. pleural effusion c. dyspnea d. aspiration pneumonia e. bronchitis ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 5. What are the bubbly sounds called (heard via stethoscope) that may indicate pulmonary pathology? a. rales b. clubbing c. percussion Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System d. auscultation e. cor pulmonale ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 6. What type of alveolar epithelium produces surfactant? a. type I cells b. type II cells c. type III cells d. goblet cells e. acinar cells ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 7. How does pulse oximetry measure the oxygenation of arterial blood? a. via x-rays b. via ultrasound c. via stethoscope d. via light waves e. via microphone ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 8. Oxygen saturation measures the amount of oxygen carried by the: a. red blood cells b. bronchioles c. alveoli d. capillaries e. glomerulus ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 9. What vitamin is metabolized more quickly in smokers versus non-smokers? a. vitamin A b. vitamin B12 c. vitamin C d. vitamin D e. vitamin K ANSWER: c DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System REFERENCES: Nutrition and Pulmonary Health 10. What type of medication is used to open or relax the bronchial tubes and relieve shortness of breath? a. bronchodilators b. corticosteroids c. NSAIDs d. analgesics e. expectorants ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Asthma 11. Increased rates of asthma, particularly in developed countries, parallel the rates of what other condition? a. ADHD b. autism c. cystic fibrosis d. diabetes e. obesity ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Asthma 12. Insufficient levels of what vitamin may be linked to bronchopulmonary dysplasia (BPD) in premature newborns? a. vitamin B2 b. folate c. vitamin A d. vitamin C e. vitamin E ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Bronchopulmonary Dysplasia 13. How much higher are the energy needs of infants with BPD compared to those of healthy, normal infants? a. about 10% b. 15-25% c. about 35% d. 40-50% e. about 75% ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Bronchopulmonary Dysplasia 14. What is the primary risk factor for COPD? a. obesity b. alcohol abuse Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System c. exposure to toxic solvents d. smoking e. low protein diet ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 15. What differentiates emphysema from chronic bronchitis? a. the primary risk factors b. destruction of lung tissue c. association with diabetes d. genetic factors e. link to lung cancer ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 16. What is a physical sign of the increased use of accessory muscles for expiration in someone with emphysema? a. “barrel chest” b. “sunken chest” c. “bird’s chest” d. enlarged heart e. enlarged liver ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 17. What do anticholinergics do? a. reduce pain and inflammation b. increase heart and breathing rates c. relax smooth muscle d. decrease airway contraction and mucus production e. increase the production of histamines ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 18. What type of medication are fluoroquinolones? a. analgesics b. anti-inflammatories c. bronchodilators d. mucolytics e. antibiotics ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 19. What kind of diet may result in a low incidence of COPD, as shown by prospective research studies? a. a diet rich in red meat and potatoes b. a strict vegan diet c. a diet rich in fruits, vegetables and fish d. a very low-carb diet e. a diet rich in saturated fat and insoluble fiber ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 20. What mineral is critical for adenosine tri-phosphate (ATP) and 2,3-diphosphoglycerate (DPG) synthesis? a. boron b. potassium c. phosphate d. calcium e. magnesium ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 21. In COPD, hyperinflation of the lungs leads to feelings of unnecessary fullness and bloating at mealtime due to flattening of what organ? a. breasts b. diaphragm c. spleen d. liver e. abdominal muscles ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 22. Compared to basal energy requirements, how much energy intake is recommended (on average) for patients admitted to a hospital due to an exacerbation of COPD? a. 80% b. 95% c. 115% d. 140% e. 175% ANSWER: d DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 23. What is the primary characteristic of cystic fibrosis? a. abnormally thick mucus secretions b. destroyed bronchioles c. destroyed alveoli d. reduced blood flow into the lungs e. pulmonary emboli ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Cystic Fibrosis 24. What kind of an inherited disease is cystic fibrosis if each time two CF carriers conceive, there is a 25% chance that their child will have CF; a 50% chance that the child will bean asymptomatic carrier of the CF gene; and a 25% chance that the child will be a non-carrier? a. x-linked recessive b. x-linked dominant c. autosomal recessive d. autosomal dominant e. mitochondrial ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Cystic Fibrosis 25. What other disease is associated with CF in 15-20% of cases in patients older than 20 years? a. ADHD b. autism c. multiple sclerosis d. muscular dystrophy e. diabetes ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 26. What vitamin deficiency is relatively common in people with CF? a. vitamin B9 b. vitamin C c. vitamin B12 d. vitamin B6 e. vitamin A ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 27. What mineral deficiencies are common in people with CF? Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System a. iron and zinc b. calcium and magnesium c. boron and selenium d. calcium and selenium e. iron and phosphorus ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 28. What is the most important supplemental enzyme for CF patients? a. lactase b. lipase c. amylase d. protease e. pepsin ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 29. What is the primary cause of infectious pneumonia? a. influenza A b. respiratory syncytial virus c. Streptococcus pneumoniae d. Pneumocystis jiroveci e. Candida yeast ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Pneumonia 30. A tracheostomy is a surgical opening made in the trachea to: a. allow talking b. allow eating c. alleviate heartburn d. remove throat cancer e. assist breathing ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Patients with Tracheostomies 31. Which of the following is an inflammatory (indirect) cause of acute respiratory distress syndrome? a. pneumonia b. pulmonary edema c. fat embolism d. sepsis Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System e. inhalation injury ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Respiratory Failure 32. What kind of fatty acids play a role in reducing a systemic inflammatory response? a. saturated fatty acids b. omega-3 fatty acids c. omega-6 fatty acids d. omega-9 fatty acids e. monounsaturated fatty acids ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Respiratory Failure 33. What is a concern after lung transplantation? a. organ rejection b. infection c. cyanosis d. pulmonary embolism e. chronic fatigue ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Transplantation 34. How long after surgery can most lung transplant patients begin to eat solid food? a. 12 hours b. 1-2 days c. 3-5 days d. 1 week e. 2 weeks ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Transplantation 35. How many viral respiratory tract infections do American children develop on average each year? a. 10 b. 8 c. 6 d. 4 e. 2 ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Upper Respiratory Infection Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System TS is an 80-year-old female admitted to the hospital with an exacerbation of COPD. She was diagnosed with the disease 20 years ago and now complains of shortness of breath, dyspnea, and an upset stomach.

HT: 5’1”

WT: 104 pounds

UBW: 115 pounds

36. What percent weight loss has TS experienced? a. 7.8% b. 8.3% c. 9% d. 9.6% e. 10.5% ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Respiratory Failure PREFACE NAME: Case21 37. According to the registered dietitian, how much protein does TS need per day? a. 48 g b. 61 g c. 70 g d. 85 g e. 102 g ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Respiratory Failure PREFACE NAME: Case21 38. How many kcal/day would be recommended for TS? a. 1,150 kcalories b. 1,266 kcalories c. 1,490 kcalories d. 1,671 kcalories e. 1,834 kcalories ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Respiratory Failure PREFACE NAME: Case21 39. All of the following would be part of registered dietitian’s nutrition plan for TS except: a. resting before meals b. focus on quick weight gain c. small frequent meals d. getting 20% of total kcalories from protein e. a diet rich in fruit, veggies and fish ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Respiratory Failure PREFACE NAME: Case21 40. What dietary supplements are most beneficial for TS? a. antioxidants, vitamin D and calcium b. vitamin B6, vitamin C and selenium c. antioxidants, phosphate and boron d. vitamin A, vitamin B3 and calcium e. antioxidants, vitamin K and selenium ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Respiratory Failure PREFACE NAME: Case21 41. The most common pulmonary function test is conducted with a machine called a spirometer. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 42. Malnutrition associated with poor intake appears to have an impact on the strength and endurance of respiratory muscles, particularly the diaphragm. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition and Pulmonary Health 43. Asthma is usually divided into two types: sinus and bronchus asthma. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Asthma 44. A number of studies have demonstrated a protective effect of breastfeeding against the development and severity of asthma in children. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Asthma 45. Because of immature swallowing function and oral aversion related to endotracheal and suctioning stimuli, nutrition Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System support for BPD patients typically includes enteral feedings. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Bronchopulmonary Dysplasia 46. Chronic bronchitis is characterized by increased air flow rates, dyspnea, hypoxemia, and hypocapnia. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 47. Females are more than twice as likely to be diagnosed with chronic bronchitis as males. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 48. Malnutrition due to COPD can weaken respiratory muscles, resulting in altered ventilation, poor muscle strength, and impaired immune function. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 49. Glucose intolerance and cystic fibrosis–related diabetes occur in approximately 80% of CF patients over the age of 10. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 50. Pulmonary edema increases the thickness of the alveolar and capillary space, leading to impaired gas exchange, hypoxia, and overall increased work of breathing. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Respiratory Failure 51. The air enters the lungs through the trachea, which divides into the right and left _______________.

ANSWER: bronchi Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 52. The bronchioles end in small air sacs called _______________, which are paper thin.

ANSWER: alveoli DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 53. Gas exchange occurs in the _______________ unit.

ANSWER: alveolar–capillary DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Respiratory System 54. According to a meta-analysis examining the relationship between cigarette smoking and nutrient intakes, smokers have lower intakes of _______________ and fiber compared to non-smokers.

ANSWER: antioxidants DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition and Pulmonary Health 55. Inflammation is the primary problem in asthma and is thought to be _______________ mediated.

ANSWER: immune or IgE DIFFICULTY: Bloom’s Remember REFERENCES: Asthma 56. _______________ are chemical mediators produced by the body that contribute to the development of asthma.

ANSWER: Leukotrienes DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Asthma 57. Infants with bronchopulmonary dysplasia (BPD) often require prolonged, intensive hospitalization accompanied by mechanical _______________.

ANSWER: ventilation DIFFICULTY: Bloom’s Remember REFERENCES: Bronchopulmonary Dysplasia 58. Infants with BPD are at risk for delayed skeletal mineralization and _______________.

ANSWER: osteopenia DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Bronchopulmonary Dysplasia 59. Emphysema develops gradually over years, usually as a result of exposure to _______________.

ANSWER: cigarette smoke DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 60. Cardiac complications of COPD include _______________ and _______________ ventricular failure.

ANSWER: cor pulmonale; left Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 61. Emphysema results in a decreased forced _______________ volume.

ANSWER: expiratory DIFFICULTY: Bloom’s Remember REFERENCES: Chronic Obstructive Pulmonary Disease 62. Individuals with bronchitis frequently have a _______________ BMI. ANSWER: normal or above-normal DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 63. The use of glucocorticosteroids, systemic inflammation, smoking, vitamin D deficiency, low BMI, low fat-free mass, and decreased mobility increase the incidence of _______________ in people with COPD. ANSWER: osteoporosis DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Chronic Obstructive Pulmonary Disease 64. Newborn screening for CF tests for elevated immunoreactive _______________.

ANSWER: trypsinogen DIFFICULTY: Bloom’s Remember REFERENCES: Cystic Fibrosis 65. Poor weight gain and poor growth in CF result from poor intake, _______________ insufficiency, and increased nutrient needs.

ANSWER: pancreatic DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 66. Due to increased _______________ losses, individuals with CF should consume a high _______________ diet, particularly during the summer months or if they live in hot climates.

ANSWER: salt and salt DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Cystic Fibrosis 67. Pneumonia is defined as an inflammation of the lungs, usually caused by bacteria, viruses, or _______________.

ANSWER: fungi DIFFICULTY: Bloom’s Remember REFERENCES: Pneumonia 68. Pneumonia is considered a _______________ cause of acute respiratory distress syndrome.

ANSWER: direct DIFFICULTY: Bloom’s Remember REFERENCES: Respiratory Failure 69. Acute respiratory distress syndrome is associated with the production of oxygen free radicals and inflammatory Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System mediators derived from _______________.

ANSWER: arachidonic acid DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Respiratory Failure 70. An upper respiratory infection is commonly known as the _______________.

ANSWER: common cold DIFFICULTY: Bloom’s Remember REFERENCES: Upper Respiratory Infection 71. Describe the anatomy of the pulmonary system.

ANSWER: The pulmonary system includes the upper and lower respiratory tracts. The upper respiratory tract includes the nose, nasal cavity, frontal and maxillary sinuses, larynx, and trachea. The lower respiratory tract includes the lungs, bronchi, and alveoli.

DIFFICULTY: Bloom’s Apply REFERENCES: Normal Anatomy and Physiology of the Respiratory System 72. What are leukotrienes and how are they involved in asthma.

ANSWER: Leukotrienes are chemical mediators produced by the body that contribute to the development of asthma.

Leukotrienes, which are synthesized from arachidonic acid, modulate the inflammatory response resulting in tissue edema, mucus secretion, smooth-muscle proliferation, and powerful bronchoconstriction.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Asthma 73. Define COPD and the two primary problems with airflow.

ANSWER: Chronic obstructive pulmonary disease (COPD) is a progressive disease that limits airflow through either inflammation of the lining of the bronchial tubes (bronchitis) or destruction of alveoli (emphysema).

DIFFICULTY: Bloom’s Apply REFERENCES: Chronic Obstructive Pulmonary Disease 74. Describe the cause of cystic fibrosis (CF).

ANSWER: CF is caused by an abnormal mutation of the cystic fibrosis transmembrane conductance regulator gene (CFTR) found on chromosome 7. There are over 1,800 possible mutations of the CFTR gene.

DIFFICULTY: Bloom’s Apply REFERENCES: Cystic Fibrosis 75. List the three major cause-related categories of pneumonia.

ANSWER: There are three major categories of pneumonia based on the cause: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP).

DIFFICULTY: Bloom’s Apply REFERENCES: Pneumonia 76. Describe the pathophysiology and clinical manifestations of asthma.

ANSWER: When asthma occurs, bronchi and bronchioles respond to stimuli by contraction of smooth muscle (bronchoconstriction).The mucosa is inflamed and edematous, with an increased production of mucus.

This results in a partially or totally obstructed airway. The initial symptoms the patient may experience include cough, dyspnea, and a tight feeling in the chest. Signs may include wheezing, increased Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System respiratory rate, and labored breathing. Increased heart rate (tachycardia) and hypoxia may also be observed. Longer, prolonged episodes of asthma may result in respiratory alkalosis that can proceed to respiratory acidosis as well.

DIFFICULTY: Bloom’s Apply REFERENCES: Asthma 77. Describe bronchopulmonary dysplasia, including treatment.

ANSWER: Bronchopulmonary dysplasia (BPD), also called chronic lung disease of prematurity, is characterized by pulmonary inflammation and impaired growth and development of the alveoli. All babies with BPD have received supplemental oxygen for at least 28 days and are less than 32 weeks gestational age. Babies characterized with mild BPD do not require supplemental oxygen at 36 weeks post-menstrual age or discharge. Factors associated with BPD include acute respiratory distress during the first week of life, required oxygen therapy or mechanical ventilation, and persistent respiratory changes.

DIFFICULTY: Bloom’s Apply REFERENCES: Bronchopulmonary Dysplasia 78. Discuss the etiology of COPD in relation to cigarette smoking.

ANSWER: Chronic bronchitis, one of the principal classifications of COPD, is diagnosed in persons with a productive cough and shortness of breath that last about 3 months or more each year for 2 or more years in a row. Cigarette smoking is the primary cause; the longer and more heavily a person smokes, the more likely it is that he or she will develop bronchitis. Secondhand smoke may also cause bronchitis. Chronic bronchitis is seen in people of all ages but is more common in individuals over the age of 45. Females are more than twice as likely to be diagnosed with chronic bronchitis as males. Emphysema develops gradually over years, usually also as a result of exposure to cigarette smoke. Approximately 95% of Americans diagnosed with emphysema are 45 years of age or older. Given that not all smokers develop severe emphysema, their susceptibility or resistance may be linked to genetic factors.

DIFFICULTY: Bloom’s Apply REFERENCES: Chronic Obstructive Pulmonary Disease 79. Discuss the nutritional implications of cystic fibrosis (CF).

ANSWER: The relationship between nutrition status and long-term survival of individuals with CF is well documented. Pancreatic insufficiency results in poor digestion, poor absorption of fat and fat-soluble vitamins, and loss of bile and bile salts. Chronic pulmonary infections and deteriorating pulmonary function may lead to anorexia, increased energy requirements, and malnutrition. The more malnourished the patient is, the poorer his or her lung function. Children with CF may have stunted growth and inadequate weight gain because of inadequate supplies of nutrients due to a combination of anorexia and poor nutrient absorption. Lower-than-average height and weight are particularly pronounced in infants, adolescents, and individuals newly diagnosed with CF. DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Cystic Fibrosis 80. Discuss the pathophysiology of lung transplantation and organ rejection.

ANSWER: Transplant recipients are at high risk for rejection of the transplanted lung. The body’s immune system considers the transplanted organ an invader and may attack it. Because of the rejection risk, patients must take immunosuppressive (anti-rejection) medications. Rejection occurs most often during the first 3 months after transplantation, but the immunosuppressive medication may need to be taken indefinitely.

Common immunosuppressive drugs used are cyclosporine, tacrolimus, mycophenolate mofetil, azathioprine, and prednisone, which lower the body’s immunity and increase the risk of infection.

DIFFICULTY: Bloom’s Apply REFERENCES: Transplantation Copyright Cengage Learning. Powered by Cognero.

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Chapter 21 - Diseases of the Respiratory System

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Chapter 22 - Metabolic Stress and the Critically Ill 1. What is the key difference between the body’s physiological reaction to starvation and metabolic stress? a. adaptation occurs during metabolic stress b. adaptation occurs during starvation c. starvation can lead to death d. weight loss occurs with starvation e. metabolic stress is not related to diet ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation 2. What happens to the basal metabolic rate during starvation? a. no change b. increases c. reduces d. wildly fluctuates e. unpredictable ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation 3. What protein is released in response to inflammation? a. insulin b. cysteine c. histamine d. C-reactive protein e. lipase ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 4. What protein is used in copper transport? a. ceruloplasmin b. serum amyloid A c. VLDL d. C-reactive protein e. fibronectin ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 5. What is the metabolic pathway through which glucose is formed from non-carbohydrate sources? a. glycolysis b. glucogenesis c. glycogenesis d. glycogenolysis Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill e. gluconeogenesis ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 6. What is the term for a systemic inflammatory response and immunosuppressive process that prevents an adequate response to infection or trauma? a. allergic reaction b. sepsis c. hypoxic injury d. necrotizing fasciitis e. multiorgan distress syndrome ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 7. What is the term for reduced blood flow? a. hypotension b. cyanosis c. alkalosis d. hypoperfusion e. vasoconstriction ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 8. During periods of starvation, what is the primary source of fuel? a. protein b. glucose c. lipids d. amino acids e. connective tissue ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation 9. During metabolic stress, what supplies the substrate used for gluconeogenesis? a. breakdown of muscle tissue b. breakdown of body fat c. breakdown of connective tissue d. breakdown of bone minerals e. breakdown of brain tissue ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill 10. What are the three phases of the stress response? a. ebb phase, flow phase, recovery or resolution phase b. injury phase, healing phase, recovery phase c. reaction phase, adjustment phase, resolution phase d. hyper-stress phase, moderation phase, reduction phase e. reaction phase, healing phase, recovery phase ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 11. Catecholamines (epinephrine, norepinephrine) increase energy availability by stimulating glycogenolysis and increasing the release of what alternative fuel source? a. glucose b. galactose c. amino acids d. polypeptides e. fatty acids ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 12. What amino acid is the primary substrate required for gluconeogenesis? a. lysine b. arginine c. alanine d. glutamine e. cysteine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 13. What amino acid is the primary fuel for enterocytes within the gastrointestinal tract and for T lymphocytes? a. lysine b. arginine c. alanine d. glutamine e. cysteine ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 14. What condition causes the highest excretion of nitrogen per day from the body? a. major trauma b. major burn Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill c. starvation d. major surgery e. sleep deprivation ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 15. Interleukin 6 (IL-6) increases production of what acute-phase proteins? a. tumor necrosis factor b. C-reactive protein c. leukotrienes d. interferon e. histamine ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 16. How long, on average, does it take for a healthy patient to progress to protein-energy malnutrition (PEM)? a. 48 hours b. 1 week c. 2 weeks d. 4 weeks e. 8 weeks ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 17. For critically ill patients, when should enteral nutrition be started in the hospital? a. within 3-4 days b. after about 72 hours c. after about 60 hours d. within the first 24-48 hours e. immediately ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 18. What amino acid supplement is strongly recommended for burn, trauma, and ICU patients? a. arginine b. lysine c. cysteine d. tyrosine e. glutamine ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 19. Which amino acid is a precursor for nitric oxide and may help as a supplement for the metabolically stressed? a. arginine b. lysine c. cysteine d. tyrosine e. glutamine ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 20. What vitamins should be given to metabolically stressed patients while recovering? a. vitamins A and B6 b. vitamins B7 and C c. vitamins C and E d. vitamins D and E e. vitamins D and K ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 21. What mineral does ASPEN recommend for supplementation in the critically ill? a. iron b. selenium c. boron d. calcium e. magnesium ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 22. What enteral formula has the highest percentage of lipids? a. Perative® b. Pivot® c. Crucial® d. Oxepa® e. Impact® ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 23. Parenteral nutrition should be reserved for those cases of prolonged nothing by mouth (NPO) status lasting how long? a. 7 days Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill b. 10 days c. 14 days d. 21 days e. 28 days ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 24. What happens to blood pressure during sepsis? a. no change b. severe fluctuations c. hypotension d. hypertension e. hyperperfusion ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Sepsis, Systemic Inflammatory Response Syndrome, and Multi-organ Distress Syndrome/Multisystem Organ Failure 25. What cells in the blood are markedly increased during sepsis? a. granulocytes b. thrombocytes c. platelets d. red blood cells e. white blood cells ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Sepsis, Systemic Inflammatory Response Syndrome, and Multi-organ Distress Syndrome/Multisystem Organ Failure 26. What is the most common source of burn wounds? a. chemicals b. electricity c. radiation d. magnetic e. heat ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Burns 27. What factor is NOT correlated with the severity of electrical burns? a. temperature b. time of exposure c. voltage d. location affected Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill e. presence of water ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Burns 28. What type of burn is typically caused by exposure to hot oil? a. superficial b. superficial partial thickness c. deep partial thickness d. full thickness e. bone dissolving ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Burns 29. Depending on the burn size and severity, how long can the hypermetabolic stress last in burn patients? a. 4 years b. 2 years c. 1 year d. 6 months e. 3 months ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Burns 30. What are the daily protein requirements for burn victims? a. 0.5-0.7 g protein/kg IBW per day b. 0.8-1.1 g protein/kg IBW per day c. 1.1-1.5 g protein/kg IBW per day d. 1.5-2 g protein/kg IBW per day e. 1.9-2.4 g protein/kg IBW per day ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns 31. Enteral nutrition formulas for burn patients should be high in what nutrients? a. saturated fat and sucrose b. monounsaturated fat and glucose c. essential amino acids and simple carbohydrates d. protein and omega-6 fatty acids e. protein and omega-3 fatty acids ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill 32. What mineral supplements are most important for burn victims? a. iron and calcium b. zinc and selenium c. calcium and magnesium d. boron and selenium e. zinc and iron ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns 33. What did the National VA Surgical Risk Study find to be the best predictor of complications and mortality following surgical procedures? a. preoperative albumin levels b. liver function c. smoking d. blood pressure e. age ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Surgery 34. What is post-operative ileus? a. liver damage b. quick drop in blood pressure c. general paralysis of the GI tract d. severe headaches e. reduced stomach acidity ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Surgery 35. When should enteral and/or parenteral feeding be initiated after surgery? a. as soon as possible and safe b. 12-15 hours post-op c. 18- 24 hours post-op d. 1-2 days post-op e. at least 72 hours post-op ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Post-Surgery BM is a 35-year-old firefighter who has sustained major burns and smoke inhalation. He is taken to the burn unit and a consult with the registered dietitian has been ordered.

HT: 6’1”

WT: 180 pounds (81.6 kg)

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Chapter 22 - Metabolic Stress and the Critically Ill 36. What is the best way to estimate his caloric needs? a. Harris-Benedict equation b. Curreri equation c. Fick equation d. indirect calorimetry e. ESPEN guidelines ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns PREFACE NAME: Case22 37. What would be the best way to feed him while he’s in the hospital and cannot eat on his own? a. keep him NPO (nothing by mouth) indefinitely b. parenteral nutrition c. gastric feeding tube d. enteral feeding to the large bowel e. enteral feeding to the small bowel ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns PREFACE NAME: Case22 38. The dietitian should supplement with what amino acid to stimulate the GI tract? a. alanine b. arginine c. glutamine d. lysine e. cysteine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns PREFACE NAME: Case22 39. The dietitian should look for a formula that contains which of the following to induce an anti-inflammatory response? a. saturated fatty acids b. omega-3 fatty acids c. omega-6 fatty acids d. probiotics e. arginine ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns PREFACE NAME: Case22 Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill 40. What are his protein requirements while in the hospital? a. 1.5-2.0 g/kg of body weight b. 1.1-1.5 g/kg of body weight c. 0.9-1.2 g/kg of body weight d. 0.7-1.0 g/kg of body weight e. 0.5-0.7 g/kg of body weight ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns PREFACE NAME: Case22 41. It was not until the hallmark studies of Dr. Ancel Keys that the manner in which the body responds to starvation through physiological adaptations was understood. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation 42. Metabolic stress is the hypermetabolic, catabolic response to acute injury or disease. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 43. The degree of metabolic stress is inversely proportionate with the seriousness of the injury. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 44. Indirect calorimetry is the method of choice to establish energy and protein requirements for the critically ill. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 45. For critically ill individuals, nutritional needs can normally be met by the oral route. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill REFERENCES: Nutrition Therapy for Metabolic Stress 46. Once access to the GI tract has been established, the first step in developing the nutrition prescription is choosing the appropriate enteral formula. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 47. Multiorgan distress syndrome is also referred to as multisystem organ failure. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Sepsis, Systemic Inflammatory Response Syndrome, and Multi-organ Distress Syndrome/Multisystem Organ Failure 48. The depth of the wound and the percentage of the body surface area that is affected are used to classify burn injury. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Burns 49. Weaning from nutritional support is recommended when the patient is able to meet at least 25% of nutritional needs orally. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns 50. Many general surgical procedures do not pose nutritional risk. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Surgery 51. In burn patients, enteral nutrition that is initiated within 24 hours of injury has been associated with prevention of Curling’s _______________.

ANSWER: ulcer DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill 52. One of the most important distinctions between starvation and metabolic stress is the difference in _______________ and fuel substrate requirements.

ANSWER: energy DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation 53. Energy requirements are _______________ during metabolic stress and injury.

ANSWER: increased DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Starvation 54. Increased levels of glucagon serve to increase glucose production from amino acids – a process called _______________.

ANSWER: gluconeogenesis DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 55. Release of either glucagon or cortisol can result in _______________ during the stress response.

ANSWER: hyperglycemia DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 56. The increased rate of gluconeogenesis during the stress response creates reliance on protein as a source of _______________.

ANSWER: glucose DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 57. Negative _______________ balance is a consistent marker of metabolic stress.

ANSWER: nitrogen DIFFICULTY: Bloom’s Remember REFERENCES: Physiological Response to Stress 58. For normal-weight individuals, _______________ kcal/kg of actual body weight per day are recommended during critical illness.

ANSWER: 25–30 kcal/kg DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 59. When providing nutrition support to the critically ill, it is crucial to avoid _______________ and its subsequent metabolic complications, which include increased _______________ production and hyperglycemia.

ANSWER: overfeeding; CO2 DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 60. Compared to parenteral nutrition, _______________ is more cost-effective and is associated with reduced infectious complications, fewer surgical interventions, and fewer hospital days.

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Chapter 22 - Metabolic Stress and the Critically Ill ANSWER: enteral nutrition DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 61. Substrates such as inulin, guar gum, and other soluble fibers are fermented in the gut to _______________ and lactate.

ANSWER: short-chain fatty acids DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 62. Omega-3 fatty acids can serve to reduce the _______________ cytokines that are involved metabolic stress.

ANSWER: pro-inflammatory DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 63. Complications of enteral feeding may include metabolic complications, _______________, or mechanical complications.

ANSWER: aspiration DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Metabolic Stress 64. Sepsis is actually a(n) _______________ process that prevents an adequate response to infection.

ANSWER: immunosuppressive DIFFICULTY: Bloom’s Remember REFERENCES: Sepsis, Systemic Inflammatory Response Syndrome, and Multi-organ Distress Syndrome/Multisystem Organ Failure 65. Inflammation results in vascular _______________, which is caused by high levels of nitric oxide.

ANSWER: permeability DIFFICULTY: Bloom’s Remember REFERENCES: Sepsis, Systemic Inflammatory Response Syndrome, and Multi-organ Distress Syndrome/Multisystem Organ Failure 66. Burn wounds are described as superficial, superficial partial thickness, _______________ partial thickness, or _______________ thickness.

ANSWER: deep; full DIFFICULTY: Bloom’s Remember REFERENCES: Burns 67. _______________ burns destroy all layers of the skin and can involve underlying muscle, organs, and bone.

ANSWER: Full thickness DIFFICULTY: Bloom’s Remember REFERENCES: Burns 68. While the degree of hypermetabolism and catabolism correlates with the patient’s level of burn injury, researchers agree that the level of hypermetabolism does not increase beyond that reached for a _______________ percent total body surface area burn.

ANSWER: 50-60 Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Burns 69. Patients are required to refrain from eating or drinking for at least _______________ hours before surgery.

ANSWER: 12 hours DIFFICULTY: Bloom’s Remember REFERENCES: Surgery 70. General anesthesia may result in a post-operative _______________.

ANSWER: ileus DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Post-Surgery 71. Describe the main objectives of nutritional support for the critically ill.

ANSWER: Nutrition support has three main objectives: to preserve lean body mass, to maintain immune function, and to avert metabolic complications.

DIFFICULTY: Bloom’s Apply REFERENCES: Introduction 72. Describe the metabolic consequences of injury and stress.

ANSWER: The metabolic consequences of injury and stress result from numerous factors including hormone release, acute-phase protein synthesis, sustained inflammatory response, hypermetabolism, increased reliance on gluconeogenesis, and shifts in fluid balance and decreased urine output.

DIFFICULTY: Bloom’s Apply REFERENCES: Physiological Response to Stress 73. Explain what methods are used to feed the critically ill and when weaning can occur.

ANSWER: For critically ill individuals, nutritional needs can rarely be met by the oral route, and alternate feeding routes including both enteral and parenteral nutrition are standard components of the medical and nutritional care. As recovery proceeds and the patient is able, oral feedings can be initiated. Weaning from nutrition support is recommended when the patient is able to meet at least 60% of nutritional needs orally.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Metabolic Stress 74. List what four types of external forces can cause burns.

ANSWER: Burns are a result of tissue injury caused by exposure to heat, chemicals, radiation, or electricity.

DIFFICULTY: Bloom’s Apply REFERENCES: Burns 75. Describe how severe burn injuries affect the nutrition assessment.

ANSWER: Standard nutritional parameters are affected by both the nature of the burn injury and the metabolic stress response. High protein losses from wounds and the overall acute inflammatory response can affect accurate interpretation of the protein markers albumin, prealbumin, and C-reactive protein in relationship to nutritional status.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Burns Copyright Cengage Learning. Powered by Cognero.

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Chapter 22 - Metabolic Stress and the Critically Ill 76. Describe the clinical manifestations of the physiological response to stress.

ANSWER: The stress response has been described as a progression through three phases: the ebb phase, the flow phase, and the recovery or resolution phase. The ebb phase encompasses the immediate period after injury (2–48 hours). This period is characterized by shock resulting in hypovolemia and decreased oxygen availability to tissues. The reduction in blood volume results in decreased cardiac output and urinary output. The goal of medical care during this acute period is to restore blood flow to organs, maintain oxygenation of all tissues, and stop all hemorrhaging. As the patient stabilizes hemodynamically, the flow phase begins. This phase encompasses the classic signs and symptoms of metabolic stress: hypermetabolism, catabolism, and altered immune and hormonal responses. The final adaptation phase or recovery phase indicates a resolution of the stress with a return to anabolism and normal metabolic rate.

DIFFICULTY: Bloom’s Apply REFERENCES: Physiological Response to Stress 77. Discuss the importance of glutamine during times of metabolic stress.

ANSWER: Though glutamine is a non-essential amino acid, the body’s synthesis rate cannot meet the increased needs during the stress of critical illness. Glutamine has thus been recommended for burn, trauma, and ICU patients. Most specialized formulas provide 0.3–0.4 g/kg/day of glutamine, and glutamine can be added to an enteral formula that does not already contain it. Glutamine can also be supplemented parenterally and a recent review suggests that this route of supplementation may produce more consistent positive results. Glutamine is the preferred fuel for the enterocytes and assists in maintaining intestinal membrane permeability. Additionally, glutamine supports immune cell growth, reduces levels of pro-inflammatory cytokines, and is a precursor to the antioxidant glutathione.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Metabolic Stress 78. Provide a comprehensive definition of sepsis.

ANSWER: Sepsis has historically been defined as an uncontrolled inflammatory response to infection or trauma. It is now understood that sepsis is actually an immunosuppressive process that prevents an adequate response to infection and includes a range of conditions such as systemic inflammatory response syndrome and multi-organ failure. The Society for Critical Care Medicine defines sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection” and severe sepsis as sepsis plus “infection-induced organ dysfunction or hypoperfusion abnormalities.” Septic shock is defined as “severe sepsis with hypotension not reversed with fluid resuscitation and associated with organ dysfunction or hypoperfusion abnormalities.”

DIFFICULTY: Bloom’s Apply REFERENCES: Sepsis, Systemic Inflammatory Response Syndrome, and Multi-organ Distress Syndrome/Multisystem Organ Failure 79. Explain why nutrition therapy is so important for burn injuries.

ANSWER: The patient with a burn injury is at significant nutritional risk due to the hypermetabolic, catabolic response that occurs after the injury. It is estimated that as much as 20% of body protein can be lost within the first 2 weeks of a burn injury. Fluid imbalance, pain, and immobility make it difficult for the patient with extensive burns to maintain his or her nutritional status. And the patient requires optimal nutrition therapy to support wound healing during the treatment and recovery phases.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Burns 80. Describe the effects general anesthesia can have on the GI tract and how this effects post-operative feeding recommendations.

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Chapter 22 - Metabolic Stress and the Critically Ill ANSWER:

General anesthesia may result in a post-operative ileus (lack of motility), a general paralysis of the gastrointestinal tract. Resolution of the ileus generally occurs within 24–48 hours, depending on the type of procedure. Traditionally, the patient was prevented from eating or drinking until the ileus was resolved, and the production of gas or bowel movement was a sign of resolution of ileus. Because it is difficult to ascertain when GI function has returned, however, the determination of when to actually begin post-operative feeding has been debated. However, early feeding may become standard in postoperative protocols. Many patients who have entered surgery with nutritional deficits cannot withstand additional weight loss. Allowing a patient to be fed as soon after surgery as is possible and safe is recommended.

DIFFICULTY: Bloom’s Apply REFERENCES: Surgery

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Chapter 23 - Neoplastic Disease 1. How many types of diseases fall under the term “cancer”? a. 1 b. 10 c. about 25 d. at least 100 e. thousands ANSWER: d REFERENCES: Introduction KEYWORDS: Bloom’s Remember 2. Where does cancer rank in terms of causes of mortality in the United States? a. 1st b. 2nd c. 3rd d. 4th e. 5th ANSWER: b REFERENCES: Epidemiology KEYWORDS: Bloom’s Remember 3. What are the three deadliest cancers in American men (most mortality)? a. prostate, liver, lung b. liver, bone, brain c. lung, prostate, colorectal d. bone, lung, skin e. prostate, skin, pancreas ANSWER: c REFERENCES: Epidemiology KEYWORDS: Bloom’s Remember 4. What are the three deadliest cancers in American women (most mortality? a. lung, breast, colorectal b. breast, liver, bone c. brain, lung, breast d. bone, blood, brain e. breast, colorectal, pancreas ANSWER: a REFERENCES: Epidemiology KEYWORDS: Bloom’s Remember 5. What ethnicity has the higher incidence of cancer and mortality rates? a. Caucasian (European ancestry) b. Asian Americans c. Native Americans d. Latinos Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease e. African Americans ANSWER: e REFERENCES: Epidemiology KEYWORDS: Bloom’s Remember 6. What does the term angiogenesis refer to? a. increase in blood flow b. development of new blood vessels c. destruction of arteries d. synthesis of red blood cells e. change in blood pressure ANSWER: b REFERENCES: Glossary KEYWORDS: Bloom’s Remember 7. What does the term apoptosis refer to? a. genetic mutations b. stoppage of blood flow c. severe weight loss d. programmed cell death e. uncontrollable cell division ANSWER: d REFERENCES: Glossary KEYWORDS: Bloom’s Remember 8. What does the term cachexia mean? a. genetic mutations b. stoppage of blood flow c. severe weight and appetite loss d. programmed cell death e. uncontrollable cell division ANSWER: c REFERENCES: Glossary KEYWORDS: Bloom’s Remember 9. What term is used to infer the spread of cancer from the primary site to nearby or distant areas through the blood or lymph? a. metastasis b. malignant c. benign d. neoplasm e. apheresis ANSWER: a REFERENCES: Glossary KEYWORDS: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease 10. In 2014, how many people are estimated to die from cancer in the United States? a. about 1.1 million b. about 820,000 c. about 565,000 d. about 430, 000 e. about 255,000 ANSWER: c REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 11. Breast cancer accounts for what percentage of cancer-related deaths in American women? a. 41% b. 31% c. 24% d. 20% e. 14% ANSWER: e REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 12. In what phase of cell division is the DNA replicated? a. S phase b. G1 phase c. G2 phase d. G3 phase e. D phase ANSWER: a REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 13. What type of hormone promotes altered gene expression and is linked to prostate cancer? a. eicosanoids b. peptides c. catecholamines d. androgens e. estrogens ANSWER: d REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 14. Where does breast cancer typically metastasize to? a. bone and armpits b. brain and lung tissue c. GI tract and lung tissue Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease d. brain and liver e. bone and GI tract ANSWER: b REFERENCES: Pathophysiology KEYWORDS: Bloom’s Remember 15. What is the primary tumor marker for ovarian cancer that’s found in the blood? a. CEA b. HE4 c. PSA d. AFP e. CA15-3 ANSWER: b REFERENCES: Medical Diagnosis KEYWORDS: Bloom’s Remember 16. In the Tumor Node Metastases (TNM) Staging System, what does “N0” mean? a. nearby lymph nodes do not contain cancer b. nearby lymph nodes cannot be evaluated c. tumor can’t be measured d. metastasis can’t be evaluated e. no distant metastases were found ANSWER: a REFERENCES: Treatment KEYWORDS: Bloom’s Remember 17. In the Tumor Node Metastases (TNM) Staging System, what are the stages? a. 0, I, II b. I, II, III c. 0, I, II, III d. 0, I, II, III, IV e. I, II, III, IV, V ANSWER: d REFERENCES: Treatment KEYWORDS: Bloom’s Remember 18. What percent of cancer patients are purportedly cured by surgery? a. 5% b. 15% c. 22% d. 33% e. 40% ANSWER: e REFERENCES: Treatment Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease KEYWORDS:

Bloom’s Remember

19. What class of chemotherapy drug works by arresting cellular metaphase by inhibiting mitotic tubular formation (spindle)? a. alkylating agents b. nitrosureas c. antimitotics d. indirect DNA agents e. topoisomerase inhibitors ANSWER: c REFERENCES: Treatment KEYWORDS: Bloom’s Remember 20. What radionuclide, taken orally, is used to treat thyroid cancer? a. thyroxin b. carbon 14 c. iodine 131 d. gadolinium 153 e. strontium 90 ANSWER: c REFERENCES: Treatment KEYWORDS: Bloom’s Remember 21. Two types of cytokines are used to treat patients with cancer: a. chemokines and lymphokines b. interferons and interleukins c. monokines and interleukins d. interferons and lymphokines e. chemokines and monokines ANSWER: b REFERENCES: Treatment KEYWORDS: Bloom’s Remember 22. What growth factor is used to counteract side effects of certain chemotherapy regimens? a. exocrine b. endocrine c. skeletal d. hematopoietic e. metabolic ANSWER: d REFERENCES: Treatment KEYWORDS: Bloom’s Remember 23. What cells are used for hematopoietic stem cell transplantation? a. peripheral blood stem cells Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease b. fetal stem cells c. bone marrow stem cells d. brain tissue e. stem cells from pigs / cows ANSWER: a REFERENCES: Treatment KEYWORDS: Bloom’s Remember 24. What is the name of the procedure for harvesting stem cells from the blood? a. marrow scraping b. brachytherapy c. apheresis d. dysgeusia e. erythropoiesis ANSWER: c REFERENCES: Treatment KEYWORDS: Bloom’s Remember 25. Which chemotherapy agent has the lowest emetogenic potential? a. cisplatin b. mechlorethamine c. dacarbazine d. idarubicin e. rituximab ANSWER: e REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 26. What analgesic given to cancer patients is a common cause of nausea? a. ibuprofen b. acetaminophen c. ASA d. Demerol e. morphine ANSWER: e REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 27. What nutritional supplement may help cancer patients with nausea? a. ginger b. vitamin C c. black cohosh d. flaxseed e. milk thistle Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease ANSWER: a REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 28. What nutritional supplement is used by cancer patients with depression? a. PC-SPES b. St. John’s wort c. mistletoe extract d. Essiac tea e. coenzyme Q10 ANSWER: b REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 29. What nutritional supplement is used to treat prostate cancer patients? a. probiotics b. ginger c. tea d. flaxseed e. St. John’s wort ANSWER: c REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 30. What nutritional supplement may help stabilize weight in cancer patients on oral diets experiencing progressive, unintentional weight loss? a. B-complex vitamin b. probiotics c. PC-SPES d. dark chocolate e. omega-3 fatty acids ANSWER: e REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 31. What are the two agents that have been recognized as useful for appetite stimulation in cancer patients? a. methotrexate and anti-diarrheal agents b. sugar-free chewing gum and hard sour candy c. methotrexate and prokinetics d. megestrol acetate and corticosteroid agents e. cisplatin and corticosteroid agents ANSWER: d REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease 32. What is the survival rate of children who receive chemotherapy for acute lymphoblastic leukemia? a. 95% b. 80% c. 65% d. 40% e. 25% ANSWER: b REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 33. Pharmacologic doses of what amino acid may benefit patients undergoing hematopoietic cell transplantation? a. glutamine b. arginine c. lysine d. cysteine e. tyrosine ANSWER: a REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 34. What energy needs equation is commonly used to determine the caloric needs of cancer patients? a. Harris-Benedict equation b. WHO equation c. Mifflin-St. Jeor equation d. Institute of Medicine equation e. Schofield equation ANSWER: c REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 35. What is the average protein need per day for non-stressed cancer patients? a. 0.7–1.1 g/kg b. 1.0–1.5 g/kg c. 1.4–1.8 g/kg d. 1.9–2.5 g/kg e. 2.3–2.8 g/kg ANSWER: b REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember AS is a 54 year old business man who has a family history of lung cancer. AS started smoking at 15; years later, he got what he thought was a very bad cold that lasted for a week, started experiencing pain in his tongue, and was given ibuprofen for pain. He then noticed white sores that were getting bigger in his oral cavity near the tongue. He started feeling generally lousy and was unable to eat due to severe pain, and lost 30 lbs in a month. AS went to the clinic, where they did a biopsy that revealed squamous cell cancer of the tongue. AS has undergone radiation therapy (RT) Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease and surgery to remove the cancer and a restorative surgery was scheduled. Due to RT, AS has developed mucositis and xerostomia in his oral cavity. All his nodes that were sent to the laboratory tested negative for metastasis, and no further RT was needed. The surgeons felt confident that they had removed all the cancer.

HT: 5`11”

UBW: 165 lbs WT: 135 lbs

Meds: Corticosteroids and antineoplastic (dexamethasone) to reduce inflammation, K depletion, Na retention; and morphine for pain.

36. What is AS’s percent IBW? a. 78% b. 81% c. 87% d. 91% e. 103% ANSWER: b REFERENCES: Nutrition Therapy PREFACE NAME: AS KEYWORDS: Bloom’s Remember 37. Given AS’s weight loss, what would his MD likely diagnose him with? a. failure to thrive b. anorexia nervosa c. mildly underweight d. moderately underweight e. cancer cachexia ANSWER: e REFERENCES: Nutrition Therapy PREFACE NAME: AS KEYWORDS: Bloom’s Remember 38. What values should be used to estimate AS’s caloric requirements? a. 20-25 kcal/kg IBW b. 25-30 kcal/kg current body weight c. 30-35 kcal/kg current body weight d. 35-40 kcal/kg IBW e. 40-45 kcal/kg IBW ANSWER: c REFERENCES: Nutrition Therapy PREFACE NAME: AS KEYWORDS: Bloom’s Remember 39. What simple and inexpensive recommendation might help AS with his xerostomia? a. supplement with vitamin C b. chew sugar-free gum c. supplement with omega-6 fatty acids d. eat high fiber foods Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease e. supplement with coenzyme Q10 ANSWER: b REFERENCES: Nutrition Therapy PREFACE NAME: AS KEYWORDS: Bloom’s Remember 40. To help combat the mucositis what would the registered dietitian recommend? a. avoid acidic food b. rinsing with commercial mouthwash c. rinsing with hydrogen peroxide d. taking oral arginine e. using a tongue scraper ANSWER: a REFERENCES: Nutrition Therapy PREFACE NAME: AS KEYWORDS: Bloom’s Remember 41. Cancer of the lung and bronchus remains the number one killer in both men and women. a. True b. False ANSWER: True REFERENCES: Epidemiology KEYWORDS: Bloom’s Remember 42. Tumor suppressor genes normally cause apoptosis, but in a mutated form they may lose this function. a. True b. False ANSWER: True REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 43. A neoplasm is malignant when it grows without tissue invasion. a. True b. False ANSWER: False REFERENCES: Pathophysiology KEYWORDS: Bloom’s Remember 44. Biochemical analysis of blood, serum, urine, and other body fluids can detect tumor biomarkers. a. True b. False ANSWER: True REFERENCES: Medical Diagnosis KEYWORDS: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease 45. Palliative surgery is used to ameliorate disease and/or treatment-related symptoms and cure the cancer. a. True b. False ANSWER: False REFERENCES: Treatment KEYWORDS: Bloom’s Remember 46. It is estimated that 60% of patients with head and neck cancers will present with malnutrition at the time of diagnosis. a. True b. False ANSWER: True REFERENCES: Treatment KEYWORDS: Bloom’s Remember 47. Some biological therapies for cancer use live viruses or parasites to stimulate the body’s immune system to act against cancer cells. a. True b. False ANSWER: False REFERENCES: Treatment KEYWORDS: Bloom’s Remember 48. The most common cause of nausea and vomiting in cancer patients is radiation therapy. a. True b. False ANSWER: False REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 49. Nausea and vomiting related to radiation are dependent on the field being irradiated. a. True b. False ANSWER: True REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 50. Malnutrition is more prevalent in those who have been sick for longer periods of time, had multiple treatments, and have certain types of cancer including lung, pancreatic, GI, and ovarian cancers. a. True b. False ANSWER: True REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 51. Cancer is a disorder of cell _______________ and regulation.

ANSWER: growth Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease REFERENCES: Definition KEYWORDS: Bloom’s Remember 52. African-American women have a 10% _______________ incidence rate than white females for all cancers combined.

ANSWER: lower REFERENCES: Epidemiology KEYWORDS: Bloom’s Remember 53. There are two major types of genes that are thought to influence the development of cancer: oncogenes and _______________ genes.

ANSWER: tumor suppressor REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 54. _______________ is the study of changes in gene activity that are not caused by changes in the DNA sequence.

ANSWER: Epigenetics REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 55. Epidemiologic studies have found that heavy consumption of _______________ increase cancer risk, especially for colorectal, bladder, prostate, breast, gastric, oral, and pancreatic cancers.

ANSWER: red meats REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Remember 56. Cancers are characterized by unregulated cell growth, tissue invasion, and _______________.

ANSWER: metastasis REFERENCES: Pathophysiology KEYWORDS: Bloom’s Remember 57. Cancers are named based on their origin: those derived from epithelial tissue are called _______________.

ANSWER: carcinomas REFERENCES: Medical Diagnosis KEYWORDS: Bloom’s Remember 58. Because hair follicles also contain rapidly dividing cells, _______________ is also a common side effect of chemotherapy.

ANSWER: alopecia (hair loss) REFERENCES: Treatment KEYWORDS: Bloom’s Remember 59. _______________ involves the placement of radioactive sources either within an existing body cavity in close proximity to the tumor, or directly within a tumor.

ANSWER: Brachytherapy REFERENCES: Treatment KEYWORDS: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease 60. Radioimmunotherapy can also deliver radiation to a specific tissue through attachment to a(n) _______________ or other ligands.

ANSWER: monoclonal antibody (MAb) REFERENCES: Treatment KEYWORDS: Bloom’s Remember 61. Biological therapies that interfere with specific molecules involved in tumor growth and progression are also referred to as _______________ therapies.

ANSWER: targeted REFERENCES: Treatment KEYWORDS: Bloom’s Remember 62. _______________ are signaling proteins that are produced by white blood cells and help mediate and regulate immune responses, inflammation, and hematopoiesis.

ANSWER: Cytokines REFERENCES: Treatment KEYWORDS: Bloom’s Remember 63. Erythropoietin stimulates _______________ blood cell formation, and IL-11 increases _______________ production.

ANSWER: red; platelet REFERENCES: Treatment KEYWORDS: Bloom’s Remember 64. The most _______________ chemotherapeutic agents include cisplatin, methotrexate, doxorubicin, and cyclophosphamide.

ANSWER: emetogenic REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 65. Chemotherapy-induced mucositis commonly occurs _______________ days after chemotherapy is initiated.

ANSWER: 5-7 days REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 66. Probiotic therapy is a nutritional supplement used to help manage _______________.

ANSWER: diarrhea REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 67. _______________, or alterations in taste, can have a profound effect on a patient’s ability to ingest an adequate amount of nutrition.

ANSWER: Dysgeusia REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 68. Patients should be advised not to take _______________ supplements during radiation treatments.

ANSWER: antioxidant Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 69. Studies suggest that _______________ nutrition may be beneficial when used perioperatively in severely malnourished patients.

ANSWER: parenteral REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 70. Immune-enhancing enteral formulas containing mixtures of arginine, nucleic acids, and _______________ may be beneficial in malnourished patients undergoing major cancer operations.

ANSWER: essential fatty acids REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Remember 71. Define cancer.

ANSWER: Cancer is a disorder of cell growth and regulation. As defined by the National Cancer Institute, “cancer is a disease in which abnormal cells divide without control and are able to invade other tissues.”

REFERENCES: Definition KEYWORDS: Bloom’s Apply 72. List the primary signs and symptoms of cancer.

ANSWER: According to the American Cancer society, the primary categories of cancer signs and symptoms include: unexplained weight loss, fever, pain, fatigue, and skin changes.

REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Apply 73. List the tumor imaging techniques available today.

ANSWER: Imaging techniques include magnetic resonance imaging (MRI), computerized axial tomography (CT), X-rays, ultrasound, positron emission tomography (PET), mammograms, bone scans, and endoscopy.

REFERENCES: Medical Diagnosis KEYWORDS: Bloom’s Apply 74. Outline radiation therapy (RT) for cancer.

ANSWER: RT is delivered with electromagnetic rays (gamma rays and X-rays) and charged particles (electrons) and destroys cancer cells by altering cellular and nuclear material, especially DNA. REFERENCES: Treatment KEYWORDS: Bloom’s Apply 75. Describe the main causes of dysgeusia.

ANSWER: Many chemotherapeutic agents, specifically cisplatin, and radiation to the head and neck area cause dysgeusia, or alterations in taste. Furthermore, the presence of certain tumors can elicit taste changes even before any treatment is given.

REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Apply 76. Discuss the etiology of cancer.

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Chapter 23 - Neoplastic Disease ANSWER:

The etiology of cancer is multifactorial: genetic, environmental, and/or lifestyle factors result in genetic and epigenetic changes and unrestrained proliferation of cells. Risk factors include growing older; tobacco use; exposure to sunlight, ionizing radiation, certain chemicals and other substances (carcinogens), some viruses and bacteria, and certain hormones; family history of cancer; alcohol consumption; poor diet; lack of physical activity; and being overweight. Prevention guidelines were developed by the American Cancer Society (ACS). Screening is available for some cancers -- for example, the Papanicolaou (Pap) test and cervical exam screen for cervical cancer -- but unavailable for many others.

REFERENCES: Etiology of Cancer KEYWORDS: Bloom’s Apply 77. Discuss the diagnosis and complications of pancreatic cancer.

ANSWER: Pancreatic cancer is the fourth leading cause of cancer-related death for both men and women, and is responsible for 6% of all cancer-related deaths. Because pancreatic cancer can seldom be diagnosed when it is still localized and surgically resectable and effective systemic therapies are lacking, the incidence rates are virtually the same as the mortality rates. Pancreatic cancer is frequently diagnosed late due to the vague and non-specific symptoms that accompany the disease; however, weight loss and anorexia are common symptoms at diagnosis. Pancreatic exocrine insufficiency due to obstruction of the pancreatic duct commonly results in malabsorption and steatorrhea. Most patients with pancreatic cancer also have hyperglycemia.

REFERENCES: Treatment KEYWORDS: Bloom’s Apply 78. Describe the different types of chemotherapy agents.

ANSWER: Chemotherapy agents can be grouped into four broad categories: 1) those that target DNA during replication; 2) small molecules or “biologicals” (such as antibodies or cytokines) designed and developed to interact with a molecular target that leads to uncontrolled proliferation in the tumor cells; 3) hormonal therapies for aberrant cellular behavior, such as that in breast cancer; and 4) macromolecules that have a more specific target, such as cytokines or antibodies, that regulate growth of tumor cells or induce a host immune response to kill tumor cells. Combination chemotherapy, the co-administration of several drugs, may be used to achieve an additive effect.

REFERENCES: Treatment KEYWORDS: Bloom’s Apply 79. Describe the GI side effects of chemotherapy and how they can be managed.

ANSWER: Antineoplastic agents target those cells that have a high replication rate including those in the GI tract, resulting in diarrhea. In addition, these drugs, especially Antimetabolites (e.g., 5-fluorouracil), inhibit mitosis in rapidly proliferating crypt cells, leading to a disproportionate increase in the number of immature crypt cells. The patient with diarrhea should be encouraged to drink small amounts of fluid frequently throughout the day. Large amounts of fruit juices should be avoided as excessive fructose can exacerbate diarrhea. Clear liquid nutritional beverages and other oral rehydration fluids are recommended. Patients should be encouraged to use anti-diarrheal medications as prescribed by their physicians. Instructing the patient to increase his or her intake of foods high in soluble fiber may also help with the treatment of diarrhea.

REFERENCES: Disorders of Carbohydrate Metabolism KEYWORDS: Bloom’s Apply 80. Describe the causes and treatment for xerostomia.

ANSWER: Xerostomia, or reduced saliva production, is a common side effect of head and neck radiation and chemotherapy (methotrexate, 5-fluorouracil, paclitaxel, carboplatin, cisplatin). Other causes of Copyright Cengage Learning. Powered by Cognero.

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Chapter 23 - Neoplastic Disease xerostomia include dehydration, chronic graft-versus-host disease of the GI tract, and certain medications (narcotic analgesics). The severity of xerostomia is correlated with the severity of oral discomfort, dysgeusia, dysphagia, and dysphonia. Drugs used to treat cancer can also thicken the saliva, causing the mouth to feel dry. Treatment of xerostomia may include use of artificial saliva (saliva substitutes) and/or mouth moisturizers.

REFERENCES: Nutrition Therapy KEYWORDS: Bloom’s Apply

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Chapter 24 - HIV and AIDS 1. How is the HIV virus transmitted among people? a. aerosol b. body fluids c. casual touch d. inanimate objects e. animal vectors ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Introduction 2. Where do most of the HIV positive people in the world live? a. U.S. b. Caribbean c. Africa d. Asia e. Europe ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology 3. As of 2011, approximately how many people in the U.S. were living with HIV infection? a. 1.35 million b. 2.9 million c. 4.22 million d. 6.5 million e. 8.25 million ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology 4. What is the term for a measure of the strength of antigen–antibody binding? a. virulence b. adaptability c. antibody load d. antigen load e. avidity ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 5. What is the name for the medications that interrupt the viral replication cycle by inhibiting fusion of the HIV virus to the target cell? a. retro meds b. integrase strand transfer inhibitors c. protease inhibitors Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS d. fusion inhibitors e. entry inhibitors ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 6. What is the term for a change in a person’s antibody status from negative to positive? a. phenotype conversion b. seroconversion c. reciprocity d. serotransition e. genotype transition ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 7. What is unique about a retrovirus? a. it infects host cells b. it is highly virulent c. it targets CD4 cells d. it carries RNA rather than DNA e. it carries DNA rather than RNA ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 8. What symptom sometimes accompanies primary HIV infection? a. a skin rash b. a very high fever c. a flu-like syndrome d. a Candida infection e. bloody diarrhea ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 9. What are symptoms of lactic acidosis? a. abdominal pain, vomiting, rapid breathing b. high fever, sore throat, dehydration c. headache, shallow breathing, chest pain d. vomiting, diarrhea, hypertension e. high fever, anorexia, hypotension ANSWER: a DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS REFERENCES: Glossary 10. What kind of virus is HIV? a. retrovirus b. DNA virus c. bacteriophage d. rhabdovirus e. coronavirus ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Pathophysiology 11. How many genes does HIV contain? a. 3 b. 6 c. 7 d. 8 e. 9 ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Pathophysiology 12. Where do more than 60% of the body’s T lymphocytes reside? a. liver b. spleen c. GI tract d. lymph glands e. bone marrow ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 13. Viral DNA is combined with the cell's own DNA by what enzyme? a. transcriptase b. RNA protease c. receptorase d. integrase e. retroase ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 14. What musculoskeletal symptom is relatively common with HIV infection? a. osteoarthritis b. myopathy Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS c. ligament laxity d. tendonitis e. rheumatoid arthritis ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 15. What subtype of HIV is endemic in western Africa? a. HIV 1 b. HIV 2 c. HIV 3 d. HIV 4 e. HIV 5 ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis 16. How many clinical stages are used to categorize HIV infection, according to the WHO? a. 2 b. 3 c. 4 d. 5 e. 6 ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis 17. How many types or classes of antiretroviral medications are used to combat HIV infection? a. 2 b. 3 c. 4 d. 5 e. 6 ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 18. How many virons per day can the HIV virus reproduce in the human body? a. between 10,000 and 50,000 virons per day b. between 50,000 and 200,000 virons per day c. between 500,000 and 5 million virons per day d. between 50 million and 200 million virons per day e. between 1 billion and 1 trillion virons per day ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 19. What is a virus called that has not undergone mutations due to the use of antiviral meds? a. wild type b. pristine sample c. original viron d. first generation e. mother type ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 20. Which of the following HIV drugs tends to cause the most negative symptoms? a. maraviroc b. fosamprenavir c. ritonavir d. emtricitabine e. rilpivirine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 21. How much unexplained weight loss within 6 months is cause for a diagnosis of AIDS-related wasting syndrome (according to the CDC)? a. at least 5% b. at least 10% c. at least 15% d. between 15-20% e. between 20-25% ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 22. Why is Dronabinol used for HIV-positive patients? a. it is an anabolic steroid b. it is a sleeping aid c. it is an insulin resistance reducer d. it is an appetite stimulant e. it is an energy booster ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 23. Why is Nandrolone used for HIV-positive patients?

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Chapter 24 - HIV and AIDS a. to maintain lean muscle mass b. to aid in restful sleep c. to prevent insulin resistance d. to stimulate the appetite e. to boost energy ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 24. What is the beneficial function of Glitazones for HIV-positive patients? a. anabolic steroids b. sleeping aids c. insulin resistance reducers d. appetite stimulants e. energy boosters ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 25. What nutritional supplement or herb should not be taken with any protease inhibitor or non-nucleoside reverse transcriptase inhibitor? a. tea tree oil and selenium b. vitamin C and L-carnitine c. hydrogen peroxide and aloe vera d. Astragalus and olive leaf extract e. St. John’s wort and milk thistle ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 26. What nutritional supplement or herb improves antioxidant capacity of body and immune system, as well as increases iron absorption from non-heme sources? a. selenium b. aloe vera c. cat’s claw d. coenzyme Q10 e. vitamin C ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 27. Anecdotal reports suggest what nutritional supplement is effective in treating HIV-related infections and increasing CD4 cell counts? a. Hyssop b. milk thistle Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS c. propolis d. tea tree oil e. St. John’s wort ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 28. What BMI (body mass index) value is associated with increased risk for HIV-related morbidity and mortality? a. less than 17 b. less than 20 c. less than 22 d. less than 24 e. less than 27 ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 29. What percentage of weight loss is associated with increased risk for HIV-related morbidity and mortality? a. at least 1-2% b. at least 3-5% c. at least 5-10% d. at least 15% e. at least 20% ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 30. A CD4 count below what level defines AIDS? a. below 400/μL b. below 350/μL c. below 300/μL d. below 250/μL e. below 200/μL ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 31. What type of fatty acid is recommended to help reduce inflammation effects as well as improve lipid profiles? a. saturated fatty acids b. monounsaturated fatty acids c. omega-3 fatty acids d. omega-6 fatty acids e. omega-9 fatty acids ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 32. A low level of what nutrient is associated with greater HIV transmission risk between mother and child? a. iron b. vitamin A c. selenium d. vitamin E e. calcium ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 33. What kind of exercise improves insulin sensitivity? a. aerobic b. anaerobic c. static resistance d. progressive resistance e. fluctuating resistance ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 34. What kind of exercise is used to prevent muscle wasting, assuming an appropriate diet? a. aerobic b. anaerobic c. isotonic d. progressive resistance e. fluctuating resistance ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 35. Which medication is commonly used to treat chronic diarrhea? a. cisapride b. Kaopectate, c. megestrol acetate d. proton pump inhibitors e. H2 blockers ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy NP is a 30-year-old female who was diagnosed with HIV 10 years ago after exposure to the virus as a result of sharing needles (drug addiction). She has come to an outpatient clinic to get her medications and is now being visited by a Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS registered dietitian. She reports that a physician diagnosed her with listeriosis three months ago and prescribed antidiarrheal medication.

HT: 5’2

WT: 129 pounds

CD4 count: 451 cells/μL

UBW: 136 pounds (3 months ago)

Alb: 2.9 mg/dL

36. Currently, what is NP’s % UBW? a. 88% b. 90% c. 92% d. 95% e. 110% ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Treatment PREFACE NAME: Case24 37. What % body weight has NP lost? a. 12.6% b. 8.4% c. 3.1% d. 10.8% e. 5.1% ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Treatment PREFACE NAME: Case24 38. Given NP’s laboratory data, what clinical and immune cell category is she in? a. stage 0 b. stage 1 c. stage 2 d. stage 3 e. stage 4 ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Treatment PREFACE NAME: Case24 39. What recommendations might the RD suggest regarding NP’s diarrhea? a. avoid bland foods b. replace fluids and electrolytes c. increase caffeine consumption d. a high-fiber diet e. an appetite stimulant Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Treatment PREFACE NAME: Case24 40. If NP’s diarrhea cannot be remedied or controlled, what is the primary short-term concern? a. dehydration b. muscle cramps c. muscle wasting d. osteoporosis e. peripheral neuropathy ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Treatment PREFACE NAME: Case24 41. The estimated number of new HIV infections is greatest among men having sex with men in the youngest age group (13–24 years). a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology 42. HIV RNA is transcribed to DNA particles using reverse transcriptase enzymes. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Pathophysiology 43. The level of destruction of CD4 cells appears to be less predictive of survival than viral load. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 44. The Western blot test has a sensitivity of screening serologic tests of greater than 99.9%. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS 45. ARV medications are used to lower HIV load with the goal of achieving and maintaining an undetectable level of 800–1,000 copies/mL. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 46. Lipodystrophy syndrome is the significant gain of fat in the body during HIV infection. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 47. Growth hormone and related treatments have demonstrated efficacy in improving body cell mass. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 48. Because viral load and CD4 counts have been associated with changes in weight, a low viral load or a high CD4 count should be considered a nutritional risk factor. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 49. Limited evidence supports the use of the glycemic index, fiber, or specific fatty acids in individuals with HIV. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 50. Response to ART can vary according to sex, and men and women with HIV infection may experience problems associated with medication interactions differently. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 51. According to the World Health Organization, the HIV epidemic has _______________.

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Chapter 24 - HIV and AIDS ANSWER: leveled off DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology 52. HIV is most typically transmitted via _______________.

ANSWER: blood DIFFICULTY: Bloom’s Remember REFERENCES: Pathophysiology 53. There is a strong relationship among _______________ cell counts, HIV viral load, and progression to a diagnosis of AIDS. ANSWER: CD4 DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 54. Peripheral neuropathy has been associated with a number of the _______________ therapies.

ANSWER: antiretroviral DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 55. A number of _______________ abnormalities can persist despite the suppression of HIV replication.

ANSWER: immunologic DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations 56. Available assays to identify early HIV infection evaluate _______________ antigen levels and titers of viral RNA or DNA. ANSWER: p24 DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis 57. Combination _______________ testing for both antigen and antibodies allows for earlier diagnosis of HIV infection.

ANSWER: ELISA DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis 58. _______________ inhibitors interfere with the virus’s ability to bind to receptors on the outer surface of the cell it tries to enter.

ANSWER: Entry DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 59. Metformin reduces hepatic _______________ resistance and may be used to reduce the effect of _______________ accumulation.

ANSWER: insulin; fat DIFFICULTY: Bloom’s Remember REFERENCES: Treatment Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS 60. In 2010, the FDA approved the daily injectable drug _______________ to treat accumulation of visceral fat around the liver, stomach, and other abdominal organs.

ANSWER: Egrifta (tesamorelin) DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 61. _______________ syndrome is the loss or absence of fat or the abnormal distribution of fat in the body in HIV infection.

ANSWER: Lipodystrophy DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 62. AIDS-related wasting is similar to _______________, which is commonly seen in cancer patients.

ANSWER: cachexia DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 63. Oxymetholone is a drug given to HIV-positive patients to prevent _______________.

ANSWER: muscle wasting DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 64. Research has shown that _______________ can improve insulin resistance, metabolic abnormalities, and body composition in HIV patients.

ANSWER: chromium DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 65. Research shows that _______________ improves peripheral neuropathy and reduces levels of cholesterol and triglycerides in subjects with HIV. ANSWER: L-carnitine DIFFICULTY: Bloom’s Remember REFERENCES: Treatment 66. Food and nutrition insecurity can exacerbate _______________ in clients with HIV as well as encourage behaviors that increase the risk for exposure to HIV and affect treatment adherence.

ANSWER: malnutrition DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 67. HDL cholesterol levels are _______________ in AIDS patients.

ANSWER: decreased DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 68. Electrolyte levels are typically _______________ in AIDS patients.

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Chapter 24 - HIV and AIDS ANSWER: decreased DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 69. Proton pump inhibitors reduce acid and may affect absorption of _______________.

ANSWER: antiretrovirals DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 70. The most common symptoms related to the complications of HIV infection and treatments are _______________ and _______________.

ANSWER: fatigue; diarrhea DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy 71. What does HIV target and how does it result in immunodeficiency syndrome?

ANSWER: HIV targets many cells in the body, particularly CD4 T helper cells. The resulting immunodeficiency syndrome is most closely related to the infection of activated CD4 cells, which become viral factories.

DIFFICULTY: Bloom’s Apply REFERENCES: Pathophysiology 72. Define AIDS-related wasting syndrome (AWS).

ANSWER: AIDS-related wasting syndrome was identified as an AIDS-defining diagnosis by the CDC in 1987. The CDC’s definition states that weight loss of 10% without any known cause accompanied by fever or diarrhea for more than a month is AWS and qualifies for the diagnosis of AIDS DIFFICULTY: Bloom’s Apply REFERENCES: Clinical Manifestations 73. Provide an overview of treatment for chronic HIV infection.

ANSWER: Treatment for chronic HIV infection includes antiretroviral medications, prevention of and treatment for opportunistic events, modulation of the altered hormonal milieu, and maintenance and restoration of nutritional status.

DIFFICULTY: Bloom’s Apply REFERENCES: Treatment 74. Discuss the use of Atractylodes in HIV-positive individuals.

ANSWER: HIV-positive people use Atractylodes primarily to help increase body weight and muscle strength, reduce diarrhea, and enhance immune function. Atractylodes may also reduce platelet function.

DIFFICULTY: Bloom’s Apply REFERENCES: Treatment 75. Describe what a biochemical nutritional assessment for an HIV-positive patient involves.

ANSWER: Biochemical measures that assist in nutrition assessment of HIV-positive individuals include measures of disease progression (e.g., viral load, CD4 count), current inflammatory process (e.g., C-reactive protein), and general nutritional status, with inflammatory processes in mind (e.g., albumin, transferrin, others).

DIFFICULTY: Bloom’s Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS REFERENCES: Nutrition Therapy 76. Discuss renal problems associated with HIV infection.

ANSWER: Renal failure in the form of HIV-associated nephropathy (HIVAN) is associated with risk factors such as infection, certain medications, male gender, and black African ancestry. Tubular necrosis is associated with several medications commonly used in HIV-infected patients, such as acyclovir, tenofovir, adefovir, and cidofovir, among other nephrotoxic medications. Nephrolithiasis (formation of kidney stones) has been associated with indinavir, and adequate hydration is a key recommendation when using indinavir. Volume depletion, which can occur in patients experiencing diarrhea related to infections or medication tolerance, increase the risk for renal involvement and hyponatremia, hypokalemia, and other imbalances.

DIFFICULTY: Bloom’s Apply REFERENCES: Clinical Manifestations 77. Describe testing of genotype and phenotype assays for HIV mutations.

ANSWER: In addition to adequate testing for the presence and levels of HIV in the blood, testing for viral mutations through genotype and phenotype assays can assist the process of choosing the most potentially effective therapies. A genotype assay is used to identify points in the DNA sequence of the virus genome that may be mutated and cause resistance to treatment. Phenotype assays are used to determine viral susceptibility to a particular drug. In some cases, genotype predictions of drug resistance and phenotype testing for resistance may show different results or discordance. The prediction of virus susceptibility based on genotype and phenotype testing may assist in the effective use of medications and help to limit the exposure to medications and their associated toxicities when resistance is likely.

DIFFICULTY: Bloom’s Apply REFERENCES: Medical Diagnosis 78. Describe the different classes of antiretroviral meds used to combat HIV infection.

ANSWER: There are currently five classes of antiretroviral medications: 1) Entry inhibitors interfere with the virus’s ability to bind to receptors on the outer surface of the cell it tries to enter. When receptor binding fails, HIV cannot infect the cell; 2) Fusion inhibitors interfere with the virus’s ability to fuse with a cellular membrane, preventing HIV from entering a cell; 3) Nucleoside/nucleotide reverse transcriptase inhibitors are faulty DNA building blocks. When one of these faulty building blocks is added to a growing HIV DNA chain, no further segments can be added on, halting HIV DNA synthesis. Nonnucleoside reverse transcriptase inhibitors bind to reverse transcriptase, interfering with its ability to convert HIV RNA into HIV DNA; 4) Integrase strand transfer inhibitors block the HIV enzyme integrase, which the virus uses to integrate its genetic material into the DNA of the cell it has infected; and 5) Protease inhibitors interfere with the HIV enzyme called protease, which normally cuts long chains of HIV proteins into smaller individual proteins, thus preventing the assembly of new virus particles.

DIFFICULTY: Bloom’s Apply REFERENCES: Treatment 79. Describe clinical criteria used to diagnose HIV infection Clinical Stage 3 (according to the WHO).

ANSWER: Weight loss of greater than 10% of body weight; persistent constitutional symptoms such as fever, diarrhea; oral candidiasis (Candida albicans) or hairy leukoplakia; acute necrotizing ulcerative gingivitis or necrotizing ulcerative periodontitis within the oral cavity; pulmonary tuberculosis; severe bacterial infections in the lungs, GI tract; unexplained anemia, neutropenia, and/or thrombocytopenia for more than a month (confirmatory testing is required for anemias).

DIFFICULTY: Bloom’s Apply Copyright Cengage Learning. Powered by Cognero.

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Chapter 24 - HIV and AIDS REFERENCES: Treatment 80. Describe a nutritional risk screening for a patient with HIV infection.

ANSWER: Nutritional risk screening should be conducted on all patients with HIV infection, with follow-up assessment for identified risk factors. Initial screening may include items from a self-screener that can identify general risk factors related to access to food, consumption of food groups, symptoms, and so forth. An assessment can then be completed on patients who are at risk, or if baseline measurements are desired. Physical factors, biochemical factors, nutrition-related behaviors, and social factors are assessed.

Physical evaluation should include at least the minimum dataset of height, weight, and body mass index.

In addition, physical measures such as anthropometry, body composition, and examination for clinical signs of over- and under-nutrition can help to provide an overview of the patient's nutritional status and identify issues to address. Biochemical measures will include disease-related measures, nutrition-related measures, and selected measures of concomitant disease factors such as diabetes or cardiovascular disease. Patient food access and food choices should be explored with consideration to psychosocial and economic factors.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy

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Chapter 25 - Diseases of the Musculoskeletal System 1. What is the most abundant glycoprotein in the body? a. chondroitin sulfate b. glucosamine c. collagen d. arachidonic acid e. hyaluronic acid ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 2. What is the most common polysaccharide found in the proteoglycan molecules of cartilage? a. chondroitin sulfate b. glucosamine c. collagen d. arachidonic acid e. hyaluronic acid ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 3. Which of the following is a naturally occurring form of vitamin D produced in human skin? a. calcitonin b. cholecalciferol c. chondroitin d. ergocalciferol e. hydroxyapatite ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 4. Which of the following is a naturally occurring form of vitamin D produced in plants? a. calcitonin b. cholecalciferol c. chondroitin d. ergocalciferol e. hydroxyapatite ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 5. What type of cells synthesize, deposit, and then orient the fibrous proteins of the organic matter of the bone matrix? a. osteocytes b. osteoclasts c. chondrocytes d. osteogenic cells Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System e. osteoblasts ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 6. What type of bone-removing cells dissolve the mineral component of the bone matrix and play a major role in bone resorption? a. osteocytes b. osteoclasts c. chondrocytes d. osteogenic cells e. osteoblasts ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 7. Duchenne muscular dystrophy (DMD) is an X-linked disorder that mainly affects what demographic? a. people with Down’s Syndrome b. adult males c. adult females d. boys e. girls ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 8. What compound makes up 85% of the inorganic or mineral component of bone? a. calcium carbonate b. magnesium c. hydroxyapatite d. potassium e. glucosamine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 9. What compound makes up 10% of the inorganic or mineral component of bone? a. calcium carbonate b. magnesium c. hydroxyapatite d. potassium e. glucosamine ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System 10. Carpopedal spasm results from tetany occurring in the hands and feet and can be a sign of what? a. hypocalcemia b. hypercalcemia c. hypophosphatemia d. hyperphosphatemia e. hyperkalemia ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 11. The bones of the skeleton are made from what two types of osseous tissue? a. primary bone and secondary bone b. osseous bone and spongy bone c. compact bone and bone marrow d. chondrocytes and osteocytes e. cortical bone and trabecular bone ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 12. What is a common consequence of osteoporosis, which leads to loss of height? a. osteoarthritis b. osteopenia c. vertebral compression fractures d. muscle contraction e. bone spurs ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 13. Approximately how many American women currently are diagnosed with osteoporosis? a. 18 million b. 15 million c. 11 million d. 8 million e. 4 million ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 14. Research indicates that people residing above what latitude have insufficient sunlight exposure for optimal synthesis of vitamin D? a. 60 degrees north latitude b. 40 degrees north latitude Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System c. 20 degrees north latitude d. equator e. 20 degrees south latitude ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 15. What body type in women is a risk factor for osteoporosis? a. any body type b. small size, thin bones c. heavy set, thick bones d. short and stocky e. tall and muscular ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 16. What is the recommended daily amount of calcium for women between the ages of 51-70 years? a. 1,200 mg b. 1,400 mg c. 1,600 mg d. 1,800 mg e. 2,000 mg ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 17. What is the recommended daily amount of vitamin D for women 50 years and older (according to NOF guidelines)? a. 100 IU b. 200-500 IU c. 600 IU d. 800-1,000 IU e. 1,500 IU ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 18. Which of the following cheese types is the best source of calcium? a. feta cheese b. mozzarella cheese c. blue cheese d. ricotta cheese e. Romano cheese ANSWER: e Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 19. What type of fish / seafood is the best source of calcium? a. blue crab b. trout c. sardines d. ocean perch e. clams ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 20. Nicotine and cadmium in tobacco smoke are toxic to what type of cells? a. chondrocytes b. osteoclasts c. osteoblasts d. osteocytes e. osteogenic cells ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 21. What anti-inflammatory medication significantly increases the risk of osteoporosis? a. ASA b. glucocorticoids c. thiazolidinediones d. ibuprofen e. naproxen ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 22. What is the most common cause of rickets? a. calcium deficiency b. phosphorus deficiency c. vitamin C deficiency d. vitamin D deficiency e. lack of physical activity ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 23. What compound found in unrefined grains increases the risk of rickets? a. phytates Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System b. gluten c. omega-6 fatty acids d. arachidonic acid e. vitamin B12 ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 24. What noticeable physical deformity is characteristic of rickets? a. overly large skull b. crooked fingers and toes c. bowing of the legs d. scoliosis of the thoracic spine e. extensive skin rash ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 25. The American Academy of Pediatrics recommends that beginning at 2 months of age, exclusively breastfed infants be given a daily multivitamin supplement containing how much vitamin D? a. 50 IU b. 100 IU c. 200 IU d. 300 IU e. 400 IU ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 26. What organs are required for converting the vitamin D from the diet or synthesized in the skin into its biologically active form? a. liver and pancreas b. small intestine and large intestine c. pancreas and large intestine d. small intestine and kidneys e. liver and kidneys ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 27. What is the term for the destructive tissue formed in the synovial membrane of patients with advanced rheumatoid arthritis? a. pannus b. fibroids c. bone spurs Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System d. calcifications e. osteomas ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 28. What are three main physical characteristics of osteoarthritis? a. thick synovial membrane, pannus, severe swelling b. cartilage erosion, bone spurs, bone cysts c. reduced mineralization, tendonitis, cartilage cracking d. mild inflammation, bone deformity, hypermobility e. pannus, ligament laxity, hypomobility ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 29. What type of NSAID may increase the risk of coronary heart disease? a. ibuprofen b. naproxen c. COX-2 inhibitors d. diclofenac e. aspirin (ASA) ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 30. Increased serum concentration of what acid contributes to development of gout? a. hyaluronic acid b. ascorbic acid c. arachidonic acid d. citric acid e. uric acid ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 31. What type of diet increases the risk of gout? a. a vegetarian diet b. a diet rich in dairy c. a high-fiber diet d. a diet rich in purines e. a low cholesterol diet ANSWER: d DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System REFERENCES: Arthritic Conditions 32. What crystals precipitate out of the blood and become lodged in and around joints, causing gout? a. citrate crystals b. urate crystals c. ascorbate crystals d. hydroxyapatite crystals e. sodium chloride crystals ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 33. What type of arthritic condition may benefit from supplementing with glucosamine and chondroitin? a. osteoarthritis b. rheumatoid arthritis c. fibromyalgia d. gout e. osteoporosis ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 34. Willow bark may be helpful for osteoarthritis primarily due to what property? a. antipyretic b. analgesic c. anti-inflammatory d. blood thinning e. anti-hypertensive ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 35. What joint is most often affected by gout attacks? a. knee b. big toe c. shoulder d. upper neck e. wrist ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions KL is a 72-year-old African American female living in a long-term care facility close to the Canadian border. She has a history of RA, which was well controlled until recently. She reports taking calcium supplements and eating lots of cheese. She presents to the hospital with a hip fracture following a fall.

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Chapter 25 - Diseases of the Musculoskeletal System Height: 5’8”

Weight: 210 pounds

36. Which of the following conditions is most related to KL’s fracture? a. rheumatoid arthritis b. neuropathy c. osteoarthritis d. osteoporosis e. osteomalacia ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis PREFACE NAME: Case25 37. What is likely the primary cause of KL’s condition? a. calcium deficiency b. phosphorus deficiency c. being overweight d. RA meds e. low vitamin D status ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis PREFACE NAME: Case25 38. What non-permanent factor is most related to KL’s condition? a. her skin color b. her gender c. her physical location d. physical activity level e. her weight ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis PREFACE NAME: Case25 39. What is the recommended daily amount of vitamin D for KL, given her age and according to the NOF guidelines? a. 500-600 IU b. 800-1,000 IU c. 1,100-1,200 IU d. 1,200-1,500 IU e. 1,500-1,800 IU ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System PREFACE NAME: Case25 40. What is the best practical advice to give KL to help prevent future fractures? a. supplement with vitamin D b. move to a sunny climate c. take more calcium d. lose significant weight e. supplement with glucosamine / chondroitin ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis PREFACE NAME: Case25 41. Composed of cartilage, ligaments, tendons, and bones, the skeletal system forms a strong, tightly bound but flexible framework for the body. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 42. Collagen makes up about half of the total body protein by weight. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 43. It is estimated that 15-20% of the wet weight of cartilage is water. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 44. Osteoporosis is the most common bone disease in humans. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 45. Secondary osteoporosis is related to aging and decreased gonadal function. a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 46. African Americans and Hispanics with osteoporosis have the same elevated fracture risk as whites with osteoporosis. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 47. Rickets is characterized by inadequate maturation and mineralization of the cartilaginous growth plate and inadequate mineralization of the organic matrix within the bones of children. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 48. A major consequence of long-standing vitamin D deficiency is increased intestinal calcium absorption leading to hypercalcemia, which, in turn, results in decreased secretion of PTH. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 49. Arthritic conditions affect over one in five Americans and nearly one in four with the condition report activity limitation. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 50. Compared with females, arthritic conditions are diagnosed more frequently in males, who account for 85% of cases in persons age 15 years and older. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 51. Cartilage is formed by cells called _______________.

ANSWER: chondroblasts DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System REFERENCES: Normal Anatomy and Physiology of the Skeletal System 52. Muscular dystrophy is a term that refers to a group of over 30 different genetic disorders that reduce _______________.

ANSWER: muscle function DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 53. Chondrocytes have low rates of _______________ and cell division and, when injured, cartilage heals slowly.

ANSWER: metabolism DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 54. The average adult body contains about 500–800 g of _______________ and 85%–90% of this is in the bones.

ANSWER: phosphorus DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 55. _______________ are mature osteoblasts surrounded and entrapped by the ECM they have synthesized and calcified.

ANSWER: Osteocytes DIFFICULTY: Bloom’s Remember REFERENCES: Normal Anatomy and Physiology of the Skeletal System 56. Inadequate _______________ intake during growth will result in suboptimal development of peak bone mass and increased risk of osteoporosis in the latter decades of life.

ANSWER: calcium DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 57. Serum _______________ concentration is the best indicator of vitamin D status because it represents both dietary vitamin D intake and vitamin D synthesized by the body.

ANSWER: 25-hydroxyvitamin D DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 58. Bone mass peaks in the _______________ decade of life and slowly decreases thereafter.

ANSWER: third DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 59. _______________ account for up to 80% of the variance in peak bone mass between individuals.

ANSWER: Genetics DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 60. Bone mineral density (BMD) is best measured using _______________.

ANSWER: dual-energy X-ray absorptiometry (DXA) Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 61. Regular weight-bearing and muscle-strengthening exercise will reduce the risk of _______________ and fractures as well as increase _______________.

ANSWER: falls; bone density DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 62. _______________ reduces bone turnover, prevents bone loss, increases BMD by 5%–10% in the hip, spine, and total body, and significantly reduces fracture risk, but can also increase the risk of breast cancer.

ANSWER: Estrogen DIFFICULTY: Bloom’s Remember REFERENCES: Osteoporosis 63. An overt deficiency of _______________ is linked to rickets in children and osteomalacia in adults.

ANSWER: vitamin D DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 64. Rickets is a disease of _______________, whereas osteomalacia develops in _______________.

ANSWER: childhood; adults DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 65. Increased secretion of _______________ stimulates the removal of mineral from the organic matrix of bone in order to raise the serum calcium concentration, but also results in a weakening of bone.

ANSWER: PTH DIFFICULTY: Bloom’s Remember REFERENCES: Rickets and Osteomalacia 66. Among Americans 65 years of age and older, arthritic symptoms are second only to _______________ as the most commonly reported chronic condition.

ANSWER: hypertension DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 67. There are several factors known to increase the risk of some arthritic conditions, three of which are modifiable: overweight, _______________, and infections.

ANSWER: joint injuries DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 68. A loss of only 5 kg (11 lb) can reduce the risk of symptomatic _______________ by 50%.

ANSWER: knee osteoarthritis DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System 69. _______________ is a specific glycosaminoglycan found in the proteoglycans of articular cartilage.

ANSWER: Chondroitin DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 70. Chronic hyperuricemia can result in the formation of _______________crystals in the joints and the soft tissues surrounding the joints, which form large deposits called tophi.

ANSWER: uric acid DIFFICULTY: Bloom’s Remember REFERENCES: Arthritic Conditions 71. List the principal types of cells that are found in osseous tissue.

ANSWER: The four principal types of cells that are found in osseous tissue are osteogenic cells, osteoblasts, osteoclasts, and osteocytes.

DIFFICULTY: Bloom’s Apply REFERENCES: Normal Anatomy and Physiology of the Skeletal System 72. Define osteoporosis.

ANSWER: The U.S. National Institutes of Health (NIH) defines osteoporosis as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.

DIFFICULTY: Bloom’s Apply REFERENCES: Osteoporosis 73. Describe the causes of secondary osteoporosis.

ANSWER: Secondary osteoporosis results from chronic conditions that contribute significantly to accelerated bone loss, such as endogenous and exogenous thyroxine excess, hyperparathyroidism, malignancies, gastrointestinal diseases, medications, renal failure, and connective tissue diseases.

DIFFICULTY: Bloom’s Apply REFERENCES: Osteoporosis 74. Outline the difference between rickets, osteomalacia and osteoporosis.

ANSWER: In rickets and osteomalacia, the organic matrix is present, but it is not sufficiently mineralized. In osteoporosis, by contrast, a loss of both the organic matrix and bone mineral content occurs. Rickets is a disease of childhood, whereas osteomalacia develops in adults.

DIFFICULTY: Bloom’s Apply REFERENCES: Rickets and Osteomalacia 75. List the primary non-modifiable risk factors for arthritis.

ANSWER: The main non-modifiable risk factors for arthritic conditions include female gender, increasing age, and family history (genetic).

DIFFICULTY: Bloom’s Apply REFERENCES: Arthritic Conditions 76. Describe the function of osteoblasts.

ANSWER: Osteoblasts, or bone-building cells, produce the ECM and then participate in the calcification or mineralization of the matrix, in a process known as bone formation or mineral deposition. Active osteoblasts are found on the surface of newly forming bone. They remove ions of calcium, phosphate, Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System and other minerals from the blood plasma and deposit them within the bone ECM, thus hardening it. In response to bone fracture or the stress of weight-bearing exercise, the osteogenic cells multiply more rapidly and then differentiate to become osteoblasts.

DIFFICULTY: Bloom’s Apply REFERENCES: Normal Anatomy and Physiology of the Skeletal System 77. Describe the etiology of osteoporosis.

ANSWER: Risk of osteoporosis (primary or secondary) and related fractures is influenced by a number of factors.

Risk factors having a particularly strong bearing on the development of peak bone mineral density from childhood through early adulthood include genetic susceptibility and family history, female sex, Caucasian race, premenopausal amenorrhea, physical inactivity, and low lifetime calcium and vitamin D intakes. Low lifetime intakes of fluoride, magnesium, and zinc may also have a bearing. Genetics is a particularly important determinant of peak bone mass and of subsequent fracture risk. Factors that decrease bone remineralization and/or increase demineralization once peak BMD has been achieved include female sex, premenopausal amenorrhea, menopause before age 45 years, age, glucocorticoid therapy, cigarette smoking, physical inactivity, and low intakes of calcium and vitamin D. Low intakes of fluoride, magnesium, zinc, and vitamin K may also influence bone demineralization.

DIFFICULTY: Bloom’s Apply REFERENCES: Osteoporosis 78. Describe the treatment for osteomalacia.

ANSWER: Persons 65 years old and older are at increased risk of osteomalacia due to diets low in calcium and vitamin D, a lack of sun exposure, decreased efficiency in synthesizing vitamin D, and increased incidence of intestinal malabsorption problems. The treatment of osteomalacia should address the underlying causes. Effective treatment of vitamin D deficiency may require a multivitamin providing as much as 20 μg of vitamin D. Calcium intake should be adequate and may require a supplement providing as much as 1,500–2,000 mg of elemental calcium per day. Patients with severe, longstanding vitamin D deficiency may initially require pharmacologic doses of up to 1,250 μg per week for 3–12 weeks, followed by maintenance therapy of 20 μg per day. Patients taking drugs that accelerate hepatic breakdown of vitamin D, and those with intestinal malabsorption problems, will require vitamin D in doses much greater than the RDA. Patients with liver or kidney diseases that prevent the activation of vitamin D into its biologically active form will require a form of vitamin D that is already biologically active, such as calcitriol.

DIFFICULTY: Bloom’s Apply REFERENCES: Rickets and Osteomalacia 79. Describe the prevalence, symptoms, and treatment of fibromyalgia.

ANSWER: Fibromyalgia, also referred to as fibromyalgia syndrome or FMS, is a chronic musculoskeletal disorder characterized by widespread muscle pain, joint stiffness, disturbed sleep, fatigue, headache, cognitive and memory problems (sometimes referred to as “fibro fog”), paresthesias, irritable bowel syndrome, painful menstrual periods, and numerous tender points, which are specific muscle-tendon sites throughout the body that are painful when pressed. Fibromyalgia is the second most common musculoskeletal condition encountered by rheumatologists, affecting an estimated 5 million adults in 2005. Prevalence is about 2%, and is much higher among women than men (3.4% vs. 0.5%). The etiology of fibromyalgia is multifactorial and includes both environmental and genetic factors. Treating fibromyalgia involves a multidisciplinary approach aimed at improving the quality of sleep; treating depression, anxiety, and pain; increasing physical activity; and using various approaches to help patients better cope with stressful events and improve their ability to relax.

DIFFICULTY: Bloom’s Apply REFERENCES: Arthritic Conditions Copyright Cengage Learning. Powered by Cognero.

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Chapter 25 - Diseases of the Musculoskeletal System 80. Describe the etiology and clinical manifestations of osteoarthritis (OA).

ANSWER: OA is not a specific entity, but a disease process involving all the structures of the joint, including the articular cartilage, the subchondral bone, the synovial fluid and synovial membranes, the ligaments, and the nerves and muscles supporting the joint. However, the most striking changes seen in OA are those within the load bearing articular cartilage. Although osteoarthritis has been classified as a noninflammatory form, increasing evidence has shown that inflammation occurs as cytokines and metalloproteinases are released into the joint. These agents are involved in the excessive matrix degradation that characterizes cartilage degeneration in osteoarthritis. The progressive loss of articular cartilage and the inflammation of the other tissues composing the joint result in joint pain, stiffness, limited joint movement, wasting of periarticular muscles, and in some instances, joint instability and deformity. No specific laboratory abnormalities are associated with osteoarthritis and it is typically diagnosed on the basis of clinical and radiographic evidence.

DIFFICULTY: Bloom’s Apply REFERENCES: Arthritic Conditions

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Chapter 26 - Metabolic Disorders 1. How are most inborn errors of metabolism acquired? a. autosomal dominant inheritance b. autosomal recessive inheritance c. infection d. dietary deficiency e. blood toxicity ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology and Inheritance 2. What is the term used to refer to the variation in the presentation of metabolic disorders? a. variant b. genotype c. haplotype d. phenotype e. degree ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology and Inheritance 3. What is the insoluble component of starch? a. carnitine b. glucagon c. raffinose d. ribose e. amylopectin ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 4. What trisaccharide made of galactose, fructose and glucose cannot be digested by people? a. carnitine b. glucagon c. raffinose d. ribose e. amylopectin ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 5. What is a substrate needed for the normal metabolism of fat for energy? a. carnitine b. glucagon c. raffinose d. ribose Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders e. amylopectin ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Glossary 6. What is a common secondary consequence of metabolic defects? a. bacterial infections b. nutritional deficiencies c. arthritis d. cancer e. autoimmune disorders ANSWER: b DIFFICULTY: Bloom’sRemember REFERENCES: Pathophysiology of Impaired Metabolism 7. How many metabolic disorders can be screened for at a time using tandem mass spectroscopy? a. 110 b. over 80 c. 58 d. over 30 e. 15 ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis/Newborn Screening 8. Methylcrotonylglycinuria is a metabolic disorder of what branched-chain amino acid? a. valine b. isoleucine c. leucine d. tryptophan e. arginine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis/Newborn Screening 9. What is a common neurologic sign of inborn errors of metabolism in neonates? a. seizures b. hyperpnea c. tachypnea d. vomiting e. ectopialentis ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations of Inborn Errors of Metabolism Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders 10. What is a typical sign of an inborn error of metabolism that mothers quickly pick up on? a. baby smells funny b. baby won’t wake up c. baby bleeds from the ears d. baby yawns uncontrollably e. baby makes high-pitched screeches ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations of Inborn Errors of Metabolism 11. What amino acid supplement used for metabolic disorders displays antiatherogenic, antioxidant, and immunomodulatory properties? a. valine b. isoleucine c. leucine d. tryptophan e. arginine ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 12. What occurs with the amino acid disorder homocystinuria? a. cysteine is unable to be converted to homocysteine b. homocysteine is unable to be converted to cysteine c. homocysteine is unable to be converted to lysine d. homocysteine is unable to be converted to leucine e. cysteine is unable to be converted to leucine ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 13. How long are medium chain triglycerides? a. 16 – 20 carbons in chain length b. 12 – 15 carbons in chain length c. 9 – 11 carbons in chain length d. 6 – 8 carbons in chain length e. 4 - 5 carbons in chain length ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 14. Vitamin-responsive forms of methylmalonic acidemia are treated with pharmacological amounts of what vitamin? a. biotin b. B12 c. B6 Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders d. riboflavin e. thiamin ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 15. What is the most common amino acid disorder? a. homocystinuria b. phenylketonuria c. tyrosinemia d. isovaleric acidemia e. maple syrup urine disease ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 16. What is the affected amino acid in the metabolic condition homocystinuria? a. methionine b. leucine c. isoleucine d. phenylalanine e. cysteine ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 17. What is the affected amino acid in the metabolic condition phenylketonuria (PKU)? a. methionine b. leucine c. isoleucine d. phenylalanine e. cysteine ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 18. People with PKU can have a musty or mousy smell due to phenylketones accumulating where? a. breath b. sweat c. ear wax d. feces e. urine ANSWER: e DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders REFERENCES: Amino Acidopathies 19. What is the targeted blood Phe range, as recommended in the new ACMG guidelines, for all individuals with PKU? a. 20–30 μmol/L b. 65–105 μmol/L c. 120–360 μmol/L d. 400–600 μmol/L e. 650–820 μmol/L ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 20. What is the affected amino acid in the metabolic disorder isovaleric acidemia? a. valine b. tryptophan c. leucine d. isoleucine e. arginine ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Organic Acidemias 21. What is the affected amino acid in the metabolic disorder 3-hydroxyisobutyric aciduria? a. valine b. tryptophan c. leucine d. isoleucine e. arginine ANSWER: a DIFFICULTY: Bloom’s: Remember REFERENCES: Organic Acidemias 22. What is the most predominant type of mitochondrial disorders? a. fatty acid transport disorders b. fatty acid oxidation defects c. glycogen complex disorders d. respiratory chain disorders e. pyruvate complex disorders ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Mitochondrial Disorders 23. What is the function of riboflavin and thiamin in the respiratory chain? a. antioxidants b. cofactors Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders c. artificial electron receptors d. artificial electron transporters e. antivirals ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Mitochondrial Disorders 24. In holocarboxylase synthetase deficiency, what vitamin supplement is used as treatment and to prevent serious complications? a. thiamin b. riboflavin c. biotin d. niacin e. folic acid ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Disorders Related to Vitamin Metabolism and Vitamin-Responsive Metabolic Disorders 25. Toxicity is not a concern when megavitamin doses of what vitamins are used? a. antioxidants b. metabolic cofactors c. electron acceptors d. fat soluble e. water soluble ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Disorders Related to Vitamin Metabolism and Vitamin-Responsive Metabolic Disorders 26. For hereditary fructose intolerance, treatment includes dietary restriction of fructose, sucrose, and what other compound? a. glucose b. galactose c. aspartame d. stevia e. sorbitol ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 27. In addition to classic galactosemia, what are two variants of the disease? a. Duarte and Black b. variant I and variant II c. Edwards and Jackson d. dairy and fruit e. secondary and tertiary Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 28. What is the predominant dietary source of galactose? a. fructose from fruit b. lactose from milk c. glucose from honey d. glycogen from meat e. fiber from vegetables ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 29. How many enzymes are needed to convert fructose into intermediates of the glycolytic gluconeogenic pathway? a. 1 b. 2 c. 3 d. 4 e. 5 ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 30. Fructose-induced hypoglycemia results from inhibition of gluconeogenesis and what other process? a. glucogenesis b. glycogenesis c. the chaperoning effect d. glycolysis e. glycogenolysis ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 31. What type of glycogen storage disease causes a muscle phosphorylase deficiency? a. type II b. type III c. type IV d. type V e. type VI ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders 32. People from what region seem to have much less incidence of fat metabolism disorders? a. Africa b. Asia c. Europe d. United States e. Australia ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism 33. What type of vegetable oil contains the most linolenic acid? a. flaxseed b. safflower c. corn d. peanut e. olive ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism 34. What type of vegetable oil contains the most linoleic acid? a. flaxseed b. safflower c. corn d. peanut e. olive ANSWER: b DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism 35. What type of fatty acids are linoleic and linolenic acids? a. short-chain b. medium-chain c. long-chain d. very long-chain e. polysaccharide ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism PD is an 11-month-old boy with phenylketonuria (PKU). His mother brought him to an outpatient nutrition center in the local pediatric hospital for evaluation.

Length: 28 inches

Weight: 19 pounds (8.7 kg)

36. What are PD’s daily caloric needs?

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Chapter 26 - Metabolic Disorders a. 1,151 kcal b. 1,022 kcal c. 986 kcal d. 914 kcal e. 845 kcal ANSWER: d DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies PREFACE NAME: Case26 37. What are PD’s daily protein needs? a. about 32 g b. 30.6 g c. about 29 g d. 27.8 g e. about 24 g ANSWER: e DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies PREFACE NAME: Case26 38. What is the highest total amount of phenylalanine that PD should consume during any single day? a. 168.5 b. 246 mg c. 304.5 mg d. 391 mg e. 451.5 mg ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies PREFACE NAME: Case26 39. Phe restriction should achieve optimal blood Phe levels of: a. 20–30 μmol/L b. 65–105 μmol/L c. 120–360 μmol/L d. 400–600 μmol/L e. 650–820 μmol/L ANSWER: c DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies PREFACE NAME: Case26 40. What are two common PKU characteristics that PD’s mom likely noticed in her son?

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Chapter 26 - Metabolic Disorders a. very light complexion and musty smelling urine b. dark skin pigmentation and foul breath c. bowed legs and high pitched screeching d. bloody diarrhea and muscle paralysis e. severe insomnia and fatty stool ANSWER: a DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies PREFACE NAME: Case26 41. Impaired metabolism of nutrients can be caused by a defective gene that results in a change to the binding site of cofactors. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Pathophysiology of Impaired Metabolism 42. The detection of inborn errors of metabolism is complicated by the fact that many symptoms are non-specific and can be similar from one inborn error of metabolism to the next. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis/Newborn Screening 43. Skin lymphocytes or peripheral blood fibroblasts can be used to determine the extent of enzymatic activity present. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations of Inborn Errors of Metabolism 44. Additional amounts of cofactor can provide for a chaperoning effect where the cofactor helps to stabilize the enzyme complex, allowing for an increase in enzyme activity. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 45. Isovaleric acidemia (IVA) is an amino acid disorder affecting the metabolism of multiple amino acids. a. True b. False ANSWER: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 46. The genetic defect in phenylalanine hydroxylase leads to a reduction in or an absence of phenylalanine hydroxylase activity. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 47. Urea cycle disorders result in an impaired capacity of the body to excrete nitrogen in the form of urea. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Urea Cycle Disorders 48. Mitochondria are found in every cell in the human body. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Mitochondrial Disorders 49. Because galactose is a monosaccharide found in milk products, galactosemia may be rapidly fatal in infants if milk feedings are not discontinued. a. True b. False ANSWER: True DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 50. Fatty acids must be taken into the mitochondria using the leucine transport system. a. True b. False ANSWER: False DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism 51. In an autosomal recessive disorder, carrier parents have a _______________ percent chance of having an affected child with each pregnancy.

ANSWER: 25 DIFFICULTY: Bloom’s Remember REFERENCES: Epidemiology and Inheritance Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders 52. Enzymatic precursors can accumulate as a direct result of a block or as a result of impaired _______________ related to the inability to produce the end substrate.

ANSWER: feedback inhibition DIFFICULTY: Bloom’s Remember REFERENCES: Pathophysiology of Impaired Metabolism 53. Selective neonatal screening is the testing of an individual known to be at increased risk for a _______________ disorder.

ANSWER: genetic DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis/Newborn Screening 54. Tandem _______________ allows clinicians to screen for over 30 metabolic disorders by analyzing metabolites in a blood spot collected on a filter paper from a simple heel prick on the newborn.

ANSWER: mass spectroscopy DIFFICULTY: Bloom’s Remember REFERENCES: Medical Diagnosis/Newborn Screening 55. Neonates with a metabolic disorder generally show acute central nervous system symptoms, including generalized or partial _______________.

ANSWER: seizures DIFFICULTY: Bloom’s Remember REFERENCES: Clinical Manifestations of Inborn Errors of Metabolism 56. _______________ is used to remove and detoxify waste products that accumulate in organic acid disorders affecting the metabolism of proteins, carbohydrates, and/or fats.

ANSWER: Carnitine DIFFICULTY: Bloom’s Remember REFERENCES: Medical Approaches to Treatment 57. While certain amino acids may be restricted in individuals with inborn errors of metabolism, essential nutrients, such as proteins, cannot be restricted over a prolonged period as the body will become ________________ if deprived for an extended period of time.

ANSWER: catabolic DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 58. In glycogen storage disease type III, protein is used as an alternative source of glucose production, via the _______________ shunt.

ANSWER: alanine DIFFICULTY: Bloom’s Remember REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 59. The deficiency or absence of the phenylalanine _______________ enzyme leads to the inability to convert the essential amino acid phenylalanine into the amino acid _______________.

ANSWER: hydroxylase; tyrosine DIFFICULTY: Bloom’s Remember Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders REFERENCES: Amino Acidopathies 60. Untreated _______________ can cause neurologic abnormalities.

ANSWER: PKU DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 61. Sapropterindi hydrochloride is an oral formulation of the biologically active tetrahydrobiopterin, cofactor to the _______________ hydroxylase enzyme.

ANSWER: phenylalanine DIFFICULTY: Bloom’s Remember REFERENCES: Amino Acidopathies 62. Organic acidemias are a subset of _______________ disorders that involve a dysfunction in the metabolism of intermediary products.

ANSWER: amino acid DIFFICULTY: Bloom’s Remember REFERENCES: Organic Acidemias 63. The urea cycle resides primarily in the _______________, but this process can also take place to a lesser extent in the kidneys and small intestine.

ANSWER: hepatocytes DIFFICULTY: Bloom’s Remember REFERENCES: Urea Cycle Disorders 64. Mitochondria are essential for the production of _______________ in all types of tissues.

ANSWER: energy DIFFICULTY: Bloom’s Remember REFERENCES: Mitochondrial Disorders 65. With the exception of ornithine transcarbamylase (OTC) deficiency, all urea cycle disorders have a(n)_______________ recessive mode of inheritance.

ANSWER: autosomal DIFFICULTY: Bloom’s Remember REFERENCES: Urea Cycle Disorders 66. A pharmacologic dose of vitamin B12 is given to a newly diagnosed patient with _______________ acidemia to determine whether the enzymatic defect is vitamin responsive.

ANSWER: methylmalonic DIFFICULTY: Bloom’s Remember REFERENCES: Disorders Related to Vitamin Metabolism and Vitamin-Responsive Metabolic Disorders 67. In patients with galactosemia, the enzyme defect occurs in uridyltransferase, which normally converts galactose, in the form of galactose-1-phosphate, to _______________ -1-phosphate.

ANSWER: glucose DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism Copyright Cengage Learning. Powered by Cognero.

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Chapter 26 - Metabolic Disorders 68. Some of the galactose in fruits and vegetables may be found as the galactose _______________, raffinose and stachyose, and hence is most likely unavailable for absorption.

ANSWER: oligosaccharides DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Carbohydrate Metabolism 69. Once inside the mitochondria, the process of beta-oxidation is used to convert the fatty acids to _______________.

ANSWER: ketone bodies DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism 70. Carnitine is usually supplemented if the amount of free carnitine is _______________ and/or the ratio of esterified to free carnitine is _______________.

ANSWER: low; high DIFFICULTY: Bloom’s Remember REFERENCES: Disorders of Fat Metabolism 71. Describe how clinicians screen for multiple metabolic disorders in infants.

ANSWER: Tandem mass spectroscopy allows clinicians to screen for over 30 metabolic disorders by analyzing metabolites in a blood spot collected on a filter paper from a simple heel prick on the newborn.

DIFFICULTY: Bloom’s Apply REFERENCES: Medical Diagnosis/Newborn Screening 72. Define the alanine shunt and in what disease it is used.

ANSWER: The alanine shunt is a process that allows glucose production from protein sources through conversion of the amino acid alanine to pyruvate to glucose in the liver; the glucose produced can then be used in the muscle to generate additional alanine. In glycogen storage disease type III, protein is used as an alternative source of glucose production, via the alanine shunt, since the use of carbohydrates is compromised due to the glycogen debranching enzyme malfunction.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 73. Describe the use and benefits of sapropterin dihydrochloride.

ANSWER: Sapropterin dihydrochloride is an oral formulation of the biologically active tetrahydrobiopterin, cofactor to the phenylalanine hydroxylase enzyme. Sapropterin is effective for lowering blood Phe levels in some individuals with PKU by activating residual activity of the PAH enzyme. Sapropterin improves dietary Phe tolerance, allowing more dietary consumption of natural sources of protein.

DIFFICULTY: Bloom’s Apply REFERENCES: Amino Acidopathies 74. Describe the etiology of urea cycle disorders.

ANSWER: Ammonia is normally converted to urea in the liver by means of several biochemical steps and eventually excreted as urea. A disruption in any one of the eight component pathways involved in the urea cycle results in disorders of the urea cycle. These pathways are governed by enzymes that undergo a cascade of enzymatic transformations to convert the toxic ammonia molecule to non-toxic, water-soluble urea, which contains two nitrogen groups and is eliminated in the urine. Therefore, urea cycle disorders result in an impaired capacity of the body to excrete nitrogen in the form of urea.

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Chapter 26 - Metabolic Disorders DIFFICULTY: Bloom’s Apply REFERENCES: Urea Cycle Disorders 75. Explain how fructose is normally metabolized.

ANSWER: Fructose is predominantly metabolized in the liver, kidney, and small intestine in a specialized pathway composed of three enzymes -- fructokinase, aldolase type B, and triokinase -- that convert fructose into intermediates of the glycolytic gluconeogenic pathway.

DIFFICULTY: Bloom’s Apply REFERENCES: Disorders of Carbohydrate Metabolism 76. Describe supplementation of end products as an approach for chronic management of metabolic disorders and provide a specific example.

ANSWER: Substrates that should have been formed from the enzymatic reactions that are defective in metabolic disorders are needed for energy production, protein turnover, feedback inhibition of metabolic pathways, and/or production of other substrates. In the case of metabolic blocks in these enzymatic reactions, an alternative means of achieving the end goal of the reaction must be provided. In glycogen storage disease type I, for example, the enzymatic block results in an inability to produce glucose. Consequently, providing a continuous source of glucose through frequent feedings is the therapy for this disorder.

Similarly, in the amino acid disorder homocystinuria, where the amino acid homocysteine is unable to be converted to cysteine, cysteine consequently needs to be supplemented in the diet.

DIFFICULTY: Bloom’s Apply REFERENCES: Nutrition Therapy for Inborn Errors of Metabolism: General Guidelines 77. Discuss the epidemiology of amino acidopathies.

ANSWER: Amino acid disorders include conditions affecting the metabolism of a single amino acid, such as PKU or isovaleric acidemia (IVA), as well as disorders involving multiple amino acids, such as MSUD. Several of these conditions were discovered less than 50 years ago. Incidence of these disorders can vary significantly, with the most common amino acid disorder, PKU, having an incidence of 1 in 15,000 births. The rarer disorders such as isovaleric acidemia or homocystinuria, however, have incidences of less than 1 in 100,000 births. Incidence of these disorders can vary based on ethnicity. Those populations that tend to be more homogenous have been found to have higher rates of certain disorders. For example, MSUD has been detected at an incidence of 1 in 290,000 births in state screening programs. In the Mennonite Community, a homogeneous group in Pennsylvania, there is a much higher prevalence for this condition at 1 in every 790 births.

DIFFICULTY: Bloom’s Apply REFERENCES: Amino Acidopathies 78. Describe the acute nutritional interventions used for urea cycle disorders.

ANSWER: Initial treatment includes administration of intravenous fluids because many infants are dehydrated at presentation due to anorexia and poor oral intake. Over-hydration should be avoided because most patients with urea cycle defects have some degree of cerebral swelling. Caloric supplementation should be maximized to reverse catabolism and nitrogen turnover. In addition to glucose, intralipid administration can provide much-needed kilocalories in a smaller volume. Complete protein restriction is recommended only for a 24- to 48-hour period in order to avoid depletion of essential amino acids, which would result in further protein catabolism and nitrogen release. If enteral feedings cannot be tolerated, total parenteral nutrition (TPN) should be started. When protein is reintroduced into the diet, a standard TPN solution with a low percentage of amino acids may be used if TPN is only needed for a short duration. If enteral feedings are not resumed quickly, then the use of a special TPN solution rich in the essential branched-chain amino acids should be considered.

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Chapter 26 - Metabolic Disorders REFERENCES: Urea Cycle Disorders 79. Describe the causes, symptoms and incidence of galactosemia.

ANSWER: Classical galactosemia is an enzyme defect in galactose metabolism leading to failure to thrive, hepatomegaly (enlarged liver), and life-threatening sepsis in the newborn period. Vomiting and jaundice may develop as early as a few days after milk feedings are begun. Anorexia, failure to gain weight or to grow, or even weight loss ensues. In the absence of treatment, parenchymal damage to the liver leads to the development of cirrhosis. Patients may present with edema, ascites, bleeding problems, and an enlarged spleen. Because galactose is a monosaccharide found in milk products, the disease may be rapidly fatal if milk feedings are continued. Other complications associated with the continued ingestion of galactose include cataract formation, mental retardation, and renal tubular dysfunction. All states now screen for galactosemia in the newborn period before symptoms are present or complications of the disease have taken place. Galactosemia has been reported to occur in approximately one in every 60,000–80,000 births in the United States.

DIFFICULTY: Bloom’s Apply REFERENCES: Disorders of Carbohydrate Metabolism 80. Describe the acute nutritional interventions used for disorders of fat metabolism.

ANSWER: The metabolic crises associated with disorders of fatty acid metabolism are usually precipitated by febrile illness, fasting, and/or excess energy expenditure. Acute treatment is aimed at stopping catabolism and the subsequent release of free fatty acids. Use of antipyretic and antiemetic medications to reduce fever and vomiting is helpful. Intravenous dextrose is used to provide a constant source of glucose. The high-glucose feedings used in order to prevent or recover from hypoglycemia may necessitate the use of insulin to achieve euglycemia. The dextrose should not be discontinued until the patient is able to maintain his or her blood sugar and to tolerate enteral feedings. The use of mediumchain triglycerides in treatment of disorders besides MCADD is an effective way to provide additional calories without increasing the load on the enzymatic block. Fluids should be provided at a rate of 1.5-2 times maintenance requirements in order to flush out the metabolites. Carnitine can be given either intravenously or by mouth to help conjugate the excess fatty acids.

DIFFICULTY: Bloom’s Apply REFERENCES: Disorders of Fat Metabolism

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