Understanding Normal And Clinical Nutrition 11th Edition by Sharon Rady Rolfes, Kathryn Pinna, Ellie

Understanding Normal and Clinical Nutrition 11th Edition Rolfes Test Bank MULTIPLE CHOICE

1 : Research suggests that genetics is likely to influence dislikes.

A : ad susceptibility B : ethnic biases C : taste perception D : socioeconomic status

and, therefore, food likes and

Correct Answer : C 2 : A child develops a strong dislike of noodle soup after she eats some while sick with the flu.

This is an example of a food-related .

A : habit B : association C : emotion D : social interaction Correct Answer : B 3 : A person who eats a bowl of oatmeal for breakfast every day is most likely making a food choice based on .

A : environmental concerns B : availability C : ethnic heritage D : habit Correct Answer : D 4 : Approximately what percentage of meals in the United States is prepared in the home?

A : 30 B : 50 C : 70 D : 90 Correct Answer : C 5 : Individuals who frequently prepare their own meals are more likely to A : consume larger amounts of fat, protein, and kcalories B : have a lower incidence of acute health problems C : report more positive emotions and healthier food choices D : eat with family members than to eat alone

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Correct Answer : C 6 : Eating in response to negative emotions and stress can easily lead to A : overweight and obesity B : food aversions C : healthy food choices D : lack of appetite

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Correct Answer : A 1 / 14

7 : Foods that provide health benefits beyond their nutrient combinations are called A : health-enhancing foods B : enriched foods C : fortified foods D : functional foods

.

Correct Answer : D 8 : What are the simplest types of functional foods?

A : whole foods B : food supplements C : commercial foods D : antioxidants Correct Answer : A 9 : Nonnutrient substances found in plant foods that show biological activity in the body are commonly known as .

A : folionutrients B : inorganic nutriments C : phytochemicals D : carotenoids Correct Answer : C 10 : What is the best example of a functional food?

A : tomato B : instant oatmeal C : white bread D : calcium-fortified orange juice Correct Answer : D 11 : Approximately how much water would be found in a 120-pound person?

A : 12 pounds B : 24 pounds C : 36 pounds D : 72 pounds Correct Answer : D 12 : Inorganic nutrients are those that do not contain which element?

A : hydrogen B : oxygen C : carbon D : chloride Correct Answer : C 13 : Which term refers to a nutrient needed by the body that must be supplied by foods?

A : nutraceutical B : metabolic unit 2 / 14

C : essential nutrient D : phytonutrient Correct Answer : C 14 : Which element would be classified as a micronutrient?

A : protein B : iron C : alcohol D : carbohydrate Correct Answer : B 15 : Which component is an organic compound?

A : salt B : water C : calcium D : vitamin C Correct Answer : D 16 : What compound is an example of an energy-yielding nutrient?

A : protein B : water C : minerals D : vitamins Correct Answer : A 17 : Gram for gram, which element provides the most energy?

A : fats B : alcohol C : proteins D : carbohydrates Correct Answer : A 18 : Food energy is commonly expressed in kcalories and in A : kilojoules B : thermal units C : fluence of energy D : newtons

.

Correct Answer : A 19 : Lisa is trying to lose weight and has reduced her daily intake to 1400 kcalories, which includes 30 grams of fat. Approximately what percentage of the total energy in Lisas diet consists of fat?

A : 8.5 percent B : 15 percent C : 19 percent D : 25.5 percent 3 / 14

Correct Answer : C 20 : Jeremys diet provides a total of 2200 kcalories, of which 40 percent of the energy is from fat and 20 percent is from protein. How many grams of carbohydrate are contained in the diet?

A : 220 grams B : 285 grams C : 450 grams D : 800 grams Correct Answer : A 21 : What is the kcalorie value of a meal that contains 110 grams of carbohydrates, 25 grams of protein, 20 grams of fat, and 5 grams of alcohol?

A : 160 kcalories B : 345 kcalories C : 550 kcalories D : 755 kcalories Correct Answer : D 22 : Each of the A:8 B : 11 C : 13 D : 15

total vitamins has a special role to play in the human body.

Correct Answer : C 23 : What best describes a feature of the minerals as nutrients?

A : Minerals yield only a small amount of energy.

B : Minerals are easily destroyed and must be handled carefully.

C : Minerals are never bound to any substance in the body.

D : Minerals can be lost during food-refining processes.

Correct Answer : D 24 : Only A : 12 B : 16 C : 21 D : 24

minerals are known to be essential in human nutrition.

Correct Answer : B 25 : The study of how a persons genes interact with nutrients is known as A : genetic counseling B : nutritional genomics C : nutrigenetics D : biomics

.

Correct Answer : B 26 : Carrie took a daily supplement of vitamin C and then stated that she felt a lot better. Her 4 / 14

experience is best described as a(n) A : blind experiment B : random outcome C : case control experiment D : anecdote

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Correct Answer : D 27 : What best describes a double-blind experiment?

A : Both subject groups alternate receiving each treatment.

B : Neither the subjects nor the researchers know which subjects are in each group.

C : The subjects do not know whether they are in the control or experimental groups, but the researchers do know.

D : The subjects know whether they are in the control or experimental groups, but the researchers do not know.

Correct Answer : B 28 : In the scientific method, a tentative solution to a problem is called the A : anecdote B : experiment C : hypothesis D : analysis

.

Correct Answer : C 29 : What best describes a major weakness of a laboratory-based study?

A : The costs are too high.

B : The results cannot be replicated in humans.

C : The sample sizes are not large enough.

D : The findings usually cannot be published.

Correct Answer : B 30 : In studies examining the effectiveness of a nutrient, subjects are divided into two groups.

The group receives the nutrient, while the control group does not.

A : experimental B : placebo C : randomized D : sample Correct Answer : A 31 : What is the benefit of using controls in an experiment?

A : The size of the groups can be very large.

B : The subjects do not need to know anything about the experiment.

C : The subjects who are treated are balanced against the placebos.

D : The groups are similar in all respects except for the treatment being tested.

Correct Answer : D 32 : What is a benefit of using placebos in an experiment?

A : All of the subjects are similar.

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B : All of the subjects receive pills.

C : Neither the subjects nor the researchers know who is receiving treatment.

D : One group of subjects receives a treatment and the other group receives nothing.

Correct Answer : B 33 : Which type of study is an example of an experimental study?

A : case control study B : human intervention study C : cohort study D : cross-sectional study Correct Answer : B 34 : An increase in exercise accompanied by a decrease in body weight is an example of a .

A : variable effect B : positive correlation C : negative correlation D : randomization effect Correct Answer : C 35 : The lowest continuing intake of a nutrient that maintains a specified criterion of adequacy is called the nutrient .

A : allowance B : requirement C : tolerable limit D : adequate intake Correct Answer : B 36 : The is the usual amount of each nutrient that appears sufficient for half of the population.

A : Recommended Dietary Allowance (RDA) B : Estimated Average Requirements (EAR) C : Adequate Intake (AI) requirement D : Tolerable Upper Intake Level (UL) Correct Answer : B 37 : Recommended Dietary Allowances may be used to A : measure nutrient balance of population groups B : assess dietary nutrient adequacy for individuals C : treat persons with diet-related illnesses D : calculate exact food requirements for most individuals

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Correct Answer : B 38 : Recommended Dietary Allowances are based on the A : Lower Tolerable Limit B : Upper Tolerable Limit C : Subclinical Deficiency Value

.

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D : Estimated Average Requirement Correct Answer : D 39 : The amount of a nutrient that meets the needs of about 98 percent of a population is termed the .

A : Adequate Intake B : Daily Recommended Value C : Tolerable Upper Intake Level D : Recommended Dietary Allowance Correct Answer : D 40 : What is one purpose of both the Recommended Dietary Allowance and Adequate Intake?

A : setting nutrient goals for individuals B : identifying toxic intakes of nutrients C : restoring the health of malnourished individuals D : developing nutrition programs for schoolchildren Correct Answer : A 41 : What set of values is used to recommend the average kcalorie intake to maintain populations in energy balance?

A : Estimated Energy Requirement B : Adequate Average Requirement C : Recommended Dietary Allowance D : Acceptable Energy Distribution Range Correct Answer : A 42 : Shelly is working with a registered dietitian to review her diet and food choices so that she can lose weight. Shelly is confused about how many nutrients she needs to take each day and may have misunderstood information related to Recommended Dietary Allowances. What would be an accurate recommendation for Shelly?

A : Shelly should strive to take in no more than 45 percent of her kcalories from fat.

B : In addition to a balanced diet, Shelly should take a vitamin supplement to ensure that she reaches the upper limit of vitamin C. C : In contrast to the RDA and AI values for nutrients, the energy recommendation for Shelly is generous.

D : The nutrient intakes for Shelly refer to average daily intakes; she should not try to meet the recommendations for every nutrient every day.

Correct Answer : D 43 : Which standard covers the percentages of kcalorie intakes for protein, fat, and carbohydrate that are thought to reduce the risk of chronic diseases?

A : Estimated Energy Requirements B : Tolerable Range of Kilocalorie Intakes C : Estimated Energy Nutrient Recommendations D : Acceptable Macronutrient Distribution Ranges Correct Answer : D 7 / 14

44 : What is the AMDR for protein?

A : 1035 percent B : 4045 percent C : 5065 percent D : 7085 percent Correct Answer : A 45 : If a person consumed the upper AMDR limit for protein as part of a diet providing 2500 kcalories, approximately how many grams of protein would be ingested?

A : 41 grams B : 63 grams C : 135 grams D : 219 grams Correct Answer : D 46 : The Dietary Reference Intakes may be used to A : treat people with diet-related disorders B : assess adequacy of all required nutrients C : plan and evaluate diets for healthy people D : assess adequacy of only vitamins and minerals

.

Correct Answer : C 47 : With a deficiency of energy, a person may display the symptoms of extremely thin and losing muscle tissue.

A : malnutrition B : undernutrition C : subclinical nutrition D : overnutrition

by becoming

Correct Answer : B 48 : Which process would most likely be used to detect nutrient deficiencies?

A : assessment techniques B : nutrient stages identification C : overt symptoms identification D : outward manifestations assessment Correct Answer : A 49 : As a registered dietitian at Jones Hospital, you are instructed to write a policy statement on nutrition assessment procedures for all new patients. What are the most useful parameters for the nutrition assessment of individuals?

A : diet recall, food likes and dislikes, allergies, and favorite family recipes B : anthropometric data, physical examinations, food likes and dislikes, and family tree C : diet record that includes what the patient usually eats, which will provide sufficient information D : historical information, anthropometric data, physical examinations, and laboratory tests Correct Answer : D 8 / 14

50 : What is an example of an anthropometric measure?

A : body weight B : urinalysis C : blood iron level D : food intake information Correct Answer : A 51 : Inspection of hair, eyes, skin, and posture is part of the nutrition assessment component known as .

A : a diet history B : anthropometrics C : laboratory testing D : physical examination Correct Answer : D 52 : Michael has a primary deficiency of iron due to inadequate intake of foods containing the nutrient. Which assessment method would most likely reveal changes related to Michaels primary iron deficiency?

A : anthropometric measurements B : laboratory tests C : diet history D : physical examination Correct Answer : C 53 : Which factor would most likely lead to a primary nutrient deficiency?

A : inadequate nutrient intake B : reduced nutrient absorption C : increased nutrient excretion D : increased nutrient destruction Correct Answer : A 54 : What type of deficiency is caused by inadequate absorption of a nutrient?

A : primary B : clinical C : secondary D : subclinical Correct Answer : C 55 : A subclinical nutrient deficiency is defined as one that A : shows overt signs B : is in the early stages C : shows resistance to treatment D : is similar to a secondary deficiency

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Correct Answer : B 56 : The purpose of the Healthy People initiative is to A : establish the DRI

.

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B : identify national trends in food consumption C : identify leading causes of death in the United States D : set goals for the nations health over the next 10 years Correct Answer : D 57 : Of the ten leading causes of illness and death, how many are associated directly with nutrition?

A : one B : four C : seven D : ten Correct Answer : B 58 : Factors known to be related to a disease but not proven to be causal are called A : risk factors B : genetic factors C : degenerative factors D : environmental factors

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Correct Answer : A 59 : Which statement defines the association between a risk factor and the development of a disease?

A : All people with the risk factor will develop the disease.

B : The absence of a risk factor guarantees freedom from the disease.

C : The more risk factors for a disease, the greater the chance of developing that disease.

D : The presence of a factor such as heredity can be modified to lower the risk of degenerative diseases.

Correct Answer : C 60 : An estimated percent of adults in the United States consume five or more alcoholic drinks in a single day at least once a year.

A : 14 B : 20 C : 26 D : 35 Correct Answer : B 61 : One of the most trustworthy sites used by scientists and others is , which provides free access to more than 23 million abstracts of research papers published in scientific journals around the world.

A : nature.com B : SagePub C : PubMed D : InTech Open Correct Answer : C 62 : What statement describes the legal limitations, if any, for a person who disseminates 10 / 14

dietary advice to the public?

A : The title dietitian can be used by anyone in all states.

B : The title nutritionist can be used by anyone in all states.

C : A license to practice as a nutritionist or dietitian is required by some states.

D : A license to practice as a nutritionist or dietitian is mandatory in all states.

Correct Answer : C 63 : For which title, by definition, must the individual be college educated and pass a national examination administered by the Academy of Nutrition and Dietetics?

A : medical doctor B : registered dietician C : certified nutritionist D : certified nutrition therapist Correct Answer : B 64 : A person who assists registered dietitians has the formal title of A : dietetic assistant B : nutrition assistant C : dietetic technician D : nutrition technician

.

Correct Answer : C 65 : Having permission under state or federal law, granted on meeting specified criteria, to use a certain title (such as dietitian) and offer certain services is called .

A : accreditation B : a license to practice C : registration D : specialty certification Correct Answer : B

MATCHING 66 : Match each value or word or phrase with the most appropriate definition or explanation.

A : nutrient with the highest body concentration A : 7 B : 16 B : substance containing no carbon or not pertaining to living things C : number of indispensable nutrients for C : 20 human beings D : most substances containing carbonD : 40 hydrogen bonds E : substance containing nitrogen E : 1 kcalorie F : energy required to increase temperature of 1F : fat kilogram of water from 0° C to 100° C G : nutrient with the highest energy density G : water H : energy (kcalorie) yield of 5 grams of sugar H : energy I : energy (kcalorie) yield of 1 gram of alcohol I : protein J : number of minerals known to be essential in J : organic 11 / 14

human nutrition K : an unproven statement K : placebo L : an inert medication L : inorganic M : possessing the quality of being evidence- M : validity based N : the recommended intake is set at the N : hypothesis population mean O : excess nutrient intake leads to this O : undernutrition P : deficient nutrient intake leads to this P : overnutrition Q : measurement of physical characteristics Q : anthropometrics R : inspection of skin, tongue, eyes, hair, and R : overt deficiency fingernails S : a nutrient deficiency showing outward signs S : physical examination T : a nutrient deficiency in the early stages T : subclinical deficiency Correct Answer : A:G B : A11 C:D D:J E:I F:E G:F H:C I:A J:B K : A13 L:K M : A12 N:H O : A15 P : A14 Q : A16 R : A18 S : A17 12 / 14

T : A19

ESSAY 67 : Describe how emotions can negatively and positively govern food choices.

Correct Answer : ?Emotions guide food choices and eating behaviors. Some people cannot eat when they are emotionally upset. Others may eat in response to a variety of emotional stimuli— for example, to relieve boredom or depression or to calm anxiety. A person may chooseto eat to help himself feel better after a difficult day. Alternatively, another person who has returned home from an exciting evening out may unwind with a late-night snack. These people may find emotional comfort because foods can influence the brain’s chemistry and the mind’s response.

Carbohydrates and alcohol tend to calm, whereas proteins and caffeine are more likely to stimulate. Eating in response to emotions and stress can easily lead to overeating and obesity, but it may be helpful at times. For example, sharing food at times of bereavement serves both the giver’s need to provide comfort and the receiver’s need to be cared for and to interact with others as well as to take nourishment.

68 : List the strengths and weaknesses of epidemiological studies and experimental studies.

Correct Answer : Epidemiological studies research the incidence, distribution, and control of disease within a population. Epidemiological studies include cross-sectional, case-control, and cohort studies. They are beneficial in that they help researchers to narrow down possible causes of disease and they can raise other, relevant questions about the disease through the research process. Alternatively, epidemiological studies cannot control the variables that may influence the development or prevention of a disease, and they cannot prove cause and effect.

Experimental studies test cause-and-effect relationships between variables. Experimental studies include laboratory-based studies—on animals or in test tubes (in vitro)—and human intervention (or clinical) trials. They are beneficial because they can control conditions of the study, they can determine the effects of a variable, and they can apply some of their effects to humans. However, experimental studies cannot generalize their findings to humans and they often must refrain from certain treatments due to ethical reasons.

69 : Briefly describe each component of a nutrition assessment.

Correct Answer : The health history involves obtaining information about a person’s history with respect to health status, socioeconomic status, drug use, and diet. The health history reflects a person’s medical record and may reveal a disease that interferes with the person’s ability to eat or the body’s use of nutrients. The person’s family history of major diseases may reveal conditions such as heart disease that have a genetic tendency to run in families. Social factors such as marital status, ethnic background, and educational level also influence food choices. A drug history can highlight potential drug–food interactions. Anthropometric measures involve such calculations as height and weight. The assessor compares a person’s measurements with standards specific for gender and age or with previous measures on the same individual. The physical examination looks for clues to poor nutrition status through visual inspection of the hair, eyes, skin, posture, tongue, and fingernails. A fourth way to detect a developing deficiency, imbalance, or toxicity is to take samples of blood or urine, analyze them in the laboratory, and compare the results with normal values for a similar population. Laboratory tests are most useful in uncovering early signs of malnutrition before symptoms appear. In addition, they can confirm 13 / 14

suspicions raised by other assessment methods.

70 : Discuss the meaning and significance of the relationships between risk factors and chronic diseases.

Correct Answer : ?Factors that increase or reduce the risk of developing chronic diseases can be identified by analyzing statistical data. A strong association between a risk factor and a disease means that when the factor is present, the likelihood of developing the disease increases. It does not mean that all people with the risk factor will develop the disease.

Similarly, a lack of risk factors does not guarantee freedom from a given disease. On average, though, the more risk factors in a person’s life, the greater that person’s chances of developing the disease. Conversely, the fewer risk factors in a person’s life, the better the chances for good health.

71 : List common signs that an unsolicited e-mail with nutrition information should be suspected as untrustworthy.

Correct Answer : When nutrition information arrives in unsolicited e-mails, the consumer should be suspicious if certain items are present as part of the message. Signs of a suspicious e-mail include a lack of an author or if an author is present, he or she is someone without a nutrition background; the phrase, “forward this to everyone you know” appears, the e-mail insists that the news is legitimate and sensational but the consumer has never heard of it before; there are misspellings in the text of the message or it is full of exclamation points, bold lettering, or different font sizes; or there are no references available to support the theory of the message.

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MULTIPLE CHOICE 1 : A persons customary intake of foods and beverages over time defines her or his A : body weight B : eating pattern C : genetic predisposition D : risk for inherited diseases

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Correct Answer : B 2 : The diet-planning principle that provides all the nutrients, fiber, and energy in amounts sufficient to maintain health is called .

A : variety B : adequacy C : moderation D : kcalorie control Correct Answer : B 3 : What are the principles of diet planning?

A : abundance, B vitamins, kcalories, diet control, minerals, and variety B : abundance, balance, conservative, diversity, moderation, and vitamins C : adequacy, bone development, correction, vitamin density, master, and variety D : adequacy, balance, kcalorie control, nutrient density, moderation, and variety Correct Answer : D 4 : In a balanced diet, foods that are rich in some nutrients .

A : provide enough energy and nutrients to meet the needs of almost everyone B : do not crowd out foods that are rich in other nutrients C : provide enough energy at the expense of kcalorie control D : take the place of any other foods with other nutrients Correct Answer : B 5 : Nutrient dense refers to foods that .

A : carry the USDA nutrition labeling B : are higher in weight relative to volume C : provide more nutrients relative to kcalories D : contain a mixture of carbohydrate, fat, and protein Correct Answer : C 6 : The concept of nutrient density is most helpful in achieving what principle of diet planning?

A : variety B : balance C : moderation D : kcalorie control Correct Answer : D 7 : What is an added sugar that contributes to weight gain without providing nutrients?

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A : sucrose B : fructose C : saccharin D : lactose Correct Answer : A 8 : An empty-kcalorie food is one that contains .

A : no kcalories B : an abundance of vitamins but little or no minerals C : an abundance of minerals but little or no vitamins D : energy and little or no proteins, vitamins, or minerals Correct Answer : D 9 : A food that provides 100 milligrams of magnesium and 25 kcalories in a serving has a magnesium density (mg per kcal) of .

A : 0.4 B : 4.0 C : 250 D : 2500 Correct Answer : B 10 : Ranking foods according to their overall nutrient composition is known as A : biological value B : nutrient profiling C : the risk reduction score D : the healthy eating index

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Correct Answer : B 11 : Providing enough, but not an excess, of a food is a diet-planning principle known as A : safety B : variety C : moderation D : undernutrition

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Correct Answer : C 12 : A person who eats the same foods day after day may have an adequate diet but it would lack .

A : moderation B : kcalorie control C : nutrient density D : variety Correct Answer : D 13 : By law, how often are the Dietary Guidelines for Americans reviewed and revised?

A : every year B : every 5 years C : every 10 years 2 / 14

D : every 25 years Correct Answer : B 14 : Matt is drinking a cup of orange juice that has been fortified with calcium. One cup of orange juice contains 100 kcal and has 250 mg of calcium. What is the nutrient density of this orange juice per kcalorie?

A : 2.5 milligrams per kcalorie B : 3.5 milligrams per kcalorie C : 25 milligrams per kcalorie D : 35 milligrams per kcalorie Correct Answer : A 15 : What is a key recommendation associated with the Dietary Guidelines for Americans 20152020?

A : Decrease sodium intake to < 3000 mg per day.

B : Focus on nutrient variety and adequacy.

C : Meet the Physical Activity Guidelines for Americans.

D : Limit protein intakes to fewer than two servings per day.

Correct Answer : C 16 : Jamie is a vegetarian who is planning a healthy diet according to the USDA Food Patterns.

Which protein foods would be the best nutrient choices for one day?

A : 2 pieces of bacon, ½ can tuna, 2 pieces of bread B : ½ c pinto beans, ½ c tofu, 2 tbs peanut butter C : ½ c black beans, 2 tbs peanut butter, 1 c spinach D : 1 skinless chicken breast, 2 egg whites, meal replacement bar Correct Answer : C 17 : According to the USDA Food Patterns, which protein foods should be most limited?

A : shrimp B : baked beans C : peanut butter D : skinless chicken Correct Answer : B 18 : In what food group would legumes be found?

A : dairy B : fruits C : grains D : protein Correct Answer : D 19 : Consider the following menu from the point of view of the USDA Food Patterns.Breakfast2 eggs1 tsp margarine2 slices enriched white bread1 c whole milkcoffee Lunch2 oz tuna fishlettuce1 tbs mayonnaise2 slices enriched white bread1 apple Supper3 oz hamburger meat1 oz cheese1/2 c cooked rice1/2 c carrotscoffeeWhat describes the nutritional value of the fruits and vegetables in this menu?

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A : A source of vitamin A is missing.

B : A source of vitamin C is marginal.

C : The daily amounts recommended for a 2000-kcalorie diet are met.

D : The daily amounts recommended for a 2000-kcalorie diet are exceeded.

Correct Answer : B 20 : According to the USDA Food Patterns: Healthy US-Style Eating Pattern, a 45-year-old male on a 2200 kcalorie diet should consume how much milk or dairy each day?

A : 1½ cups B : 2 cups C : 2½ cups D : 3 cups Correct Answer : D 21 : Selena is a 21-year-old college student who leads a sedentary lifestyle and who takes in approximately 2000 kcalories per day. The RD working with Selena recommends that she eat 2½ cups of vegetables each day. What vegetable dish would be most appropriate for Selena to meet this need?

A : coleslaw B : sweet potatoes C : tempura vegetables D : potato salad Correct Answer : B 22 : Which food provides discretionary kcalories for a person on a weight-reduction diet?

A : watermelon B : canned pears in syrup C : milk with all fat removed D : chicken with the skin removed Correct Answer : B 23 : What food item would most likely be in the fruit group for someone who eats Asian cuisine?

A : olives B : papaya C : mango D : kumquats Correct Answer : D 24 : MyPlate was created to .

A : illustrate the five food groups B : reinforce the MyPyramid concept C : reinforce the Healthy Eating Index D : encourage eating more meals at home Correct Answer : A 25 : What has been shown to be a major criticism of the MyPlate educational tool?

A : It allows for oversized portions.

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B : The dairy group excludes ice cream.

C : The five groups are not clearly identified.

D : It treats all foods within a single group the same.

Correct Answer : D 26 : What is a feature of the exchange list system?

A : Foods are grouped according to their source.

B : Adequate intakes of minerals and vitamins are virtually guaranteed.

C : A fat portion provides about twice the energy as a carbohydrate portion.

D : All foods are grouped according to their content of carbohydrate, protein, and fats.

Correct Answer : D 27 : The part of the grain that remains after being refined is the A : bran B : germ C : husk D : endosperm

.

Correct Answer : D 28 : What mineral is added to refined flours in the enrichment process?

A : iron B : iodine C : calcium D : magnesium Correct Answer : A 29 : Which nutrient is used as enrichment for grains?

A : zinc B : folate C : protein D : calcium Correct Answer : B 30 : Textured vegetable protein is usually made from A : soybeans B : corn stalks C : a mixture of legumes D : cruciferous vegetables

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Correct Answer : A 31 : A meat described as prime cut means that it A : has an extended shelf life B : usually carries a high price C : is served only in restaurants D : is higher in fat than other cuts of meat

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Correct Answer : D 5 / 14

32 : What best describes an example of an imitation food?

A : powdered milk B : margarine with added plant sterols C : omega-3 enriched eggs D : pasteurized cheese snack Correct Answer : D 33 : What term describes a food that resembles and substitutes for another food but is nutritionally inferior to it?

A : faux food B : pseudo food C : imitation food D : food substitute Correct Answer : C 34 : A food scientist is developing a new and improved cereal bar. She consults with you to ask in what order the ingredients should be listed on the food label. The ingredients are: sugar: 30 g, puffed wheat: 28 g, dry milk powder: 5 g, red food coloring: 35 mg, salt: 2 g. What is the appropriate order in which to list these ingredients on the food label?

A : sugar, puffed wheat, dry milk powder, salt, red food coloring B : red food coloring, salt, dry milk powder, puffed wheat, sugar C : dry milk powder, puffed wheat, red food coloring, salt, sugar D : puffed wheat, sugar, dry milk powder, salt, red food coloring Correct Answer : A 35 : Restaurants with 20 or more locations must provide menu listings of an items kcalories, grams of saturated fat, and .

A : grams of protein B : glycemic index C : milligrams of sodium D : grams of sugar Correct Answer : C 36 : According to nutrition labeling laws, what two minerals must be listed on the package label as a percent Daily Value?

A : calcium and iron B : zinc and phosphorus C : fluoride and chloride D : chromium and magnesium Correct Answer : A 37 : A food label ingredient list reads in the following order: wheat flour, vegetable shortening, sugar, salt, and cornstarch. What item would be found in the smallest amount in the food?

A : salt B : sugar C : cornstarch D : wheat flour 6 / 14

Correct Answer : C 38 : To maintain the voluntary status of front-of-package labels, major food industry associations have created a standardized presentation of nutrient information called .

A : Label It B : Facts Up Front C : To Your Health D : Quick Guidelines Correct Answer : B 39 : Food labels express the nutrient content in relation to a set of standard values known as the .

A : Daily Values B : FDA Standards C : Dietary Reference Intakes D : Recommended Dietary Intakes Correct Answer : A 40 : On a food label, the % Daily Value table compares key nutrients per serving for a person consuming how many kcalories daily?

A : 1,500 B : 2,000 C : 2,500 D : 3,000 Correct Answer : B 41 : Luciannas energy requirement is 1,600 kcal/day. What is her personal Daily Value for saturated fat?

A : 17 grams B : 20 grams C : 53 grams D : 65 grams Correct Answer : C 42 : What is a feature of the Daily Values found on food labels?

A : They are updated every 2 years as mandated by the USDA. B : They are expressed on a per 1,000-kcalorie intake basis.

C : They assist people in determining whether a food contains a little or a lot of a nutrient.

D : They define a food as an excellent source of a nutrient if it contributes at least 50 percent of the dietary recommended intake.

Correct Answer : C 43 : What is a feature of the Nutrition Facts panel on a food label?

A : Trans fat content is optional.

B : Saturated fat must be listed.

C : Naturally present sugars are excluded.

D : Soluble and insoluble fiber must be listed separately.

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Correct Answer : B 44 : According to the FDA, a food label that reads improves memory is an example of a A : health claim B : Daily Value claim C : qualified health claim D : structure-function claim

.

Correct Answer : D 45 : Greg is trying to decide which brand of cereal to buy, but he is confused by the health claims. Which of the following represents the highest level of significant scientific agreement?

A : This cereal promotes a healthy heart.

B : This cereal supports heart health.

C : This cereal product contains whole grains, which have been proven to reduce the risk of heart disease and certain cancers.

D : This cereal may reduce risk for cancers from the limited scientific evidence that has been cited about this product.

Correct Answer : C 46 : A food that has fewer than 5 kcalories per serving can be labeled as A : low kcalorie B : kcalorie free C : light D : reduced kcalorie

.

Correct Answer : B 47 : What classification would be included in mayonnaise that is labeled as being low fat?

A : 25 percent less fat than a comparison brand of mayonnaise B : less than 0.5 gram of trans fat per serving C : less than 2 grams of both saturated fat and cholesterol per serving D : 3 grams or less of fat per serving Correct Answer : D 48 : Which description is a characteristic of structure-function claims on food labels?

A : They are allowed only for unprocessed food.

B : They can be made without any FDA approval.

C : They must include evidence supporting their claim.

D : They must state the name of the disease or symptom for which a benefit is claimed.

Correct Answer : B 49 : Which foods are allowed in the diet of a lactovegetarian?

A : plant foods only B : eggs and plant foods only C : meat, eggs, and plant foods only D : milk products and plant foods only Correct Answer : D 8 / 14

50 : A diet that does not exclude specific foods but that does include many foods derived from both animals and plants is called a(n) diet.

A : omnivorous B : vegan C : macrobiotic D : lacto-ovo vegetarian Correct Answer : A 51 : Tempeh is made from .

A : soybeans B : any legume C : fermented leafy vegetables D : fermented yellow vegetables Correct Answer : A 52 : What is another name for a vegan diet?

A : pure vegetarian diet B : plant-based diet C : lacto-vegetarian diet D : macrobiotic diet Correct Answer : A 53 : What is a feature of people who regularly eat meals based on tofu?

A : They show less heart disease but more colon cancer than omnivores.

B : They show evidence of marginal protein intake compared with omnivores.

C : They have lower blood pressure levels than those eating meat.

D : They have lower sodium intakes but blood pressure is similar to those eating red meat.

Correct Answer : C 54 : What dietary factor, which is less frequently found in a vegetarian diet, contributes the most to heart disease?

A : added sugars B : sodium C : saturated fat D : alcohol Correct Answer : C 55 : Which ingredient found on a food label is a source of protein?

A : BHT B : tofu C : corn starch D : diglycerides Correct Answer : B 56 : Meat replacements consumed by vegetarians are usually made of A : soy protein

.

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B : fish protein C : bean plus rice proteins D : bean plus cheese proteins Correct Answer : A 57 : What describes a feature of vitamin B12 nutrition in vegetarians?

A : Vitamin B12 in fortified cereals has low bioavailability.

B : Vegan mothers need only infrequent intake of vitamin B12-fortified cereals.

C : The vitamin B12 in fermented soy products may be present in an inactive form.

D : Infants born to vegan mothers are resistant to the development of vitamin B12 deficiency.

Correct Answer : C 58 : When selecting from the vegetable and fruit groups, vegetarians may want to emphasize particularly good sources of which two nutrients?

A : sodium and magnesium B : calcium and iron C : potassium and vitamin A D : vitamin C and folate Correct Answer : B 59 : What food would be a good source of zinc for a person who follows a vegetarian diet?

A : spinach B : whole grains C : dried fruit D : walnut oil Correct Answer : B 60 : What best describes iron nutrition in vegetarians?

A : The iron RDA for vegetarians is higher than for others.

B : Iron utilization is inhibited by the high zinc content in grains.

C : The absorption of iron is low due to the high vitamin C intake.

D : More iron deficiency is found in vegetarians than in people eating a mixed diet.

Correct Answer : A 61 : What is a characteristic of a macrobiotic diet?

A : It excludes all hot and salty foods.

B : It permits inclusion of many nonorganic foods.

C : It represents a way of life rather than just a way of eating.

D : It emphasizes abundant amounts of fish, fruits, nuts, and seeds.

Correct Answer : C 62 : What statement best describes the vitamin D status of vegetarians?

A : The requirement for vitamin D is small and it only comes from animal proteins.

B : Vegetarians are at risk of vitamin D deficiency when they do not drink milk.

C : Vegetarians are not usually deficient in vitamin D, but vegan dieters are.

D : The vitamin D status of vegetarians is similar to that of nonvegetarians.

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Correct Answer : D

MATCHING 63 : Match each value or word or phrase with the most appropriate definition or explanation.

A : the principle of consuming a number of A:5 foods in proportion to each other B : the principle of recognizing that a food has B : 40 more iron than another food when expressed per kcalorie C : origin of the MyPlate graphic C : 65 D : number of major food groups D : ½ cup E : legume belonging to the starch category of E : 1 cup exchange lists F : part of grain richest in fiber F : FDA G : part of grain containing most of the starch G : bran H : nutrient added in grain-enrichment process H : iron I : example of a fortified food I : USDA J : commonly used to make textured vegetable J : soybeans protein K : example of a functional food K : green peas L : nutrient commonly added in cows milk L : balance fortification process M : maximum number of grams of fat M : vitamin B12 recommended on a 2,000-kcalorie diet based on the Daily Value N : the amount of cooked rice that is equivalent N : vitamin D to 1 oz serving of grains O : the amount of dry pasta that is equivalent to O : endosperm 1 oz serving of grains P : agency that regulates food labeling P : nutrient density Q : hypertension Q : grams of fat supplied by a 1,200-kcalorie diet that is 30 percent fat R : condition that is less commonly associated R : omega-3 fatty acids with a vegetarian diet S : nutrients provided by flaxseed or walnuts if S : margarine containing plant sterols fatty fish is not part of the diet T : nutrient that may be added in soy milk T : orange juice containing added calcium fortification process Correct Answer : A : A11 B : A15 C:I D:A E:K

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F:G G : A14 H:H I : A19 J:J K : A18 L : A13 M:C N:D O:E P:F Q:B R : A16 S : A17 T : A12

ESSAY 64 : Define the term discretionary kcalories and provide three examples of foods that provide them. Under what circumstances is the intake of discretionary kcalories permitted?

Correct Answer : ?Discretionary kcalories are the kcalories remaining in a person’s energy allowance after consuming enough nutrient-dense foods to meet all nutrient needs for a day, also referred to as kcalories available for other uses. Discretionary kcalories allow a person to choose whether to eat additional nutrient-dense foods, such as an extra serving of skinless chicken or a second ear of corn; select a few foods with solid fats or added sugars; add a little fat or sugar to foods, such as butter or jelly on toast; or consume a little alcohol. Alternatively, a person wanting to lose weight might choose not to use discretionary kcalories. Discretionary kcalories reflect about 5 to 15 percent of total kcalories.

65 : Discuss how dietary planning guides can be applied to ethnic diets and list examples of some foods included.

Correct Answer : ?People can use the USDA Food Patterns and still enjoy a diverse array of culinary styles by sorting ethnic foods into their appropriate food groups. For example, a person eating Mexican foods would find tortillas in the grains group, jicama in the vegetable group, and 12 / 14

guava in the fruit group. Ethnic foods can be subdivided into the main food groups including grains (rice, noodles, couscous) vegetables (cactus, yams, grape leaves, baby corn, bok choy), fruits (guava, kumquat, lychee, figs, olives), protein foods (fish, seafood, soy products, lamb, peanuts), and milk and milk products (feta cheese, mozzarella, yogurt, custard).

66 : Discuss the meaning, significance, and utility of MyPlate as an educational tool.

Correct Answer : ?The USDA created an educational tool called MyPlate to illustrate the five food groups. The MyPlate icon divides a plate into four sections, each representing a food group—fruits, vegetables, grains, and protein foods. The sections vary in size, indicating the relative proportion each food group contributes to a healthy diet. A circle next to the plate represents the milk group (dairy). The MyPlate icon does not stand alone as an educational tool. A wealth of information can be found at the website. Consumers can choose the kinds and amounts of foods they need to eat each day based on their height, weight, age, gender, and activity level. Information is also available for children, pregnant and breastfeeding women, and college students. In addition to creating a personal plan, consumers can find daily tips to help them improve their diet and increase physical activity. A key message of the website is to enjoy food, but eat less by avoiding oversized portions.

67 : Discuss the meaning and significance of foods that are refined, enriched, fortified, or wholegrain.

Correct Answer : When shopping for grain products, you will find them described as refined, enriched, or whole grain. These terms refer to the milling process and the making of grain products, and they have different nutrition implications. Refined grains have lost many nutrients during processing; enriched grains have had some nutrients added back; and whole-grain products have all the nutrients and fiber found in the original grain. Products described as “multigrain,” “stone-ground,” or “100% wheat” are usually not whole-grain products. Brown color is also not a useful hint, but fiber content often is.?

68 : What is textured vegetable protein and how is it used in nutrition?

Correct Answer : ?Textured vegetable protein is processed soybean protein used in vegetarian products such as soy burgers. It can be used instead of ground beef in a casserole, spaghetti sauce, or chili, saving fat kcalories. Meat replacements are products formulated to look and taste like meat, seafood, or poultry and are usually made of textured vegetable protein.

69 : What is a structure-function claim? Provide four examples.

Correct Answer : ?Unlike health claims, which require food manufacturers to collect scientific evidence and petition the FDA, structure-function claims can be made without any FDA approval. Structure-function claims are statements that characterize the relationship between a nutrient or other substance in a food and its role in the body. The only criterion for a structurefunction claim is that it must not mention a disease or symptom. Examples of structure-function claims include products that say, “promotes a healthy heart,” “builds strong bones,” “improves memory,” and “slows aging.”

70 : List some reasons for why people become vegetarians.

Correct Answer : People who choose to exclude meat and other animal-derived foods from their diets today do so for many of the same reasons the Greek philosopher Pythagoras cited in the 6th century BC: physical health, ecological responsibility, and philosophical concerns. They might also cite world hunger issues, economic reasons, ethical concerns, or religious beliefs as 13 / 14

motivating factors. Whatever their reasons—and even if they don’t have a particular reason—people who exclude meat will be better prepared to plan well-balanced meals if they understand the nutrition and health implications of their choices.?

71 : Explain the concepts and dietary practices associated with the macrobiotic diet.

Correct Answer : ?Some vegetarians choose to follow a macrobiotic diet. Those following a macrobiotic diet select natural, organic foods and embrace a Zen-like spirituality. In other words, a macrobiotic diet represents a way of life, not just an eating pattern. Such a diet emphasizes whole grains, legumes, and vegetables, with small amounts of fish, fruits, nuts, and seeds.

Practices include selecting locally grown foods, eating foods in their most natural state, and balancing cold, sweet, and passive foods with hot, salty, and aggressive ones. Some items, such as processed foods, alcohol, hot spices, and potatoes, are excluded from the diet.

Today’s macrobiotic diet reflects a modified vegetarian approach with an appreciation of how foods can enhance health. With careful planning, a macrobiotic diet can provide an array of nutrients that support good health

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MULTIPLE CHOICE 1 : The process by which food is broken down into absorbable components is called A : digestion B : absorption C : excretion D : mastication

.

Correct Answer : A 2 : Chyme is released from the stomach when A : it is completely liquefied B : protein is completely digested C : the pyloric sphincter closes D : its muscles begin to churn the food

.

Correct Answer : A 3 : The lumen of the GI tract is the A : circular muscle B : capillaries C : inner space D : mucosal surface

.

Correct Answer : C 4 : In which structure does the digestion process begin?

A : mouth B : stomach C : duodenum D : sigmoid colon Correct Answer : A 5 : After consuming a slice a pizza, carbohydrate digestion will begin in the mouth, and then continue in the small intestine. Why does carbohydrate digestion cease in the stomach?

A : Salivary carbohydrases do not function in an acidic environment.

B : Gastric juices digest fats only, not carbohydrates or protein.

C : Salivary carbohydrases are activated from zymogens only in the intestine.

D : Carbohydrates are digested only by mastication, not by enzymatic hydrolysis.

Correct Answer : A 6 : Which description accurately depicts the anatomy of the gastrointestinal tract?

A : a vatlike vessel B : a rigid, solid tunnel C : a flexible muscular tube D : a firm, ductlike channel Correct Answer : C 7 : Which structure prevents the entrance of food into the trachea?

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A : tongue B : epiglottis C : cardiac sphincter D : larynx Correct Answer : B 8 : What is the function of the appendix?

A : It ferments fiber.

B : It contains lymph cells.

C : It slows down peristalsis.

D : It stores preformed stools.

Correct Answer : B 9 : The portion of food swallowed at one time, known as the stomach via the .

A : a sphincter; epiglottis B : chyme; pyloric sphincter C : a bolus; esophagus D : mucus; large intestine

, is transported from the mouth to

Correct Answer : C 10 : Which structure controls the passage of material from the small intestine to the large intestine?

A : pyloric sphincter B : ileocecal valve C : upper esophageal sphincter D : cardiac sphincter Correct Answer : B 11 : After swallowing, in which order does food pass through the regions of the GI tract?

A : jejunum, duodenum, colon, ileum, rectum B : jejunum, ileum, duodenum, rectum, colon C : stomach, duodenum, jejunum, ileum, colon D : stomach, jejunum, duodenum, colon, ileum Correct Answer : C 12 : Chyme is a .

A : semisolid mass of undigested food that passes through the ileocecal valve B : semiliquid mass of partially digested food released by the stomach into the small intestine C : mixture of pancreatic juices containing enzymes for macronutrient digestion D : thick, viscous material synthesized by mucosal cells for protection against digestive juices Correct Answer : B 13 : What is the primary function of the rectum?

A : The rectum controls functioning of the colon.

B : The rectum absorbs minerals from waste materials.

C : The rectum stores waste materials prior to evacuation.

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D : The rectum absorbs excess water from waste materials.

Correct Answer : C 14 : Peristalsis .

A : ceases between meals when the GI tract is empty B : occurs at a constant rate along the GI tract, but only when food is present C : involves parallel and circular muscles found in the walls of the intestines, but not the stomach D : is characterized by wavelike contractions due to the action of circular and longitudinal muscles Correct Answer : D 15 : Which structure controls the release of material from the stomach to the small intestine and prevents the contents of the small intestine from backing up into the stomach?

A : ileocecal valve B : pyloric sphincter C : diaphragmatic valve D : esophageal sphincter Correct Answer : B 16 : Which statement describes the muscular contractions of the GI tract?

A : Peristalsis begins in the stomach upon the initiation of the swallowing reflex.

B : To withstand the pressure of stool evacuation, the colon must have the thickest and strongest muscles of the GI tract.

C : The jejunum has a third layer of diagonal muscles to enhance contraction and relaxation phases for optimal digestion.

D : The periodic contractions of intestinal muscles mix the chyme before allowing the contents to move toward the colon.

Correct Answer : D 17 : Sphincter muscles .

A : control peristalsis and segmentation B : grind large food particles into chyme C : secrete digestive juices into the GI tract D : control the passage of food through the GI tract Correct Answer : D 18 : The backward flow of stomach contents, a process known as .

A : peristalsis; cardiac sphincter B : segmentation; ileocecal valve C : motility; upper esophageal sphincter D : reflux; lower esophageal sphincter

, is prevented by the

Correct Answer : D 19 : Which enzymes are responsible for hydrolyzing the proteins in foods?

A : lipases 3 / 20

B : zymogens C : proteases D : carbohydrases Correct Answer : C 20 : What is the function of mucus in the stomach?

A : to emulsify fats B : to neutralize stomach acid C : to digest proteins and carbohydrates D : to protect stomach cells from gastric juices Correct Answer : D 21 : In the stomach, hydrochloric acid A : kills bacteria B : activates pancreatic lipase C : activates pancreatic carbohydrases D : inhibits hydrolysis of dietary protein

.

Correct Answer : A 22 : Your cousin Miguel is extolling the virtues of his new dietary supplement. He says that it contains enzymes that will make him healthier, and he asks for your opinion. How should you respond?

A : The supplement will increase the digestibility of the foods he eats.

B : The supplement could likely interfere with the enzymes secreted by his pancreas.

C : The supplement could likely overload his gastrointestinal tract and lead to diarrhea.

D : Enzymes are proteins, which will be destroyed in the gastrointestinal tract.

Correct Answer : D 23 : Which organ does not secrete digestive enzymes?

A : liver B : stomach C : pancreas D : salivary glands Correct Answer : A 24 : Bile brings fats into suspension in water in a process known as break down the fat molecules.

A : condensation B : emulsification C : segmentation D : peristalsis

, allowing enzymes to

Correct Answer : B 25 : The purpose of bicarbonate in the digestive process is to A : raise the pH of chyme B : lower the pH of chyme C : hydrolyze large proteins

.

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D : hydrolyze fats Correct Answer : A 26 : Which dietary substance is not a substrate for the digestive enzymes present in the pancreatic juice secreted into the intestinal tract?

A : fats B : fiber C : proteins D : carbohydrates Correct Answer : B 27 : In the colon, is/are absorbed and A : bile; small fat fragments B : fats; bile C : dissolved salts; gas D : hormones; water

is produced from the fermentation of fibers.

Correct Answer : C 28 : Which substance is not a typical component of feces?

A : water B : fiber C : starch D : bacteria Correct Answer : C 29 : Which class of nutrients requires the least amount of digestion before being absorbed in the small intestine?

A : lipids B : proteins C : vitamins D : carbohydrates Correct Answer : C 30 : Which substance cannot be digested by humans but instead stimulates intestinal muscle contractions?

A : bile B : fiber C : starch D : protein Correct Answer : B 31 : Dietary fiber .

A : inhibits protease activity B : promotes water retention of stools C : inhibits intestinal motility D : promotes vitamin excretion 5 / 20

Correct Answer : B 32 : Within the intestinal villi crypts, .

A : chylomicrons are synthesized B : intestinal juices are secreted into the small intestine C : small fat fragments are synthesized for use by the colon D : fat-soluble nutrients are transported into intestinal capillaries Correct Answer : B 33 : The primary function of the intestinal microvilli is to A : secrete bile salts B : secrete digestive acids C : transport nutrient molecules into the cells D : transport pancreatic enzymes into the lumen

.

Correct Answer : C 34 : Intestinal cells absorb nutrients by .

A : diffusion only B : active transport only C : active transport and diffusion only D : active transport, diffusion, and facilitated diffusion Correct Answer : D 35 : After sitting through a 2-hour math lecture, your stomach is growling. You have just learned about surface area and its role in mathematics. Your classmate points out that surface area is also integral to the absorption of nutrients due to the .

A : protective effect of the gastric mucosa B : relatively large size of digested protein molecules C : enormous number of villi and microvilli in the small intestine D : presence of both circular and longitudinal muscles in the GI tract Correct Answer : C 36 : For optimal absorption of nutrients, it is usually best to .

A : eat several small meals each day so that the GI tract is not overwhelmed B : combine different food types to enhance the absorption process C : avoid eating meat and fruit at the same meal to prevent competition D : take enzyme pills periodically so the GI tract can rest and rejuvenate Correct Answer : B 37 : Water-soluble nutrients are transported from intestinal epithelial cells to the .

A : liver; hepatic portal vein B : heart; aorta C : liver; hepatic vein D : kidneys; lymphatic system

via the

Correct Answer : A 6 / 20

38 : Which product of digestion is not normally released directly into the bloodstream?

A : fats B : minerals C : vitamin C D : carbohydrates Correct Answer : A 39 : Exchange of oxygen, nutrients, and waste materials takes place across the walls of small blood vessels called .

A : ducts B : venules C : arterioles D : capillaries Correct Answer : D 40 : What is the bodys most metabolically active organ?

A : liver B : spleen C : stomach D : pancreas Correct Answer : A 41 : When alcohol and barbiturates are ingested, they are absorbed from the gastrointestinal tract and transported immediately to the .

A : liver B : heart C : spleen D : kidneys Correct Answer : A 42 : Which structure conducts lymph into the vascular system?

A : thoracic duct B : hepatic vein C : subclavian vein D : common bile duct Correct Answer : C 43 : The lymphatic system .

A : carries fats away from the intestines and fluids towards the heart B : contains a fluid with a composition similar to pancreatic fluid C : circulates lymph via a one-way pump situated near the subclavian vein D : transports both fat-soluble and water-soluble vitamins to the vascular system Correct Answer : A 44 : Lacteals are .

A : gastric secretory cells B : products of milk digestion 7 / 20

C : intestinal lymphatic vessels D : products of fermentation Correct Answer : C 45 : Approximately how many different species and subspecies of bacteria live in a healthy GI tract?

A : 20 B : 100 C : 400 D : 1000 Correct Answer : C 46 : Lymph is a .

A : light-red fluid that stores fat-soluble vitamins B : transparent yellowish fluid that contains no red blood cells or platelets C : white fluid that contains probiotics and appears at the site of infections D : reddish fluid that contains abundant platelets and water-soluble vitamins Correct Answer : B 47 : Microorganisms in food (e.g., yogurt) that are viable when consumed and promote healthful changes in the human microbiome are known as .

A : probiotics B : prebiotics C : enemas D : laxatives Correct Answer : A 48 : Which role is performed by the human microbiome?

A : construction of long, fat fragments B : digestion of indigestible fibers C : digestion of vitamins and minerals D : activation of digestive hormones Correct Answer : D 49 : Which substance is produced by bacteria in the small intestine?

A : mucus B : chyme C : glucose D : vitamins Correct Answer : D 50 : Which substance controls the release of hydrochloric acid in the stomach to prevent excessive acidity?

A : cholecystokinin B : gastrin C : secretin D : bicarbonate 8 / 20

Correct Answer : B 51 : Which substance stimulates the pancreas to release bicarbonate-rich juice?

A : gastrin B : secretin C : saliva D : bile Correct Answer : B 52 : Which statement characterizes pancreatic digestive enzyme function?

A : The major hormone controlling the release of pancreatic enzymes is gastrin.

B : The release of pancreatic enzymes is controlled primarily by a pancreatic sphincter.

C : The pancreas can increase the activity of fat-degrading enzymes in response to increased fat in the diet.

D : The amounts of digestive enzymes secreted by the pancreas remain constant despite varying nutrient intake.

Correct Answer : C 53 : Which meal will require the greatest time for digestion?

A : steak and French fries B : nonfat yogurt and strawberries C : vegetable stir fry with rice D : toast with jam and skim milk Correct Answer : A 54 : Cholecystokinin stimulates the release of A : carbohydrases; salivary glands B : gastrin; pancreas C : hydrochloric acid; stomach D : bile; gallbladder

from the

.

Correct Answer : D 55 : What are the usual consequences of removing a diseased gallbladder?

A : inability to digest fats B : some damage to the pancreas C : inability to digest carbohydrates D : delivery of bile directly to the intestine Correct Answer : D 56 : Nancy is having difficulty digesting fatty foods. Her physician found no evidence of inflammation, and suspects that the gallbladder is not releasing adequate bile in response to fat in the small intestine. Which hormone may be malfunctioning?

A : cholecystokinin B : gastrin C : secretin D : pancreatic lipase 9 / 20

Correct Answer : A 57 : Digestive enzymes use water to break a molecule into smaller pieces, a process known as .

A : absorption B : negative feedback C : active transport D : hydrolysis Correct Answer : D 58 : What is the difference between the processes of nutrient absorption by simple diffusion versus active transport?

A : Nutrients absorbed by active transport cross freely into intestinal cells, while nutrients absorbed by simple diffusion move against their concentration gradient, which requires energy.

B : Nutrients absorbed by simple diffusion cross freely into intestinal cells, while nutrients absorbed by active transport move against their concentration gradient, which requires energy.

C : Nutrients absorbed by simple diffusion need a specific carrier molecule to transport them into intestinal cells, while nutrients absorbed by active transport move against their concentration gradient, which does not require energy.

D : Nutrients absorbed by simple diffusion cross freely into intestinal cells, while nutrients absorbed by active transport need a specific carrier molecule to transport them into intestinal cells, which does not require energy.

Correct Answer : B 59 : Which process is associated with the presence of fat in the GI tract?

A : inhibition of mucosal enzyme activities B : slowing of digestion and absorption C : inhibition of thiamin, riboflavin, and niacin absorption D : stimulation and hastening of digestion and absorption Correct Answer : B 60 : The chief purpose of the gallbladder is to store of dietary .

A : bile; fats B : cholecystokinin; carbohydrates C : secretin; protein D : gastrin; proteins

, which is required for the assimilation

Correct Answer : A 61 : What is intestinal ischemia?

A : reduced blood flow to the intestines B : chronic episodes of reverse peristalsis C : lack of intestinal lymph supply D : inflammation of two or more sphincter muscles Correct Answer : A 62 : Which of the following results from reverse peristalsis?

A : gas 10 / 20

B : choking C : vomiting D : diarrhea Correct Answer : C 63 : What is the first action you should take if you suspect someone is choking on food?

A : Ask the person if they can speak.

B : Perform the Heimlich maneuver.

C : Strike the person sharply on the back.

D : Attempt to dislodge the food with your fingers.

Correct Answer : A 64 : Choking occurs when a piece of food becomes firmly lodged in the A : larynx B : trachea C : epiglottis D : esophagus

.

Correct Answer : B 65 : In the GI tract, the A : goblet cells B : microvilli C : thoracic duct D : villi

secrete mucus.

Correct Answer : A 66 : A person with chronic diarrhea is at risk for A : dehydration B : constipation C : peptic ulcers D : hemorrhoids

.

Correct Answer : A 67 : Inflammation of the large intestine is known as A : colitis B : indigestion C : hemorrhoids D : celiac disease

.

Correct Answer : A 68 : Which symptom is characteristic of irritable bowel syndrome?

A : mild abdominal discomfort B : alternating diarrhea and constipation C : constipation, but not diarrhea D : vomiting in the absence of food triggers Correct Answer : B 11 / 20

69 : When ingested in large quantities, the sugar alternative sorbitol and the fat alternative olestra are known to induce .

A : diarrhea B : vomiting C : pancreatitis D : celiac disease Correct Answer : A 70 : A person on a low-fiber diet is at increased risk for experiencing elevated rectal vein pressure that can lead to the formation of .

A : reflux B : hiccups C : hemorrhoids D : peptic ulcers Correct Answer : C 71 : Constipation is characterized by .

A : painful or difficult and infrequent bowel movements B : reflux more than three times a month C : more than a day without a bowel movement D : soft or watery bowel movements Correct Answer : A 72 : Colonic irrigation is a(n) and popular practice for treatment of A : successful; belching B : potentially harmful; constipation C : unsuccessful; rapid peristalsis D : safe; diarrhea

.

Correct Answer : B 73 : An individual suffering from constipation should A : decrease water intake B : increase fiber intake C : decrease physical activity D : ignore defecation signals

.

Correct Answer : B 74 : What is the primary cause of belching?

A : swallowing air B : viral infections C : eating spicy foods D : drinking alcoholic beverages Correct Answer : A 75 : Common causes of gastroesophageal reflux include A : eating too slowly

.

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B : eating and/or drinking too much C : wearing loose clothing D : being underweight Correct Answer : B 76 : At his annual medical check-up, Jim was diagnosed with gastroesophageal reflux. Which medical condition may be the cause of Jims condition?

A : inhibition of peristalsis B : overactive cardiac sphincter activity C : overactive pyloric sphincter activity D : defective lower esophageal sphincter activity Correct Answer : D 77 : People who have frequent, regular bouts of heartburn and indigestion have a medical condition known as .

A : colitis B : watery stools C : celiac disease D : gastroesophageal reflux Correct Answer : D 78 : Over-the-counter antacids are used to treat A : excessive gas B : excessive belching C : occasional acid indigestion D : active ulcers in the stomach

.

Correct Answer : C 79 : Ingestion of which nutrients is most associated with increased production of intestinal gas?

A : iron B : fats C : proteins D : carbohydrates Correct Answer : D 80 : Untreated gastroesophageal reflux increases the risk for the more serious condition known as .

A : colitis B : diverticulitis C : Barretts esophagus D : irritable bowel syndrome Correct Answer : C 81 : The primary treatment for ulcers caused by the presence of H. pylori is A : fiber B : surgery C : antacids

.

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D : antibiotics Correct Answer : D 82 : The bodys regulation of digestion, temperature, and blood pressure are examples of A : absorption B : diffusion C : immunity D : homeostasis

.

Correct Answer : D 83 : A peptic ulcer resides in the A : stomach only B : duodenum only C : stomach or duodenum D : esophagus and stomach

.

Correct Answer : C 84 : Ulcers can be caused by .

A : consumption of spicy foods B : excessive antacid consumption C : regular use of anti-inflammatory drugs D : reduced gastric acid secretion Correct Answer : C 85 : A person with chronic GI bleeding is at risk for deficiency of A : HCl B : iron C : bile D : protein

.

Correct Answer : B 86 : Which food or drink is least likely to aggravate an existing ulcer?

A : beer B : raw carrots C : regular coffee D : decaffeinated coffee Correct Answer : B 87 : The most common cause for the development of peptic ulcers is A : infection from H. pylori B : use of anti-inflammatory drugs C : failure to adapt to a high-stress lifestyle D : excessive consumption of hot beverages

.

Correct Answer : A 88 : Pancreatic juice has pH of 8, while gastric juice has a pH of about 2. Gastric juice is 14 / 20

times more acidic than pancreatic juice.

A:6 B : 10 C : 103 D : 106 Correct Answer : D 89 : When the pancreatic juices mix with chyme in the small intestine, the pH of the resulting mixture is .

A : equal to that of the pancreatic juices B : unchanged C : strongly alkaline D : approximately neutral Correct Answer : D 90 : Infection or inflammation of bulges that form in weakened areas of the intestinal wall is known as .

A : diverticulitis B : diverticulosis C : pancreatitis D : hepatitis Correct Answer : A 91 : Which remedy will not help to ease constipation?

A : laxatives B : stool softeners C : colonic irrigation D : mineral oil Correct Answer : C 92 : The muscular reaction of the stomach to unchewed lumps of food or to being overfilled may interfere with normal peristalsis. This condition is known as .

A : defecation B : an ulcer C : flatulence D : indigestion Correct Answer : D 93 : The passageway leading from the mouth to the esophagus is called the A : larynx B : pharynx C : trachea D : diaphragm

.

Correct Answer : B 94 : The motility of the GI tract refers to the A : efficiency of lymph transport

.

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B : ability of the GI tract muscles to move C : speed of digestive juice release by gastric cells D : speed of digestive juice release by the pancreas Correct Answer : B 95 : What is the order by which digested food travels through the colon?

A : transverse colon, ascending colon, sigmoid colon, descending colon B : descending colon, transverse colon, ascending colon, sigmoid colon C : descending colon, transverse colon, sigmoid colon, ascending colon D : ascending colon, transverse colon, descending colon, sigmoid colon Correct Answer : D 96 : How many layers of muscle are present in the stomach?

A:1 B:2 C:3 D:4 Correct Answer : C 97 : Catalysts .

A : change their molecular structure while facilitating chemical reactions B : facilitate chemical reactions while remaining unchanged C : inhibit chemical reactions while remaining unchanged D : facilitate chemical reactions but do not occur in biological systems Correct Answer : B

ESSAY 98 : Describe the basic process of taste sensation.

Correct Answer : The process of digestion begins in the mouth. Fluids help dissolved the food so that the tongue can taste it; only particles in solution can react with taste buds. When stimulated, the taste buds detect one, or a combination, of the five basic taste sensations: sweet, sour, bitter, salty, and umami. In addition to these chemical triggers, aroma, appearance, texture, and temperature also affect a food's flavor.?

99 : Follow the digestive and absorptive process through the GI tract by describing the major events that occur in the mouth, stomach, small intestine, and colon. Include a discussion of the enzymes involved in digestion.

Correct Answer : ?In the mouth, the food is chewed and mixed with saliva. Saliva contains enzymes that initiate the digestion of carbohydrates. In the stomach, gastric glands secrete gastric juice, a mixture of water, enzymes, and hydrochloric acid, which acts primarily in protein digestion. In the small intestine, pancreatic digestive juices act on all three energy nutrients (enzymes on the surfaces of the small intestine cells complete the process of breaking down starch for absorption through the intestinal wall and into the hepatic portal vein; pancreatic and intestinal lipases begin to break down fats for absorption through the intestinal wall and into the 16 / 20

lymph; pancreatic and intestinal lipases break down proteins for absorption into the hepatic portal vein). Bile, an emulsifier that brings fats into suspension in water so enzymes can break them down into their component parts, is released into the small intestine. Most absorption takes place in the small intestine. By the time the contents of the GI tract reach the end of the small intestine, little remains but water, a few dissolved salts and body secretions, and undigested material such as fiber. In the colon, intestinal bacteria ferment some fibers and retrieve all materials that the body can recycle—water and dissolved salts.

100 : Discuss motility of the digestive tract by explaining the differences between peristalsis and segmentation. Identify the roles of the four major sphincter muscles that divide the GI tract into its principal regions.

Correct Answer : Motility is the spontaneous movement of the GI tract muscles. Peristalsis is the wavelike muscular contractions of the GI tract that push its contents along. Segmentation is a periodic squeezing or partitioning of the intestine at intervals along its length by its circular muscles. Sphincter muscles periodically open and close, allowing the contents of the GI tract to move along at a controlled pace. The upper esophageal sphincter opens in response to swallowing; the lower esophageal sphincter (also called the cardiac sphincter) prevents reflux of stomach contents; the pyloric sphincter holds chyme in the stomach long enough to be liquefied and prevents intestinal contents from backing up into the stomach; the ileocecal valve allows the contents of the small intestine to empty into the large intestine; two sphincters of the anus prevent continuous elimination.

101 : Describe anatomical features of the small intestine that facilitate absorption. Include a discussion of the absorption of water-soluble versus fat-soluble nutrients.

Correct Answer : ?The inner surface of the small intestine is wrinkled into hundreds of folds.

Each fold is contoured into thousands of fingerlike projections called villi. A single villus is covered with microscopic hairs called microvilli. In the crevices between the villi lie the crypts— tubular glands that secrete the intestinal juices into the small intestine. Nearby goblet cells secrete mucus. Within its 10-foot length, which provides a surface area equivalent to a tennis court, the small intestine traps and absorbs the nutrient molecules. To remove the absorbed molecules rapidly and provide room for more to be absorbed, a rush of circulating blood continuously washes the underside of this surface, carrying the absorbed nutrients away to the liver and other parts of the body. When a nutrient molecule has crossed the cell of a villus, it enters the bloodstream or the lymphatic system. The water-soluble nutrients and the small products of digestion are released directly into the bloodstream and guided directly to theliver.

The larger fats and the fat-soluble vitamins are assembled into chylomicrons, which are released into the lymphatic system. They move through the lymph until they can enter the bloodstream at a point near the heart. Consequently, chylomicrons bypass the liver.

102 : Discuss the validity of food combining to enhance digestion and absorption.

Correct Answer : ?The idea that people should not eat certain food combinations (for example, fruit and meat) at the same meal, because the digestive system cannot handle more than one task at a time, is a myth. The art of “food combining”—which actually emphasizes “food separating”—is based on this myth, and it represents faulty logic and a gross underestimation of the body's capabilities. In fact, the contrary is often true; foods eaten together can enhance each other's use by the body. For example, vitamin C in a pineapple or other citrus fruit can enhance the absorption of iron from a meal of chicken and rice or other iron-containing foods.

103 : Discuss the role of the human microbiome in the GI tract and the factors that help regulate microbial proliferation. Discuss the benefits of prebiotics and probiotics in maintaining intestinal 17 / 20

microorganisms.

Correct Answer : ?A healthy GI tract is home to a vibrant community of some 100 trillion microbes—bacteria, viruses, fungi, protozoa, and other microorganisms, collectively known as the human microbiome. The prevalence of different microbes in various parts of the GI tract depends on such factors as pH, peristalsis, diet, and other microbes. Relatively few microbes can live in the low pH of the stomach with its somewhat rapid peristalsis, whereas the neutral pH and slow peristalsis of the lower small intestine and the large intestine permit the growth of a diverse and abundant population. Bacteria digest and metabolize fibers and other nutrients that cannot be digested by the human body, producing compounds such as short fragments of fat, which can influence energy metabolism and immunity. Bacteria in the GI tract also produce several vitamins. Fibers and some other food components are called prebiotics because they encourage the growth and activity of bacteria. Some foods contain probiotics, live microbes that change the conditions of the GI tract in ways that seem to benefit health, including helping to alleviate diarrhea, constipation, inflammatory bowel disease, ulcers, allergies, lactose intolerance, and infant colic; enhance immune function; and protect against colon cancer.

104 : Name and describe the functions of three major hormones involved in digestion and absorption. Include a discussion of the feedback mechanisms that regulate hormone secretion.

Correct Answer : Food entering the stomach stimulates cells in the stomach walls to release the hormone gastrin. Gastrin, in turn, stimulates the stomach glands to secrete the components of hydrochloric acid. When a pH of 1.5 is reached, the acid itself turns off the gastrin-producing cells. The presence of chyme stimulates the cells of the duodenal wall to release the hormone secretin into the blood. When secretin reaches the pancreas, it stimulates the pancreas to release its bicarbonate-rich juices. When the need has been met, the cells of the duodenal wall are no longer stimulated to release secretin, the hormone no longer flows through the blood, and the pancreas no longer receives the message and stops sending pancreatic juice. Fat in the intestine stimulates cells of the intestinal wall to release the hormone cholecystokinin (CCK).

This hormone travels by way of the blood to the gallbladder and stimulates it to contract, which releases bile into the small intestine. CCK also travels to the pancreas and stimulates it to secrete its juices, which releases bicarbonate and enzymes into the small intestine. Once the fat in the intestine is emulsified and enzymes have begun to work on it, the fat no longer provokes release of the hormone, and the message to contract is canceled.

105 : Discuss the response of the pancreas (enzyme secretion) upon exposure to diets differing in the amounts of protein, fat, and carbohydrate. What is the most likely explanation for the observation that a person may experience upset digestion upon changing the diet? Why isnt the pancreas damaged by its own digestive enzymes?

Correct Answer : Enzyme activity changes proportionately in response to the amounts of carbohydrate, fat, and protein in the diet. If a person has been eating mostly carbohydrates, the pancreas makes and secretes mostly carbohydrases; if the person's diet has been high in fat, the pancreas produces more lipases; and so forth. Hormones from the GI tract, secreted in response to meals, keep the pancreas informed as to its digestive tasks. The day or two lag between the time a person's diet changes dramatically and the time digestion of the new diet becomes efficient explains why dietary changes can "upset digestion" and should be made gradually. The pancreas protects itself from harm by producing an inactive form of the enzymes (zymogens). It releases these proteins into the small intestine, where they are activated to become enzymes.

106 : Trace the flow of blood in the general circulation. Compare this to the flow of blood as it leaves the digestive system, ending at the heart.

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Correct Answer : Blood leaving the right side of the heart circulates through the lungs and then back to the left side of the heart. The left side of the heart then pumps the blood out of the aorta through arteries to all systems of the body. The blood circulates in the capillaries, where it exchanges material with the cells and then collects in veins, which return it again to the right side of the heart (heart to arteries to capillaries to veins to heart).?Blood leaving the digestive system, however, goes by way of a vein. The hepatic portal vein directs blood not back to the heart but to the liver. The vein branches into a network of large capillaries so that every cell of the liver has access to the blood. Blood leaving the liver then collects into the hepatic vein, which returns blood to the heart (heart to arteries to capillaries in the intestines to hepatic portal vein to capillaries in the liver to hepatic vein to heart).

107 : Cirrhosis of the liver is characterized by extensive scarring that occurs as the liver tries to repair itself in response to damage. This condition has many causes, most notably chronic alcoholism. Why can excessive consumption of alcohol (a toxin) lead to cirrhosis?

Correct Answer : The liver is the first to receive the nutrients absorbed from the GI tract. In addition, the liver defends the body by detoxifying substances that might cause harm and preparing wastes for excretion. This is why, when people ingest poisons that succeed in passing the first barrier (the intestinal cells), the liver quite often suffers the damage—from viruses such as hepatitis, from drugs such as barbiturates or alcohol, from toxins such as pesticide residues, and from contaminants such as mercury.

108 : Describe the similarities and differences in fluid and nutrient losses associated with vomiting and diarrhea.

Correct Answer : Vomiting is the expulsion of the contents of the stomach up through the esophagus to the mouth. Vomiting is often not a cause for alarm, but may cause large losses of fluid (threatening dehydration) accompanied by salts that are absolutely essential to the life of the cells. Diarrhea is the frequent passage of watery bowel movements. Like vomiting, diarrhea can lead to considerable fluid and salt losses, but the composition of the fluids is different.

Stomach fluids lost in vomiting are highly acidic, whereas intestinal fluids lost in diarrhea are nearly neutral.

109 : Compare and contrast the causes, symptoms, and treatments of irritable bowel disease, colitis, and celiac disease.

Correct Answer : Irritable bowel disease is characterized by frequent or severe abdominal discomfort and a disturbance in the motility of the GI tract. In most cases, GI contractions are stronger and last longer than normal, forcing intestinal contents through quickly and causing gas, bloating, and diarrhea. In some cases, however, GI contractions are weaker than normal, slowing the passage of intestinal contents and causing constipation. The exact cause of irritable bowel syndrome is not known but may involve the nervous system. The condition seems to worsen for some people when they eat certain foods or during stressful events. These triggers seem to aggravate the symptoms but not cause them. Dietary treatment hinges on identifying and avoiding individual foods that aggravate symptoms and eating small meals. Other treatments that may be effective include antispasmodic drugs and peppermint oil.?People with colitis, an inflammation of the large intestine, may also suffer from severe diarrhea. They often benefit from complete bowel rest and medication. If treatment fails, surgery to remove the colon and rectum may be necessary.?Celiac disease is an autoimmune disease characterized by inflammation of the small intestine that occurs in response to foods that contain gluten, a protein commonly found in wheat, barley, rye, and possibly oats. Gluten triggers an immune system reaction in the small intestine that causes inflammation, which damages the villi and decreases 19 / 20

nutrient absorption. Common symptoms include abdominal pains, bloating and gas, and diarrhea—making it commonly misdiagnosed as irritable bowel syndrome. Treatment focuses on a gluten-free diet. Despite the growing popularity of gluten-free products, there is no evidence to suggest that a gluten-free diet is beneficial for the general population.

110 : What triggers choking? What is the best way to assist a person who is choking? Which foods are commonly associated with choking?

Correct Answer : Sometimes a sip of a beverage or a tiny bit of food “slips down the wrong pipe.” The body’s first response is to cough, and quite often coughing clears the passage.

When someone is truly choking, however, food has slipped into the trachea and completely blocked the air passageways. Thus the person cannot cough—or even breathe or speak. For this reason, to help a person who is choking, first ask “Can you speak?” If the person is coughing, breathing adequately, or able to speak, do not interfere. Do not hit him on the back as the particle may become lodged more firmly in his air passageway. If the person cannot speak or cough, shout for help and perform the Heimlich maneuver. Almost any food can cause choking, although some are cited more often than others: chunks of meat, hot dogs, nuts, whole grapes, raw carrots, marshmallows, hard or sticky candies, gum, popcorn, and peanut butter. These foods are particularly difficult for young children (especially those 4 years of age and younger) to safely chew and swallow.

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MULTIPLE CHOICE 1 : Which foods almost always provide ample amounts of carbohydrates?

A : plant foods B : health foods C : animal products D : protein-rich foods Correct Answer : A 2 : What type of nutrient is starch?

A : fiber B : gluten C : simple carbohydrate D : complex carbohydrate Correct Answer : D 3 : How many carbon atoms are found in most common dietary monosaccharides?

A:5 B:6 C:8 D : 12 Correct Answer : B 4 : Which specific type of sugar is known as blood sugar or dextrose?

A : glucose B : maltose C : sucrose D : fructose Correct Answer : A 5 : What is the sweetest-tasting simple carbohydrate in the diet?

A : glucose B : lactose C : fructose D : sucrose Correct Answer : C 6 : What reaction links two monosaccharides together?

A : hydrolysis B : absorption C : disaccharide D : condensation Correct Answer : D 7 : What chemical is a byproduct of the condensation of two molecules of glucose?

A : water 1 / 14

B : oxygen C : hydrogen D : carbon dioxide Correct Answer : A 8 : What chemical reaction splits starch into individual monosaccharides?

A : hydrolysis B : condensation C : gluconeogenesis D : homeostatic balancing Correct Answer : A 9 : What is the composition of sucrose?

A : two fructose units B : one glucose and one fructose unit C : one glucose and one galactose unit D : one galactose and one fructose unit Correct Answer : B 10 : Which monosaccharide is a component of all three dietary disaccharides?

A : sucrose B : glucose C : fructose D : galactose Correct Answer : B 11 : What is the primary storage form of carbohydrate in the body?

A : fiber B : starch C : glucose D : glycogen Correct Answer : D 12 : What are cellulose, pectin, hemicellulose, and lignin?

A : fibers B : starches C : sugar alcohols D : artificial sweeteners Correct Answer : A 13 : What is the difference between the chemical bonds in starch and those in cellulose?

A : Starch bonds are single.

B : Starch bonds are fatty acids.

C : Cellulose bonds release energy.

D : Cellulose bonds are not hydrolyzed by human enzymes.

Correct Answer : D 2 / 14

14 : A functional fiber is one that .

A : occurs naturally in the intact plant B : performs a specific function in the plant C : is extracted from plants and has a beneficial health effect D : is a polysaccharide that is stored primarily in muscle and liver of animals Correct Answer : C 15 : Which carbohydrate is the least likely to contribute to the energy for the body?

A : sucrose B : glycogen C : maltose D : cellulose Correct Answer : D 16 : What change would you expect in milk that has been treated with a commercially available lactase?

A : an increase in sweetness B : a decrease in sweetness C : an increase in carbohydrate content D : a decrease in carbohydrate content Correct Answer : A 17 : Enzymatic digestion of starches takes place both in the small intestine and the A : mouth B : colon C : stomach D : pancreas

.

Correct Answer : A 18 : The short chains of glucose units that result from starch breakdown are called A : sucrose B : lignins C : pectins D : dextrins

.

Correct Answer : D 19 : What is the primary absorption site for digestible carbohydrates?

A : mouth B : stomach C : small intestine D : large intestine Correct Answer : C 20 : The enzymes that digest dietary sugars are produced by the A : gall bladder B : stomach

.

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C : pancreas D : small intestine Correct Answer : D 21 : What is the primary means for degradation of soluble fibers in the large intestines?

A : bacterial enzymes B : pancreatic amylase C : peristaltic segmentation D : villus brush border hydrolases Correct Answer : A 22 : What is the first organ to receive carbohydrates absorbed from the intestine?

A : heart B : liver C : pancreas D : skeletal muscle Correct Answer : B 23 : Why are hard cheeses lower in lactose than soft cheeses?

A : The lactose molecules bond to casein.

B : More lactose is removed during manufacturing.

C : The bacterial culture is selected to degrade more of the lactose.

D : The lactose molecules condense to form a poorly digested oligosaccharide.

Correct Answer : B 24 : Which dairy product provides the least amount of lactose per serving?

A : low-fat milk B : cottage cheese C : chocolate milk D : cheddar cheese Correct Answer : D 25 : Among the following population groups, which shows the highest prevalence of lactose intolerance?

A : Hispanics B : Caucasians C : Scandinavians D : Native Americans Correct Answer : D 26 : Which ingredient listed on food labels would be acceptable to the person who is highly intolerant to lactose in the diet?

A : whey B : casein C : dextrins D : milk solids 4 / 14

Correct Answer : C 27 : Which organ contains most of the bodys glycogen?

A : liver B : muscle C : kidney D : intestine Correct Answer : B 28 : When a typical body is at rest, what is the maximum amount of time stores of glycogen can provide energy to sustain the body?

A : 4 hours B : 1 day C : 3 days D : 1 week Correct Answer : B 29 : What is the primary function of insulin?

A : to raise blood glucose levels B : to lower blood glucose levels C : to stimulate glycogen breakdown D : to stimulate intestinal carbohydrate absorption Correct Answer : B 30 : Ketosis leads to a change in A : carbohydrate metabolism B : blood acid-base balance C : fat synthesis D : insulin homeostasis

.

Correct Answer : B 31 : What is the best food source to prevent ketosis?

A : protein rich foods, such as steak B : foods with high fat content, such as cheeses C : carbohydrates, such as vegetables D : foods containing lactase, such as yogurt Correct Answer : C 32 : Ketone bodies are formed from A : amino acids B : fat fragments C : nucleic acids D : monosaccharides

.

Correct Answer : B 33 : What is the most common cause of hypoglycemia?

A : overeating 5 / 14

B : brain tumors C : uncontrolled diabetes D : fasting Correct Answer : C 34 : What is the process by which an amino acid is used to make glucose?

A : glycation B : ketogenesis C : protein sparing D : gluconeogenesis Correct Answer : D 35 : What is the first organ to respond to an increase in blood glucose concentration?

A : brain B : liver C : muscle D : pancreas Correct Answer : D 36 : What is a normal range (in mg/dL) for blood glucose?

A : 6080 B : 70100 C : 120140 D : 140180 Correct Answer : B 37 : What is the typical response of the body to changes in blood glucose?

A : Blood glucose levels that fall too low signal the release of insulin.

B : Blood glucose levels that fall too low signal the release of glucagon.

C : Blood glucose levels that rise too high signal the release of glycogen.

D : Blood glucose levels that rise too high signal the release of epinephrine.

Correct Answer : B 38 : When you are under physical stress, what hormone is released quickly to stimulate an increase in blood glucose concentration?

A : insulin B : secretin C : glycogen D : epinephrine Correct Answer : D 39 : A person eating lots of white bread, white rice, and ready-to-eat cereals would have a diet with a glycemic index that is .

A : very low B : low C : moderate D : high 6 / 14

Correct Answer : D 40 : Your nephew Jimmy, who is 10 years old, has told you that his body doesnt make insulin.

He confides in you that he craves candy but was told by his parents that he can only eat sugarfree snacks. Jimmy has most likely been diagnosed with .

A : hyperactivity B : type 1 diabetes C : type 2 diabetes D : non-insulin dependent diabetes mellitus Correct Answer : B 41 : What is one feature of people diagnosed with diabetes?

A : Many people with type 2 diabetes are obese.

B : Most people who have diabetes require insulin therapy.

C : Diabetes results chiefly from excess dietary intake of simple carbohydrates.

D : People with type 1 diabetes fail to respond to the insulin made by the pancreas.

Correct Answer : A 42 : The glycemic index of foods is .

A : a method of ranking foods according to their potential to increase blood glucose B : the newest, most practical means for planning diets for people with diabetes C : a well-utilized, highly valued mechanism to control the intake of simple sugars D : a measure of the percentage of digestible carbohydrates in relation to total energy content of the food Correct Answer : A 43 : High-fructose corn syrup contains significant amounts of A : glucose B : maltose C : sucrose D : galactose

.

Correct Answer : A 44 : What is the predominant sweetener used in formulating beverages?

A : glucose B : sucrose C : invert sugar D : high-fructose corn syrup Correct Answer : D 45 : Food manufacturers prefer to use high-fructose corn syrup instead of sugar because sugar .

A : is more soluble B : is more expensive C : retains more moisture D : contains less soluble fiber 7 / 14

Correct Answer : B 46 : Which condition is a known indicator of prediabetes?

A : insulin resistance B : severe hunger 45 hours after a meal C : carbohydrate intake as a percentage of total kcalories D : more than two episodes per week of hypoglycemia Correct Answer : A 47 : Honey contains .

A : both fructose and lactose B : both glucose and galactose C : more kcalories per teaspoon than sucrose D : abundant amounts of calcium and iron Correct Answer : C 48 : Which sweetener contains a significant amount of calcium?

A : molasses B : brown sugar C : maple sugar D : invert sugar Correct Answer : A 49 : Which dietary strategy will have the most effect in reducing the incidence of dental caries?

A : Eat sugary foods separate from meals.

B : Eat dried fruits in place of whole fruits.

C : Sip a sugary soft drink slowly rather than quickly.

D : Eat a sugary snack all at one time rather than in parts throughout the day.

Correct Answer : D 50 : Which statement accurately describes the relationship between carbohydrate intake and dental health?

A : Starches cannot promote the formation of dental caries.

B : After exposure to a single snack, mouth bacteria produce acid for 6090 minutes.

C : Eating a sugary dessert at the beginning of a meal, rather than the end, is less likely to promote dental caries.

D : Sugar consumed in a soft drink promotes more bacterial fermentation than the same amount of sugar in a doughnut.

Correct Answer : C 51 : What is stevia?

A : an herb-derived sweetener B : an FDA-approved sugar alcohol C : a poorly digested polysaccharide D : an inhibitor of lactase enzyme activity Correct Answer : A 8 / 14

52 : Among the following approved sweeteners, which has the highest relative sweetness?

A : tagatose B : neotame C : aspartame D : acesulfame-K Correct Answer : B 53 : What is a characteristic of the sugar replacers (sugar alcohols)?

A : They have a low glycemic index.

B : They promote constipation in children.

C : They demonstrate fewer GI side effects than the artificial sweeteners.

D : They are less effective than artificial sweeteners in inhibiting dental caries.

Correct Answer : A 54 : When consumed in excess, which food component is most likely to lead to diarrhea?

A : fiber B : sucrose C : wheat starch D : sugar alcohols Correct Answer : D 55 : Which food component is known to correlate most strongly with reduced risk of deaths from heart disease when consumed in high amounts?

A : fiber B : sugar C : levulose D : corn syrup Correct Answer : A 56 : What are the two main mechanisms by which starch decreases the risk of colon cancer?

A : binding and removing potential carcinogens and the activation of cancer-killing enzymes B : decreasing the rate at which carcinogens pass through large intestines and the activation of cancer-killing enzymes C : binding and removing potential carcinogens and increasing inflammation in the colon in response to carcinogens D : activation of cancer-killing enzymes and increasing inflammation in the colon in response to carcinogens Correct Answer : A 57 : According to most dietary guidelines, what percentage of the days total energy intake should be furnished by carbohydrates?

A : 1015 B : 3035 C : 4565 D : 9095 Correct Answer : C 9 / 14

58 : What is a characteristic of carbohydrate information on food labels?

A : The Sugars amount includes only added sugars.

B : The amount of starch is listed as a separate category.

C : The Total Carbohydrate amount includes starch, sugars, and fiber.

D : The Total Carbohydrate amount includes starch and sugars but not fiber.

Correct Answer : C 59 : What is a typical response in people following a low-carbohydrate diet?

A : They often complain of diet-induced diarrhea.

B : They experience frequent bouts of hyperglycemia.

C : Their total weight loss is about the same as in people on a low-fat diet.

D : They lose about the same amount of weight as people on conventional diets for the first 6 months.

Correct Answer : C 60 : People who are insulin resistant are more likely to increase A : glycogen stores in the muscles B : glycogen stores in the liver C : fat production in the muscles D : fat production in the liver

.

Correct Answer : D 61 : Eating foods with a low glycemic index most likely leads to weight loss by A : curbing appetite to prevent overeating B : increasing insulin production to stimulate digestion C : decreasing insulin production to stimulate fat production D : stimulating glucagon production to break down fats in storage

.

Correct Answer : A 62 : What nutrient has accounted for virtually all of the increase in kcalorie intake of people in the United States since the 1970s?

A : fat B : protein C : alcohol D : carbohydrate Correct Answer : D 63 : What is a common result when a person with type 2 diabetes loses weight?

A : a decrease in glucagon sensitivity B : a decrease in carbohydrate cravings C : an increase in insulin sensitivity D : an increase in epinephrine secretion Correct Answer : C

MATCHING 10 / 14

64 : Match each word or phrase with the most appropriate definition or explanation.

A : disaccharide containing fructose A : pectin B : chemical reaction that links two molecules B : insulin together C : mouth C : chemical reaction that splits a larger molecule into smaller molecules D : a complex carbohydrate in muscle D : starch E : a complex carbohydrate in legumes E : sucrose F : structurally similar to starch but resistant to F : lactose digestion G : a water-soluble fiber G : lignin H : a water-insoluble fiber H : sucralose I : site where digestion of disaccharides takes I : glycogen place J : site where digestion of starch begins J : glucagon K : site where fibers may be metabolized to K : cellulose short-chain fatty acids L : when digested, yields galactose L : hydrolysis M : substance that signals the release of M : high fructose corn syrup glucose into blood N : substance that signals removal of glucose N : epinephrine from the blood O : condensation O : stress hormone that modulates blood glucose P : processed syrup made from cornstarch P : small intestine Q : an alternative sweetener Q : large intestine Correct Answer : A:E B : A14 C : A11 D:I E:D F:K G:A H:G I : A15 J:C K : A16 L:F M:J 11 / 14

N:B O : A13 P : A12 Q:H

ESSAY 65 : List the three most common types of polysaccharides in nutrition, and describe each one in terms of its function and monosaccharide composition.

Correct Answer : The three major polysaccharides are glycogen, starches, and dietary fibers.

Glycogen is found in the muscle and liver of animals, while starch and fibers are both plantbased polysaccharides. Glycogen, which serves as the glucose storage for animals, is comprised entirely of glucose molecules attached together in a highly branched structure.

Starches are how plants store their excess glucose, and therefore are also comprised entirely of glucose molecules; however, the glucose molecules are linked together in long branched and unbranched chains. Fibers, which comprise the structural parts of plants, are mostly polysaccharides, though it can be comprised of other chemicals and different monosaccharides.

However, these fibers cannot be broken down into monosaccharides by enzymes in the digestive tract due to differences in the type of bonds that hold the monosaccharides together.

These types of polysaccharides cannot contribute energy to the body, as they pass through undigested.?

66 : Describe carbohydrate digestion, including the processes occurring in the mouth, stomach, small intestines, and large intestines to break down polysaccharides, disaccharides, monosaccharides, and the fate of fiber.

Correct Answer : ?Carbohydrate digestion begins in the mouth with salivary enzymes (salivary amylase) that can break down starches into smaller polysaccharides and disaccharides.

Digestion of carbohydrates ceases in the stomach, as acids in the stomach create a pH environment that is unfriendly to the enzymes that break down the carbohydrates. Fiber in the stomach also remains intact, which helps with a feeling of fullness. In the small intestines, enzymes are secreted that completely break all of the polysaccharides (pancreatic amylase) and disaccharides (maltase, sucrase, and lactase) into monosaccharides, which are then absorbed into the body. The cellulose passes through the small intestines untouched and into the large intestines. Some of fiber is digested by bacteria living in the large intestine, while most remains intact, aiding with defecation by retaining water and increasing heart health by binding cholesterol for elimination.

67 : Explain how high levels of glucose in the blood after you eat affect insulin levels, glucagon levels, and the fate of glucose in the blood stream.

Correct Answer : ?After you eat, increased blood glucose levels will stimulate the beta cells in the pancreas to increase insulin levels, while simultaneously inhibiting the release of glucagon from the alpha cells of the pancreas, decreasing these levels. The increase in insulin levels will trigger the removal of glucose from the blood stream into liver and muscle cells for storage as 12 / 14

glycogen.

68 : Explain how the glycemic response is dependent on the source of carbohydrates that you consume. Is it better to have a high or low glycemic response? Explain.

Correct Answer : ?The glycemic response, or the speed at which glucose is absorbed into the blood stream, increases when glucose is easily digested, such as when you consume large amounts of foods containing added sugars, like honey or corn syrup, particularly in the absence of any other foods. The glycemic response would decrease when the carbohydrates are less easily digested, such as when you consume foods that are high in polysaccharides, like fruits and vegetables, or when you eat the sugars with other foods that may alter sugar absorption. It is better to have a low glycemic index, as this maintains more steady-state levels of glucose and allow for lower levels of insulin to be released, rather than a large spike of glucose triggering a larger bolus of insulin, which would then lead to a sharp decline in glucose levels.

69 : Explain how carbohydrate consumption leads to dental carries.

Correct Answer : ?Bacteria that live in the mouth ferment the sugars, which produce acid that erodes tooth enamel.

70 : Explain the difference between artificial sweeteners and sugar alcohols, including the benefits and drawbacks of each type.

Correct Answer : ?Artificial sweeteners and sugar alcohols are both used to add sweetness to foods without the caloric value. Artificial sweeteners do not contain any appreciable amount of energy for a body, which is good for weight gain. The biggest drawback to these sweeteners is that in high doses, these chemicals can cause adverse effects, though the exact degree to which they do this and the exact relationship between quantity and the development of these effects is still being studied. Sugar alcohols, however, do contribute calories to the diet but fewer than regular sugars. Sugar alcohols may cause abdominal discomfort and diarrhea.

However, they do not contribute to dental carries.

71 : How does a diet that is high in fiber benefit patients with diabetes?

Correct Answer : ?Soluble fibers can trap nutrients as they pass through the digestive tract, which slows glucose absorption. The decrease in absorption prevents a high surge of glucose, and the rebound that comes after the insulin levels spike.

72 : An adolescent male comes to you for advice as to how best manage his diet. In the initial evaluation, you decide that he should be consuming approximately 2500 kcalories. How many of these kcalories should be contributed by carbohydrates, and what is the approximate amount of fiber you would recommend for this young man.

Correct Answer : ?Carbohydrates should contribute between 45 to 65 percent of the kcalories, so between 1125 and 1625 kcalories should come from carbohydrates. Fiber should be about 14 grams per 1000 kcalories, so he should be consuming about 35 grams of fiber. (14g fiber/1000 kCalories ´ 2500 kCalories = 35 grams of fiber).

73 : Describe the mechanism by which a high-fiber diet decreases the risk of heart disease independent of decreasing fat intake.

Correct Answer : ?Soluble fibers can bind to bile acids in the GI tract, leading to their excretion from the body rather than being recycled for reuse. When this happens, the liver is forced to 13 / 14

make new bile acids by breaking down cholesterol that is stored in the liver. This, in turn, will decrease blood cholesterol.

74 : Explain why the consumption of high fructose corn syrup is particularly problematic for people trying to lose weight.

Correct Answer : ?Fructose can only be metabolized in the liver, which will convert most of the fructose into fat. Additionally, fructose does not stimulate an insulin response, which would normally suppress the appetite. In the absence of this cue, one would not feel that they had been satiated after eating foods that contain high amounts of fructose.

14 / 14

MULTIPLE CHOICE 1 : Most dietary lipids are A : sterols B : glycerols C : triglycerides D : monoglycerides

.

Correct Answer : C 2 : Lipids that are solid at room temperature are known as A : oils B : fats C : omegas D : glycerols

.

Correct Answer : B 3 : What is the simplest 18-carbon fatty acid?

A : stearic acid B : linoleic acid C : palmitic acid D : linolenic acid Correct Answer : A 4 : Like , lipids are made of A : vitamins; C, N, and O B : carbohydrates; C, H, and O C : protein; C, H, O, and N D : water; C, H, and O

atoms.

Correct Answer : B 5 : Which type of fatty acid is missing four or more hydrogen atoms?

A : monounsaturated fatty acid B : polyunsaturated fatty acid C : long-chain saturated fatty acid D : short-chain saturated fatty acid Correct Answer : B 6 : An omega-3 fatty acid has its first double bond on the A : third carbon from the acid end B : first three carbons from the acid end C : third carbon from the methyl end D : first three carbons from the methyl end

.

Correct Answer : C 7 : A triglyceride always contains three A : carbons

.

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B : glycerols C : fatty acids D : double bonds Correct Answer : C 8 : Which factor determines the hardness of a fat at a given temperature?

A : origin of the fat B : degree of saturation C : number of acid groups D : number of oxygen atoms Correct Answer : B 9 : Which food source would yield the softest lipids at room temperature?

A : lard B : beef C : pork D : safflower Correct Answer : D 10 : Which structural feature of fatty acids determines their susceptibility to spoilage by oxygen?

A : chain length B : number of double bonds C : position of first saturated bond D : size of adjacent fatty acids on the triglyceride molecule Correct Answer : B 11 : What is the target of hydrogenation?

A : bond between the fatty acid chain and the glycerol backbone B : bond between the phosphate group and the choline C : carbon-carbon double bond D : carbon-hydrogen bond Correct Answer : C 12 : What is a negative consequence of hydrogenation?

A : addition of trans double bonds in fatty acids B : addition of cis double bonds in fatty acids C : loss of trans double bonds in fatty acids D : loss of cis double bonds in fatty acids Correct Answer : A 13 : How does the presence of a double bond alter the firmness of fatty acid molecules?

A : Double bonds bend the molecule, which leads to an increase in the stacking of molecules.

B : Double bonds straighten the molecule, which leads to an increase in the stacking of molecules.

C : Double bonds bend the molecule, which leads to a decrease in the stacking of molecules.

D : Double bonds straighten the molecule, which leads to a decrease in the stacking of molecules.

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Correct Answer : C 14 : What is a feature of phospholipids?

A : resistant to digestion B : soluble in both water and fat C : highly susceptible to oxidation D : found naturally only in animal foods Correct Answer : B 15 : What characteristic is shared by cholesterol and lecithin?

A : Both are sterols.

B : Both are phospholipids.

C : Both are synthesized in the body.

D : Both are essential dietary nutrients.

Correct Answer : C 16 : What is the major sterol in an omnivorous diet?

A : palm oil B : lecithin C : cholesterol D : arachidonic acid Correct Answer : C 17 : What is the main composition of the cell membrane?

A : phospholipids with the fatty acid tails facing the outside and the phosphates on the inside B : phospholipids with the phosphates facing the outside and the fatty acids on the inside C : sterols with the fatty acid tails facing the outside and the phosphates on the inside D : sterols with the phosphates facing the outside and the fatty acids on the inside Correct Answer : B 18 : A common feature of the plant sterols is they A : raise LDL and lower HDL B : inhibit absorption of dietary cholesterol C : inhibit absorption of bad cholesterol D : enhance absorption of omega-3 fatty acids

.

Correct Answer : B 19 : Which compound is a sterol?

A : vitamin D B : phospholipid C : triglyceride D : oleic acid Correct Answer : A 20 : What is a characteristic of the lipase enzymes?

A : Gastric lipase plays a significant role in fat digestion in adults.

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B : Intestinal mucosal lipase is responsible for fat storage in adipocytes.

C : Salivary gland lipase (lingual lipase) plays an active role in fat digestion in infants.

D : Pancreatic lipase hydrolyzes most dietary triglycerides completely to glycerol and free fatty acids.

Correct Answer : C 21 : In the digestion of fats, emulsifiers function as A : enzymes B : hormones C : detergents D : chylomicrons

.

Correct Answer : C 22 : What part of the gastrointestinal tract is the predominant site of dietary fat hydrolysis?

A : mouth B : stomach C : small intestine D : large intestine Correct Answer : C 23 : Chylomicrons are synthesized within the A : liver B : intestinal cells C : lymphatic system D : storage compartment of plant seeds

.

Correct Answer : B 24 : Bile assists in the absorption of A : fat only B : all nutrients C : carbohydrate and fat only D : carbohydrate, fat, and protein

.

Correct Answer : A 25 : Where is bile stored in the body?

A : liver B : pancreas C : gallbladder D : intestinal epithelial cells Correct Answer : C 26 : After a meal, most of the fat that eventually empties into the blood is in the form of particles known as .

A : micelles B : chylomicrons C : low-density lipoproteins D : very-low-density lipoproteins 4 / 13

Correct Answer : B 27 : Your Aunt Gladys has a family history of heart disease. She decides to begin eating a bowl of oatmeal every morning to help lower her blood cholesterol. After about a month of following this routine, her cholesterol declined about five points. What is the most likely explanation for this effect?

A : Oatmeal is a low-fat food and inhibits the bodys synthesis of cholesterol.

B : Oatmeal is high in complex fibers that inhibit cholesterol-synthesizing enzymes.

C : Oatmeal consumed on a regular basis suppresses the craving for high-cholesterol foods.

D : Oatmeal is high in soluble fibers that trap bile, causing the body to use more cholesterol for bile replacement.

Correct Answer : D 28 : Which lipoprotein is largest in size?

A : chylomicron B : high-density lipoprotein C : low-density lipoprotein D : very-low-density lipoprotein Correct Answer : A 29 : In comparison to a low-density lipoprotein, a high-density lipoprotein contains A : less lipid B : less protein C : more cholesterol D : more carbohydrate

.

Correct Answer : A 30 : A high risk of heart attack correlates with high blood levels of A : free fatty acids B : high-density lipoproteins C : low-density lipoproteins D : very low-density lipoproteins

.

Correct Answer : C 31 : What lipoprotein is responsible for transporting cholesterol back to the liver from the periphery?

A : chylomicron B : low-density lipoprotein C : high-density lipoprotein D : very-low density lipoprotein Correct Answer : C 32 : Resistin and adiponectin are .

A : glycolipids that regulate synthesis of lipoproteins B : intestinal cell hormones that regulate secretion of bile C : intestinal cell hormones that trigger secretion of pancreatic juice D : protein hormones secreted from fat cells that help regulate energy balance 5 / 13

Correct Answer : D 33 : What fatty acid is used by the body to synthesize arachidonic acid?

A : oleic acid B : linoleic acid C : palmitic acid D : linolenic acid Correct Answer : B 34 : Aspirin works to reduce the symptoms of infection or pain by retarding the synthesis of .

A : arachidonic acid B : certain eicosanoids C : certain saturated fatty acids D : certain unsaturated fatty acids Correct Answer : B 35 : Which food or foods provide(s) essential fatty acids?

A : fish only B : beef only C : plants only D : fish, beef, and plants Correct Answer : D 36 : What is the function of lipoprotein lipase?

A : to synthesize lipoproteins in liver cells B : to synthesize triglycerides in adipose cells C : to assemble lipid particles into chylomicrons D : to hydrolyze blood triglycerides for uptake into cells Correct Answer : D 37 : Which two fatty acids are absolutely essential and cannot be produced by the body?

A : arachidonic acid and linoleic acid B : DHA and EPA C : oleic acid and linolenic acid D : linoleic acid and linolenic acid Correct Answer : D 38 : What is the highest total blood cholesterol concentration (mg/dL) that falls within the desirable range?

A : 50 B : 101 C : 199 D : 299 Correct Answer : C 6 / 13

39 : Which lipids are measured in a lipid profile?

A : cholesterol and phospholipids B : cholesterol and eicosanoids C : phospholipids and eicosanoids D : triglycerides and cholesterol Correct Answer : D 40 : Your roommate Bob has just come back from the doctor, where he was subjected to a blood lipid profile analysis. The doctor recommended he make dietary changes because his blood cholesterol levels put him at increased risk for cardiovascular disease. Bob most likely has .

A : low LDL and high HDL B : low HDL and high LDL C : high LDL and HDL D : low LDL and HDL Correct Answer : B 41 : What is a feature of fat intake and health?

A : Intake of saturated fat raises blood cholesterol more than intake of cholesterol.

B : High intakes of fish oil decrease bleeding time and improve diabetes and wound healing.

C : High intakes of short- and medium-chain fatty acids raise high-density lipoprotein levels.

D : Trans-fatty acids contained in polyunsaturated fats but not in monounsaturated fats alter blood cholesterol levels.

Correct Answer : A 42 : What describes a recognized relationship between dietary fat and cancer?

A : Fat from milk does not increase risk for cancer.

B : Dietary fat initiates rather than promotes cancer formation.

C : High intakes of omega-3 fatty acids promote cancer development in animals.

D : The evidence linking fat intake with cancer is stronger than that linking it with heart disease.

Correct Answer : A 43 : Jenny is trying to lose weight by decreasing the fat in her diet. At the grocery store, she is overwhelmed by all the claims on the food product labels and finally chooses an expensive fatfree frozen dessert. What would be an appropriate analysis of Jennys decision?

A : Most frozen desserts are fat-free and she should not pay extra for one with a fat-free claim.

B : Since fats contribute 9 kcalories per gram, she can eat twice as many kcalories from this dessert and still lose weight.

C : As long as she makes sure to eat the dessert before 9 p.m., it should not contribute much to her daily kcaloric intake.

D : Fat-free products typically have so much added sugar that the kcalorie count can be as high as in the regular-fat product.

Correct Answer : D 44 : What is a feature of fat in the diet of athletes?

A : A minimum of 20 percent fat energy in the diet is needed.

B : Energy derived from fat has very little bearing on performance.

C : Optimal performance is found with a high-carbohydrate, 15 percent total fat kcalories diet.

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D : Diets with at least 10 percent total kcalories from fat are still able to provide the recommended amounts of micronutrients.

Correct Answer : A 45 : Although eating fish supports heart health and fish provides many vitamins and minerals, it is notably poor in .

A : iron B : protein C : unsaturated fats D : omega-3 fatty acids Correct Answer : A 46 : What is a potential consequence of high intakes of fish oil supplements?

A : increased clotting B : excessive bleeding C : hypertension D : diabetes Correct Answer : B 47 : Ronnie eats a fairly balanced diet but wants to include a good source of omega-3 fats.

Which food should you recommend?

A : eggs B : salmon C : low-fat cheese D : lean chicken breast Correct Answer : B 48 : Which sources of lipids should be substituted for saturated fats to help lower blood cholesterol levels?

A : butter B : canola oil C : coconut oil D : stick margarine Correct Answer : B 49 : What is a characteristic of eggs in our diets today?

A : Eggs are high in both cholesterol and saturated fat.

B : High omega-3 fat eggs are now available by prescription only.

C : Although it is high in cholesterol, eggs are low in saturated fat.

D : Even in people with a healthy lipid profile, consumption of one egg per day is detrimental.

Correct Answer : C 50 : Which type of fish has the highest amount of omega-3 fatty acids?

A : catfish B : European sea bass C : cod D : grouper 8 / 13

Correct Answer : B 51 : What is a characteristic of the lipid content of meat?

A : The meat from grass-fed animals is similar in composition to soy protein.

B : Grass-fed animals contain more omega-3 fats in the meat than grain-fed animals.

C : Grain-fed animals contain more polyunsaturated fatty acids in the meat compared with grassfed animals.

D : Grain-fed animals contain lower concentrations of fat in the meat compared with grass-fed animals.

Correct Answer : B 52 : You and your friend John are planning a college graduation party and you want to include healthy snack alternatives. You select fruit, veggies, low-fat dips, low-fat cheeses, whole-wheat crackers, and low-fat potato chips. John says he has heard about the fat replacer olestra in the potato chips and asks you how it works. You reply that olestra .

A : slows the pancreass release of lipase enzyme B : consists of tight protein-binding molecules that replace the fat molecules usually present in potato chips C : contains a fat-like substance that the bodys enzymes cant break down and, therefore, cannot be absorbed D : is first subjected to radiation exposure to desaturate the bonds within the fat molecules, which reduces the kcalorie content Correct Answer : C 53 : What is the percent of kcalories from fat for a cookie that contains 10 grams of fat and 150 kcalories?

A : 90 percent B : 72.3 percent C : 60 percent D : 52.8 percent Correct Answer : C 54 : What is a feature of nut consumption and improved cardiovascular health?

A : The benefit is unrelated to the phytochemical content.

B : The benefit is unrelated to changes in LDL concentration.

C : The benefit is found only from ingestion of a few types of nuts.

D : The benefit may be related, in part, to the high content of monounsaturated fats and low content of saturated fats.

Correct Answer : D 55 : Studies show that regular consumption of fatty fish leads to A : lower blood pressure B : higher blood cholesterol C : greater tendency of the blood to clot D : decreased storage of omega-3 fatty acids

.

Correct Answer : A 9 / 13

56 : Which fish is generally highest in mercury?

A : shark B : catfish C : salmon D : canned light tuna Correct Answer : A 57 : A characteristic of farm-raised fish is that they contain A : lower levels of omega-3 fats B : higher levels of soluble fiber C : higher levels of trace elements D : higher levels of mercury

.

Correct Answer : A 58 : Studies show that a 1 percent increase in dietary saturated fatty acids will raise the risk of heart disease by what percentage?

A : 0.5 B : 1.0 C : 2.0 D : 5.0 Correct Answer : C 59 : What is a good plant source of omega-3 lipids?

A : flax seeds B : safflower oil C : sunflower seeds D : corn oil margarine Correct Answer : A 60 : A major feature of the Mediterranean diet is the liberal intake of A : eggs B : olive oil C : lean meat D : fortified butter

.

Correct Answer : B

MATCHING 61 : Match each word or phrase with the most appropriate definition or explanation.

A : an 18-carbon monounsaturated fatty acid A : liver B : olestra B : a plant-derived source of abundant saturated fatty acids C : a long-chain saturated fatty acid C : micelle D : a good source of monounsaturated fats D : aspirin E : a phospholipid E : lecithin F : major dietary precursor for vitamin D F : corn oil 10 / 13

synthesis G : source of bile G : olive oil H : signals the release of bile H : sardines I : major source of lipase I : pancreas J : structure assisting absorption of long-chain J : canola oil fats K : oleic acid K : a lipoprotein synthesized within intestinal absorptive cells L : a lipoprotein made primarily by the liver L : stearic acid M : cholesterol M : the lipoprotein type with the highest percentage of protein N : slows the synthesis of eicosanoids N : potato chips O : an essential fatty acid O : tropical oils P : common source of trans-fatty acids P : chylomicron Q : good food source of omega-3 fatty acids Q : linolenic acid R : good food source of omega-6 fatty acids R : cholecystokinin S : fat replacement product made from fatty S : high-density lipoprotein acids and sucrose T : oil that is characteristic of the Mediterranean T : very-low density lipoprotein diet Correct Answer : A:K B : A14 C : A11 D:J E:E F : A12 G:A H : A17 I:I J:C K : A15 L : A19 M : A18 N:D O : A16 P : A13 11 / 13

Q:H R:F S:B T:G

ESSAY 62 : What are the pros and cons of using hydrogenation in food preparation?

Correct Answer : ?Hydrogenation protects foods from spoiling too fast, increasing the shelf life of a product. It also increases the versatility of a fat by altering its texture (such as using vegetable oils to make margarine). The biggest drawback of the process of hydrogenation is that it introduces trans bonds into the fats. Essentially, this takes a healthier unsaturated fat and turns it into a fat that acts more like a saturated fat in the body, increasing cholesterol and risk of heart disease.

63 : Compare and contrast the firmness and stability of saturated, monounsaturated, and polyunsaturated fats.

Correct Answer : Firmness increases as you increase saturation, so the fewer the number of double bonds, the firmer the fat is at room temperature. Therefore, saturated fatty acids, which do not have any double bonds, are most firm at room temperature, followed by monounsaturated fats with a single double bond, and then polyunsaturated fats with multiple double bonds, which are usually oils at room temperature. Double bonds, however, are not as stable, and as such, polyunsaturated fats, with multiple double bonds, are the most likely to spoil, and saturated fats are the least likely to spoil.?

64 : What is an emulsifier? What would be the difference between normal mayonnaise and mayonnaise that was not treated with an emulsifier?

Correct Answer : ?An emulsifier is a substance that has both hydrophilic and hydrophobic regions, allowing it to interact with both water-soluble and fat soluble substances. This is important in the preparation of foods, such as mayonnaise, as it allows the water-soluble components of mayonnaise to mix well with the lipids in the condiment. In the absence of emulsifiers, the mayonnaise would separate into two separate layers.

65 : What is atherosclerosis, and what role does cholesterol play in its development?

Correct Answer : ?Atherosclerosis is a disease in the arteries caused by the accumulation of plaques on the inner wall that impede the flow of blood through the vessels. Cholesterol is a major contributor to the formation of these plaques.

66 : Describe fat digestion, beginning in the mouth and continuing through the large intestines.

Correct Answer : ?Fat digestion begins in the mouth, with some of the fats melting at body temperature. Additionally, lingual lipase released in saliva begins to hydrolyze the fats to some 12 / 13

extent, largely affecting short- and medium-chain fatty acids, such as those in dairy products.

Digestion continues in the stomach with gastric lipases, which also only hydrolyze a small amount of the fat. Most of the digestion of fats occurs in the small intestine, with the addition of bile, which emulsifies the fats, and pancreatic and intestinal lipases, which fully breaks down the emulsified triglycerides into monoglycerides, glycerol, and fatty acids, which can then be absorbed. Some fats may avoid absorption if they become trapped in fiber, which is then excreted from the body in feces.

67 : Describe the enterohepatic circulation of bile.

Correct Answer : ?Bile is made in the liver from cholesterol, which is then sent to the gallbladder for storage. After eating, bile is released into the small intestines to emulsify fats in this organ.

As it progresses through the small intestine, the bile can either be reabsorbed for reuse or is trapped by soluble fiber and removed in the feces.

68 : Describe the route of large lipid transport throughout the body in lipoproteins, beginning with absorption in the small intestine, and the roles of VLDL, LDL, and HDL. Correct Answer : ?Large lipids are absorbed into the intestine and form chylomicrons, which travel in the lymph to the thoracic valve, where they enter the blood. The chylomicrons then travel to fat and muscle cells for storage. The liver then removes any remnants of the chylomicrons from the blood. When fats are needed, the liver forms VLDL, which can then deliver the lipids throughout the body to where they are needed. As the lipids are removed from the VLDL, the VLDL transitions to LDL, which then travels back to the liver. The liver also makes HDL, which can pick up cholesterol from the body and return it to the liver for use or excretion.

69 : Aside from their role in energy production for the body, list three other important roles of fat in the body.

Correct Answer : ?Fat insulates the body from changes in temperature, provide protection for the major organs from shock, and provide structural and signaling support for cells.

70 : What is olestra? What are the benefits and safety issues with the use of olestra?

Correct Answer : ?Olestra is an artificial fat. Artificial fats contain fewer kcalories than normal fats. Olestra cannot be digested in the gastrointestinal track, which means that it will not be absorbed by the body. However, as it passes through the GI tract, it binds to fat soluble vitamins, preventing them from being absorbed. To compensate, foods with olestra are fortified with vitamins, however, it is still less ideal than simply choosing better foods to begin with.

71 : Describe the study that determined that the type of fat had more impact on health than the amount of fat.

Correct Answer : ?A study that compared diets around the world, (The Seven Countries Study), determined that in two countries with a similar high-fat intake had very different risk of heart disease. Upon examination, people from Finland, which had a high-fat intake and a high risk of heart disease, ate a diet that was high in saturated fats. People from Crete, however, had a diet that was high in monounsaturated and polyunsaturated fats, and a very low risk for heart disease. This led to the idea that it was the type of fat, rather than simply the amount of fat, that was important in determining this risk.

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MULTIPLE CHOICE 1 : In comparison to the composition of carbohydrates and fats, which element found in proteins makes them unique?

A : carbon B : oxygen C : nitrogen D : hydrogen Correct Answer : C 2 : What is the primary factor that differentiates one amino acid from another?

A : the side group B : the central carbon atom C : the number of oxygen atoms D : the number of nitrogen atoms Correct Answer : A 3 : What type of reaction is required to bind two molecules of glycine together and release a molecule of water?

A : hydrolysis B : deamination C : denaturation D : condensation Correct Answer : D 4 : What is the composition of a tripeptide?

A : one amino acid with three carbons B : three amino acids bonded together C : one amino acid with three acid groups D : three small protein chains bonded together Correct Answer : B 5 : What is the tertiary structure of a protein?

A : the structure of the protein after post-translational modifications have occurred B : the structure of the protein determined by electrostatic interactions C : the structure of the protein determined by hydrophobic and hydrophilic interactions D : the structure of the protein including multiple protein subunits Correct Answer : C 6 : A dispensable amino acid is one that .

A : is not needed by the body B : can be synthesized by the body C : can be used to synthesize an indispensable amino acid D : cannot be synthesized by the body because of a genetic defect Correct Answer : B

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7 : Cells are able to synthesize thousands of different proteins due to the A : unlimited availability of essential amino acids B : number of different amino acids C : availability of amino acids containing sulfur D : availability of amino acids containing hydroxyl groups

.

Correct Answer : B 8 : The weak electrical attractions within polypeptide chains account for the proteins structure.

A : primary B : secondary C : tertiary D : quaternary Correct Answer : B 9 : What is an example of protein denaturation?

A : the formation of a scab over a wound B : the change occurring in an enzyme to promote catalysis of a chemical reaction C : the alteration of the protein structure in hydrochloric acid D : the activation of protein synthesis after changes in gene expression Correct Answer : C 10 : Where does protein digestion begin in the human body?

A : mouth B : stomach C : small intestine D : large intestine Correct Answer : B 11 : What digestive enzyme would be most affected in people who are unable to produce hydrochloric acid?

A : pepsin B : transaminase C : pancreatic protease D : intestinal peptidase Correct Answer : A 12 : Protein-hydrolyzing enzymes are commonly known as A : proteases B : hydrolyzers C : prodigestins D : denaturases

.

Correct Answer : A 13 : What is the chief function of pepsin?

A : It emulsifies dietary proteins.

B : It activates hydrochloric acid.

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C : It activates pancreatic proteases.

D : It cleaves proteins into smaller polypeptides.

Correct Answer : D 14 : What percentage of dietary protein is hydrolyzed in the mouth?

A:0 B : 510 C : 1520 D : 2530 Correct Answer : A 15 : After digestion of proteins, what products are absorbed into the circulation?

A : free amino acids only B : free amino acids and oligopeptides C : free amino acids and dipeptides only D : free amino acids and a few dipeptides and tripeptides Correct Answer : D 16 : What is the usual fate of orally ingested enzyme supplements?

A : digested by gastrointestinal proteases B : rapidly degraded by salivary secretions C : mostly absorbed in original form from the stomach D : completely absorbed in original form from the jejunum Correct Answer : A 17 : The process whereby messenger RNA is made from a DNA template is known as A : expression B : sequencing C : transcription D : ribosome assembly

.

Correct Answer : C 18 : What is a ribosome?

A : a template for protein synthesis B : a hard knot of subcutaneous protein mass C : a structure upon which proteins are assembled D : an antibody synthesized by specialized immune cells Correct Answer : C 19 : A common genetic variation that causes a change in the amino acid sequence in the structure of hemoglobin leads to the disease .

A : diabetes B : marasmus C : phenylketonuria D : sickle-cell anemia Correct Answer : D 3 / 13

20 : What class of macromolecule is an enzyme?

A : carbohydrate B : lipid C : protein D : nucleic acid Correct Answer : C 21 : What is a characteristic of hormones?

A : inactivate bacteria B : act as messenger molecules C : coordinate visual responses D : act as buffers in the bloodstream Correct Answer : B 22 : A patient with acidosis may have a pH of A : 7.3 B : 7.35 C : 7.4 D : 7.45

.

Correct Answer : A 23 : Edema is caused by .

A : a decrease in protein loss B : an increase in protein synthesis C : excessive dietary protein D : negative protein balance Correct Answer : D 24 : How do proteins function as regulators of blood pH? A : Proteins react with acids to produce uric acid, which can be excreted.

B : Proteins bind hydrogen ions to prevent them from altering blood pH. C : Proteins attract acids out of the blood stream and into cells.

D : Amino acids that are highly acidic or basic are specifically excreted.

Correct Answer : B 25 : Why do proteins often function as carriers for lipids in the blood?

A : Proteins are required to activate pumps for lipids to gain entry into cells.

B : Proteins prevent the lipids from being recognized as foreign to avert an immune response.

C : Proteins in the carriers begin the digestion process as they move through the blood.

D : Proteins protect the hydrophobic regions of the lipids to allow easy transport through the blood.

Correct Answer : D 26 : What is opsin?

A : an antigen B : an antibody 4 / 13

C : light-sensitive protein D : a blood transport protein Correct Answer : C 27 : What is the amino acid pool?

A : the total amino acid content derived from a 24-hour dietary intake B : a measure of the circulating essential amino acid levels available for protein synthesis C : the total amount of free amino acids in the circulation destined for deamination and excretion D : a mix of essential and nonessential amino acids derived from protein breakdown and dietary protein intake Correct Answer : B 28 : How do protein rich foods contribute to weight gain?

A : High protein diets are also often high in saturated fats, which is what leads to weight gain.

B : High protein diets increase absorption of lipids in the small intestine.

C : High protein diets often prevent fiber from removing excess fats in the small intestine.

D : High protein diets can lead to an excess of amino acid being converted into fat.

Correct Answer : D 29 : What is the usual state of nitrogen balance for healthy infants, children, and pregnant women?

A : equilibrium B : metabolic C : positive D : negative Correct Answer : C 30 : What amino acid is used to synthesize the neurotransmitter serotonin and the vitamin niacin?

A : glycine B : tyrosine C : methionine D : tryptophan Correct Answer : D 31 : What is the fate of excess dietary protein?

A : After absorption, the liver will store the extra amino acids.

B : After absorption, the extra amino acids will be rapidly degraded.

C : Digestion will be decreased by 30 to 60 percent, resulting in less absorption.

D : After absorption, extra proteins will be synthesized and stored for use when protein intake returns to normal.

Correct Answer : B 32 : When amino acids are deaminated, the immediate products are ammonia and often a acid.

A : uric B : keto 5 / 13

C : folic D : gluco Correct Answer : B 33 : A person who is starving is losing A : fat only B : glycogen only C : glycogen and fat only D : glycogen, protein, and fat

.

Correct Answer : D 34 : What are the two products of deamination?

A : ammonia and keto acid B : amino acid and keto acid C : ammonia and an amino acid D : urea and a keto acid Correct Answer : A 35 : What is a consequence of excess protein intake?

A : decreased excretion of calcium B : decreased size of the liver and kidneys C : increased production and excretion of urea D : increased protein storage by the liver and kidneys Correct Answer : C 36 : What are the products of transamination?

A : ammonia and keto acid B : amino acid and keto acid C : ammonia and an amino acid D : urea and a keto acid Correct Answer : B 37 : In the metabolism of amino acids for energy, what is the fate of the amino group?

A : excreted as urea B : burned for energy C : stored in the liver D : converted to glucose Correct Answer : A 38 : Jason is 35 years old and was recently diagnosed with two failing kidneys. He was advised to decrease the amount of protein he consumes. If Jason cheats by eating an 8-ounce steak for dinner tonight, shortly thereafter there would most likely be an increase in the urea levels of his .

A : urine B : blood C : stools D : sweat 6 / 13

Correct Answer : B 39 : A result of transamination reactions is the synthesis of A : essential amino acids B : nonessential amino acids C : neurotransmitters and hormones D : both nonessential and essential amino acids

.

Correct Answer : B 40 : Your father, who has a high blood ammonia concentration, most likely has a poorly functioning .

A : liver B : spleen C : kidney D : intestinal tract Correct Answer : A 41 : What is the percent digestibility of most plant proteins?

A : 2545 B : 5065 C : 7090 D : 9599 Correct Answer : C 42 : Which food protein has the best assortment of essential amino acids for the human body?

A : egg B : rice C : corn D : gelatin Correct Answer : A 43 : Which factor is related to the quality of a food protein?

A : essential amino acid balance B : nonessential amino acid balance C : total amino acids per gram of food D : quantity of nonessential amino acids that can be converted to glucose Correct Answer : A 44 : If the diet is lacking an essential amino acid, what will be the course of action?

A : Body cells will synthesize it.

B : Protein synthesis will be limited.

C : Health will not be affected as long as other nutrients are adequate.

D : Proteins will be made but they will lack that particular amino acid.

Correct Answer : B 45 : Alberta is a 20-year-old who has been a vegetarian for three years. She comes to you for 7 / 13

advice after reading some material online by the Meat Promoters of America organization. One of their statements is ...vegetarians are at risk for protein deficiency because they cannot consume all of the essential amino acids necessary for healthy individuals. How should Alberta be advised?

A : She should consume dairy and egg products at every meal to protect herself against protein deficiency.

B : She should avoid the limiting amino acids because they are limiting her ability to maintain proper protein status.

C : Because the statement is basically true, she should consider eating small quantities of meat every day in order to avoid protein deficiency.

D : Although many foods dont provide all the essential amino acids individually, she could consume complementary proteins throughout the day, which would provide all the essential amino acids she needs.

Correct Answer : D 46 : Relative to animal proteins, which amino acid is present in lesser amounts in proteins of legumes?

A : alanine B : isoleucine C : tryptophan D : glutamic acid Correct Answer : C 47 : Excessive amounts of homocysteine in the blood are thought to increase the risk for A : cancer B : diabetes C : heart disease D : protein-energy malnutrition

.

Correct Answer : C 48 : Which statement describes an association between protein intake and kidney function?

A : Low-protein diets increase the risk for kidney stone formation.

B : Restricting protein intake may slow the progression of kidney disease.

C : High protein intakes over the long term represent a risk factor for kidney disease.

D : Liberal protein intakes result in high urea production, which increases the long-term efficiency of the kidneys.

Correct Answer : B 49 : Which statement describes a relationship between protein intake and calcium metabolism?

A : Calcium excretion falls with increasing intake of animal-derived proteins.

B : Calcium excretion rises with increasing intake of animal-derived proteins.

C : Calcium absorption declines with higher intakes of plant-derived proteins.

D : Calcium absorption increases with higher intakes of animal-derived proteins.

Correct Answer : B 50 : What is a feature of the protein RDA? A : The recommendations are generous.

B : It is highest proportionately for adult males.

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C : It is established at 8 grams per kilogram of ideal body weight.

D : An assumption is made that dietary protein is from animal sources only.

Correct Answer : A 51 : If protein needs are expressed per kilogram of body weight, what describes the requirements of infants?

A : less than adults B : similar to adults C : greater than adults D : less than adolescents Correct Answer : C 52 : What is an assumption made in the formulation of the RDA for protein?

A : Dietary protein is of high quality only.

B : Dietary protein is of animal origin only.

C : Dietary carbohydrate and fat intakes are adequate.

D : Dietary protein should represent 12 percent of total energy.

Correct Answer : C 53 : What is a feature of protein nutrition?

A : Protein in body tissues is preserved fairly well on low-energy diets.

B : The protein RDA assumes that dietary protein is from a mix of low- and high-quality sources.

C : Many people in the United States and Canada consume somewhat less protein than is needed.

D : Athletes in training benefit from increasing their protein energy intake to 45 to 50 percent of total daily energy.

Correct Answer : B 54 : What is the percentage of total energy derived from protein in a diet containing 50 grams of protein and 2000 kcalories?

A : 2.5 B:5 C : 10 D : 20 Correct Answer : C 55 : Jim, a college baseball player, tells you that he has started to take glutamine supplements.

How would you advise him?

A : As long as he keeps the dose under 10 grams per day, the benefits outweigh the costs.

B : Since he plays baseball, he should consider taking alanine supplements instead.

C : Since he plays baseball, he should consider taking tryptophan supplements instead.

D : Since single amino acids do not occur naturally in foods, they offer no benefit to the body and may even be harmful.

Correct Answer : D 56 : What is a feature of the branched-chain amino acids?

A : They are all dispensable amino acids.

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B : They suppress ammonia production if taken in large doses.

C : They represent the major energy source for muscle tissue.

D : They may be helpful in treatment of advanced liver failure.

Correct Answer : D 57 : What amino acid supplement has been advertised in the popular media for treating herpes infections?

A : lysine B : arginine C : tryptophan D : phenylalanine Correct Answer : A 58 : The disease phenylketonuria is related chiefly to abnormal metabolism of A : lactose B : omega-3 fats C : soy polysaccharides D : a certain amino acid

.

Correct Answer : D 59 : The study of how food interacts with genes is known as A : nutritional genomics B : chromosomals C : nucleotide expression D : mutagenic expression

.

Correct Answer : A 60 : The cells proteome consists of A : all nucleotide bases B : all the protein in the cell C : the ratio of DNA to RNA D : the protein metabolic apparatus

.

Correct Answer : B 61 : The cellular process of silencing or activating genes is in part accomplished by A : DNA methylation B : multigene genomics C : translational sequencing D : a transcription-translation cycle

.

Correct Answer : A 62 : What dispensable amino acid becomes essential in people with PKU? A : glycine B : tyrosine C : arginine D : glutamine 10 / 13

Correct Answer : B

MATCHING 63 : Match each word or phrase with the most appropriate definition or explanation.

A : a dietary nonessential amino acid A : soy B : a conditionally essential amino acid B : urea C : a small protein hormone C : pepsin D : a large protein that carries oxygen D : gelatin E : describes substances repelled by water E : alanine F : describes protein exposed to severe heat F : insulin G : an active protease G : infection H : a cell structure where protein synthesis H : tyrosine takes place I : a connective tissue protein I : collagen J : a protein catalyst J : denatured K : excessive fluid residing between cells K : ribosome L : substance that keeps the pH constant L : enzyme M : a condition that favors positive nitrogen M : pregnancy balance N : edema N : a condition that favors negative nitrogen balance O : a product of amino acid breakdown O : hemoglobin P : a dietary protein lacking tryptophan P : hydrophobic Q : a good quality protein source Q : homocysteine R : an amino acid associated with heart diseaseR : buffer Correct Answer : A:E B:H C:F D : A14 E : A15 F:J G:C H:K I:I J : A11 K : A13 L : A17 11 / 13

M : A12 N:G O:B P:D Q:A R : A16

ESSAY 64 : Describe the primary, secondary, tertiary, and quaternary structure of a protein.

Correct Answer : The primary structure of a protein is the amino acid sequence of the polypeptide. The secondary structure is determined by weak electrical forces between the amino acids, folding the peptide sequence into helixes and pleated sheets. The tertiary structure is the more complex three-dimensional shape based on the amino acid composition, positioning amino acids with hydrophobic amino acids on the inside and amino acids with hydrophilic side chains on the outside of the structure. Disulfide bonds between amino acids also contribute to the tertiary structure. Quaternary structure is determined by the association of individual polypeptides with each other, forming a larger complex of multiple polypeptide chains.

65 : Outline the process of protein digestion from the mouth through the large intestine.

Correct Answer : ?In the mouth, proteins are softened and mixed with saliva. In the stomach, the hydrochloric acid denatures the proteins into highly accessible polypeptide chains, which can then be cleaved into smaller polypeptides with the enzyme pepsin. In the small intestines, the smaller polypeptide chains are further broken down with peptidases into individual amino acids, which can then be absorbed. Amino acids rarely end up in the large intestine, but are introduced into the blood stream and removed later by the liver for excretion as urine.

66 : Outline the process of protein synthesis, beginning with DNA and ending with a completed protein strand.

Correct Answer : The DNA in the nucleus of a cell serves as a template for mRNA. The mRNA, which is almost an exact copy of the DNA, is then transported to the cytoplasm or rough endoplasmic reticulum and attaches itself to a ribosome to serve as template for protein synthesis. Once the ribosome and mRNA are joined, a tRNA, charged with specific amino acids, will bind to the mRNA/ribosomal complex in a sequence specific manner dictated by the mRNA sequence. The next loaded tRNA will then bind to the mRNA/ribosomal complex, and an enzyme joins the two amino acids together. The tRNA will be released to go reload with another amino acid, and the process will continue with another loaded tRNA. When the polypeptide chain is complete, the polypeptide chain and ribosome separate and the protein can then be further processed and folded into its final shape.

67 : Explain how proteins regulate blood pH. 12 / 13

Correct Answer : ?Proteins can regulate blood pH by serving as buffers. Proteins can bind and release hydrogen ions in response to changes in blood pH, serving as both proton donors and acceptors depending on the pH of the blood. By serving this role, the proteins can prevent the blood pH from changing dramatically, protecting the body.

68 : List at least five major, general, functions of proteins in the body.

Correct Answer : ?Proteins can function as enzymes, antibodies, transporters, structural support, regulators of fluid balance, acid-base regulators, and a source of energy and glucose formation.

69 : Are vegetables considered high-quality proteins? Explain your answer.

Correct Answer : ?Vegetables are not considered high-quality proteins, because they rarely contain all of the essential amino acids in a ratio that humans require. Rather, vegetables can be consumed with other foods to provide a complete balance of the amino acids. By choosing complementary proteins, vegetarians can still meet their required protein intakes.

70 : Explain how the amount of protein in ones diet would impact bone health.

Correct Answer : ?Bones are comprised of both calcium and proteins. However, if protein intake is too high, calcium is excreted at a higher rate, which can lead to demineralization of the bones and osteoporosis. If protein intake is too low, proteins essential for bone structure are lost, which can also lead to osteoporosis.

71 : Explain the role of homocysteine in health.

Correct Answer : ?High homocysteine levels seem to serve as a negative indicator for a number of different conditions, including heart disease and heart attacks, as well as under conditions associated with these diseases, including smoking and drinking alcohol or coffee. However, it is unclear whether homocysteine is a cause or an effect of these diseases and conditions.

72 : Give two reasons why amino acid supplements should not be taken by healthy individuals.

Correct Answer : ?Amino acid supplements can be harmful to the body. Large doses of amino acids can cause diarrhea. Additionally, too much of a single amino acid can prevent the uptake of a variety of different amino acids, potentially leading to an amino acid deficiency. Finally, as amino acids are not proven to have any health benefits, they are a waste of money.

73 : Describe how nutrition affects the number or types of proteins that are present in a given cell.

Correct Answer : Nutrients consumed within a diet can both positively and negatively affect the body by activating or silencing gene expression. One way they do this is by changing the methylation at the start of a specific gene, which turns the gene on and off like a switch. By turning on or off the ability of the cell to make mRNA copies of itself, it will alter protein synthesis of a given protein. When the DNA for a gene coding for a specific protein is turned on, mRNA expression will increase, and subsequently levels of that protein will increase. When the DNA for that gene is turned off, mRNA expression will decrease, and the levels of that protein will decrease.?

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MULTIPLE CHOICE 1 : What process describes the sum of all chemical reactions that go on in living cells?

A : digestion B : metabolism C : absorption D : catabolism Correct Answer : B 2 : In photosynthesis, the plant uses energy from the sun, plus water and carbon dioxide, to synthesize .

A : carbohydrates only B : fats and carbohydrates only C : proteins and carbohydrates only D : fats, proteins, and carbohydrates Correct Answer : A 3 : A typical cell contains powerhouses, which is another name for the A : DNA B : ribosomes C : mitochondria D : electron transport chains

.

Correct Answer : C 4 : Which organ is the most metabolically active?

A : liver B : brain C : kidney D : small intestines Correct Answer : A 5 : Proteins that facilitate chemical reactions without being changed in the process are called .

A : ATP B : peptides C : amines D : enzymes Correct Answer : D 6 : The formation of glycogen by the liver cell is an example of A : oxidation B : glycolysis C : anabolism D : catabolism

.

Correct Answer : C

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7 : Which reaction is an example of a catabolic reaction?

A : glucose formation from glycerol B : pyruvate formation from glucose C : albumin formation from amino acids D : palmitic acid formation from acetate Correct Answer : B 8 : In the adult body, food energy not stored as fat or glycogen is lost as A : heat B : photons C : carbon dioxide D : electromagnetic radiation

.

Correct Answer : A 9 : What is a coenzyme?

A : a unit consisting of an enzyme bound to reactants plus ATP B : an organic molecule required for the functioning of an enzyme C : the small, active part of an enzyme that binds to the organic reactants D : an inactive enzyme that becomes functional upon contact with specific cofactors Correct Answer : B 10 : The hydrolysis of ATP that often occurs simultaneously with the synthesis of many compounds is an example of .

A : coupled reactions B : tandem cleavages C : metabolic couplings D : high-energy processes Correct Answer : A 11 : Which metabolic reaction occurs when a cell uses energy?

A : ATP gains a phosphate group and becomes ADP. B : ADP gains a phosphate group and becomes ATP. C : ATP releases a phosphate group and becomes ADP. D : ADP releases a phosphate group and becomes ATP. Correct Answer : C 12 : What is the major energy carrier molecule in most cells?

A : ATP B : glucose C : pyruvate D : kcalorie Correct Answer : A 13 : Glycolysis is the conversion of A : glycogen to fat B : glycogen to protein C : glucose to pyruvate

.

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D : glucose to glycogen Correct Answer : C 14 : Which sequence of events outlines the complete oxidation of glucose?

A : glycolysis, electron transport chain, TCA cycle B : glycolysis, TCA cycle, electron transport chain C : electron transport chain, TCA cycle, glycolysis D : TCA cycle, electron transport chain, glycolysis Correct Answer : B 15 : An aerobic reaction is one that requires A : alcohol B : oxygen C : nitrogen D : ammonia

.

Correct Answer : B 16 : The Cori cycle involves the interconversion of A : lactate and glucose B : glucose and amino acids C : pyruvate and citric acids D : fatty acids and acetyl CoA

.

Correct Answer : A 17 : Your roommate Demetrius is participating in a weightlifting program and complains of a burning pain during workouts. You explain to Demetrius that the rapid breakdown of glucose in his muscles produces large amounts of pyruvate, which leads to a fall in pH within the muscle and that the muscle responds by converting excess pyruvate to .

A : lactate B : glycerol C : acetyl CoA D : amino acids Correct Answer : A 18 : Which reaction listed is an actual metabolic reaction that occurs in the cell?

A : pyruvate to urea B : lactate to pyruvate C : acetyl CoA to pyruvate D : carbon dioxide to glycerol Correct Answer : B 19 : What is a possible fate of acetyl CoA? A : degradation to urea B : synthesis to glycerol C : synthesis to fatty acids D : degradation to ammonia 3 / 14

Correct Answer : C 20 : Production of excessive amounts of acetyl CoA molecules leads to the synthesis of A : fatty acids only B : fatty acids and glucose only C : fatty acids and fructose only D : fatty acids, glucose, and amino acids

.

Correct Answer : A 21 : In a triglyceride that contains 54 carbon atoms, how many carbons can become part of glucose?

A:3 B:9 C : 54 D : 108 Correct Answer : A 22 : How many acetyl CoA molecules can be obtained from oxidation of an 18-carbon fatty acid?

A:3 B:6 C:9 D : 18 Correct Answer : C 23 : An immediate consequence of a cellular deficiency of oxaloacetate is a slowing of A : glycolysis B : the TCA cycle C : lactate synthesis D : ketone formation

.

Correct Answer : B 24 : What type of molecules serve as electron carriers to the electron transport chain?

A : acids B : lipids C : amines D : coenzymes Correct Answer : D 25 : After digestion and absorption, an amino acid not used to build protein will first be subjected to .

A : removal of its amino group B : removal of its carboxyl group C : hydrolysis of its peptide bond D : condensation of its peptide bond Correct Answer : A 4 / 14

26 : Which process leads to the production of urea?

A : oxidation of glucose B : oxidation of amino acids C : incomplete oxidation of fatty acids D : synthesis of protein from amino acids Correct Answer : B 27 : When energy-yielding nutrients are consumed in excess, which one(s) can lead to storage of fat?

A : fat only B : carbohydrate only C : and carbohydrate only D : fat, carbohydrate, and protein Correct Answer : D 28 : If the carbohydrate content of the diet is insufficient to meet the bodys needs for glucose, which compound can be converted to glucose?

A : fatty acids B : acetyl CoA C : amino acids D : carbon dioxide Correct Answer : C 29 : In addition to energy, what are the principal end products of cellular oxidation of carbohydrates?

A : water and carbon dioxide B : carbon, hydrogen, and urea C : carbon, hydrogen and oxygen D : urea and acetone Correct Answer : A 30 : At what point is oxygen used in the electron transport chain?

A : at the end B : at every step C : at the beginning D : when ATP is synthesized Correct Answer : A 31 : What is a feature of the electron transport chain?

A : It captures energy in the high-energy bonds of ATP. B : It pumps carbon dioxide across the mitochondrial membrane.

C : It is the transfer of energy from ATP to generate an electron gradient.

D : It combines oxygen from carbon dioxide with hydrogen generated from the splitting of water.

Correct Answer : A 32 : Which compound can be synthesized from all three energy-yielding nutrients?

A : lactate 5 / 14

B : glycogen C : acetyl CoA D : oxaloacetate Correct Answer : C 33 : If a person consumes 100 kcalories in excess of energy needs from olive oil, approximately what percentage of the kcalories are stored in the body?

A : 25 B : 45 C : 65 D : 95 Correct Answer : D 34 : What is a characteristic of the metabolism of specific macronutrients?

A : The rate of fat oxidation does not change when fat is eaten in excess.

B : The rate of protein oxidation does not change when protein is eaten in excess.

C : The rate of glucose oxidation does not change when carbohydrate is eaten in excess.

D : The conversion of dietary glucose to fat is the major pathway of carbohydrate utilization.

Correct Answer : A 35 : Jake is getting ready for spring training and is sitting down to a dinner of half a chicken, a rib-eye steak, black beans, and 5 slices of bacon. He has been eating typical dinners like this for about a month and has since gained 7 pounds, while exercising only briefly. When Jake asks why he doesnt see an increase in his biceps or abs, the proper response should be that .

A : dietary protein alone does not contribute to muscle accretion B : it takes at least 6 months to document changes in muscle accretion C : the weight he has gained can be attributed to a substantial increase in his protein stores D : because muscle accretion only responds to very lean meat choices, he should eliminate the fatty bacon and steak from his diet to promote muscle gain Correct Answer : A 36 : How does excess carbohydrate intake contribute to obesity?

A : It is efficiently converted to storage fat.

B : It spares oxidation of body fat and dietary fat.

C : It stimulates glucagon release, resulting in inhibition of fatty acid oxidation.

D : It stimulates pancreatic lipase secretion, which results in higher dietary fat absorption.

Correct Answer : B 37 : What is the bodys first response to the absorption of abundant amounts of carbohydrate?

A : catabolism of body fat B : catabolism of glycogen C : synthesis and storage of glycogen D : synthesis and storage of triglycerides Correct Answer : C 38 : If a normal person expends 1200 kcalories while at rest, approximately how many are used 6 / 14

by the brain?

A : 40 B : 100 C : 200 D : 300 Correct Answer : D 39 : During the first few days of a fast, what energy source provides about 90 percent of the glucose needed to fuel the body?

A : protein B : ketones C : glycogen D : triglycerides Correct Answer : A 40 : Which dietary nutrient would most rapidly reverse a state of ketosis in a starving person?

A : fat B : protein C : amino acids D : carbohydrate Correct Answer : D 41 : How soon would death occur from starvation if the body was unable to shift to a state of ketosis?

A : within 3 weeks B : less than 2 weeks C : between 5 and 6 weeks D : between 2 and 3 months Correct Answer : A 42 : A feature of ketosis is that it .

A : occurs from lack of protein in the diet B : occurs when fats are partially oxidized C : results from excess acetoacetate in the diet D : results from excess carbohydrate in the diet Correct Answer : B 43 : The effects on metabolism from starvation are similar to those from A : fasting B : feasting C : lipogenesis D : Cori cycling

.

Correct Answer : A 44 : What compounds are used to supply some of the fuel needed by the brain only after the body has been fasting for a while?

A : ketones 7 / 14

B : glycerols C : fatty acids D : amino acids Correct Answer : A 45 : Ketonemia is defined as an elevation of A : ketones in the blood B : ketones in the urine C : alpha-ketoglutarate in the blood D : alpha-ketoglutarate in the urine

.

Correct Answer : A 46 : What organ is the major site for gluconeogenesis?

A : liver B : brain C : muscle D : small intestine Correct Answer : A 47 : What is a feature of low-carbohydrate diets?

A : Body glycogen stores are preserved.

B : Ketosis is evident within the first 12 days.

C : In the first few days, body fat loss exceeds water loss.

D : Overall body fat losses are about the same as with other diets.

Correct Answer : D 48 : Lillie has been losing weight by following a very-low-carbohydrate diet for 2 months. Her primary care physician just diagnosed ketosis through a urine sample. Which symptom would be another way the physician might have suspected ketosis in Lillie?

A : thinning hair B : irritable temper C : fishy body odor D : fruity odor on breath Correct Answer : D 49 : The health benefits of moderate alcohol intake occur in people older.

A : 21 B : 35 C : 55 D : 65

years of age and

Correct Answer : B 50 : A moderate level of alcohol intake per day for the average-sized woman is defined as up to drink(s).

A : one B : two 8 / 14

C : three D : five Correct Answer : A 51 : One average-sized can of beer contains about the same amount of alcohol as A : ½ ounce of rum B : ½ quart of wine C : 1½ ounces of vodka D : 1 quart of wine cooler

.

Correct Answer : C 52 : What is the percentage of ethanol in 120-proof scotch whiskey?

A:5 B : 30 C : 60 D : 120 Correct Answer : C 53 : What organ is first to absorb alcohol after a person takes a drink?

A : colon B : stomach C : jejunum D : duodenum Correct Answer : B 54 : What is the primary organ that oxidizes alcohol?

A : brain B : liver C : pancreas D : stomach Correct Answer : B 55 : What is acetaldehyde?

A : an intermediate in fatty acid synthesis B : an intermediate in alcohol metabolism C : the first product of fatty acid catabolism D : the TCA compound that combines with acetyl CoA Correct Answer : B 56 : Your middle-aged aunt says that she always feels more tipsy than her same-size husband, even though their alcohol intake is the same. You respond to your aunt by saying that .

A : men have greater amounts of liver acetaldehyde dehydrogenase and so can oxidize the alcohol at a faster rate B : women have less stomach alcohol dehydrogenase enzyme and consequently absorb more of the alcohol into the bloodstream C : men have greater amounts of alcohol dehydrogenase in the brain, resulting in reduced exposure of brain neurons to alcohol 9 / 14

D : women have less liver alcohol dehydrogenase and acetaldehyde dehydrogenase and so more alcohol is released into the systemic circulation Correct Answer : B 57 : What is the first stage of liver deterioration in heavy drinkers?

A : fibrosis B : fatty liver C : primary cirrhosis D : failure of the MEOS pathway Correct Answer : B 58 : Excess alcohol intake leads to a reduction in the rate of A : liver fat B : liver glucose C : ketone bodies D : acetyl CoA molecules

synthesis.

Correct Answer : B 59 : Approximately what percentage of alcohol in the body is eliminated via urine and the breath?

A:1 B:2 C : 10 D : 25 Correct Answer : C 60 : What is MEOS? A : an advanced liver disorder B : a drug that inhibits alcohol absorption C : a waste product of alcohol metabolism D : a system of enzymes that oxidizes alcohol and drugs Correct Answer : D 61 : Which function(s) is(are) first to be affected when a person begins to drink alcohol?

A : speech and vision B : judgment and reasoning C : voluntary muscle control D : respiration and heart function Correct Answer : B 62 : What minimum concentration of blood alcohol leads to impaired judgment and increased heart rate?

A : 0.01 B : 0.05 C : 0.10 D : 0.35 10 / 14

Correct Answer : B 63 : What is a consequence of alcohol intake?

A : The MEOS is suppressed.

B : Homocysteine production is reduced.

C : Water content of the blood is increased.

D : Antidiuretic hormone production is suppressed.

Correct Answer : D 64 : The Wernicke-Korsakoff syndrome in people with chronic alcohol abuse stems primarily from a deficiency of .

A : folate B : thiamin C : antidiuretic hormone D : alcohol dehydrogenase Correct Answer : B 65 : Which statement is true regarding alcoholic beverages containing caffeine?

A : The FDA has banned their sales.

B : The time to intoxication is slowed by the caffeine.

C : The presence of caffeine slows down consumption.

D : The caffeine slows the development of alcohol-induced impairment.

Correct Answer : A

MATCHING 66 : Match the subcellular location with the processes indicated in the questions below.

A : lipid synthesis A : cytoplasm B : glycolysis B : inner membrane of the mitochondria C : electron transport chain C : inner compartment of the mitochondria D : TCA cycle D : smooth endoplasmic reticulum E : protein synthesis E : rough endoplasmic reticulum Correct Answer : A:D B:A C:B D:C E:E

67 : Match each word or phrase with the most appropriate definition or explanation.

A : final product of glycolysis A : glycolysis B : generates acetyl CoA for every two amino B : gluconeogenesis 11 / 14

acids C : process that begins immediately after C : TCA glycogen stores are depleted D : specific pathway in metabolism by which D : electron transport chain most ATP is generated in metabolism of all energy-yielding nutrients E : molecule that both begins and ends a series E : lactate of chemical reactions F : specific process in metabolism in which F : beta oxidation carbon dioxide is formed during metabolism G : oxaloacetate G : the molecule that all energy yielding nutrients can be broken down into H : requires the addition of 2ATP H : Cori cycle I : process used remove lactate from muscle I : acetyl CoA cells J : product formed when pH and oxygen in the J : pyruvate cells are low Correct Answer : A:J B:F C:B D:D E:G F:C G:I H:A I:H J:E

ESSAY 68 : Explain the role of photosynthesis in human metabolism.

Correct Answer : ?The energy that humans utilize ultimately comes from the sun. However, humans and other animals are not capable of harnessing that energy for themselves. Instead, plants harness that energy for humans and other animals through photosynthesis.

Photosynthesis is a process by which plants make sugars from the captured sunlight. Animals, including humans, can then consume these plants, or animals that consume these plants, in order to obtain the energy that is required for life and utilized in our metabolic pathways.

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69 : Explain how coupled reactions drive metabolism.

Correct Answer : ?When a compound breaks down (catabolism), energy is released, whereas when a compound is being formed (anabolism), energy is required. In metabolism, both catabolic and anabolic processes are going on simultaneously. By pairing the reactions in a way that energy released from catabolic reactions can be captured by anabolic reactions that require energy, one reaction can provide the energy required by the other reaction. The most common catabolic reaction that drives metabolism is the breakdown of ATP to ADP, which provides the energy required for many of the biological reactions that occur in our bodies.

70 : Identify each individual pathway in order that a molecule of glucose must go through in order to be completely oxidized, and identify how many ATP are derived from each step.

Correct Answer : ?Initially, glucose enters glycolysis. For this step, 2 ATP are required, and 4 ATP are formed, for a net gain of 2 ATP from glycolysis. At the end of glycolysis, the pyruvate that is formed reacts to form acetyl Co-A, which then enters the TCA cycle. Finally, the electrons generated in glycolysis and the TCA cycle enter the electron transport chain, which then converts the electrons into ATP. Approximately 28–30 ATP are made during the electron transport chain. Together, one molecule of glucose yields approximately 32 ATP. 71 : Explain the difference in energy yield between fat and glucose metabolism.

Correct Answer : ?The breakdown of fat begins with beta oxidation, which breaks all of the fatty acids into two-carbon molecules. Unlike glycolysis where a single acetyl CoA is formed for every molecule of glucose, each of those 2-carbon chains from beta oxidation can be formed into a molecule of acetyl CoA. Most fatty acid chains range from 4–22 carbons, giving between 2 and 11 acetyl CoA molecules for every fatty acid that is broken down. The acetyl CoA then enters the TCA cycle, where it generates a number of electrons that can be used in the electron transport chain to generate ATP. The more acetyl CoA that are formed in fats leads to a much higher yield of ATP than the single acetyl CoA that is formed from glucose.

72 : Which class of molecules cannot be used to produce glucose directly? Explain the structural reason why this does not occur.

Correct Answer : ?Fatty acids cannot be used to form glucose. This is because during beta oxidation, fatty acids are broken down into two-carbon fragments, which cannot be used to make pyruvate, the three carbon precursor for glucose synthesis.

73 : Discuss the change in energy usage as a person goes from fasting for a few hours to starving for a few days/weeks.

Correct Answer : ?Glycogen from the liver and fatty acids liberated from adipose tissue are the first sources of energy the body will utilize. When all of the glycogen is gone (after a few hours), gluconeogenesis begins in the liver, using amino acids and the glycerol from triglycerides to generate the pyruvate necessary for the starting point of gluconeogenesis. For the first few days, protein breakdown provides the largest portion of energy; however, after several days, the body begins using fatty acids to create ketone bodies, which can then supply the majority of the needs of the nervous system. Additionally, the body begins to slow metabolism to conserve energy.

74 : Discuss the pros and cons of a low-carbohydrate diet.

Correct Answer : ?Low-carbohydrate diets can trigger rapid weight loss, particularly after only a 13 / 14

few days. Unfortunately, most of the weight loss is from muscle and glycogen rather than from fat. Long term, these diets deplete the body of necessary nutrients, causing more harm than the benefits gained from losing weight. Additionally, these diets are difficult to maintain in the longterm, and often result in rebounding weight gain.

75 : Explain how and where alcohol is metabolized in the body, beginning with absorption into the body and ending with the metabolites of alcohol metabolism.

Correct Answer : ?Alcohol is absorbed into the body in the stomach and small intestines, with some alcohol breakdown beginning in the stomach by stomach alcohol dehydrogenases; however, alcohol can be absorbed directly into the blood stream in the stomach, as well as the small intestines, which allows it to have effects in the body soon after consumption. Once in the bloodstream, alcohol is taken to the liver, which then begins breaking down the alcohol with additional alcohol dehydrogenases in the liver. The first step of breakdown in the liver is to break the alcohol into acetaldehyde. The second step is to convert the acetaldehyde to acetate, which can then be converted to either carbon dioxide or acetyl CoA. Hydrogen ions are also produced, which can then be used in the electron transport chain.

76 : Describe two specific examples of damage to the body from chronic alcohol abuse. Do not include accidents as part of this list.

Correct Answer : ?Alcohol can damage the liver, initially by increasing the synthesis of fatty acids, which can interfere with liver function. If consumption of high levels of alcohol continues, eventually this will lead to fibrosis of the liver, followed eventually by cirrhosis of the liver.

Additionally, chronic alcohol abuse leads to malnourishment, which can lead to a decrease in B vitamins, such as thiamin as seen in Wernicke-Korsakoff syndrome, or vitamin B6, which leads to a decreased production of red blood cells.

77 : Explain why taking drugs, prescription or recreational, while drinking is particularly harmful.

Correct Answer : ?The metabolism of alcohol is given priority over other drugs in the liver, such that drinking alcohol will inhibit the breakdown of drugs in the liver. This means that these drugs will stay active in the system longer, amplifying the intended effects.

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MULTIPLE CHOICE 1 : What would be the approximate weight gain of a person who consumes an excess of 500 kcalories daily for one month?

A : 0.5 pounds B : 2 pounds C : 3 pounds D : 4 pounds Correct Answer : D 2 : When an adult gains an extra 10 pounds of body weight over a prolonged period of time, approximately how much of this weight is fat?

A : 5.0 pounds B : 7.5 pounds C : 9.5 pounds D : 10 pounds Correct Answer : B 3 : Approximately what percentage of weight loss during starvation is lean body mass?

A:0 B : 20 C : 35 D : 50 Correct Answer : D 4 : What instrument is used to measure the energy content of foods?

A : energy chamber B : exothermic meter C : bomb calorimeter D : combustion chamber Correct Answer : C 5 : Which statement describes an association between energy measurement and foods?

A : Indirect calorimetry cannot be used to determine the energy value of alcohol.

B : A bomb calorimeter measures the amount of oxygen released when a food is oxidized.

C : Direct calorimetry and indirect calorimetry of the same food rarely give similar values.

D : The physiological fuel value of a food is almost always lower than the energy value of that food as determined by bomb calorimetry.

Correct Answer : D 6 : Which quantity represents an indirect measure of the amount of energy released from food?

A : the increase in heat given off when the food is burned B : the quantity of oxygen consumed when the food is burned C : the quantity of carbon dioxide consumed when the food is burned D : the increase in heat retained by the food when it is slowly brought to 100° C Correct Answer : B 1 / 14

7 : A persons causes them to eat after a long fast, whereas a persons to eat in response to a pleasant aroma.

A : hunger; appetite B : appetite; satiety C : satiety; hunger D : appetite; hunger

causes them

Correct Answer : A 8 : The feeling of satisfaction resulting from consumption of a meal is termed A : satiety B : appetite C : postabsorptive hunger D : resting postabsorptive increment

.

Correct Answer : A 9 : Which hormone is most responsible for signaling satiety as well as reducing food intake during a meal?

A : gastrin B : adipokines C : neuropeptide Y D : cholecystokinin Correct Answer : D 10 : About how long does it take for a meal to be completely eliminated from the stomach?

A : 30 minutes B : 1.5 hours C : 4 hours D : 8 hours Correct Answer : C 11 : The day after Thanksgiving, you and your sisters are a little hungry and want to eat leftovers before going shopping. Which food would most readily satisfy the feeling of hunger?

A : turkey B : pecan pie C : mashed potatoes D : noodle casserole Correct Answer : A 12 : High-fat foods stimulate the appetite because they A : are satiating B : are flavorful C : suppress salivary gland secretion D : trigger the release of oxyntomodulin

.

Correct Answer : B 13 : The brain chemical neuropeptide Y is known to specifically enhance the craving for

.

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A : fat B : salt C : protein D : carbohydrate Correct Answer : D 14 : What is the process of thermogenesis?

A : burning of fat B : synthesis of fat C : generation of heat D : vaporization of water Correct Answer : C 15 : Why might the measurement of the resting metabolic rate in a person be somewhat higher than her basal metabolic rate?

A : She was mildly malnourished.

B : She slept through the procedure.

C : She was wearing shorts and a tank top.

D : She ate right before the measurement was done.

Correct Answer : D 16 : For an average person on a 2000 kcalorie diet, how many kcalories are used specifically for basal metabolism?

A : 500 kcalories B : 1000 kcalories C : 1500 kcalories D : 2000 kcalories Correct Answer : B 17 : Which factor has the most influence on the bodys metabolic rate?

A : age B : gender C : amount of fat tissue D : amount of lean body tissue Correct Answer : D 18 : Which measurement may be used to calculate the amount of energy expended by the body?

A : oxygen consumed B : total air exchanged C : intestinal gas expelled D : carbon dioxide consumed Correct Answer : A 19 : Which measurements are used to compute a womans BMR? A : body fat, height, and age B : body weight, height, and age 3 / 14

C : physical activity level, body weight, and height D : energy intake, physical activity level, and body weight Correct Answer : B 20 : You are planning a diet for a hospitalized patient who cannot participate in physical activity because both of his legs are broken and he will be bedridden for 6 weeks. Which measurement would best assess the patients energy expenditure?

A : body composition B : basal metabolic rate C : physical activity level D : adaptive thermogenesis Correct Answer : B 21 : What is a feature of the basal metabolic rate (BMR)?

A : Fever decreases the BMR. B : Fasting increases the BMR. C : Pregnancy increases the BMR. D : Males and females have a similar BMR when corrected for differences in body weight.

Correct Answer : C 22 : What diet promotes the greatest loss of body heat?

A : high fat, low protein B : high protein, low fat C : high carbohydrate, low fat D : balanced protein, fat, and carbohydrate Correct Answer : B 23 : What term describes the increase in energy expenditure that occurs in a person who fractures a leg?

A : febrile hyperthermia B : physical hyperthermia C : specific thermogenesis D : adaptive thermogenesis Correct Answer : D 24 : What is the approximate value for the thermic effect of a 2500-kcalorie diet?

A : 25 kcalories B : 250 kcalories C : 400 kcalories D : 500 kcalories Correct Answer : B 25 : Which group has the highest metabolic rate?

A : females B : older individuals C : younger individuals D : people with smaller surface areas 4 / 14

Correct Answer : C 26 : If a dancer and a typist with a sedentary lifestyle are the same height and have the exact same body build, who will most likely weigh more and why?

A : The typist will weigh more because she has more body fat.

B : The typist will weigh more because she has less muscle mass.

C : The dancer will weigh more because she has less body fat.

D : The dancer will weigh more because she has more muscle mass.

Correct Answer : D 27 : What is the main explanation for the difference in basal metabolic rates between males and females of the same body weight?

A : Males are usually taller than females.

B : Females have lower levels of thyroid hormones.

C : Males have a higher percentage of lean body mass.

D : Females have a lower percentage of adipose tissue.

Correct Answer : C 28 : How many kcalories would a woman require at the age of 40 if she required 1800 kcalories at the age of 30?

A : 1530 B : 1620 C : 1710 D : 1764 Correct Answer : C 29 : The weight of the body, less the fat content, is known as the A : cherubic index B : lean body mass C : body mass index D : ideal body weight

.

Correct Answer : B 30 : A person is at high risk for signs of illness and diminished work capacity when the BMI first drops below .

A : 12 B : 14 C : 17 D : 18.5 Correct Answer : C 31 : Jim is a 45-year-old who eats fast food at least three times a week and smokes a pack of cigarettes each day. He just had a physical examination and was told that his body mass index is 24. In what category would Jims BMI be classified?

A : obese B : overweight C : underweight 5 / 14

D : healthy weight Correct Answer : D 32 : What is a feature of the body mass index?

A : It correlates with disease risks.

B : It decreases by 1 unit for every 10 years of life.

C : It provides an estimate of the fat level of the body.

D : It is defined as the persons height divided by the square of the weight.

Correct Answer : A 33 : Jacki, who has a sedentary lifestyle, is 55 tall and weighs 165 pounds. She calculated her BMI to be 27.5. She recognizes that her body weight is unhealthy and vows to improve her eating habits and begin a regular program of physical fitness. Her goal is to achieve a BMI of 22. Approximately how much weight (pounds) must she lose?

A : 21 B : 27 C : 33 D : 41 Correct Answer : C 34 : Why does use of the BMI overestimate the prevalence of obesity in the African American population?

A : Blacks have a higher average height than whites.

B : Blacks have denser bones and higher body protein concentrations than whites.

C : Blacks tend to have different proportions of brown and white adipose tissue than whites.

D : Blacks have fat pads situated primarily around the hips, whereas in whites, the pads are primarily abdominal.

Correct Answer : B 35 : What is the weight classification assigned both to young women with 30 percent body fat and young men with 20 percent body fat?

A : obese B : normal C : mildly overweight D : slightly underweight Correct Answer : B 36 : What is a characteristic of excess intra-abdominal fat?

A : It is more common in women than men.

B : It has been proven to be a poorer indicator of degenerative diseases than the BMI. C : It may be more harmful than fat in other locations, according to some research.

D : It is associated with increased risk for heart disease and diabetes in men but not in women.

Correct Answer : C 37 : What defines central obesity?

A : accumulation of fat during the mid-years of life B : storage of excess fat around the trunk of the body 6 / 14

C : overfatness due to a large number of interacting behavioral problems D : overfatness due to reliance on high-fat foods as a central part of the diet Correct Answer : B 38 : Research in obese people seems to show that there is less susceptibility to health problems provided that the excess body fat is distributed around the .

A : stomach B : arms and chest C : hips and thighs D : neck and shoulders Correct Answer : C 39 : Waist circumference can best be used to assess A : BMI B : total body water C : abdominal fat stores D : subcutaneous fat stores

.

Correct Answer : C 40 : Which characteristic is associated with using current weight measures to assess risk of disease?

A : They are expensive to perform.

B : They are complicated to perform.

C : They are able to quantitate total body fat.

D : They cannot reveal fat distribution and central obesity.

Correct Answer : D 41 : Visceral fat is stored chiefly .

A : around the thighs and neck B : within the liver and spleen C : around the abdominal organs D : within subcutaneous adipocytes Correct Answer : C 42 : To assess body composition, health-care professionals most often use BMI and A : skinfold thickness B : hydrodensitometry C : waist circumference D : bioelectric impedance

.

Correct Answer : C 43 : Which method is commonly used to assess body fat?

A : impedance densitometry B : radioactive sodium count C : bioelectric absorptiometry D : air displacement plethysmography 7 / 14

Correct Answer : D 44 : A graph of the relationship between mortality (Y or vertical axis) and body mass index is shaped like a(n) .

A:J B:S C : backslash D : inverted U Correct Answer : A 45 : Premature deaths caused by A : underweight; obesity B : tobacco; underweight C : tobacco; obesity D : obesity; tobacco

are second only to

.

Correct Answer : D 46 : Ben is worried that his family history of heart disease and his BMI of 28 are putting him at very high risk for developing cardiovascular disease. What would a clinician advise Ben to help lower his risk?

A : Take steps to raise his LDL and lower his HDL. B : Consider liposuction surgery for removing extra abdominal fat.

C : Lose weight as this can lower both blood cholesterol and blood pressure.

D : Obtain genetic testing to determine the exact percent chance of developing cardiovascular disease.

Correct Answer : C 47 : What is a consequence of losing excess body weight?

A : It reverses atherosclerosis.

B : It lowers HDL-cholesterol.

C : It increases insulin resistance.

D : It raises the number of immune cells in adipose tissue.

Correct Answer : A 48 : Inflammation is characterized by an increase in A : adipocytes B : stress eating C : immune cell accumulation D : subcutaneous fat stores

.

Correct Answer : C 49 : When fat accumulates in the stomach, adipokines are released that directly result in an increase in .

A : fat synthesis B : inflammation C : allergies D : cancer 8 / 14

Correct Answer : B 50 : Metabolic syndrome .

A : is a cluster of symptoms associated with aging B : is triggered when weight loss occurs too rapidly C : has a higher prevalence in people who have high basal metabolic rates D : is associated with an increase in atherosclerosis Correct Answer : D 51 : Which statement describes an association between body weight and mortality?

A : Obesity is the fourth leading cause of premature death.

B : Overweight men who are physically fit have a lower mortality risk than normal-weight, unfit men.

C : Normal-weight men who are physically unfit have a similar mortality risk versus normalweight fit men.

D : The amount of weight gain in adulthood that is not associated with increased mortality is 20 pounds or less.

Correct Answer : B 52 : Which statement may best explain the relationship between excess body fat and higher risk for cancers of the female reproductive system?

A : Obese women are more sedentary, which promotes cancer development.

B : The higher levels of body fat act as a reservoir of carcinogenic substances.

C : Excess body fat produces more estrogen, which may promote tumor development.

D : The greater food consumption of obese women provides a higher intake of naturallyoccurring carcinogens.

Correct Answer : C 53 : What term is given to the condition of a female athlete who has an eating disorder and develops amenorrhea and osteoporosis?

A : female athlete triad B : triathlete medical disorder C : high stress tertiary disorder D : nonadaptable training syndrome Correct Answer : A 54 : What is an emetic?

A : an appetite suppressant B : an inhibitor of intestinal lipase C : a substance that induces vomiting D : an over-the-counter weight loss product Correct Answer : C 55 : A cathartic is a .

A : strong laxative B : drug that induces vomiting C : device to measure skinfold thickness D : device to measure the amount of intra-abdominal fat 9 / 14

Correct Answer : A 56 : What are the three most common eating disorders, in order from highest to lowest prevalence?

A : binge eating, bulimia nervosa, and anorexia nervosa B : anorexia nervosa, binge eating, and bulimia nervosa C : bulimia nervosa, binge eating, and anorexia nervosa D : bulimia nervosa, anorexia nervosa, and binge eating Correct Answer : A 57 : What is a characteristic of amenorrhea?

A : It induces prolonged bone loss.

B : It is a risk factor for women with bulimia.

C : It is a normal adaptation to strenuous physical training.

D : It is precipitated by high serum estrogen concentrations.

Correct Answer : A 58 : What is a characteristic of people with anorexia nervosa?

A : Most are aware of their condition and seek treatment.

B : Fewer than 200 women die each year from the disease.

C : Among those who are treated, many relapse into abnormal eating patterns.

D : During initial treatment, metabolism slows and appetite increases but thereafter subsides.

Correct Answer : C 59 : The first dietary objective in the treatment of anorexia nervosa is to A : stop further weight loss B : increase physical activity C : decrease physical activity D : eat foods with higher fiber content

.

Correct Answer : A 60 : Approximately what fraction of people treated for anorexia nervosa show reasonable maintenance of their weight gain?

A : 1/4 B : 1/2 C : 4/5 D : 9/10 Correct Answer : B 61 : What is characteristic of the eating pattern of people with bulimia nervosa?

A : Binge eating usually occurs during the daytime.

B : Binge eating is frequently done at restaurant buffets.

C : Binge eating typically occurs after a period of strict dieting.

D : A binge eating episode is usually completed within 20 minutes.

Correct Answer : C 10 / 14

62 : What is the primary factor that differentiates bulimia nervosa from binge eating?

A : Purging is rarely practiced in binge-eating disorder.

B : Higher rates of depression are reported in bulimia nervosa.

C : More food is consumed at one setting in binge-eating disorders.

D : Uncontrollable cravings for high-fat foods are seen only in bulimia nervosa.

Correct Answer : A

MATCHING 63 : Match each word or phrase with the most appropriate definition or explanation.

A : technique used to measure the amount of A : fasting heat given off when a food burns B : technique used to measure the amount of B : satiety oxygen consumed when a food burns C : response to the smell of favorite food C : hunger D : irritating sensation that initiates thoughts of D : caffeine food E : a feeling of fullness after eating E : appetite F : eating in response to arousal F : external cue G : reason we eat at a specific time of day G : stress eating H : energy needed to maintain the body at rest H : thermic effect I : a factor that lowers basal metabolism I : basal metabolism J : a factor that raises basal metabolism J : direct calorimetry K : indirect calorimetry K : term that describes the energy needed to process food L : changes in energy expenditure consequent L : specific dynamic effect to changes in environment M : synonymous with the thermic effect of food M : adaptive thermogenesis N : combination of medical conditions N : female athlete triad characterized by disordered eating, amenorrhea, and osteoporosis O : a disorder with symptoms that are similar to O : RED-S those see in starvation P : a disorder often associated with a BMI P : anorexia nervosa greater than 30 Q : bulimia nervosa Q : a disorder associated with cathartics and emetics R : a syndrome caused by energy deficiency R : binge eating Correct Answer : A:J B:K C:E D:C E:B

11 / 14

F:G G:F H:I I:A J:D K:H L : A12 M : A11 N : A13 O : A15 P : A17 Q : A16 R : A14

ESSAY 64 : Explain why the physiological fuel value is different than the value measured in a bomb calorimeter.

Correct Answer : ?The amount of energy that is derived from food is less than the amount of energy available in the food. This is due to the fact that the body is not as efficient as the bomb calorimeter at breaking the bonds, and some of the foods cannot be digested in our digestive tracts.

65 : What are at least five factors that affect basal metabolism? Explain how variations in these factors either increases or decreases basal metabolism.

Correct Answer : 1) As you age, your lean body mass decreases, which lowers your basal metabolic rate. 2) Basal metabolism is higher in people that are actively growing, such as young children and pregnant women. 3) Caffeine consumption increases basal metabolism. 4) Malnutrition lowers your basal metabolic rate. 5) Stress increases basal metabolic rate.

66 : What three pieces of advice would you offer to a patient who is having difficulty accepting a healthy body weight.

Correct Answer : ?I would suggest that the patient accept that there is not anything magical about weight loss—it will take time and hard work. Instead of dieting to lose weight, change your lifestyle to accommodate a healthy diet and exercise routine. Finally, seek help from friends, 12 / 14

family or a medical professional to help deal with any psychological issues that may be hindering their perspective.

67 : What are the benefits and limitations of using the body mass index?

Correct Answer : ?The body mass index is an easy to use formula that relates weight and height to overall health. This scale is extremely user friendly, making it very easy to use and requiring no special equipment. In general, the scale is a fairly good predictor of overall health. However, it fails to take into account body composition (lean muscle versus fat) and the different types of fat, which can have different health effects.

68 : Explain what is meant by apple and pear body types, and the different impacts of these on health.

Correct Answer : ?An “apple” body type is one that tends to have more upper body fat as compared to lower body fat seen in people with a “pear” body type. Upper body fat is visceral fat and is more closely associated with heart disease risks than the subcutaneous fat in the lower body.

69 : What is the purpose of bioelectrical impedance? How does this method work?

Correct Answer : ?Bioelectrical impedance is a method of determining overall body fat by measuring electrical currents that are sent through the body. Fats function as insulators, whereas lean body tissue can conduct these signals. Using mathematical calculations of the signal transmitted, one can determine the percentage of body fat.

70 : Explain the relationship between obesity and inflammation in obesity related diseases.

Correct Answer : ?Obesity is accompanied by inflammation. As fats accumulate, adipokines increase the production of proteins involved in inflammation. Additionally, elevated blood lipids also induce inflammation. Chronic inflammation leads to the progression of chronic diseases.

71 : What are some useful tips you can offer a high school cheerleading coach to help prevent eating disorders in her athletes?

Correct Answer : ?It is first important that both the coach and her athletes take the time to learn about what an ideal body should look like and what a good weight should be for each individual athlete, as this will vary based on body type. Additionally, they should discuss proper dietary needs and outline possible weight loss strategies that are safe for the athletes should they be necessary. If eating disorders are suspected, health professionals should be contacted for the best advice of how to deal with the individual.

72 : Sarah is a 15-year-old ballerina, hoping to get the lead role in the Nutcracker this Christmas season. During her training, she has become obsessed with being Clara at all costs, and has focused so much on her training and appearance that she has not been taking care of her health. She has restricted her caloric intake so that she is consuming far fewer calories than she should be given her height, weight, and physical activity level. She has been so busy, that she has not even realized that her period is over three months late. What would be your diagnosis of her disorder? What other symptoms might you expect to see?

Correct Answer : ?Sarah most likely has the female athlete triad, which falls under the Relative Energy Deficiency in Sport (RED-S). In addition to disordered eating and amenorrhea, Sarah is also at risk for osteoporosis. If she is not careful, she could break a bone during training.

13 / 14

Additionally, she is at risk for psychological disorders, like depression, or a decrease in her ability to be a good dancer from a loss of coordination and endurance.

73 : Compare and contrast anorexia nervosa and bulimia nervosa.

Correct Answer : ?Anorexia is a disorder in which the person feels that he or she is overweight due to a poor perception of body image. They will lose weight obsessively until they are severely underweight. Bulimia nervosa is a disorder in which the person is concerned with gaining weight, but will frequently binge eat and then will either force themselves to throw up, use laxatives, or exercise obsessively to prevent weight gain.

14 / 14

MULTIPLE CHOICE 1 : According to body mass index values, what percentage of the U.S. adult population is considered overweight or obese?

A : 59 B : 63 C : 69 D : 72 Correct Answer : C 2 : An estimated percent of children and adolescents aged 2 to 19 years are either overweight or obese.

A : 12 B : 32 C : 40 D : 48 Correct Answer : B 3 : One characteristic of fat cell development is that .

A : the amount of fat in the body is substantially determined by the size of the fat cells B : more and larger fat cells are found in obese people compared with healthy-weight persons C : fat cell number increases most readily during early adulthood, when energy expenditure declines D : fat cells may enlarge but not increase in number upon reaching the age of 50 Correct Answer : B 4 : Tom was overweight when he was 13. During puberty, he continued to gain weight steadily until the age of 23, when he decided to lose weight. Tom successfully lost 50 pounds. What most likely happened to Toms fat cells?

A : They shrank in size but did not decrease in number.

B : They melted away when he burned all the excess fat.

C : They decreased in number but did not decrease in size.

D : They changed very little since fat cells shrink only with a weight loss greater than 100 pounds.

Correct Answer : A 5 : What is a characteristic of the lipoprotein lipase enzyme?

A : In men, the enzyme activity is high in abdominal fat cells.

B : Obese people who lose weight show markedly higher enzyme activity.

C : Obese people have less enzyme activity in their adipocytes than lean people do.

D : In women, the enzyme activity is low in fat cells within the breasts, hips, and thighs.

Correct Answer : A 6 : What best describes the results of an increase in LPL activity?

A : Fat storage becomes more efficient.

B : The cells are less likely to obtain energy from glucose.

C : The liver increases production of triglycerides.

1 / 14

D : The rate of weight loss is increased.

Correct Answer : A 7 : Which description best defines the bodys set point?

A : the minimum weight of a person B : the maximum weight of a person C : the point at which a persons weight plateaus before dropping again quickly D : the point above which the body tends to lose weight and below which it tends to gain weight Correct Answer : D 8 : Women often have a more difficult time losing fat in general, and from the hips and thighs in particular. What best describes this rationale?

A : Women have increased amounts of ghrelin in their bodies.

B : A womans liver produces greater amounts of glycogen than a mans liver.

C : When women lose weight, their fat cells do not shrink in size.

D : The release of lower body fat is less active in women.

Correct Answer : D 9 : What occurs as fat cells accumulate triglycerides?

A : The fat cells decrease in number.

B : Energy expenditure exceeds energy intake.

C : The fat cells expand in size.

D : Lipoprotein lipase is released.

Correct Answer : C 10 : Fat cells increase in number the most during which time period?

A : infancy B : childhood and adolescence C : young adulthood D : middle adulthood Correct Answer : B 11 : What is a characteristic of the risk for obesity?

A : It is higher in fraternal than in identical twins.

B : It is associated more with environment than genetics.

C : It is usually higher in people with more brown adipose tissue.

D : It is higher in people who have obese friends, siblings, or spouses.

Correct Answer : D 12 : What best describes the connection between weight gain and genetics?

A : Obese people can change their genomes but not their epigenomes.

B : Exercise has little, if any, effect on the genetic influence on weight gain.

C : Identical twins are half as likely to weigh the same compared with fraternal twins.

D : Adopted children tend to have body weights similar to their biological parents than their adoptive parents.

Correct Answer : D 2 / 14

13 : What describes a relationship between leptin and energy balance?

A : Fat cell sensitivity to leptin is higher in obese people.

B : A deficiency of leptin is characteristic of all obese people.

C : Blood levels of leptin usually correlate directly with body fat.

D : Major functions of leptin include an increase in hunger and a decrease in metabolic rate.

Correct Answer : C 14 : What is a feature of leptin?

A : It is an enzyme.

B : It is a satiety signal.

C : It is usually deficient in obese people.

D : It is secreted by the brain and acts on fat cells.

Correct Answer : B 15 : What is a feature of ghrelin?

A : It is a metabolic antagonist of leptin.

B : It stimulates appetite and energy storage.

C : It allows blood levels in the fasting state to correlate directly with body weight.

D : It is released in high amounts from adipocytes during periods of excess energy intake.

Correct Answer : B 16 : Human adults have little brown fat, which is stored primarily around which area of the body?

A : the lower back B : the neck and clavicle C : the hips and thighs D : the abdomen Correct Answer : B 17 : What is the significance of the uncoupling proteins in adipose tissue?

A : increased loss of energy as heat B : reduction of fat cell numbers C : lowering of basal metabolism D : proliferation of fat cell numbers Correct Answer : A 18 : Kirima is a Native Eskimo who lives in one of the coldest regions in the world. What type of adipose tissue is most effective at helping her to maintain warm body temperatures during the coldest parts of the year?

A : black B : white C : brown D : yellow Correct Answer : C 19 : What statement best describes the features of physical inactivity and energy balance?

A : There is a strong genetic component to reduced physical activity of overweight people.

3 / 14

B : Differences in the time obese and lean people spend lying, sitting, standing, and moving account for about 350 kcalories per day.

C : Although watching television correlates with weight gain, playing video games does not, presumably due to the heightened excitement engendered by action games.

D : Extraordinarily inactive people who lower their food intakes below that of their lean counterparts activate brown adipose tissue uncoupling proteins that stimulate hyperthermic weight loss.

Correct Answer : B 20 : The concept of nonexercise activity thermogenesis (NEAT) is best described as the A : minimum weight of a person required to balance energy input with output B : rate at which a person is so inactive that they still have energy surplus C : point at which a persons weight plateaus before dropping again quickly D : energy expended in spontaneous everyday activities

.

Correct Answer : D 21 : Aggressive weight loss treatment should be introduced in overweight people if they have which risk factor?

A : a history of breast cancer B : age over 40 C : high LDL and low HDL D : orthostatic hypotension Correct Answer : C 22 : When performing an obesity evaluation, the disease risk profile takes into account family history, life- threatening diseases, and .

A : body mass index B : socioeconomic factors C : waist circumference D : common risk factors for chronic diseases Correct Answer : D 23 : Millions of people in the United States use over-the-counter weight-loss products and approximately percent are of normal weight.

A:5 B : 10 C : 20 D : 30 Correct Answer : B 24 : A popular eating plan that promises quick weight loss is known as a(n) A : fad diet B : discretionary diet C : spot reduction program D : aggressive bariatric program

.

Correct Answer : A 4 / 14

25 : What is the principal reason that the FDA has banned the sale of products containing ephedrine?

A : The costs are prohibitive.

B : The products were found to be ineffective for weight loss.

C : The products were implicated in several cases of heart attacks and seizures.

D : The products were found to contain contaminants that were believed to be responsible for inducing liver failure.

Correct Answer : C 26 : What statement accurately describes weight-loss remedies?

A : Dietary supplements are not necessarily tested for safety or effectiveness.

B : Body wraps and creams that have FDA approval are helpful for weight-reduction regimes.

C : Sauna baths may reach temperatures high enough to melt visceral but not subcutaneous fat stores.

D : Hot baths raise the metabolic rate by 510% for 12 hours and may serve as part of a general weight-loss program.

Correct Answer : A 27 : The FDA has identified more than products within herbal products and dietary supplements that contain undeclared, active pharmaceutical ingredients that can have serious consequences.

A : 15 B : 40 C : 75 D : 150 Correct Answer : C 28 : What is a feature of prescription drug use for treatment of obesity?

A : Most drugs may be safely prescribed even in otherwise healthy obese people.

B : Most experts believe that drugs should not be used because obesity is not a disease.

C : Most currently available drugs are highly effective in both the short and long term treatment of obesity.

D : Off-label drugs are commonly taken for their modest weight loss effects.

Correct Answer : D 29 : The prescription drug phentermine acts by regulating the utilization of A : blood insulin B : norepinephrine C : hormone-sensitive lipase D : adipocyte lipoprotein lipase

.

Correct Answer : B 30 : Your patient, Mr. Sinclair, has a BMI of 43 and is taking drugs to lose weight. He has heard that some drugs cause gastrointestinal discomfort and would prefer to take one that doesnt give him any of these side effects. What should be prescribed for Mr. Sinclair?

A : Xenical B : Alli C : Belviq 5 / 14

D : Qsymia Correct Answer : D 31 : What is the primary action of the weight-loss drug orlistat?

A : It reduces taste sensation.

B : It inhibits lipoprotein lipase.

C : It inhibits pancreatic lipase.

D : It alters circulating leptin concentrations.

Correct Answer : C 32 : What is a feature of gastric surgery for the treatment of clinically severe obesity?

A : Weight regain almost never occurs.

B : Surgery is always an irreversible medical procedure.

C : Gastric surgery is less effective than traditional liposuction.

D : Gastric surgery diminishes the amount of food that can be eaten without GI distress.

Correct Answer : D 33 : What best describes an advantage of the gastric banding procedure for weight loss?

A : It requires no need for adjustments after surgery.

B : It has been shown to be more reliable and effective than some other types of surgery.

C : It has the highest success rate for weight loss of any bariatric surgery procedure.

D : It is less invasive than some other forms of bariatric surgery.

Correct Answer : D 34 : What best describes a characteristic of liposuction?

A : Blood pressure and insulin sensitivity often improves.

B : The typical loss of body weight ranges from 2550 pounds.

C : Within a year, body fat returns, primarily to the abdomen.

D : Liposuction is a valid but slightly less effective alternative to gastric bypass.

Correct Answer : C 35 : What is a safe rate of weight loss on a long-term basis for most overweight people?

A : 0.5 to 2 pounds per week B : 3 to 5 pounds per week C : 5 percent body weight per month D : 10 percent body weight per month Correct Answer : A 36 : As a general rule, what minimum number of kcalories per day is necessary to ensure nutritional adequacy in an eating plan for reducing body weight in women?

A : 500 kcalories B : 800 kcalories C : 1200 kcalories D : 1600 kcalories Correct Answer : C 6 / 14

37 : Which activity would be most effective at lowering energy intake in a person on a weight reduction program?

A : decreasing portion sizes B : selecting fewer energy-dense foods C : restricting fiber intake as a means to reduce excess water retention D : consuming a small high-fat snack before each meal to reduce appetite Correct Answer : B 38 : Charlene tries to maintain a consistent energy intake of 1800 kcalories per day. How much protein does this kcalorie level allow for on a daily basis?

A : 3 oz.

B : 5 oz.

C : 6 oz.

D : 8 oz.

Correct Answer : B 39 : An important aid in any weight-loss diet program is to .

A : decrease water intake B : increase physical activity C : speed up thyroid activity with metabolic enhancers D : develop ketosis by keeping carbohydrate intake as low as possible Correct Answer : B 40 : The use of artificial sweeteners to control body weight A : may lead to weight gain in some people B : automatically lowers a persons daily energy intake C : delays gastric emptying time, leading to enhanced satiety D : triggers epinephrine secretion, which suppresses appetite

.

Correct Answer : A 41 : A person who weighs 150 pounds and walks at a pace of 3.5 miles per hour expends about how many kcalories in that hour?

A : 115 B : 315 C : 410 D : 850 Correct Answer : B 42 : What statement best describes the bodys response to engaging in physical activity?

A : After an intense and vigorous workout, metabolism remains elevated for several hours.

B : Lower body fat is more readily lost from vigorous exercises that work primarily the hip and leg muscles.

C : Blood glucose and fatty acid levels are low immediately after working out, but thereafter recover on their own.

D : After an intense workout, most people immediately feel the urge to eat a large carbohydrate meal to replace glycogen stores.

Correct Answer : A 7 / 14

43 : What is the principal reason that appetite is turned off immediately after a person finishes an intense workout?

A : The feeling of thirst overpowers the desire for food.

B : The elevated blood lactate level antagonizes ghrelin.

C : Glucose and fatty acids are still abundant in the blood.

D : The senses of smell and taste are suppressed for at least one hour.

Correct Answer : C 44 : What best explains the relationship of spot reducing to exercise?

A : No exercise can target fat removal from any specific area of the body.

B : Upper body fat is mostly unaffected by exercising lower body muscles.

C : Lower body fat in women is depleted at a faster rate than abdominal fat.

D : Abdominal fat in men is released more readily with anaerobic exercise.

Correct Answer : A 45 : Approximately how many kcalories per week should be expended in physical activity in order to maintain a weight loss?

A : 2000 B : 4000 C : 6000 D : 9000 Correct Answer : A 46 : To help maximize the long-term success of a persons weight-loss program, which personal attitudes should be encouraged in the individual?

A : strongly believing that weight can be lost B : viewing the body realistically as being fat rather than thin C : refraining from expressing overconfidence in the ability to lose weight D : accepting that little or no exercise is a part of the lifestyle of most overweight people Correct Answer : A 47 : An example of a behavior modification technique for weight control is to A : feel guilty after overeating B : keep a record of eating habits C : always clean your plate D : have someone watch you to prevent overeating

.

Correct Answer : B 48 : What is the relationship between smoking and weight maintenance?

A : Smokers on average weigh about 5 pounds more than nonsmokers.

B : Smoking a cigarette increases the appetite for energy-dense foods.

C : People who give up smoking gain an average of 10 pounds in the first year.

D : Psychotherapy is effective at reducing either smoking or body weight but not both.

Correct Answer : C 49 : Approximately what percentage of overweight people who intentionally lose weight are able 8 / 14

to maintain at least a 10 percent weight loss for at least one year?

A:5 B : 17 C : 50 D : 85 Correct Answer : B 50 : Which recommendation is an example of a national strategy to prevent obesity?

A : Limit television time to less than 20 hours per week.

B : Encourage media messages that promote physically active lifestyles.

C : Support a diet that encourages high energy-density foods with low nutrient-density foods.

D : Promote energy expenditure of at least 3000 kcalories per week to prevent weight gain.

Correct Answer : B 51 : Approximately what percentage of U.S. adults is classified as underweight?

A : 0.2 B:2 C:5 D : 10 Correct Answer : B 52 : A person is classified as being underweight when his BMI is below A : 14 B : 18.5 C : 20 D : 22.5

.

Correct Answer : B 53 : One difference between a person with anorexia nervosa and other underweight people is that .

A : people with anorexia may weigh less than 70 pounds at times B : anorexia causes malnutrition C : starvation is intentional with anorexia D : those with anorexia strive to control their weight Correct Answer : C 54 : Which kind of food is most appropriate for an underweight individual who needs to gain weight?

A : avocados B : donuts C : dried apricots D : chocolate Correct Answer : A 55 : What strategy would be most beneficial for an underweight person to gain weight?

A : Consume at least three meals per day.

B : Eat until satisfied but not full.

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C : Skip snacking and focus on regular meals.

D : Avoid exercise, which promotes weight loss.

Correct Answer : A 56 : John is underweight because of a prolonged illness. What approach would be most beneficial for helping John to gain some weight?

A : increasing intake of potassium-rich foods B : reducing energy expenditure by increasing resting times C : increasing fluid intake through water and sugar-free beverages D : consuming a high-kcalorie, high-protein liquid formula daily Correct Answer : D 57 : Fad diets often produce weight loss, at least initially, because they A : dictate the correct distribution of energy among the macronutrients B : prevent rapid spikes and declines in blood glucose levels C : dont require people to count kcalories, and are thus easier to stick to D : are designed to limit energy intake to around 1200 kcalories per day

.

Correct Answer : D 58 : What is a characteristic of most fad diets?

A : They produce long-lasting results just like healthy diets.

B : They limit food choices, thereby reducing energy intake.

C : They are balanced and therefore do not require a dietary supplement.

D : Their success depends on the ratios of macronutrients more than the total energy value.

Correct Answer : B 59 : Jody is taking a nutrition class and has been assigned to evaluate a popular diet plan. She finds a description of a plan for her assignment in a magazine at the grocery store. Which statement in the magazine would suggest that this plan is a fad diet?

A : On this plan, you can lose up to 2 pounds per week!

B : Once you complete this 6-month plan, youll never have to diet again.

C : Keep fresh fruit or carrot sticks in the fridge at work so you wont be tempted to raid the vending machine for a snack.

D : Starting an aerobic exercise plan may seem daunting, but you can start out with shorter, easier sessions and then build up to 3 or more hours a week.

Correct Answer : B 60 : Carol is considering a diet plan that claims that by following their method, she will create body confusion, which prevents metabolism from settling into homeostasis. Which diet method is Carol most likely considering?

A : the Biggest Loser Diet B : the Dukan Diet C : the 17-Day Diet D : the New Sonoma Diet Correct Answer : C

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MATCHING 61 : Match each value or word or phrase with the most appropriate definition or explanation.

A : percentage of U.S. adults considered A:1 overweight or obese B : an enzyme that promotes fat storage B:2 C : a term that describes environmental C : 10 influences that promote weight gain D : a theory that the body tends to maintain a D : 40 certain weight by internal controls E : substitution of positive, supportive thoughts E : 60 for negative, self-defeating thoughts F : hormone that regulates appetite in response F : 69 to body fat levels G : hormone that stimulates appetite G : leptin H : a high-protein, low-kcalorie diet that H : orlistat promotes permanent weight loss I : type of adipose that primarily stores fat I : ghrelin J : type of adipose that primarily produces heat J : New Sonoma K : percentage of nonprescription weight-loss K : set point product users in the United States who are at a normal weight L : white fat L : substance in some herbs that may cause heart attacks and seizures M : a diet that promotes coastal California-style M : Dukan foods in controlled portions N : surgical procedure on the stomach N : brown fat O : inhibitor of pancreatic lipase O : ephedrine P : minimum BMI of a clinically severe obese P : liposuction person Q : a cosmetic surgical procedure that removes Q : bypass fat deposits R : safe rate of weight loss, in pounds per week R : lipoprotein lipase S : recommended minimum number of minutes S : cognitive restructuring per day of moderately intense physical activity to prevent weight gain T : percentage of U.S. adults classified as T : obesogenic underweight Correct Answer : A:F B : A17 C : A19 D:K E : A18 F:G

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G:I H : A12 I : A11 J : A13 K:C L : A14 M:J N : A16 O:H P:D Q : A15 R:A S:E T:B

ESSAY 62 : Briefly describe the change in trends of obesity in the United States within the last four decades.

Correct Answer : ?The prevalence of overweight and obesity in the United States continues to be high. In the past four decades, obesity increased in every state, in both genders, and across all ages, races, and educational levels. An estimated 69 percent of the adults in the United States are now considered overweight or obese, as defined by a BMI of 25–29.9, or greater than 30, respectively. The prevalence of overweight is especially high among women, the poor, blacks, and Mexican Americans. The prevalence of overweight among children in the United States has also risen at an alarming rate. An estimated 32 percent of children and adolescents aged 2–19 years are either overweight or obese.

63 : Explain the association between ghrelin secretion and sleep.

Correct Answer : ?Some research indicates that ghrelin promotes sleep. Interestingly, a lack of sleep increases the hunger hormone ghrelin and decreases the satiety hormone leptin—which may help to explain the association between inadequate sleep and overweight.

64 : Describe the differences between white adipose tissue and brown adipose tissue.

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Correct Answer : ?The body has two main types of fat: white and brown adipose tissue. White adipose tissue stores fat for other cells to use for energy; brown adipose tissue releases stored energy as heat, thus defending against cold and preventing obesity. Brown fat is most metabolically active during exposure to cold. Importantly, brown fat activity declines with age and with obesity; overweight and obese individuals have less brown fat activity than others.

Recent research has revealed that some white fat cells can undergo a process known as browning as they take on characteristics of brown fat, most notably the activity of uncoupled proteins; these fat cells have been named brite adipocytes.

65 : Explain the factors involved in the promotion of obesity by high-fat diets and food portion sizes.

Correct Answer : ?We live in an environment that exposes us to an abundance of high-kcalorie, high-fat foods that are readily available, relatively inexpensive, heavily advertised, and reasonably tasty. Food is convenient and it’s available morning, noon, and night—and all times in between. Consequently, we are eating more meals more frequently than in decades past—and energy intake has risen accordingly. Eating large portion sizes multiple times a day accounts for much of the weight increase seen over the decades. People buy the large portions and combinations, perceiving them to be a good value, but then they eat more than they need.

Restaurant food, especially fast food, contributes significantly to the development of obesity.

Fast food is often energy-dense food, which increases energy intake, BMI, and body fatness.

66 : Describe psychological problems encountered by obese people in their attempts to lose weight.

Correct Answer : ?Psychologically, obese people may suffer embarrassment when others treat them with hostility and contempt, and many have come to view their own bodies as flawed.

Feelings of rejection, shame, and depression are common among obese people. Anxiety and depression, in turn, may contribute to the development of obesity, which perpetuates the problem. Most weight-loss programs assume that the problem can be solved simply by applying willpower and hard work. If determination were the only factor involved, though, the success rate would be far greater than it is.

67 : Discuss the safety and efficacy of liposuction as a means of body fat reduction.

Correct Answer : ?Liposuction is a cosmetic procedure that has little effect on body weight (less than 10 pounds), but it can alter body shape slightly in specific areas. Liposuction is a popular procedure in part because of its perceived safety, but immediate and delayed complications can arise. Removing adipose tissue by way of liposuction does not provide the health benefits that typically accompany weight loss. In other words, liposuction does not improve blood pressure, inflammation, blood lipid profile, or insulin sensitivity. Perhaps most surprisingly, a year after liposuction, body fat returns and redistributes itself from the thighs to the abdomen.

68 : Explain what is meant by spot reducing and discuss its effectiveness in altering body fat content.

Correct Answer : ?Unfortunately, muscles do not “own” the fat that surrounds them. Fat cells all over the body release fat in response to the demand of physical activity for use by whatever muscles are active. Specific exercises—whether moderate or intense—do not influence the site of adipose tissue loss. Exercise can help with trouble spots in another way, though. The “trouble spot” for most men is the abdomen, their primary site of fat storage. During aerobic exercise, abdominal fat readily releases its stores, providing fuel to the physically active body. With regular exercise and weight loss, men will deplete these abdominal fat stores before those in 13 / 14

the lower body. Women may also deplete abdominal fat with exercise, but their “trouble spots” are more likely to be their hips and thighs.

69 : Provide an explanation for the higher food consumption of people who eat in the presence of others.

Correct Answer : ?People tend to eat more when socializing with others. Pleasant conversations extend the duration of a meal, allowing a person more time to eat more, and the longer the meal, the greater the consumption. In addition, by taking a visual cue from companions, a person might eat more when others at the table eat large portions or go to the buffet line for seconds. Social interactions also distract a person from paying attention to how much has been eaten. In some cases, socializing with friends during a meal may provide comfort and lower a person’s motivation to limit consumption. In other cases, socializing with unfamiliar people during a meal—during a job interview or blind date, for example—may create stress and reduce food consumption. To eat less while socializing, pay attention to portion size.

70 : Explain the role of behavior modification strategies in weight reduction programs.

Correct Answer : ?Behavior modification strategies focus on learning desired eating and activity behaviors and eliminating unwanted behaviors. Examples include not grocery shopping when hungry and exercising when watching television. With so many possible behavior changes, a person can feel overwhelmed. Start with small time-specific goals for each behavior—for example, “I’m going to take a 30-minute walk after dinner every evening” instead of “I’m going to run in a marathon someday.” Practice desired behaviors until they become routine.

Addressing multiple behaviors that focus on a common goal simultaneously may better support changes than taking on one at a time. Using a reward system also seems to effectively support weight-loss efforts.

71 : Why are fad diets so popular?

Correct Answer : ?Perhaps the greatest appeal of fad diets is that they tend to ignore dietary recommendations. Foods such as meats and milk products that need to be selected carefully to limit saturated fat can be eaten with abandon. Whole grains, legumes, vegetables, and fruits that should be eaten in abundance can now be bypassed. For some people, this is a dream come true: steaks without the potatoes, ribs without the coleslaw, and meatballs without the pasta. Dieters are also lured into fad diets by sophisticated—yet often erroneous—explanations of the metabolic consequences of eating certain foods. Terms such as eicosanoids and de novo lipogenesis are scattered about, often intimidating readers into believing that the authors must be right given their brilliance in understanding the body.

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MULTIPLE CHOICE 1 : What is a general feature of a vitamin?

A : It is inorganic.

B : It may contain nitrogen.

C : It may be required in large amounts.

D : It may support growth but not maintenance.

Correct Answer : B 2 : What is meant by the bioavailability of a vitamin in food?

A : the total amount available from plant and animal food B : the amount absorbed and subsequently used by the body C : the amount that escapes destruction from food processing D : the number of different chemical forms of the same vitamin Correct Answer : B 3 : What is the primary excretory route for the water-soluble vitamins?

A : bile B : kidney C : intestine D : perspiration Correct Answer : B 4 : Which factor explains why B vitamin deficiencies lead to lack of energy?

A : B vitamins are a source of kilocalories.

B : Absorption of carbohydrates and fats is decreased.

C : Oxygen for energy metabolism cannot be transported to the cells.

D : Coenzymes needed for energy metabolism are produced in insufficient amounts.

Correct Answer : D 5 : What describes the basic function of a coenzyme?

A : It attaches to RNA to assist in the synthesis of an enzyme.

B : It attaches to cell membranes to assist in uptake of an enzyme.

C : It attaches to an enzyme and allows a chemical reaction to take place.

D : It attaches to an enzyme, which allows for transport of the enzyme through the circulation.

Correct Answer : C 6 : What is the primary chemical reaction in which thiamin participates as a coenzyme?

A : It transfers amine groups in the synthesis of amino acids.

B : It transfers hydrogen atoms in the synthesis of erythrocytes.

C : It assists in addition of methyl groups to compounds involved in energy metabolism.

D : It assists in removal of one-carbon units from compounds involved in energy metabolism.

Correct Answer : D 7 : Beriberi results from a deficiency of A : niacin

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B : thiamin C : vitamin C D : vitamin B12 Correct Answer : B 8 : Which food provides the most thiamin per serving size?

A : ham B : squash C : whole milk D : whole-grain breads Correct Answer : A 9 : How does the method of cooking affect thiamin stability?

A : Microwaving the food conserves much of the thiamin.

B : Prolonged heating of the food has little, if any, effect on thiamin.

C : Boiling the food tends to conserve thiamin by forming a stable, hydrated complex.

D : Steaming the food can lead to substantial thiamin loss due to the high heat needed to form the steam.

Correct Answer : A 10 : The signs and symptoms of riboflavin deficiency are known collectively as A : pellagra B : antiflavonosis C : ariboflavinosis D : flavin adenine dinucleosis

.

Correct Answer : C 11 : Riboflavin needs are more difficult to meet when the diet is low in A : meats B : grains C : vegetables D : dairy foods

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Correct Answer : D 12 : Riboflavin is most easily destroyed when exposed to A : heat B : acid C : alkali D : ultraviolet light

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Correct Answer : D 13 : A deficiency of what vitamin produces a characteristic cracking and redness at the corners of the mouth?

A : biotin B : niacin C : riboflavin D : ascorbic acid 2 / 14

Correct Answer : C 14 : Which property is shared by niacin and riboflavin coenzymes?

A : acceptance and transfer of amino groups B : acceptance and transfer of activated carbon dioxide C : acceptance and transfer of hydrogen atoms D : acceptance and transfer of carboxyl groups Correct Answer : C 15 : When the diet contains an adequate amount of protein, what amino acid can be used by the body to synthesize niacin?

A : lysine B : valine C : tryptophan D : phenylalanine Correct Answer : C 16 : What term identifies the characteristic tingling sensations and reddening of the skin after ingesting a pharmacologic dose of nicotinic acid?

A : niacin flush B : NAD dermatitis C : niacin erythema D : bilateral symmetrical dermatitis Correct Answer : A 17 : What is a feature of niacin nutrition?

A : Low doses may lead to kidney stones.

B : High doses may lower blood cholesterol.

C : Low doses may lead to heartburn and low blood pressure.

D : High doses may elevate red blood cell count in mildly anemic individuals.

Correct Answer : B 18 : Your friend Jane just returned from the doctor, who diagnosed her with a specific vitamin B toxicity. However, she doesnt recall the name of the vitamin. Which vitamin listed is the only possible culprit associated with toxicity symptoms?

A : niacin B : biotin C : riboflavin D : vitamin B12 Correct Answer : A 19 : Which food would be the best source of niacin equivalents?

A : milk B : broccoli C : chicken D : strawberries 3 / 14

Correct Answer : C 20 : Which food contains a protein that decreases the bioavailability of biotin?

A : aged wine B : aged cheese C : raw egg whites D : raw cauliflower Correct Answer : C 21 : Which vitamin is synthesized in significant amounts by intestinal bacteria?

A : folate B : biotin C : cyanocobalamin D : pantothenic acid Correct Answer : B 22 : Which vitamin is known to sustain substantial losses during processing of food?

A : biotin B : niacin C : riboflavin D : pantothenic acid Correct Answer : D 23 : Which vitamin is stored primarily in muscle tissue?

A : biotin B : folate C : vitamin B6 D : pantothenic acid Correct Answer : C 24 : The chief symptoms of early vitamin B6 deficiency include A : confusion and depression B : muscle cramps and stiffness C : profound fatigue and anemia D : hyperactivity and shortness of breath

.

Correct Answer : A 25 : In what major way does alcohol intake affect vitamin B6 metabolism?

A : It reduces acetaldehyde formation.

B : It increases fecal excretion of the vitamin.

C : It dislodges the PLP coenzyme from its enzyme.

D : It interferes with synthesis of the PLP coenzyme.

Correct Answer : C 26 : On a per-kcalorie basis, which food is richest in vitamin B6?

A : meats B : fruits 4 / 14

C : legumes D : grains Correct Answer : B 27 : Which vitamin undergoes significant enterohepatic circulation?

A : folate B : niacin C : thiamin D : pyridoxine Correct Answer : A 28 : Which vitamin is usually found in a form that is bound to one or more glutamic acid molecules in food?

A : folate B : thiamin C : vitamin B6 D : ascorbic acid Correct Answer : A 29 : A person with a disorder that limits absorption of bile is at increased risk for deficiency of .

A : folate B : niacin C : riboflavin D : ascorbic acid Correct Answer : A 30 : What is the most likely explanation for the impaired functioning of the GI tract resulting from folate deficiency?

A : insufficient bile production, thereby promoting fat malabsorption and diarrhea B : reduced mucosal cell replacement, thereby resulting in decreased GI functioning C : decreased enzymatic capacity in the intestines, thereby resulting in malabsorption D : decreased oxygen supply to body tissues, with the intestines being particularly affected because of their high metabolic activity Correct Answer : B 31 : Approximately what percentage of naturally occurring dietary folate is bioavailable?

A : 10 B : 25 C : 50 D : 80 Correct Answer : C 32 : Which term is a type of neural tube defect?

A : scurvy B : beriberi C : pellagra 5 / 14

D : spina bifida Correct Answer : D 33 : Nicole is pregnant and is trying to monitor her folate intake. She is eating foods high in folate as well as taking folate supplements, and she is having a hard time determining how many dietary folate equivalents she is consuming. Below is a list of her daily intake with respect to folate:½ cup of cooked lentils (180 micrograms food folate)½ cup of fresh orange juice (60 micrograms food folate)folate supplement (200 micrograms)How many DFEs is Nicole consuming?

A : 440 B : 480 C : 540 D : 580 Correct Answer : D 34 : A deficiency of which vitamin results in accumulation of homocysteine in the blood?

A : folate B : biotin C : niacin D : vitamin K Correct Answer : A 35 : Regular use of which substance is known to adversely affect folate utilization?

A : insulin B : calcium supplements C : antacids D : vitamin B12 supplements Correct Answer : C 36 : Which disease is associated with a deficiency of folate?

A : hemolysis B : hypoxemia C : hemolytic anemia D : macrocytic anemia Correct Answer : D 37 : Folate deficiency has been reported in infants fed A : soy milk B : goats milk C : baby cereal D : infant formula

.

Correct Answer : B 38 : Which food is highest in folate?

A : steak B : whole-wheat bread C : cheddar cheese 6 / 14

D : spinach Correct Answer : D 39 : What is the function of intrinsic factor in vitamin B12 absorption?

A : It catalyzes release of the vitamin from its protein-bound form.

B : It attaches to the vitamin, thereby allowing absorption from the small intestine.

C : It acts as a storage protein for the vitamin within the intestinal epithelial cells.

D : It acts as a cofactor for mucosal enzymes involved in absorption of the vitamin.

Correct Answer : B 40 : What is the most likely reason for the development of a vitamin B12 deficiency?

A : inadequate intake B : increased excretion C : inadequate absorption D : increased losses in food preparation Correct Answer : C 41 : Pernicious anemia results from a deficiency of A : folate B : selenium C : vitamin B12 D : iron and copper

.

Correct Answer : C 42 : The absorption of which vitamin is most affected by the disorder atrophic gastritis?

A : choline B : vitamin C C : vitamin B12 D : pantothenic acid Correct Answer : C 43 : A similar type of anemia is produced when there is a deficiency of either A : riboflavin or niacin B : vitamin B12 or folate C : thiamin or riboflavin D : vitamin B6 or vitamin B12

.

Correct Answer : B 44 : What is a feature of vitamin B12 bioavailability?

A : Synthetic B12 in supplement form is highly utilizable.

B : Fermented soy products are optimal sources of the vitamin.

C : Yeast consumed by vegans is a good source of the vitamin.

D : Sea algae such as spirulina contain vitamin B12 that is about 50 percent available.

Correct Answer : A 45 : Which food choice would be the only substantial source of vitamin B12?

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A : pecans B : hot dog C : cauliflower D : whole-grain bread Correct Answer : B 46 : What is a feature of choline in nutrition?

A : It is an analog of ascorbic acid.

B : It is abundant in green leafy vegetables.

C : It is synthesized by the body from cysteine.

D : Its average intakes in the United States are lower than recommended.

Correct Answer : D 47 : Which nutrient is synthesized in significant amounts in the body?

A : choline B : thiamine C : ascorbic acid D : pantothenic acid Correct Answer : A 48 : Which nutrient is known to perform an essential function in the human body?

A : carnitine B : orotic acid C : methoxantin D : pangamic acid Correct Answer : A 49 : What is an overt sign of a possible B vitamin deficiency?

A : anemia B : smooth tongue C : abnormal liver function D : abnormal heart function Correct Answer : B 50 : What is a free radical?

A : an inactive vitamin B : an unphosphorylated vitamin C : a molecule of unbound cobalamin D : a molecule with at least one unpaired electron Correct Answer : D 51 : The synthesis of collagen requires both vitamin C and A : iron B : zinc C : cobalamin D : beta-carotene

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Correct Answer : A 52 : Why might vitamin C supplements be beneficial in treating the common cold?

A : They deactivate histamine.

B : They reduce episodes of diarrhea.

C : They destroy intestinal pathogens.

D : They alter hypothalamic control of body temperature.

Correct Answer : A 53 : What is an early sign of vitamin C deficiency?

A : bleeding gums B : pernicious anemia C : appearance of a cold D : hysteria and depression Correct Answer : A 54 : Which food group is a rich source of vitamin C? A : milk B : meat C : fruit D : grains Correct Answer : C 55 : What term is used to describe the outcome of a diagnostic test that apparently shows that you have mononucleosis, when in reality, you do not?

A : true positive B : true negative C : false positive D : false negative Correct Answer : C 56 : Which food provides ample amounts of vitamin C? A : tofu B : yogurt C : legumes D : broccoli Correct Answer : D 57 : What food makes a significant contribution to vitamin C intakes in the U.S. population despite its modest vitamin C concentration?

A : potatoes B : organ meats C : breaded fish D : whole-grain cereals Correct Answer : A 58 : A vitamin supplement labeled as high potency contains an amount that is

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A : 50 percent of the Daily Value B : equal to the UL C : up to 200 percent of the Daily Value D : 100 percent or more of the Daily Value Correct Answer : D 59 : A person who shuns dairy and spends most of her time indoors would likely benefit from a supplement of .

A : vitamin A B : vitamin B6 C : vitamin C D : vitamin D Correct Answer : D 60 : What is a feature of nutrient intakes and supplement use in the United States?

A : Few people ingest the optimal amounts of all vitamins and minerals from foods.

B : The NIH recommends that people use supplements to prevent chronic diseases.

C : The NIH does not recommend the use of supplements to prevent chronic diseases.

D : The FDA recognizes that most nutrient supplements are associated with little, if any, harm.

Correct Answer : A 61 : Why shouldnt vitamin E supplements be taken for at least one week before surgery?

A : Vitamin E interferes with barbiturate pain medications.

B : The antioxidant activity affects stability of most anesthetic agents.

C : Vitamin E acts as a blood thinner and could lead to excessive bleeding.

D : The antioxidant activity interferes with synthesis of replacement erythrocytes.

Correct Answer : C 62 : What nutrient is responsible for causing the most accidental ingestion deaths in children?

A : iron B : calcium C : vitamin A D : vitamin D Correct Answer : A 63 : Nutrient supplements known as green pills often contain A : mostly food coloring B : high-potency vitamin C C : dehydrated alfalfa and parsley D : dried extracts of spoiled meats

.

Correct Answer : C 64 : If a dietary supplement poses a significant risk of illness to consumers, what agency must prove harm before removing the product from the market?

A : FDA B : CDC C : USDA 10 / 14

D : USPHS Correct Answer : A

MATCHING 65 : Match the vitamin with its primary function.

A : part of coenzyme TPP in energy metabolismA : biotin B : part of coenzyme FAD and FMN in energy B : folate metabolism C : niacin C : part of coenzyme NAD and NADP in metabolism D : part of coenzyme in energy metabolism that D : pantothenic acid carries activated carbon dioxide E : part of coenzyme A in energy metabolism E : riboflavin F : part of the coenzyme PLP used to transfer F : thiamin amino groups to form amino acids G : activates vitamin B12 and synthesizes DNA G : vitamin B6 for new cell growth H : activates folate, helps synthesize DNA for H : vitamin B12 new growth; protects nerve cells I : synthesis of collagen, carnitine, hormones, I : vitamin C and neurotransmitters; serves as an antioxidant Correct Answer : A:F B:E C:C D:A E:D F:G G:B H:H I:I

66 : Match the each vitamin to its alternative name.

A : ascorbic acid A : folate B : cobalamin B : niacin C : nicotinic acid C : riboflavin D : vitamin B1 D : thiamin E : vitamin B2 E : vitamin B6 F : pyridoxine F : vitamin B12 11 / 14

G : pteroylglutamic acid

G : vitamin C

Correct Answer : A:G B:F C:B D:D E:C F:E G:A

ESSAY 67 : Describe the major differences between vitamins and the energy-containing nutrients.

Correct Answer : ?Unlike the energy-containing nutrients, vitamins do not yield energy when they are metabolized, but rather participate in the body in different ways, including aiding in metabolism. Additionally, vitamins are comprised of single units that are not linked together.

Finally, vitamins are required in much smaller amounts than the energy-containing nutrients.

68 : Discuss the difference between the absorbance, transport, and excretion of the watersoluble vitamins and the fat-soluble vitamins in the body.

Correct Answer : ?Water soluble vitamins are absorbed in the GI tract, and then travel through the blood to the cells. Vitamins can travel freely through the blood, and are removed by the kidneys when the levels get too high. Fat-soluble vitamins enter the blood through the lymph, and usually require transport proteins to allow them to travel freely through the blood. Excess fatsoluble vitamins are stored in adipose tissue, and are largely not excreted.

69 : A new world that can support life has been discovered, and a group of brave people are heading there to colonize the planet. As the resident nutritionist, you need to plan which crops and livestock should accompany you for the journey to ensure that proper nutrition will be met.

In order to prevent your colonists from developing beriberi, what would you recommend bringing on the journey? How would you recognize early symptoms of this disease to monitor any possible affects that the planet may have on the bioavailability of this vitamin or mineral over time.

Correct Answer : ?Beriberi is a disease caused by prolonged thiamin deficiency. In order to prevent this disease, you would recommend bringing along pigs, as pork is an excellent source of thiamin. Additionally, crops, including soya beans (to use to make soy milk), squash, and watermelon are good choices for vegetarians, and would be good choices for providing adequate thiamin to the colonists. In order to monitor for this disease, you should monitor for changes in cardiac function, muscular weakness, and behavioral changes, like memory loss, confusion, and irritability.

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70 : You are working in a small clinic in Guatemala. An elderly woman with rashes on both arms, both legs, and face was brought to you by her son from a very remote region. She has been in severe gastrointestinal distress, with diarrhea, vomiting, and abdominal pain. What would your diagnosis and recommendations be for the patient?

Correct Answer : ?The patient most likely has pellagra, a disease caused by a deficiency in niacin. She is likely eating a vegetarian diet, without a lot of variety in her diet, and perhaps consisting of a lot of corn. This patient should increase meat in her diet if possible, but if she is a vegetarian or meat is unattainable for her on a regular basis, eating potatoes, tomatoes, or nuts, while decreasing corn consumption would help alleviate the symptoms of pellagra.

71 : A hypochondriac patient, who drinks a large bottle of V8 and takes multiple supplements every day, develops a painful flush and skin lesions. She is lethargic, acting like she may be depressed, and complains of numbness in her limbs. Based on her history, identify which B vitamins she is taking in excess, and specifically indicate which vitamin is likely causing each of her symptoms.

Correct Answer : ?High levels of niacin lead to the painful flush. Vitamin B6 toxicity is responsible for the skin lesions, and the behavioral symptoms and the numbness. Although the other B vitamins do not have toxicity symptoms reported, the interdependence of the vitamins on one another could lead to additional health problems that may be undetected at this early point.

72 : What specific function of folate in the cells is so important in embryo development? Explain your answer.

Correct Answer : ?Folate's primary coenzyme form, THF, is central in the synthesis of DNA for rapidly growing cells. This particular role is vital to embryo development, as during early development, cells are proliferating at a very high rate to form the new fetus.

73 : A patient with tuberculosis is diagnosed with anemia. Further analysis of the anemia indicates that it is microcytic anemia due to a deficiency in red blood cells. Which vitamin B deficiency is at the root of this problem, and what is the reason for the small size of the red blood cells?

Correct Answer : A deficiency in vitamin B6 is the most likely culprit for the microcytic anemia.

PLP, vitamin B6's coenzyme, participates in heme synthesis, which is part of the hemoglobin molecules found in red blood cells. Without enough heme molecules for the hemoglobin, these blood cells are smaller and less efficient at carrying oxygen.

74 : Give an example of the interdependence of the B vitamins.

Correct Answer : Vitamin B12 is required for the activation of folate, and this process activates vitamin B12. Additionally, if folate is taken in excess, it can mask a deficiency of vitamin B12.

75 : List three of the functions of vitamin C. Explain how these functions are altered when vitamin C levels are not sufficient for a long period of time, and how this is manifested in patients.

Correct Answer : ?The main role of vitamin C is as an antioxidant, protecting the body from free radicals. Additionally, vitamin C is responsible for the synthesis of collagen and some neurotransmitters. When vitamin C levels are low for a prolonged period of time, the body is 13 / 14

more likely to succumb to infections without the presence of the antioxidants. Additionally, the body fails to make sufficient amounts of collagen, which can affect blood vessel function and lead to bleeding. Initially this bleeding is only in the gums and small hemorrhages, but if left unchecked, the patient can develop scurvy symptoms, with teeth falling out and possible internal bleeding. The lack of sufficient collagen can also lead to wounds that cannot heal.

Finally, when the body fails to make neurotransmitters, this can lead to the behavioral disorders like depression and hysteria.

76 : Your friend Tanya is complaining of fatigue and is asking your advice about taking a multivitamin. How would you respond to her? Justify your position.

Correct Answer : You might tell Tanya that without a doctor checking her out, she runs the real possibility that taking the supplement would mask a more serious medical problem that needs to be addressed. Additionally, it is more likely that she would actually cause additional health problems by having too much of certain vitamins in her system, leading to a toxicity. Also, many supplements do not actually work the way they were intended, with many not ever being absorbed into the blood stream, making them a waste of money.

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MULTIPLE CHOICE 1 : What is the major carrier of the fat-soluble vitamins from the intestinal epithelial cell to the circulation?

A : albumin B : cholesterol C : chylomicrons D : lipid-soluble binding proteins Correct Answer : C 2 : What is a property of the fat-soluble vitamins?

A : Most of them are synthesized by intestinal bacteria.

B : Intestinal transport occurs by way of the portal circulation.

C : Deficiency symptoms may take years to develop on a poor diet.

D : Toxicity risk is higher for vitamins E and K than for other fat-soluble vitamins.

Correct Answer : C 3 : Which food substance can be converted into vitamin A in the body?

A : tryptophan B : chlorophyll C : xanthophyll D : beta-carotene Correct Answer : D 4 : How many different forms of vitamin A are active in the body?

A:1 B:2 C:3 D:5 Correct Answer : C 5 : What form of vitamin A supports reproduction but not growth?

A : retinal B : retinol C : retinoic acid D : retinyl esters Correct Answer : B 6 : What do retinal and unsaturated fatty acids have in common?

A : Neither is found in animal fats.

B : Neither is transported by chylomicrons.

C : They may exist in the cis or trans form.

D : They are both needed to prevent erythrocyte hemolysis.

Correct Answer : C 7 : What are the known effects of raising animals on diets containing retinoic acid as the only 1 / 14

source of vitamin A? A : Growth is stunted.

B : Blindness develops.

C : Retinal synthesis is stimulated.

D : Retinol synthesis is stimulated.

Correct Answer : B 8 : Which statement describes an association between vitamin A and vision?

A : Retinoic acid is the form required for synthesis of retinoblasts.

B : Light causes retinal to shift from a cis to a trans configuration.

C : Retinol is the form bound to beta-carotene in the corneal membrane.

D : Pigment molecules in the retina are composed of a molecule of vitamin A bound to an omega-3 fatty acid.

Correct Answer : B 9 : What is the name of the vitamin A compound that is active in the visual response?

A : opsin B : keratin C : retinal D : carotene Correct Answer : C 10 : Which statement describes the primary function of vitamin A in bone health?

A : It stimulates uptake of calcium from the intestines.

B : It promotes synthesis of specific bone proteins involved in the mineralization process.

C : It assists enzymes that degrade certain regions of the bone, thereby allowing remodeling to occur.

D : It inhibits oxidation of bone mucopolysaccharides, thereby preserving bone crystal integrity and promoting growth.

Correct Answer : C 11 : If a normal, healthy adult were to begin consuming a vitamin A-poor diet, approximately how much time would pass before the first deficiency symptoms would appear?

A : 2 weeks B : 1 to 2 months C : 6 months D : 1 to 2 years Correct Answer : D 12 : What do beta-carotene and vitamin E have in common?

A : Both act as antioxidants.

B : Both are found in animal fats.

C : Neither is involved in free radical control.

D : Neither is involved in synthesis of retinal.

Correct Answer : A 13 : Why does vitamin A status depend on the persons protein status?

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A : Adequate protein intake is a marker for liberal intake of the vitamin.

B : Dietary protein ensures synthesis of the vitamins GI tract transporter.

C : Adequate protein intake reduces the risk for infection from bacteria that degrade the vitamin.

D : Transport of the vitamin within the body requires sufficient protein to synthesize retinolbinding protein.

Correct Answer : D 14 : The first detectable sign of vitamin A deficiency is usually A : xerosis B : xerophthalmia C : night blindness D : corneal keratinization

.

Correct Answer : C 15 : The effects of vitamin A deficiency are most severe in what population group?

A : adults B : elderly C : newborns D : adolescents Correct Answer : C 16 : Which statement describes a feature of vitamin A nutrition?

A : Deficiency is common in United States.

B : Toxicity occurs from excess intakes of preformed vitamin A as well as beta-carotene.

C : Supplements are recommended for certain groups of infants and children infected with the measles in the United States.

D : In poor countries, supplements prevent and cure night blindness but offer little protection against malaria and lung disease.

Correct Answer : C 17 : What part of the body is affected most by keratomalacia?

A : bone B : liver C : cornea D : immune cells Correct Answer : C 18 : The preferred unit of expression of vitamin A is the A : milligram B : global unit C : international unit D : retinol activity equivalent

.

Correct Answer : D 19 : How many micrograms of dietary beta-carotene are equivalent to 1 retinol activity equivalent?

A:2 3 / 14

B:4 C:8 D : 12 Correct Answer : D 20 : What is the most likely side effect for a person who regularly consumes large quantities of carrots or carrot juice?

A : bone pain B : dermatitis C : skin yellowing D : vitamin A toxicity Correct Answer : C 21 : Which individual would be most likely to develop a vitamin A toxicity?

A : adolescent women B : overweight adults C : those taking vitamin A supplements D : those consuming more than 100 g of carrots daily Correct Answer : C 22 : What is a feature of vitamin A in foods?

A : Carotenoid absorption is inhibited by foods rich in chlorophyll.

B : Margarine made from corn oil is a poor source of vitamin A. C : Most carotenoids can be converted in the body to active vitamin A. D : Chlorophyll in dark green leafy vegetables masks the presence of beta-carotene.

Correct Answer : D 23 : Your sister Ellen has just joined the Peace Corps and will be working on ways to improve the nutritional status of children in Indonesia. Once there, she saw that many of the children and some adults suffer from night blindness. Which food should she recommend be incorporated into the Indonesian diet to help prevent future generations from developing this condition?

A : sweet potato B : orange juice C : peanut butter D : powdered skim milk Correct Answer : A 24 : Which food is a very good source of vitamin A? A : corn B : pumpkin pie C : baked potato D : whole-grain bread Correct Answer : B 25 : What is a characteristic of vitamin A in foods?

A : Fast foods are generally considered good sources of vitamin A. B : A regular intake of chicken liver is known to induce toxicity in children.

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C : Xanthophylls in certain vegetables can be converted to active vitamin A in the liver.

D : Chlorophyll in vegetables can be converted to active vitamin A in the intestinal cells.

Correct Answer : B 26 : The plant version of vitamin D is known as A : ergocalciferol B : foliocalciferol C : cholecalciferol D : phyllocalciferol

.

Correct Answer : A 27 : The animal version of vitamin D is known as A : ergocalciferol B : foliocalciferol C : cholecalciferol D : phyllocalciferol

.

Correct Answer : C 28 : What can the body use to synthesize vitamin D? A : bone B : carotene C : tryptophan D : exposure to sunlight Correct Answer : D 29 : Which compound is known to function as a hormone?

A : vitamin D B : vitamin K C : phylloquinone D : alpha-tocopherol Correct Answer : A 30 : What is/are the main function(s) of vitamin D? A : It promotes secretion of calcitonin.

B : It promotes synthesis of 7-dehydrocholesterol.

C : It promotes synthesis of carotenoids and controls absorption of fat-soluble vitamins.

D : It promotes calcium and phosphorus absorption and promotes calcium mobilization from bone.

Correct Answer : D 31 : Where is calbindin primarily found in the body?

A : liver B : kidneys C : intestine D : esophagus Correct Answer : C 5 / 14

32 : What population group is at highest risk for osteomalacia?

A : infants B : elderly men C : adult women D : children ages 212 years Correct Answer : C 33 : In what system would the effects of a vitamin D deficiency be most readily observed?

A : nervous B : skeletal C : muscular D : circulatory Correct Answer : B 34 : Which symptom would indicate a vitamin D deficiency?

A : bowed legs B : rupture of red blood cells C : frequent respiratory infections D : abnormally high blood calcium level Correct Answer : A 35 : Which conditions or diseases are known to be caused by a deficiency of the same nutrient?

A : osteomalacia and rickets B : xerophthalmia and breath pentane release C : kwashiorkor and fibrocystic breast disease D : hemolytic anemia and large-cell type anemia Correct Answer : A 36 : What is a feature of vitamin D? A : The bioavailability of vitamin D from soy milk is low.

B : Lifeguards on southern beaches have increased risk for vitamin D toxicity.

C : Only about one-half of the worlds population relies on sunlight to maintain adequate vitamin D nutrition.

D : Prolonged exposure to sunlight degrades the vitamin D precursor in skin, thus preventing vitamin D toxicity.

Correct Answer : D 37 : What is the most reliable source of vitamin D in the diet?

A : meat B : fortified milk C : fruits and vegetables D : enriched breads and cereals Correct Answer : B 38 : What is a feature of vitamin D synthesis?

A : Tanning lamps and tanning booths do not stimulate vitamin D synthesis.

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B : Sunscreens with sunburn protection factors of 2 and above prevent synthesis of vitamin D. C : The ultraviolet rays of the sun are able to easily pierce heavy clouds and smog to promote vitamin D synthesis.

D : Dark-skinned people require longer sunlight exposure than light-skinned people to synthesize equivalent amounts of vitamin D. Correct Answer : D 39 : What is a naturally occurring food source of vitamin D? A : egg yolks B : red meats C : tomato juice D : whole-wheat bread Correct Answer : A 40 : Absorption efficiency of vitamin D supplements is markedly improved when they are taken .

A : with a large meal B : with a small meal C : with orange juice D : on an empty stomach Correct Answer : A 41 : Which vitamin prevents the oxidation of low-density lipoproteins?

A:A B:E C:K D:D Correct Answer : B 42 : The major function of vitamin E is to inhibit the destruction of A : lysosomes B : free radicals C : mucopolysaccharides D : polyunsaturated fatty acids

.

Correct Answer : D 43 : Which vitamin is least associated with the process of bone remodeling?

A:A B:K C:E D:D Correct Answer : C 44 : What form of tocopherol shows vitamin E activity in the human body?

A : alpha B : beta C : gamma 7 / 14

D : delta Correct Answer : A 45 : What is a feature of vitamin E? A : It functions as a hormone-like substance.

B : Toxicity symptoms include bone abnormalities.

C : Deficiencies occur from inability to absorb dietary lipids.

D : Important food sources include enriched breads and pasta.

Correct Answer : C 46 : Why are primary vitamin E deficiencies rarely observed in human beings?

A : The vitamin is not essential.

B : The vitamin is widespread in foods.

C : Most people take vitamin E supplements.

D : The vitamin can be synthesized by the body.

Correct Answer : B 47 : Which condition may improve with vitamin E therapy?

A : diabetes B : pernicious anemia C : muscular dystrophy D : intermittent claudication Correct Answer : D 48 : What is a property of the tocopherols?

A : They are easily destroyed by air and oxygen.

B : They act as precursors for the menaquinones.

C : They can all be converted to the active alpha-tocopherol.

D : They are fairly stable when exposed to heat.

Correct Answer : A 49 : Which type of food is a major source of vitamin E in the diet?

A : meats B : citrus fruits C : vegetable oils D : milk and dairy products Correct Answer : C 50 : Increasing the amount of polyunsaturated fats in the diet increases the need for vitamin .

A:A B:E C:K D:D Correct Answer : B 8 / 14

51 : Which properties do vitamins D and K share?

A : Both are synthesized in the body.

B : Both are required for normal vision.

C : Neither has an effect on bone metabolism.

D : Neither has an effect on erythrocyte function.

Correct Answer : A 52 : Which molecule requires vitamin K for its synthesis?

A : albumin B : pyruvate C : prothrombin D : mucopolysaccharides Correct Answer : C 53 : What feature is shared by vitamins E and K? A : Deficiencies of either lead to anemia.

B : Both have strong antioxidant properties.

C : Neither is involved in bone development.

D : Supplements of either may interfere with anticlotting medications.

Correct Answer : D 54 : What is a feature of vitamin K? A : A deficiency increases the risk for hemophilia.

B : A deficiency leads to keratinization of the cornea.

C : Bacteria in the intestines synthesize bioavailable vitamin K. D : There are multiple forms in the diet, of which menadione is the naturally occurring form.

Correct Answer : C 55 : What is a feature of osteocalcin?

A : It activates lysosomes involved in remodeling bone.

B : It binds calcium in the GI tract to enhance absorption.

C : It requires vitamin K to bind to bone-forming minerals.

D : It works synergistically with the kidneys to reduce urinary calcium excretion.

Correct Answer : C 56 : What would most readily induce a vitamin K deficiency?

A : achlorhydria B : antibiotic therapy C : presence of oxalic acid in food D : insufficient intake of green leafy vegetables Correct Answer : B 57 : What is a characteristic of vitamin K nutrition?

A : Deficiency may lead to hemophilia.

B : Toxicity may increase risk for hemophilia.

C : Absorption is inhibited when bile production diminishes.

D : Supplements are highly effective against osteoporosis.

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Correct Answer : C 58 : Which vitamin is synthesized by intestinal bacteria?

A:A B:E C:K D:D Correct Answer : C 59 : What population group has the highest risk for vitamin K deficiency?

A : adults B : elderly C : newborns D : teenagers Correct Answer : C 60 : What is a feature of vitamin K? A : Deficiencies lead to intravascular clotting.

B : Major dietary sources are whole grains and legumes.

C : No adverse effects have been reported with high intakes.

D : Primary deficiencies are more common than secondary deficiencies.

Correct Answer : C 61 : Which molecule is a major form of vitamin K in foods?

A : ergodione B : ergoquinone C : tocopherone D : phylloquinone Correct Answer : D 62 : What is the best source of dietary vitamin K? A : spinach B : raspberries C : whole wheat bread D : baked potato Correct Answer : A 63 : What is a free radical?

A : an antioxidant substance that prevents accumulation of cell-damaging oxides B : a substance in food that interacts with nutrients to decrease their utilization C : a nutrient in excess of body needs that the body is free to degrade with no consequence D : a molecule that is unstable and highly reactive because it contains unpaired electrons Correct Answer : D 64 : What is a characteristic of free radicals?

A : They are destroyed by cigarette smoking.

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B : They arise from normal metabolic reactions.

C : They typically stop chain reactions associated with the production of peroxides.

D : They are known to accumulate even in the presence of abundant antioxidant nutrients.

Correct Answer : B 65 : Substances that promote oxidation are usually termed A : prooxidants B : antioxidants C : free radical generators D : reactive electron oxidants

.

Correct Answer : A 66 : What is a characteristic of both vitamin C and vitamin E? A : Both protect against LDL oxidation.

B : Neither reduces arterial inflammation.

C : Neither participates in regulating blood clotting.

D : Both act as prooxidants at physiological intakes.

Correct Answer : A 67 : What is a feature of antioxidants and health?

A : Dietary antioxidants protect against free radical formation but not against DNA damage.

B : Beta-carotene supplements have actually been shown to increase the risk of lung cancer in smokers.

C : Diet surveys show that most of the U.S. population consumes recommended amounts of antioxidant nutrients.

D : People who eat foods rich in vitamin E still have the same level of atherosclerotic plaques as consumers who dont.

Correct Answer : B

MATCHING 68 : Match the vitamin with its primary function.

A : raising blood calcium levels A : vitamin A B : synthesis of blood clotting proteins B : vitamin D C : stabilization of cell membranes C : vitamin E D : maintenance of mucous membranes D : vitamin K Correct Answer : A:B B:D C:C D:A

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69 : Match the vitamin with the deficiency and toxicity symptoms. Terms may be used more than once or not at all.

A : liver abnormalities A : vitamin A deficiency B : rickets B : vitamin A toxicity C : osteomalacia C : vitamin D deficiency D : keratinization D : vitamin D toxicity E : no effects known E : vitamin E deficiency F : birth defects F : vitamin E toxicity G : kidney stones G : vitamin K deficiency H : infectious diseases H : vitamin K toxicity I : xerophthalmia J : erythrocyte hemolysis Correct Answer : A:B B:C C:C D:A E:H F:B G:D H:A I:A J:E

ESSAY 70 : Explain how vitamin A deficiency alters food absorption.

Correct Answer : ?Vitamin A deficiency leads to the loss of the goblet cells in the digestive tract, which decreases the secretion of mucus. The mucus is required for digestion and absorption of nutrients from the digestive tract.

71 : What is the dietary benefit of golden rice?

Correct Answer : ?Golden rice is rice that has been genetically modified to contain betacarotene. Some parts of the developing world depend heavily on rice as a primary staple, which can lead to vitamin A deficiency. By fortifying the rice with beta-carotene, entire populations of people can be protected from vitamin A deficiency.

72 : Explain what symptoms you would expect from a person who consumes large amounts of 12 / 14

beef liver and onions? What is the cause of these symptoms?

Correct Answer : ?The liver is the storage place for vitamin A in the body, both in humans and in animals. For this reason, you would expect to see symptoms that are associated with vitamin A toxicity, including headaches and nausea initially, and ultimately leading to osteoporosis and liver abnormalities.

73 : Explain how rhodopsin is involved in vision.

Correct Answer : ?Rhodopsin is comprised of a protein called opsin, and a cofactor, retinal.

When light strikes the retina, the opsin is released, and retinal changes conformation from cis to trans, which generates an electrical impulse that travels to the brain.

74 : Explain vitamin Ds role in bone health, including the specifics of the mechanisms employed to achieve this goal.

Correct Answer : ?Vitamin D is responsible for maintaining blood concentrations of calcium and phosphorus. Vitamin D does this by increasing mineral absorption in the digestive tract, increasing reabsorption of these minerals by the kidney, and mobilization of these minerals from existing bone.

75 : Describe the process by which vitamin D from the diet is activated in order to function fully.

How does this differ from vitamin D derived from a precursor to cholesterol, 7-dehydrocholesterol?

Correct Answer : ?Vitamin D is ingested from either plants or animals as either vitamin D2 or D3, respectively, and is transported to the liver, where one hydroxyl group is added (now called calcidiol), and then transported to the kidney for a second hydroxyl group is added (now called calcitriol, or the active form of vitamin D). This differs from vitamin D that is derived from 7-dehydrocholesterol, in that this compound is converted by UV light in skin cells to previtamin D3, which is then converted to vitamin D3 using heat in the body. The vitamin D3 is then converted in the liver and kidney in the same manner that dietary vitamin D is converted to its active form.

76 : After Tracys mother develops osteoporosis, she visits her doctor about what she can do to help reduce her risk for developing this disease. If you were Tracys doctor, what lifestyle changes would you suggest, and which fat soluble vitamin(s) would you recommend she work on incorporating into her diet to decrease her risk for osteoporosis. What source(s) would you recommend to meet the RDA for this/these vitamin(s)?

Correct Answer : ?Tracy needs to increase her vitamin D levels. One way she can do this is to spend more time outside and/or use less protection while she is outside, drink fortified milk, eat more oily fish, like salmon, and begin taking vitamin D supplements.

77 : How does vitamin E protect against heart disease?

Correct Answer : ?Vitamin E protects against the oxidation of LDL. When oxidized, LDL accelerates the formation of plaques. Additionally, vitamin E protects against inflammation, which has been shown to lead to heart disease.

78 : Explain why newborns do not have significant amounts of vitamin K at birth. What are the benefits and concerns of this deficiency, and what is the standard of care given at birth to prevent vitamin K deficiency symptoms?

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Correct Answer : ?Newborns do not have a lot of vitamin K at birth because it does not easily cross the placenta. Additionally, vitamin K producing bacteria are not present in the digestive tract, nor does vitamin K exist in breast milk in high amounts. This is advantageous to the infant during the stressful birthing process, as it prevents the blood from clotting, which can cause infant to have serious complications, and possibly die. However, after the baby is born, the risk of hemorrhagic disease is high, so to prevent the baby from bleeding out, the baby is given a shot of vitamin K immediately after birth.

79 : How does smoking increase the risk for cancer?

Correct Answer : ?Smoking increases free radicals in the body. Free radicals can then damage lipids, DNA, and proteins within the cell. Damage to the DNA can lead to mutations that can cause cancer.

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MULTIPLE CHOICE 1 : Approximately how much water (pounds) is found in a 134-lb person?

A : 34 B : 65 C : 80 D : 105 Correct Answer : C 2 : What is the bodys most indispensable nutrient?

A : fat B : water C : protein D : glucose Correct Answer : B 3 : Which group of people has the highest percentage of body water?

A : elderly B : children C : obese people D : female adolescents Correct Answer : B 4 : In the body, water that resides between cells is known as A : diuretic B : interstitial C : edematous D : intravascular

fluid.

Correct Answer : B 5 : Which neuronal structure helps to regulate thirst?

A : brain stem B : cerebellum C : optic nerve D : hypothalamus Correct Answer : D 6 : What is a feature of water and nutrition?

A : Water intoxication is rare but can result in death.

B : Water losses from the body are highest through the feces.

C : Chronic high intakes increase the risk for bladder cancer.

D : Soft water has significant concentrations of magnesium and calcium.

Correct Answer : A 7 : Abnormally low blood sodium concentration is specifically known as A : hypertension

.

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B : hyponatremia C : hyperkalemia D : water intoxication Correct Answer : B 8 : What is a feature of water?

A : It is not a vital nutrient.

B : It is not found in foods.

C : It is oxidized to yield energy.

D : It is generated from the oxidation of energy nutrients.

Correct Answer : D 9 : The average daily loss of water via the kidneys, lungs, feces, and skin is approximately liters.

A : 0 to 0.5 B : 0.5 to 1.5 C : 2.0 D : 4.0 Correct Answer : C 10 : The minimum amount of water that must be excreted by the body to dispose of its wastes is termed .

A : life supporting fluid loss B : mandatory water fraction C : obligatory water excretion D : minimum daily water requirement Correct Answer : C 11 : Approximately how many milliliters of water are produced by metabolism every day?

A : 100 B : 250 C : 500 D : 750 Correct Answer : B 12 : Habitual intake of soft water is most likely to aggravate A : scurvy B : diabetes C : hypertension D : megaloblastic anemia

.

Correct Answer : C 13 : Which statement is a characteristic of caffeine intake and water balance?

A : Caffeine inhibits water absorption from the GI tract.

B : Caffeine is known to act as a diuretic only when consumed as coffee or tea.

C : Regular intake of caffeine promotes an increase in water retention of the interstitial fluid volume.

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D : Habitual consumers of caffeine lose almost no more fluid from the body than when ingesting noncaffeinated beverages.

Correct Answer : D 14 : What organ provides the major control for homeostasis of body fluids?

A : liver B : heart C : kidneys D : skeletal muscle Correct Answer : C 15 : What is the major extracellular anion?

A : sodium B : lactate C : sulfate D : chloride Correct Answer : D 16 : What is the major intracellular cation?

A : sodium B : calcium C : phosphate D : potassium Correct Answer : D 17 : The concentration of electrolyte charges is measured in A : solute minerals B : milliequivalents C : ionic dissociates D : total atomic masses

.

Correct Answer : B 18 : What is the force that moves water into a space where a solute is more concentrated?

A : buffer action B : osmotic pressure C : permeable selectivity D : electrolyte imbalance Correct Answer : B 19 : What is the sodium-potassium pump?

A : a cell membrane protein that uses energy to pump sodium into the cell B : a cell membrane protein that uses energy to pump sodium out of the cell C : a mechanism present throughout interstitial fluid for draining sodium from the circulation D : a mechanism present in the kidneys that exchanges sodium with lactic acid in order to regulate organic acid concentration Correct Answer : B 3 / 14

20 : When a person loses fluid by sweating or bleeding, what minerals are lost in greatest quantity?

A : sodium and chloride B : bicarbonate and sulfate C : calcium and magnesium D : potassium and phosphate Correct Answer : A 21 : The normal blood pH range is approximately A : 6.807.15 B : 6.987.12 C : 7.357.45 D : 7.558.55

.

Correct Answer : C 22 : What organ functions as the chief regulator of the bodys acid-base balance by controlling the bicarbonate concentration?

A : skin B : liver C : kidneys D : stomach Correct Answer : C 23 : What is a general property of the minerals?

A : When a food is burned, all the minerals are found in the ash.

B : Absorption efficiency from foods is similar among the minerals.

C : Minerals in food can be degraded by certain processing methods.

D : Some minerals in food are destroyed by exposure to ultraviolet light.

Correct Answer : A 24 : What is the relationship of the amount of sodium excreted to the amount ingested in a normal day?

A : Intake is higher.

B : Excretion is higher.

C : Intake and excretion are equal.

D : Excretion is unrelated to intake.

Correct Answer : C 25 : What is another term for hypertension?

A : high blood sodium B : high blood pressure C : excessive mental stress D : excessive muscular contraction Correct Answer : B 26 : The DASH diet plan was devised to prevent

.

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A : dehydration B : constipation C : osteoporosis D : hypertension Correct Answer : D 27 : How much sodium is contained in a fast-food deluxe hamburger that lists a salt content of 2.5 g?

A : 100 mg B : 125 mg C : 1000 mg D : 2500 mg Correct Answer : C 28 : What is the greatest single source of sodium in the diet?

A : processed foods B : unprocessed foods C : natural salt content of foods D : salt added during cooking and at the table Correct Answer : A 29 : What is a feature of sodium and health?

A : Salt sensitivity is generally rare in African Americans.

B : High sodium intake is known to promote calcium excretion.

C : High sodium intake over many years leads to hypertension in most people.

D : Sodium alone and sodium in salt have nearly equivalent effects on blood pressure.

Correct Answer : B 30 : Which statement describes a general characteristic of sodium in processed foods?

A : Instant chocolate pudding is a low-sodium food.

B : Processed foods contribute less than half of the sodium in our diets.

C : Salted peanuts contain less sodium than cereals on a per-gram basis.

D : Dairy products and meats represent major sources of sodium in our diets.

Correct Answer : C 31 : What adverse response is known to occur in people who drink copious amounts of water while participating in intense physical activity?

A : dehydration B : hyponatremia C : metabolic alkalosis D : elevated blood sodium Correct Answer : B 32 : What is a feature of sodium nutrition?

A : It has no AI because diets rarely lack sodium.

B : It has no AI because the kidneys are highly efficient at regulating sodium balance.

C : The AI is 3 g, an amount that has been shown to have little or no effect on blood pressure.

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D : The AI for young adults is only 1500 mg because the body possesses an unusually efficient retention mechanism.

Correct Answer : D 33 : For which mineral would a patient with bulimia nervosa most likely be deficient?

A : calcium B : chloride C : potassium D : phosphorus Correct Answer : B 34 : Barbara has been healthy up to the past couple of weeks, but since then has been complaining of considerable muscle weakness. Her doctor just received the results of blood tests, which showed that she is deficient in potassium. If Barbara continues her current habits of consuming a diet low in potassium, which disorder is she most likely to be at risk for developing?

A : rickets B : arthritis C : low blood pressure D : high blood pressure Correct Answer : D 35 : Which group of people is at known risk for potassium depletion?

A : athletes who are body-builders B : construction workers in cold climates C : those who ingest low amounts of fresh fruits/vegetables D : those who consume insufficient amounts of salted foods Correct Answer : C 36 : Approximately what percentage of the bodys calcium is found in the blood?

A:1 B:5 C : 15 D : 25 Correct Answer : A 37 : What is hydroxyapatite?

A : abnormal cellular structures seen in osteoporosis B : the calcium-rich crystalline structure of teeth and bones C : a calcium regulatory hormone secreted from the trabeculae region of bone D : a compound in plant foods that binds to calcium and phosphorus and inhibits absorption Correct Answer : B 38 : What is calmodulin?

A : a calcium-binding protein B : a drug that treats osteoporosis C : a calcium supplement with high bioavailability 6 / 14

D : a form of calcium used to fortify soy products Correct Answer : A 39 : Tiffany is a strict vegan and does not consume calcium-rich plant foods or take calcium supplements. Which molecule is most responsible for maintaining her blood calcium levels in the normal range?

A : calcitonin B : calmodulin C : hydroxyapatite D : parathyroid hormone Correct Answer : D 40 : Which reason is the least likely cause for an abnormal blood calcium level?

A : diseases of the liver B : diseases of the kidney C : insufficient dietary intake D : altered secretion of parathyroid hormone Correct Answer : C 41 : The muscle stiffness that results from abnormally high calcium levels in the blood is termed .

A : calcium rigor B : calcium tetany C : myosinotoxicosis D : calmodulin dysfunction Correct Answer : A 42 : Which foods are significant sources of oxalates?

A : seeds and nuts B : processed cheeses C : fermented dairy products D : spinach and sweet potatoes Correct Answer : D 43 : Calcium-binding protein acts within the A : kidneys B : intestine C : cortical bone D : trabecular bone

.

Correct Answer : B 44 : What is a risk of consuming calcium supplements above the UL? A : calcium tetany B : atrophic gastritis C : vitamin D deficiency D : kidney stone formation 7 / 14

Correct Answer : D 45 : On a per kcalorie basis, which foods are the best sources of calcium?

A : meats B : fruits C : breads D : vegetables Correct Answer : D 46 : At what age do adults normally begin to lose bone mass?

A : 3040 years B : 4050 years C : 5060 years D : 6070 years Correct Answer : A 47 : What is a feature of osteoporosis?

A : It is most common in men over 45 years of age.

B : It has virtually no effect on blood calcium levels.

C : It results from short-term deprivation of dietary calcium.

D : It causes significant alterations in the blood levels of parathyroid hormone and calcitonin.

Correct Answer : B 48 : Which mineral is involved in the transportation of lipids through the bodys lymph and blood systems?

A : iron B : sodium C : calcium D : phosphorus Correct Answer : D 49 : Where is the majority of the bodys magnesium found?

A : bones B : teeth C : fatty tissue D : cells of soft tissue Correct Answer : A 50 : Which mineral is required for the enzymatic phosphorylation of ADP? A : iron B : copper C : sodium D : magnesium Correct Answer : D 51 : What is a feature of magnesium nutrition?

A : The average body contains about 100 grams.

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B : Blood is a major reservoir of the mineral.

C : Deficiency is associated with hypertension.

D : Dietary intake data are the sum of the amounts from food and water.

Correct Answer : C 52 : The magnesium present in mineral water has a bioavailability of about A:5 B : 25 C : 50 D : 90

percent.

Correct Answer : C 53 : What is the major source of dietary sulfur?

A : fats B : protein C : mineral salts D : carbohydrates Correct Answer : B 54 : What is a function of trabecular bone?

A : synthesis of vitamin D B : synthesis of calcitonin C : storage site for calcium D : storage site for vitamin D Correct Answer : C 55 : The disorder dowagers hump is associated with a long-term deficiency of A : calcium B : potassium C : magnesium D : phosphorus

.

Correct Answer : A 56 : What does a DEXA scan measure?

A : bone density B : severity of bone microfractures C : bioavailability of calcium supplements D : calcium absorption and excretion balance Correct Answer : A 57 : The strongest predictor for loss of bone density is a persons A : sex B : age C : calcium intake D : blood estrogen level

.

Correct Answer : B 9 / 14

58 : At what age do men develop osteoporosis relative to women?

A : 10 years later B : 4 years later C : 3 years later D : at nearly the same age Correct Answer : A 59 : At what age does a person reach his/her highest bone density?

A : 18 B : 30 C : 55 D : 70 Correct Answer : B 60 : Estrogen therapy for osteoporosis is often rejected because it may increase risk for A : cancer B : heart disease C : hypertension D : diverticulosis

.

Correct Answer : A 61 : What is a feature of physical activity and bone health?

A : Dancing is not an effective activity for helping maintain bone density.

B : Weight training improves bone density in young but not older women.

C : Working the muscles places stress on bones, which promotes bone density.

D : Weight-bearing activities are effective in maintaining bone mass in adults but not in adolescents.

Correct Answer : C 62 : What is a characteristic of calcium nutrition in teenagers?

A : The recommended intake is higher for girls than boys.

B : The recommended intake is 8001000 mg for this population group.

C : The intake of calcium is higher in boys than girls because they eat more food.

D : The dietary intakes of calcium are similar for girls and boys of this population group.

Correct Answer : C 63 : Which calcium supplement is most likely to be contaminated with toxic minerals?

A : oyster shells B : calcium lactate C : calcium citrate D : calcium carbonate Correct Answer : A 64 : What is a feature of calcium supplements?

A : Common antacids are used as a source of calcium.

B : The bioavailability of calcium from most supplements is significantly lower than from milk.

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C : There are large differences in the efficiency of calcium absorption from various supplements.

D : The calcium in supplements made from oyster shell and bone meal is more absorbable than the calcium in calcium citrate and calcium lactate.

Correct Answer : A 65 : What is a characteristic of calcium supplement use?

A : Taking them with a meal enhances absorption of calcium.

B : Taking them with iron supplements enhances absorption of iron.

C : Supplements of calcium carbonate show higher bioavailability than calcium citrate.

D : Small pills containing a large amount of calcium salt show faster dissolution in the stomach.

Correct Answer : A 66 : Which calcium supplement contains the lowest percentage of calcium?

A : calcium citrate B : calcium lactate C : calcium carbonate D : calcium gluconate Correct Answer : D 67 : What is most likely to occur when a calcium supplement and an iron supplement are taken simultaneously?

A : Iron absorption is reduced.

B : Iron absorption is improved.

C : Iron excretion in the urine is reduced.

D : Iron excretion in urine is enhanced.

Correct Answer : A

MATCHING 68 : Match the hormone with its function in the body.

A : powerful vasoconstrictor A : aldosterone B : triggers reabsorption of sodium by the B : angiotensin II kidneys C : triggers reabsorption of water by the kidneysC : antidiuretic hormone D : lowers blood calcium levels when it gets too D : calcitonin high E : increases blood calcium levels when it gets E : parathyroid hormone too low Correct Answer : A:B B:A C:C D:D 11 / 14

E:E

69 : Match the mineral with its chief function.

A : assists in nerve transmission B : maintenance of teeth C : muscle contraction

A : calcium only B : calcium and phosphorus C : calcium, magnesium, potassium, and sodium D : chloride only E : chloride, potassium, and sodium

D : part of genetic material E : maintains normal fluid and electrolyte balance F : stabilizes shape of proteins F : magnesium G : mineralization of teeth and bones G : phosphorus H : part of acid found in stomach necessary for H : sodium and potassium digestion I : blood clotting I : sulfate Correct Answer : A:H B:F C:C D:G E:E F:I G:B H:D I:A

ESSAY 70 : List five roles of water in the body fluids.

Correct Answer : ?Water carries nutrients and wastes throughout the body, maintains the structure of large molecules, participates in metabolic reactions, serves as a solvent for many nutrients, and acts as a lubricant in joints.

71 : What are the differences among the mineral components of hard water, soft water, distilled water, and filtered water?

Correct Answer : ?Hard water contains a high calcium and magnesium content, soft water contains a high sodium or potassium content, distilled water contains very few dissolved 12 / 14

minerals, as they have been removed in the distillation process, and filtered water has very low levels of lead, arsenic and micro-organisms, but leaves the majority of minerals in concentrations similar to what they were before filtration.

72 : Explain why high sodium diets can lead to hypertension.

Correct Answer : ?Hypertension is an increase in blood pressure. High salt causes the body to retain water, which leads to an increase in blood volume and, therefore, an increase in blood pressure.

73 : Explain how renin functions to increase blood pressure.

Correct Answer : ?Renin is released in the kidney in response to low blood pressure and causes the kidneys to reabsorb sodium. Additionally, renin is an enzyme that then hydrolyzes angiotensinogen to angiotensin I, which is then converted to angiotensin II. Angiotensin II can trigger the constriction of blood vessels and stimulate the release of aldosterone from the adrenal glands. Aldosterone then triggers the retention of sodium in the kidneys, which leads to the retention of water and the excretion of potassium.

74 : Detail how the bicarbonate-carbonic acid buffers in the body maintain the optimal pH in the body, including the role the liver and kidneys play in this maintenance.

Correct Answer : Bicarbonate and carbonic acid work together to maintain a constant blood pH. Carbonic acid is formed when carbon dioxide, formed from metabolic processes, dissolves in the blood. The carbonic acid can then dissociate into protons and bicarbonate ions. As carbonic acid levels rise, and bicarbonate ions decrease, the pH levels drop. In order to raise the blood pH, respiration rates increase in the lungs, and carbon dioxide is exhaled. This in turn raises the blood pH levels by removing carbonic acid from the blood. Similarly, when carbonic acid levels decrease and bicarbonate ions increase, respiration rates decrease, preventing the loss of carbon dioxide, and the levels of carbonic acid are retained in the blood. Additionally, excess bicarbonate is excreted in the urine or reabsorbed by the kidney when the pH levels rise and fall, respectively.

75 : Explain the characteristics of a DASH eating pattern.

Correct Answer : ?DASH emphasizes eating foods that are high in potassium, such as fruits and vegetables, and low-fat milk products, while limiting sodium intake. Protein sources are generally poultry and fish, while limiting red and processed meats. Additionally, nuts and whole grains are emphasized, while sweets and sodas are limited.

76 : Detail how calcium balance is maintained in the body.

Correct Answer : ?When blood calcium levels are low, parathyroid hormone is secreted into the blood, which stimulates the activation of vitamin D, the reabsorption of calcium in the kidneys, and stimulates osteoclast cells to break down bone and release calcium into the blood. Vitamin D, in turn, works with parathyroid hormone to increases calcium absorption in intestines. When blood calcium levels are too high, calcitonin is secreted, which inhibits the activation of vitamin D and prevents calcium from being reabsorbed in the kidneys, as well as inhibiting osteoclast cells from breaking down bone.

77 : Describe the structure of bone, and how each of these structures influences bone strength.

Correct Answer : ?Bone has two major compartments—the outer cortical bone and the inner 13 / 14

trabecular bone. The outer bone is a thick, dense bone, whereas the trabecular bone is the inside of the long bones and is comprised of a matrix. The trabecular bone is the location where calcium primarily deposits when the blood levels are high and from where calcium is liberated when blood levels are depressed. The cortical bone provides a sturdy outer wall, while the inner matrix provides support along the stress points.

78 : After a bone scan, Alexandra learns that her bone density is lower than it should be. List at least five ways by which she can reduce her risk of osteoporosis.

Correct Answer : ?Alexandra could increase her physical activity, increase her intake of low-fat, fortified milk, quit smoking, reduce caffeine consumption, and decrease the amount of protein that she eats.

79 : List the pros and cons of using calcium supplements?

Correct Answer : ?Calcium supplements allow people who do not or cannot consume enough calcium in their diets to get adequate amounts of calcium to prevent osteoporosis. However, calcium supplements may increase the risk for heart attacks and strokes, so they should be used only after consulting a physician.

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MULTIPLE CHOICE 1 : What is a characteristic of the trace minerals?

A : Dermatitis is a common symptom of deficiencies of many trace minerals.

B : The amounts in foods are dependent, in part, on soil composition.

C : Deficiencies are more difficult to recognize in children than in adults.

D : The amount of all trace minerals in the average person totals approximately 100 grams.

Correct Answer : B 2 : A measure of the rate at which a nutrient is absorbed and used by the body is termed A : net utilization B : bioavailability C : biological value D : utilization efficiency

.

Correct Answer : B 3 : What is the ionic state of ferric iron?

A : +3 B : +2 C : ?2 D : ?3 Correct Answer : A 4 : What iron-containing compound carries oxygen in the bloodstream?

A : ferritin B : myoglobin C : transferrin D : hemoglobin Correct Answer : D 5 : Which compound provides a major storage reservoir for iron?

A : ferritin B : myoglobin C : transferrin D : hemoglobin Correct Answer : A 6 : Which characteristic is shared by zinc and iron?

A : Good food sources include dairy products.

B : Proteins in the blood are needed for their transport.

C : Severe deficiencies lead to delay in the onset of puberty.

D : Doses of 10 times the RDA may cause death in children.

Correct Answer : B 7 : How does vitamin C enhance iron absorption when consumed in the same meal?

A : It activates transferrin.

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B : It keeps iron in the reduced ferrous form.

C : It releases iron from the proteins in the stomach.

D : It complexes with iron and promotes mucosal transport.

Correct Answer : B 8 : Which food provides iron in the most absorbable form?

A : rice B : spinach C : chicken D : orange juice Correct Answer : C 9 : What is a feature of iron absorption?

A : It is higher with vegetarian diets.

B : It is higher in people with iron deficiency.

C : It is lower when iron is in the form of heme rather than non-heme.

D : It is higher in adults than children due to more mature intestinal function.

Correct Answer : B 10 : What is the function of MFP factor?

A : enhances iron absorption B : acts as an iron enrichment nutrient C : simulates metallothionein synthesis D : acts as chelating agent for iron toxicity treatment Correct Answer : A 11 : Absorption of iron from supplements is improved by taking them with A : tea B : water C : milk D : whole-grain bread

.

Correct Answer : B 12 : How would the body typically respond to loss of blood from hemorrhage?

A : More transferrin is produced to allow absorption and transport of more iron.

B : The average life of the red blood cell is increased in order to allow better tissue oxygenation.

C : Fewer iron storage proteins are produced, which increases the amount of iron available for synthesis of new red blood cells.

D : The liver and muscles release their supply of stored red blood cells, which compensates, in part, for the decrease in red blood cell concentration of the circulation.

Correct Answer : A 13 : A person with high blood levels of hepcidin responds by A : decreasing iron absorption B : increasing iron absorption C : decreasing zinc absorption D : increasing zinc absorption

.

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Correct Answer : A 14 : What is a characteristic of iron utilization?

A : Most of the bodys iron is recycled.

B : The chief storage site for iron is the intestinal epithelium.

C : Iron is absorbed better from supplements than from foods.

D : Iron from nonheme food sources is absorbed better than that from heme food sources.

Correct Answer : A 15 : What is the average lifespan of red blood cells?

A : two weeks B : one month C : four months D : six months Correct Answer : C 16 : About how much iron is absorbed from a vegetarian diet compared with an omnivorous diet?

A : the same amount B : one-half as much C : twice as much D : three times as much Correct Answer : B 17 : What is the major cause of iron deficiency?

A : blood loss B : poor nutrition C : hereditary defect D : parasitic infections of the GI tract Correct Answer : B 18 : Iron deficiency in children is likely to result from a diet that overemphasizes A : milk B : cereals C : vegetables D : dried beans

.

Correct Answer : A 19 : The erythrocyte protoporphyrin level is used as an indicator of A : late iron toxicity B : early iron toxicity C : late iron deficiency D : early iron deficiency

.

Correct Answer : C 20 : What type of anemia results from iron deficiency?

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A : hemolytic B : megaloblastic C : microcytic hypochromic D : macrocytic hyperchromic Correct Answer : C 21 : Why are hemoglobin and hematocrit tests of limited usefulness in the assessment of iron status?

A : They are expensive to perform.

B : They are notoriously inaccurate.

C : They are late indicators of iron deficiency.

D : The range of normal value is usually wide.

Correct Answer : C 22 : Which statement is descriptive of iron deficiency and behavior?

A : The practice of pica may enhance iron absorption.

B : Changes in behavior precede the appearance of anemia.

C : The practice of pica may delay the onset of iron-induced behavioral changes.

D : Adults are more resistant to iron-induced behavioral changes than children.

Correct Answer : B 23 : What is the name given to the ingestion of nonnutritive substances?

A : pica B : goiter C : tetany D : hemosiderosis Correct Answer : A 24 : Which foods should be especially limited in the diet of individuals with hemochromatosis?

A : dairy products B : fluoridated water C : iron-fortified cereals D : carbonated beverages Correct Answer : C 25 : Why are people with iron overload at increased risk for infections?

A : Excess tissue iron destroys vitamin C. B : Iron-rich blood favors growth of bacteria.

C : Iron-rich blood impairs the immune system.

D : Excess tissue iron interferes with antibiotic function.

Correct Answer : B 26 : Which disorders may be linked with the presence of high blood iron?

A : dermatitis B : diverticulosis C : heart disease D : neural tube defects 4 / 14

Correct Answer : C 27 : What population group is at the highest risk for iron overload?

A : adult men B : adult women C : pregnant women D : adolescents Correct Answer : A 28 : What is a characteristic of iron nutrition?

A : Absorption is improved on diets high in phytates.

B : Iron deficiency and iron overload share some of the same signs and symptoms.

C : The risk for acute iron toxicity is highest among women of childbearing age.

D : Iron overload results from a genetic predisposition for excessive synthesis of ferritin.

Correct Answer : B 29 : What is a feature of iron nutrition?

A : Iron plays an important role in the synthesis of thyroxine.

B : On average, people absorb about 5060 percent of dietary iron.

C : On average, women do not eat enough iron-containing foods.

D : Iron deficiency represents the second most common mineral deficiency in the United States.

Correct Answer : C 30 : Which food provides the greatest amount of iron per serving?

A : yogurt B : skim milk C : pinto beans D : American cheese Correct Answer : C 31 : What is a source of possible iron contamination?

A : an iron frying pan B : an iron chelate C : a ferric iron supplement D : a ferrous iron supplement Correct Answer : A 32 : What has been shown to improve absorption of iron from iron supplements?

A : taking them with milk B : taking them with orange juice C : taking them on an empty stomach rather than with meals D : taking them in the form of the ferric salt rather than the ferrous salt Correct Answer : C 33 : Why is taking vitamin C ineffective at enhancing iron absorption from standard iron supplements?

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A : The iron in the supplement is in a chelated form.

B : The iron in the supplement is already in the ferrous form.

C : The iron in the supplement binds irreversibly with vitamin C. D : The iron supplement already contains MFP to enhance absorption.

Correct Answer : B 34 : What is a common side effect from taking iron supplements?

A : itching B : diarrhea C : constipation D : black tongue Correct Answer : C 35 : An enzyme that includes zinc or copper as an integral part of its structure is classified as a(n) .metallothionase A : metalloenzyme B : oxidoreductase C : cytochromidase D : metallothionase Correct Answer : A 36 : What is a major binding protein for zinc?

A : ligand B : ferritin C : hemosiderin D : metallothionein Correct Answer : D 37 : What is a feature of zinc in nutrition?

A : Pancreatic enzymes are rich in zinc.

B : The bodys primary excretory route is urine.

C : Good food sources are whole-grain products.

D : Toxicity symptoms include constipation and low body temperature.

Correct Answer : A 38 : What is the chief transport substance for zinc in the circulation?metallothionein A : albumin B : metallothionein C : carbonic anhydrase D : high-density lipoproteins Correct Answer : A 39 : What is a side effect of prolonged ingestion of excessive amounts of zinc supplements?

A : Iron toxicity due to increased ferritin synthesis.

B : Zinc salt deposits in soft tissues such as the heart and kidneys.

C : Copper deficiency due to interference with copper absorption.

D : Mineral-binding protein deficiency due to a decrease in metallothionein production.

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Correct Answer : C 40 : What is the most reliable dietary source of zinc?

A : nuts and oils B : milk and yogurt C : fruits and vegetables D : meats and whole-grain cereals Correct Answer : D 41 : Zinc content is highest in foods that also contain a large amount of A : fat B : fiber C : protein D : carbohydrate

.

Correct Answer : C 42 : When are supplements of zinc reported to be beneficial?

A : in the treatment of childhood infections B : in the treatment of Menkes disease C : in the treatment of toxicity from certain vitamins D : in the treatment of slow growth syndrome in U.S. children Correct Answer : A 43 : What is the primary function of the thyroid hormones?

A : They act as precursors for hemoglobin synthesis.

B : They counteract a deficiency of goitrogens.

C : They control the rate of oxygen use by cells.

D : They regulate acetylcholine concentrations in the central nervous system.

Correct Answer : C 44 : What may result from iodine deficiency?

A : gout B : goiter C : anemia D : hypertension Correct Answer : B 45 : A woman with a severe iodine deficiency during pregnancy may give birth to a child with .

A : anemia B : rickets C : cretinism D : allergies Correct Answer : C 46 : What is a goitrogen?

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A : one of the hormones produced by the thyroid gland B : a substance that enhances absorption of dietary iodide C : a substance that interferes with the functioning of the thyroid gland D : a compound used to supplement salt as a way to increase iodide intake Correct Answer : C 47 : Which food source is known to contain goitrogens?

A : shellfish B : whole grains C : cauliflower and broccoli D : blueberries and raspberries Correct Answer : C 48 : What is the richest source of iodine?

A : corn B : seafood C : orange juice D : cruciferous vegetables Correct Answer : B 49 : What would most likely result from an excessive intake of iodine?

A : diarrhea B : skin rashes C : dehydration D : thyroid gland enlargement Correct Answer : D 50 : What would be the most appropriate food source of iodide for a person who lives inland and eats only locally grown and raised food?

A : fresh-water fish B : iodized table salt C : locally grown produce D : plants of the cabbage family Correct Answer : B 51 : Your Uncle Carlos has survived two heart attacks. He recently asked you if he might be deficient in selenium, which he read is essential to heart health. Since he has always eaten a varied diet, you explain that his condition could not be the result of a dietary deficiency of selenium because .

A : tap water is a source of selenium B : selenium is prevalent in most food groups C : he consumes legumes, a rich source of selenium D : he drinks fluoridated water, which increases bioavailability of selenium Correct Answer : B 52 : What trace element is part of the enzyme glutathione peroxidase?

A : iron 8 / 14

B : zinc C : selenium D : chromium Correct Answer : C 53 : Which nutrient has functions similar to those of vitamin E? A : iron B : selenium C : chromium D : molybdenum Correct Answer : B 54 : What is a feature of copper nutrition?

A : Absorption efficiency is similar to that of iron.

B : Copper is involved in collagen synthesis and wound healing.

C : Soft water may provide significant amounts of copper in the diet.

D : Copper deficiency is common in children of Middle East countries.

Correct Answer : B 55 : Which meat would be the best source of copper?

A : chicken B : shellfish C : beefsteak D : hamburger Correct Answer : B 56 : What is the most likely cause of manganese toxicity?

A : consumption of supplements B : increased absorption due to genetic defect C : inhalation of dust contaminated with manganese D : consumption of foods grown on manganese-rich soils Correct Answer : C 57 : Which characteristic is shared by copper and fluoride?

A : Both may be obtained from drinking tap water.

B : Both serve as cofactors for a number of enzymes.

C : Neither is involved in the integrity of bones and teeth.

D : Neither is known to be toxic at intakes of 10 times the estimated safe and adequate dietary intake.

Correct Answer : A 58 : What is the primary mechanism associated with the role of fluoride in prevention of dental caries?

A : Fluoride increases calcium absorption, which increases crystal formation of teeth.

B : Decay is inhibited due to neutralization of organic acids produced by bacteria on the teeth.

C : Decay is reduced due to the inhibitory effects of fluoride on growth of bacteria on the teeth.

D : Fluoride becomes incorporated into the crystalline structure of teeth, making them less 9 / 14

susceptible to decay.

Correct Answer : D 59 : What is a characteristic of chromium in nutrition?

A : A deficiency leads to hypothyroidism.

B : Supplements are well known to be helpful.

C : Whole grains represent an excellent source.

D : In the body, it enhances the action of ceruloplasmin.

Correct Answer : C 60 : What is a glucose tolerance factor?

A : a protein that stimulates glycolysis B : a mineral cofactor for a specific enzyme C : a hormone that enhances pancreatic function D : a small organic compound that promotes the action of insulin Correct Answer : D 61 : Chromium deficiency is characterized by A : hypertension B : hyperglycemia C : enlargement of the liver D : enlargement of the thyroid gland

.

Correct Answer : B 62 : What is a characteristic of the mineral molybdenum?

A : Molybdenum enhances the activity of insulin.

B : Deficiency symptoms of molybdenum in people are unknown.

C : Legumes and cereal grains are unusually poor food sources of molybdenum.

D : Toxicity symptoms of molybdenum in human beings include damage to red blood cells.

Correct Answer : B 63 : What term designates foods that contain nonnutrient substances that may provide health benefits beyond basic nutrition?

A : health foods B : organic foods C : functional foods D : disease-preventative foods Correct Answer : C 64 : Which food choice is a rich source of phytoestrogens?

A : potatoes B : soybeans C : cold-water fish D : green, leafy vegetables Correct Answer : B 10 / 14

65 : Lycopene is classified as a(n) A : lignan B : carotenoid C : phytoestrogen D : enzyme cofactor

.

Correct Answer : B 66 : Flaxseed is a rich source of A : lutein B : lignans C : sulforaphane D : organosulfur compounds

.

Correct Answer : B 67 : The active components in black tea and green tea associated with favorable effects on the cardiovascular system are .

A : quercetins B : flavonoids C : resveratrols D : sulforaphanes Correct Answer : B 68 : Margarine enriched with phytosterols is known to A : reduce blood cholesterol B : lower thermogenesis by 10% C : stimulate soluble fiber fermentation D : raise absorption efficiency of vitamin B12

.

Correct Answer : A

MATCHING 69 : Match the major functions with the trace mineral it best describes.

A : regulates thyroid hormone A : chromium B : prevents tooth decay B : copper C : enhances insulin action C : fluoride D : part of hemoglobin molecule D : iodine E : part of insulin molecule E : iron F : cofactor for several enzymes and bone F : manganese formation G : helps form hemoglobin G : selenium H : a component of the thyroid hormones H : zinc Correct Answer : A:G B:C

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C:A D:E E:H F:F G:B H:D

70 : Match the phytochemicals with their possible health effects.

A : modulates blood clotting A : allicin B : reduce risk of breast cancer B : capsaicin C : acts as antioxidant C : lignans D : antimicrobial that may reduce ulcers D : resveratrol Correct Answer : A:B B:C C:D D:A

ESSAY 71 : Explain how the body regulates iron levels in the body, including the specific hormones and proteins that play key roles in this process.

Correct Answer : ?Iron is absorbed in the intestines by ferritin, which then stores the iron in the intestinal cells. When the body requires iron, iron is moved into the blood for circulation by the transport protein transferrin. When iron is not required by the body, iron is shed from the intestinal cells for excretion. When iron levels become too high, hepcidin levels increase, decreasing absorption in the intestine and controlling the release of iron from other sources in the body. Additionally, hepcidin triggers the liver to convert from the synthesis of ferritin to hemosiderin, which allows the iron stores to be released more slowly to prevent high levels of free iron from introducing free radicals in the body. When iron levels become too low, hepcidin levels decrease, which in turn increases iron absorption, releasing iron from stores and increasing ferritin production while decreasing hemosiderin production in the liver.

72 : List the three stages of iron deficiency. What visual symptoms could offer clues that a person is iron deficient in the absence of a blood test?

Correct Answer : ?The first stage of iron deficiency is a loss of iron within iron stores in the body, which is reflected in a decrease in serum iron. The second stage is when serum iron falls and the levels of the iron-carrying protein transferrin increase. Finally, the third stage is when 12 / 14

hemoglobin production is impeded, with an increase in hemoglobin precursor accumulation. In the absence of a blood test, iron deficiency can be seen in a lightening of the blood vessels under the skin in pale colored people, and a decrease in the red color of the tongue and eye lining in people of all skin tones.

73 : Calculate the amount of iron required for a woman of childbearing age, showing amounts of iron lost and how it is replaced. How does this compare with a woman of childbearing age who is also a vegetarian?

Correct Answer : ?People lose about 1.0 mg of iron per day. Additionally, women of childbearing age would lose about 0.5 mg of iron per day over the course of a month. In total, women of childbearing age should replace 1.5 mg of iron per day to avoid a deficit. Because only about 18 percent of iron consumed is absorbed, we would take 1.5 × 0.18 to determine that a total of 8 mg of iron must be consumed daily to prevent a net dietary loss of iron. For a vegetarian woman of childbearing age, however, the dietary intake is 1.8 times higher for vegetarians, so take 8 mg × 1.8 to determine that these women will need a total of 14 mg of iron daily to avoid a net dietary loss of iron.

74 : Outline the enteropancreatic circulation of zinc from absorption to utilization and excretion.

Correct Answer : ?Zinc is absorbed in the intestines and can be retained in the intestinal cells by metallothionein. When the body requires zinc, the metallothionein releases the zinc, which binds to albumin for transport throughout the body. Zinc largely ends up in the pancreas to make digestive enzymes, which are then returned to the intestines during digestion, and the zinc is then reabsorbed for reuse. When the body does not require zinc, zinc absorption decreases, and zinc is shed from the intestinal cells for excretion.

75 : What are the similarities and differences between Menkes disease and Wilsons disease?

Discuss cause, symptoms, and treatments.

Correct Answer : ?Both Menkes disease and Wilson’s disease are both caused by improper copper circulation. A person with Menkes disease would exhibit signs of mental retardation, poor muscle tone, and seizures while failing to thrive, while a person with Wilson’s disease would experience tremors, impaired speech, and personality changes. To treat Menkes disease, the goal is to increase circulating copper, as this disease is associated with a failure to release copper from the digestive tract. To bypass the digestive tract, intravenous copper is given to these patients. For patients with Wilson’s disease, these patients accumulate high levels of copper in the liver and brain, so the goal is to remove excess copper from the body through the use of chelating agents, while preventing copper from absorbing into the body by both decreasing dietary amounts and increasing zinc intake with supplements, which interferes with copper absorption.

76 : Caitlin, a 7-year-old girl, has always been very careful to take good care of her teeth. She and her parents are upset that she has developed small, white spots in her teeth, and consult their dentist about what they can do to remove them. Why did Caitlin develop these spots, and what could she have done to prevent them?

Correct Answer : Caitlin (or her parents) may have been a bit too aggressive in trying to prevent tooth decay, as she is likely suffering from fluorosis, or fluoride toxicity. Of particular importance, in order for her to have developed these spots, she would have been exposed to the high levels of fluoride during the first three years of her life, as these spots are only seen when the teeth are developing. Being more careful with her fluoride levels now would have no impact on these spots now.?

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77 : Ling, a young girl from China, is taken to her pediatrician by her parents because she is extremely tired and irritable, and is showing signs of developmental delay. During the examination, the doctor notices that Ling has very brittle nails, has very thin hair, and has a distinct odor to her breath. Knowing that dietary deficiencies are common for people from Lings village, blood tests are run. What mineral deficiency and disease is she most likely suffering from? What foods would you suggest she incorporate to improve her condition?

Correct Answer : ?Ling most likely has a deficiency of selenium and has Keshan Disease. In order to rectify this deficiency, Ling should eat more seafood, liver and other meats if possible, and whole grains, particularly imported from other regions of the world where selenium levels in the soil are high.

78 : Why is it so important to test for lead levels in children? What are the physiological consequences of high lead levels?

Correct Answer : ?High lead levels in children can lead to problems in growth and development, and is particularly toxic to young children. Once the lead enters the body, the lead remains in the body for a long time, displacing other minerals from their roles in enzymes, such as the iron in heme, affecting the ability of the body to carry oxygen and calcium in the nervous system, preventing signaling in neurons.

79 : Amalie is concerned about her risk of heart disease due to an extensive family history.

When helping her plan her diet, what are at least two of the phytochemical classes you would recommend that she consume, how do they function, and what is at least one good dietary source for each of these phytochemicals?

Correct Answer : ?The flavonoids, found in whole grains, soy, and teas, serve as antioxidants that may help reduce the risk of heart disease. Additionally, plant sterols from soy also protect against heart disease by inhibiting cholesterol absorption.

80 : What are at least two pros and two cons of fortifying foods with phytochemicals?

Correct Answer : ?Adding phytochemicals to foods allows for people who otherwise would not ingest any or enough of certain chemical to obtain that substance in foods they do consume on a regular basis. This may be particularly beneficial for people in developing countries who lack access to fresh produce or meats. Additionally, some of these substances can even have a drug-like effect, imparting positive health benefits, like lowering blood pressure or blood glucose.

However, many phytochemicals have not been fully tested in many cases, particularly when used as a food additive, so it is unclear if the benefits seen in natural food sources will be continue to be there for foods in which the phytochemicals are added. Additionally, the amount a phytochemical that is beneficial versus the amount that may be toxic is not known, so using phytochemicals in foods may actually be more deleterious than beneficial to overall health.

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MULTIPLE CHOICE 1 : Excess body weight in women has been shown to have what effect in preparation for pregnancy?

A : decreased prenatal care B : disrupted menstrual regularity C : a higher incidence of sexually transmitted diseases D : higher risk of pregnancy-related depression Correct Answer : B 2 : What effect on fertility has been seen in overweight and obese men?

A : decreased sperm counts B : elevated testosterone levels C : loss of body hair D : erectile dysfunction Correct Answer : A 3 : In preparation for pregnancy, a couple would benefit from A : limiting alcohol intake to fewer than two drinks per day B : consuming 800 micrograms folate per day C : receiving regular medical care D : achieving a BMI of 27 or less

.

Correct Answer : C 4 : A newly fertilized egg is known as a(n) A : fetus B : ovum C : zygote D : embryo

.

Correct Answer : C 5 : What is the placenta?

A : an organ from which the infant receives nourishment B : a muscular organ within which the infant develops before birth C : the developing infant from the eighth week after conception until birth D : the developing infant during its second through eighth week after conception Correct Answer : A 6 : The critical period of development of the brain and spinal cord occurs at what point during gestation?

A : within 17 to 30 days after conception B : within 4 to 6 weeks after conception C : by the end of the first 12 weeks D : by the end of the first 24 weeks Correct Answer : A

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7 : What name is given to the time period during which irreversible damage to the fetus may occur from specific events such as malnutrition or exposure to toxins?

A : first trimester B : critical period C : fertility period D : conceptual period Correct Answer : B 8 : What is the term for the developing infant from the eighth week after conception until birth?

A : fetus B : ovum C : zygote D : embryo Correct Answer : A 9 : Anencephaly is characterized by .

A : an absence of a brain B : incomplete closure of the spinal cord C : paralysis D : abnormal facial features and intellectual developmental delays Correct Answer : A 10 : An infant born with incomplete closure of the spinal cord has A : spina bifida B : macrosomia C : anencephaly D : microcephaly

.

Correct Answer : A 11 : What is a characteristic of neural tube defects?

A : They occur in about 3000 pregnancies in the United States each year.

B : They include common disorders such as liver and kidney disease.

C : They can be prevented by supplementation of the pregnant womans diet with vitamin B12.

D : They are usually caused by exposure to environmental toxins.

Correct Answer : A 12 : You are working as a nutrition consultant in a womens health clinic and have been advising patients to make sure they consume about 400 micrograms of folate every day. One patient is aware that folate helps prevent birth defects but she isnt sure why she should take it if she is not pregnant. What is the most appropriate reply?

A : The folate supplementation prevents pernicious anemia, which increases the risk of spina bifida.

B : The folate supplementation is needed to ensure a large store that can be utilized by the growing fetus.

C : As long as supplementation begins the day pregnancy is confirmed, there is no risk of defects.

D : The neural tube develops early on in pregnancy, often before the woman realizes she is pregnant.

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Correct Answer : D 13 : Studies report that folate supplements for women may lower the incidence of neural tube defects among infants when the vitamin is taken during the trimester(s) of pregnancy.

A : last B : second C : second and third D : month before conception through the first Correct Answer : D 14 : What describes a characteristic of maternal nutrition and the development of abnormal metabolism?

A : Malnutrition during pregnancy leads to macrosomia and infant GI disturbances.

B : Insufficient nutrient intake during pregnancy promotes hypertrophy of the kidneys and hypotension in adulthood.

C : Nutrition during pregnancy is the chief determinant of pancreatic beta cell growth and thus affects the risk for type 2 diabetes.

D : Malnutrition during pregnancy programs the fetus to modify the genetic composition of the placenta and thereby alter nutrient delivery through the umbilical cord.

Correct Answer : C 15 : The process by which maternal nutrient intake affects the childs development of diseases later in life is known as .

A : retrogenetics B : reverse genetics C : fetal programming D : postpartum degenerative expression Correct Answer : C 16 : What is the most reliable indicator of an infants future health status?

A : infant birthweight B : prepregnancy weight C : weight gain during pregnancy D : nutrition status prior to pregnancy Correct Answer : A 17 : What is macrosomia?

A : a neural tube defect B : an abnormally large body size of the infant C : excessive weight gain of the mother D : abnormal cravings for carbohydrate during pregnancy Correct Answer : B 18 : What label describes an infant born during the 35th week of pregnancy?

A : term B : preterm C : post-term 3 / 14

D : small for gestational age Correct Answer : C 19 : What is the recommended range of pregnancy weight gain, in pounds, for a single birth in a normal-weight woman?

A : 10 to 18 pounds B : 19 to 24 pounds C : 25 to 35 pounds D : 38 to 44 pounds Correct Answer : C 20 : What is the recommended range of pregnancy weight gain, in pounds, for a single birth in an underweight woman?

A : 15 to 25 pounds B : 28 to 40 pounds C : 42 to 50 pounds D : 55 to 62 pounds Correct Answer : B 21 : For the normal-weight woman, weight gain ideally follows a pattern of 3.5 pounds during the first trimester and pound(s) per week thereafter.

A:1 B:2 C : 3.5 D:5 Correct Answer : A 22 : In obese pregnant women, the risk for neural tube defects in the infant is believed to result from .

A : insufficient exercise B : poor glycemic control C : insufficient vitamin B12 intake D : higher prevalence of cesarean section Correct Answer : B 23 : Which statement describes a relationship between body weight and pregnancy?

A : Overweight women bear the greatest number of low-birthweight infants.

B : Weight gain during pregnancy is the sole determinant of infant birthweight.

C : The increased incidence of neural tube defects of infants born to obese women is due primarily to folate insufficiency.

D : The rates of preterm births and infant deaths are higher for underweight women.

Correct Answer : D 24 : What is the minimum recommended weight gain for the obese pregnant woman?

A : 11 pounds B : 18 pounds C : 25 pounds 4 / 14

D

:

35

pounds

Correct Answer : A 25 : What describes a reflection of body weight changes associated with pregnancy?

A : Weight gain is generally steady throughout pregnancy for normal-weight women.

B : Most women are unable to lose all of the weight that is gained during pregnancy.

C : Sudden, large weight gain in pregnancy may signal the development of hypotension.

D : Overweight pregnant women should gain as much weight as underweight pregnant women.

Correct Answer : B 26 : Sarah is a pregnant patient who is at a prenatal care appointment. She asks about how much exercise she can take part in while she is pregnant. What recommendation is most appropriate for Sarah?

A : Water activities, such as scuba diving, are often beneficial for pregnant women.

B : Warm up with 5 to 10 minutes of light activity before working out.

C : A pregnant woman should exercise when she feels tired, as the activity can promote energy and strength.

D : The pregnant mother should avoid drinking water until after completing exercise.

Correct Answer : B 27 : What type of exercise would be most appropriate for a pregnant woman?

A : racquetball B : horseback riding C : skiing D : swimming Correct Answer : D 28 : Joan is 24 weeks pregnant and wants to start exercising. She admits that she has been inactive most of her adult life. What exercise option is best for Joan to start?

A : playing doubles tennis B : walking 25 minutes a day C : participating in an hour-long aerobics class D : weight lifting at the gym Correct Answer : B 29 : Jenny has just learned that she is 4 weeks pregnant (first trimester). She has been looking forward to all the ice cream, chips, and cakes she has seen women on TV and in the movies eating when they are pregnant. What is the most appropriate advice for Jenny?

A : She can eat these foods, but only up to 340 kcalories extra per day.

B : She can eat these foods, but only up to 550 kcalories extra per day.

C : She does not have increased energy needs in the first trimester and should not indulge herself.

D : She should avoid these foods and instead, include one extra serving from each food group per day.

Correct Answer : C 30 : Elizabeth is a pregnant patient who tells her physician that she has been following a low5 / 14

carbohydrate diet so that she does not gain too much weight during pregnancy. Her physician recommends including carbohydrates into her diet. What purpose do carbohydrates serve during pregnancy?

A : They provide fuel for the fetal brain.

B : They support blood flow to the placenta.

C : They prevent neural tube defects.

D : They support fetal lung development prior to birth.

Correct Answer : A 31 : What is the recommended increase in daily energy intake, in kcalories, for the third trimester of pregnancy?

A : 200 B : 300 C : 450 D : 540 Correct Answer : C 32 : Which statement characterizes energy needs during pregnancy?

A : The need for energy is proportionally greater than for most other nutrients.

B : The increased needs are similar at the beginning and end of pregnancy.

C : The needs increase by similar amounts in teenagers and 30-year-old women.

D : The enhanced work of pregnancy raises the womans basal metabolic rate dramatically and demands extra energy.

Correct Answer : D 33 : Which nutrients are required in higher amounts during pregnancy due to their roles in the synthesis of red blood cells?

A : protein and chromium B : folate and vitamin B12 C : calcium and vitamin A D : vitamin E and vitamin C Correct Answer : B 34 : Of the following nutrient needs, which is considered the most difficult to meet during pregnancy, often because of low body stores?

A : iron B : protein C : vitamin D D : vitamin B6 Correct Answer : A 35 : What describes a feature of calcium nutrition in pregnancy?

A : The RDA for calcium increases by over 100 percent.

B : Intestinal absorption increases substantially.

C : Supplements are required for most women due to the increased needs.

D : Transfer of calcium from maternal stores to the fetus increases rapidly at the beginning of the second trimester and falls during the last trimester.

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Correct Answer : B 36 : The amount of vitamin D needed in pregnancy can be obtained by consumption of fortified milk and .

A : low-mercury fish B : exposure to the sun C : tropical fruit juices D : vitamin D supplements Correct Answer : B 37 : Which nutrient would most likely need to be supplemented for a pregnant woman who is a vegan?

A : vitamin A B : potassium C : vitamin B12 D : sodium Correct Answer : C 38 : Examine the following menu for a pregnant woman.Breakfast 2 scrambled eggs 1 wheat English muffin 1 cup orange juice Lunch 2 pieces (4 oz) fried chicken 2 wheat rolls w/butter 1/2 cup mashed potatoes and gravy Iced tea Supper 3 oz pork chop 1 ear corn on the cob Lettuce and tomato salad with 2 tbs. dressing 1 slice breadAccording to the recommended food intake for pregnancy, which food group is the only one that is provided in sufficient amounts by this menu?

A : milk products B : protein foods C : vegetables D : grains Correct Answer : B 39 : Since repeated pregnancies occurring within short time frames lead to depletion of the mothers nutrient reserves, what is the optimal interval between pregnancies?

A : 6 months B : 12 months C : 1823 months D : 2435 months Correct Answer : C 40 : What describes a characteristic of vegetarian diets during pregnancy or lactation?

A : Vegan diets require supplements of selenium, zinc, and manganese.

B : Breast milk from vegetarian women is lower in protein but higher in fiber.

C : It is possible that a vegetarian diet can support a healthy pregnancy and normal lactation.

D : The increase in appetite during pregnancy allows a vegan pregnant woman to easily meet or exceed her energy requirements.

Correct Answer : C 41 : What recommendation is most appropriate to help a pregnant woman alleviate heartburn?

A : Eat dry toast or crackers between meals.

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B : Drink carbonated beverages instead of juice or water.

C : Drink liquids with meals.

D : Avoid spicy or greasy foods.

Correct Answer : D 42 : What best describes the cause of food cravings that develop during pregnancy?

A : hormone-induced changes in sensitivity to taste and smell B : the pressure of the growing fetus on the lower esophageal sphincter C : physiological vitamin or mineral deficiencies D : the increased blood volume in the mothers body Correct Answer : A 43 : Jane is visiting with her doctor during her second trimester of pregnancy and has just revealed her strange cravings. The doctor declared that Jane is experiencing pica, which is causing her intense craving for .

A : dirt B : garlic C : pickles D : pepperoni Correct Answer : A 44 : What weight classifies an infant as being low birthweight?

A : 3½ pounds or less B : 4 pounds or less C : 5½ pounds or less D : 6½ pounds or less Correct Answer : C 45 : What condition is most likely to be a risk factor associated with a high-risk pregnancy?

A : prepregnancy BMI between 22 and 25 B : less than 24 months between pregnancies C : excessive pregnancy weight gain D : age over 32 years in the mother Correct Answer : C 46 : What statement best describes the relationship between malnutrition and fertility?

A : Starvation may be more likely to induce ovulation.

B : A woman with food deprivation may develop amenorrhea.

C : Malnutrition is associated with increased progesterone but decreased estrogen.

D : Men who are malnourished are more likely to suffer from hypogonadism.

Correct Answer : B 47 : What is an example of a consequence of malnutrition during pregnancy?

A : congenital malformations B : maternal hypertension C : fetal macrosomia D : post-term birth 8 / 14

Correct Answer : A 48 : What statement explains a feature of the WIC program?

A : It caps the number of children in the program at 2 million.

B : It is strictly remedial and available chiefly to women living in the inner city.

C : It offers assistance to all at-risk pregnant women regardless of economic means.

D : It saves an estimated $3 in medical costs in the first two months after birth for every dollar spent.

Correct Answer : D 49 : Brenda is in her 26th week of gestation and has a family history of diabetes. Her prepregnancy BMI was 26, and she has gained 35 pounds. If she does not make appropriate dietary changes, she is at high risk for developing .

A : preeclampsia B : gestational diabetes C : iron deficiency anemia D : osteomalacia Correct Answer : B 50 : What is a characteristic of gestational diabetes?

A : It predicts risk of diabetes for the infant.

B : It leads to type 2 diabetes in some women.

C : It occurs in over one-half of normal weight women.

D : It occurs more often in women with a history of having premature births.

Correct Answer : B 51 : What is a distinguishing characteristic of eclampsia?

A : convulsions in the mother B : convulsions in the newborn C : low blood pressure in the mother D : low blood pressure in the newborn Correct Answer : A 52 : What describes a characteristic associated with adolescent pregnancy?

A : The recommended weight gain is approximately 35 pounds.

B : The incidence of stillbirths and preterm births is 5 to 10 percent lower compared with adult women.

C : The incidence of pregnancy-induced hypertension is 5 to 10 percent lower compared with older women.

D : The time in labor is usually shorter than for older women because there are fewer overweight teenagers.

Correct Answer : A 53 : What is the risk of giving birth to a child with Down syndrome for a woman who is 40 years old?

A : 1 in 25 B : 1 in 100 9 / 14

C : 1 in 300 D : 1 in 10,000 Correct Answer : B 54 : One out of A : 10 B : 25 C : 50 D : 100

pregnancies in older women produces an infant with genetic abnormalities.

Correct Answer : C 55 : Which statement best describes the risk of foodborne illness during pregnancy?

A : The risk for listeriosis is substantially higher in pregnant women than in other healthy adults.

B : Consumption of smoked seafood is permitted due to the beneficial effects of smoke residue on microorganisms.

C : Fish intake should be minimized due to the high lead content and susceptibility of the fetal central nervous system.

D : Foodborne pathogenic organisms are less likely to cause infection during pregnancy if the dietary intake of calcium is adequate.

Correct Answer : A 56 : What is a function of prolactin?

A : It reverses the effects of certain mutagens.

B : It reverses the effects of certain teratogens.

C : It acts on mammary glands to stimulate milk release.

D : It acts on mammary glands to promote milk production.

Correct Answer : D 57 : The number of extra kcalories per day needed to produce a normal supply of milk during the first six months of lactation is approximately .

A : 100 B : 250 C : 500 D : 1000 Correct Answer : C 58 : In general, what are the chief consequences of nutritional deprivation in the lactating mother?

A : cessation of lactation B : reduced quality of milk C : reduced quantity of milk D : an inability to pass antibodies to the infant Correct Answer : C 59 : Which hormone is responsible for the let-down reflex?

A : oxytocin B : estrogen 10 / 14

C : progesterone D : luteinizing hormone Correct Answer : A 60 : What describes a feature of lactation?

A : Breast milk protein content may be enhanced by moderate exercise.

B : The volume of breast milk may be increased by drinking plenty of fluid.

C : The iron content of breast milk may be increased by taking iron supplements.

D : Breast milk quantity but not quality is most affected by nutritional inadequacies.

Correct Answer : D 61 : Which statement describes an association between nutrient intake and lactation?

A : Milk production is increased by higher fluid intake.

B : Ingestion of garlic may lead to an off-flavor of the milk.

C : Inadequate protein intake lowers the protein concentration of the milk.

D : The energy RDA for milk production calls for an additional 1000 kcalories per day.

Correct Answer : B 62 : What explains the effects of alcohol intake on lactation?

A : It does not pass into the breast milk.

B : It hinders the infants ability to breastfeed.

C : It mildly stimulates breast milk production.

D : It passes into the breast milk but is degraded by enzymes in breast tissue.

Correct Answer : B 63 : According to many experts, what minimum level of alcohol intake increases the risk of giving birth to an infant with fetal alcohol syndrome?

A : 1 drink/day B : 2 drinks/day C : 4 drinks/day D : 7 drinks/day Correct Answer : A 64 : The most severe abnormalities at the end of the spectrum of fetal alcohol disorder are classified as .

A : prenatal alcohol exposure B : fetal alcohol syndrome C : alcohol-related neurodevelopmental disorder D : alcohol-related birth defect disorder Correct Answer : B 65 : What physical characteristic would most likely be seen in a child with FAS? A : macrocephaly B : flattened nose bridge C : upward slant of the eyes D : protruding tongue and chin 11 / 14

Correct Answer : B

MATCHING 66 : Match each value or word or phrase with the most appropriate definition or explanation.

A : a newly fertilized ovum A : 3000 B : fluid in which the fetus floats B : 35 C : developing infant from 28 weeks after C:7 conception D : number of days after conception during D : 1730 which the neural tube is highly vulnerable to nutrient deficiency E : number of pregnancies each year affected E : 25 with a neural tube defect F : adequate intakes of this nutrient within the F : 35 30 days prior to conception are especially important to lower risk of birth defects G : most reliable indicator of an infants health G : 38 H : an infant born prior to this number of weeks H : iron of pregnancy is classified as preterm I : upper limit for the recommended number of I : pica pounds that a pregnant woman of normal weight should gain J : approximate weight, in pounds, of average J : folate newborn baby K : zygote K : number of grams of extra protein per day recommended for the pregnant woman L : embryo L : supplements of this nutrient are recommended because increased needs cannot be met by maternal stores M : alcohol M : a recommended practice to prevent or relieve heartburn N : eclampsia N : a recommended practice to prevent or alleviate constipation O : a craving for nonfood substances O : amniotic P : a condition characterized by high blood P : birthweight pressure and protein in the urine Q : a condition characterized by seizures Q : preeclampsia R : age in years at which obstetricians routinely R : breastfeeding screen pregnant women for birth defects such as Down syndrome S : excess intake of this substance in S : eat small, frequent meals pregnancy known to result in intellectual disability in child T : drink at least 8 glasses of liquid a day T : a practice that conserves maternal iron stores Correct Answer : A:K B : A14 12 / 14

C : A11 D:D E:A F:J G : A15 H:G I:F J:C K:E L:H M : A18 N : A19 O:I P : A16 Q : A13 R:B S : A12 T : A17

ESSAY 67 : Discuss the term critical periods in relation to pregnancy.

Correct Answer : ?Times of intense development and rapid cell division are called critical periods—critical in the sense that those cellular activities can occur only at those times. If cell division and number are limited during a critical period, full recovery is not possible. Damage during these critical times of pregnancy has permanent consequences for the life and health of the fetus. The development of each organ and tissue is most vulnerable to adverse influences (such as nutrient deficiencies or toxins) during its own critical period. It is therefore very important that women make healthy choices during this time when the fetus is most vulnerable to nutrient deficiencies, nutrient excesses, or toxins—often, this is when most women do not yet even realize they are pregnant.

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68 : Define gestational diabetes and list risk factors.

Correct Answer : ?Gestational diabetes is glucose intolerance with onset or first recognition during pregnancy. Gestational diabetes usually develops during the second half of pregnancy, with subsequent return to normal after childbirth. Risk factors include a mother’s age over 25 years, BMI over 25 or excessive weight gain, complications in previous pregnancies, including gestational diabetes or a high-birthweight infant, prediabetes or symptoms of diabetes, a family history of type 2 diabetes, and Hispanic, African American, Native American, Asian, or Pacific Islander ethnicity.

69 : List potential complications of both mother and infant when pregnancy occurs in an older woman.

Correct Answer : ??A woman over 35 can have a healthy pregnancy, but she is at higher risk of complications during pregnancy, labor, and delivery. The few complications associated with later childbearing often reflect chronic conditions such as hypertension and diabetes. These may result in cesarean delivery, which is twice as common in women older than 35 as among younger women. The babies of older mothers have higher rates of preterm births and low birthweights, with higher rates of birth defects.

70 : Describe the risks associated with caffeine intake during pregnancy.

Correct Answer : ?Caffeine crosses the placenta, and the developing fetus has a limited ability to metabolize it. Limited evidence suggests that heavy use of caffeine increases the risk of hypertension, miscarriage, and stillbirth. Depending on the quantities consumed and the mother’s metabolism, caffeine may also interfere with fetal growth. Lower doses of caffeine— say, at levels equivalent to 3 cups of coffee or less—appear to be compatible with healthy pregnancies. All things considered, it may be most sensible to limit caffeine consumption to the equivalent of a cup or two of coffee a day.

71 : Distinguish between alcohol-related neurodevelopmental disorder and alcohol-related birth defects.

Correct Answer : ?The cluster of mental problems associated with prenatal alcohol exposure is known as alcohol-related neurodevelopmental disorder (ARND), and the physical malformations are referred to as alcohol-related birth defects (ARBD). Some children with ARBD and ARND have no outward signs; others may be short or have only minor facial abnormalities.

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MULTIPLE CHOICE 1 : During the second year of life, an infant typically gains less than A:5 B : 10 C : 15 D : 20

pounds.

Correct Answer : B 2 : A newborn baby has energy requirements of approximately A : 250 B : 450 C : 950 D : 1200

kcalories per day.

Correct Answer : B 3 : What describes a feature of energy metabolism in infancy?

A : Infants fed fat-free milk are at risk for protein overload.

B : Most of the energy in breast milk is derived from lactose.

C : The brain of an infant uses less glucose than that of an adult.

D : Infants require about 25 percent more energy than adults when expressed per kilogram of body weight.

Correct Answer : A 4 : What term is used to describe the many problems associated with infants and children suffering from protein deficiency?

A : failure to thrive B : milk protein intolerance C : alpha lactalbumin allergy D : hospitalism Correct Answer : A 5 : What best describes an infants water needs?

A : The younger the infant, the lower the percentage of body weight is water.

B : An infants body takes longer to respond to fluid loss than an adults body.

C : Much of the infants body water content is located extracellularly.

D : Conditions such as diarrhea may be successfully treated with lower doses of adult medications.

Correct Answer : C 6 : During the first few weeks after birth, an infant should breastfeed approximately how many times per day?

A : 4 to 6 B : 8 to 12 C : 13 to 15 D : 18 to 20

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Correct Answer : B 7 : The main carbohydrate in breast milk (and standard infant formula) is A : galactose B : lactose C : sucrose D : dextrose

.

Correct Answer : B 8 : What is the chief reason that breast-fed infants usually need to eat more frequently than formula-fed infants?

A : Breast milk contains less fat.

B : Breast milk is digested faster.

C : Breast milk is less nutrient dense.

D : The amount of milk consumed per feeding is lower in breast-fed infants.

Correct Answer : B 9 : What is colostrum?

A : a clot in the milk duct in the breast B : a major protein in breast milk C : a hormone that promotes milk production D : a milklike substance secreted right after delivery Correct Answer : D 10 : What is an advantage of breastfeeding compared with formula feeding?

A : There is no limit to the supply of breast milk.

B : Breast milk provides immunological protection.

C : The mother can be sure the baby is getting enough milk.

D : Breastfeeding is the only way to develop an attachment with the baby.

Correct Answer : B 11 : What describes the relationship between infant development and nutrition?

A : It is generally easier to overfeed a breastfed infant than a formula-fed infant.

B : Breastfed infants obtain iron-binding proteins that inhibit bacterial infections.

C : Breastfed infants are at high risk of iron deficiency for the first 6 months of life.

D : For optimal development, infants should be transitioned to formula after one year of breastfeeding.

Correct Answer : B 12 : What statement accurately describes the use of breast milk banks?

A : Each woman who donates breast milk gives her milk to a specific baby.

B : The women who donate breast milk are screened for hypertension and diabetes.

C : Breast milk from a bank is only used for preterm infants.

D : A breast milk bank is similar to a blood bank in that it collects the milk for donation.

Correct Answer : D 13 : What type of formula is available for infants with lactose intolerance?

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A : egg B : soy C : barley D : powdered cows milk Correct Answer : B 14 : What describes a risk associated with formula feeding?

A : excess protein consumption, which leads to kidney damage B : lack of bonding and attachment between the infant and his mother C : formula contamination from poor water sources D : an increased incidence of neural tube damage from decreased folate Correct Answer : C 15 : What describes a feature of infant soy formulas?

A : They are used in about 1 percent of the infant population.

B : They contain cornstarch and sucrose rather than lactose.

C : They are identical to milk-based formulas except for the protein source.

D : They are not acceptable to vegan families because the formulas contain omega-3 fatty acids from fish.

Correct Answer : B 16 : What is a common source of lead poisoning in infants?

A : maternal passage of lead to the fetus B : baby bottles made from lead crystal C : contaminated water used to make infant formula D : preparation of infant formula in galvanized containers Correct Answer : C 17 : Goats milk is inappropriate for infants due to its low content of A : iron B : folate C : protein D : calcium

.

Correct Answer : B 18 : Which best defines nursing bottle tooth decay?

A : caries development resulting from frequent use of non-sterile bottles and nipples B : bacterial attack of the teeth due to severe tooth misalignment from sucking on oversized bottle nipples C : marked tooth decay of an infant due to prolonged exposure to carbohydrate-rich fluids from a bottle D : tooth decay resulting from constant food exposure due to the inability of the infant to swallow normally Correct Answer : C 19 : What best describes why an infant should not be given cows milk until one year of age?

A : It is a poor source of vitamin A. 3 / 14

B : It may cause intestinal bleeding.

C : It displaces adequate vitamin C in the body.

D : It does not contain DHA, which promotes brain growth and visual acuity.

Correct Answer : B 20 : Of the following cereals, which is most likely to result in an allergic reaction upon first feeding?

A : oat B : rice C : corn D : wheat Correct Answer : D 21 : Robertas first child is now 8 months old. Roberta has been breastfeeding and would like to begin to introduce solid foods. She read somewhere to introduce one food at a time. Which food would be the best choice to first introduce to the baby?

A : oat B : rice C : wheat D : barley Correct Answer : B 22 : Infants fed honey or corn syrup are at increased risk for A : obesity B : botulism C : osteopenia D : type 1 diabetes

.

Correct Answer : B 23 : What feeding skill would be expected in a child who is 5 months old?

A : feeding self with finger foods B : grasping objects with the palm of the hand C : holding own bottle D : starting to drink from a cup Correct Answer : B 24 : What best describes milk anemia?

A : when excessive milk intake displaces iron from the diet B : a poor outcome that results from putting an infant to bed with a bottle of milk C : pallor and cyanosis that results from using formula with contaminated water D : a deficiency in vitamin D that develops after exclusive breastfeeding Correct Answer : A 25 : The DRI Committee recommends a fat intake of years of age.

A : 10 to 15 B : 15 to 30

percent of energy for children 1 to 3

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C : 30 to 40 D : 50 to 60 Correct Answer : C 26 : Approximately how many kcalories per day does an average 6 year old need to consume?

A : 400 B : 800 C : 1600 D : 2400 Correct Answer : C 27 : Which statement describes fat in the diet of children?

A : The recommended daily fat intake up to age 12 is age plus 20 grams.

B : There is an RDA for total fat for children beginning at 3 years of age.

C : Low-fat diets usually provide sufficient amounts of the micronutrients.

D : Fat intakes below 30 percent of total energy do not impair growth provided that total energy intake is adequate.

Correct Answer : D 28 : What is the most prevalent nutrient deficiency among U.S. and Canadian children?

A : iron B : protein C : calcium D : vitamin C Correct Answer : A 29 : What outcome is most likely to develop among children who do not regularly eat breakfast?

A : They are more likely to be underweight.

B : They are more hyperactive.

C : They are at higher risk of diabetes.

D : They achieve lower test scores.

Correct Answer : D 30 : At what level of lead in the bloodstream would the Centers for Disease Control and Prevention recommend public health actions be initiated?

A : 5 micrograms B : 50 micrograms C : 5 milligrams D : 50 milligrams Correct Answer : A 31 : What describes a feature of nutrition in childhood?

A : Very few children take nutrient supplements of any kind.

B : Total energy requirements are higher for a typical 3-year-old than a 12-year-old.

C : Iron-deficiency anemia in children is prevalent in Canada but not the United States due to fortification.

D : Children who fail to consume vitamin D-fortified foods should receive a daily supplement.

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Correct Answer : D 32 : Which statement describes a characteristic of hunger and behavior in children?

A : Children who fail to eat breakfast typically become hyperactive after eating lunch.

B : The nutrient deficit arising from skipping breakfast is usually made up over the following 2 days.

C : Children who eat nutritious breakfasts are absent from school less often than their friends who do not.

D : Although breakfast-skippers show reduced attention spans, their scores on intelligence tests remain unaffected.

Correct Answer : C 33 : Jenny is a 13-year-old Hare Krishna who follows a vegan diet. She has not been performing as well as her non-vegetarian study friend on math tests and has been very upset about it. The teacher reports to Jennys mom that she does not appear focused during lessons and cant seem to concentrate on her school work. What may provide a likely explanation?

A : Jennys diet doesnt provide enough energy for her to stay alert.

B : Jennys diet provides insufficient bioavailable iron and she may be anemic.

C : Jennys diet contains insufficient calcium and protein, which impairs intellectual performance.

D : The high fiber content of Jennys diet increases the urge to evacuate, which interferes with her ability to concentrate.

Correct Answer : B 34 : Once a food allergy has been diagnosed, the required treatment is A : epinephrine injection B : strict elimination of the offending food C : administration of an antihistamine medication D : daily iodine supplements

.

Correct Answer : B 35 : Caregivers of children with food allergies should recognize the signs and symptoms of anaphylactic shock, which include .

A : tingling in the mouth, swelling of the lips, and difficulty breathing B : irritability, lethargy, and somnolence C : hypertension, slow heart rate, and sweating D : low serum potassium and high serum calcium Correct Answer : B 36 : What is a characteristic of a food allergy?

A : It always elicits symptoms in the person.

B : It always involves the production of antibodies.

C : It always shows up immediately after exposure to the offending food.

D : It is elicited from very small, simple molecules as well as large, complex molecules.

Correct Answer : B 37 : Approximately what percentage of U.S. children between 2 and 19 years of age is overweight?

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A:4 B:8 C : 16 D : 32 Correct Answer : D 38 : According to the American Academy of Pediatrics, what is the recommended maximum number of hours per day of television viewing for a child under 2 years of age?

A:0 B:1 C:2 D:3 Correct Answer : A 39 : What two conditions are associated with televisions influence?

A : obesity and high blood lipids B : anorexia and nutrient deficiencies C : drug abuse and teenage pregnancy D : hyperactivity and low body weight Correct Answer : A 40 : To lower the risk of obesity in children, which practices should parents institute for their children?

A : Serve them smaller portions.

B : Serve them 3 meals a day without dessert.

C : Teach them to take appropriate food portions.

D : Serve them more beverages and less solid food.

Correct Answer : C 41 : Why is parental treatment of obese children so unsuccessful?

A : Once excess fat is stored, it is difficult to lose.

B : Children are known to rebel against their parents.

C : Parents believe that their children will simply outgrow it.

D : Parents are known to actively resist the recommendations of pediatricians.

Correct Answer : A 42 : An example of a bone-strengthening activity that could be recommended for a child or teen to increase his daily exercise would be .

A : climbing a tree B : playing tug-of-war C : swinging on playground equipment D : jumping rope Correct Answer : D 43 : Rebecca is a 9-year-old who is a picky eater. Rebeccas parents feel as if they have tried almost everything to get her to finish her meals with the family. What strategy should be recommended to help Rebecca?

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A : Allow Rebecca to stay home while one parent buys groceries.

B : Plan meals but first ask Rebecca if it is okay to have them.

C : Ask Rebecca to help with cooking meals.

D : Have Rebecca watch videos about gardening and farming.

Correct Answer : C 44 : What best describes a feature of public school food programs?

A : They must follow the Dietary Guidelines for Americans.

B : They allow for low-fat menus while still meeting the needs for iron.

C : They ensure a lunch period long enough to consume the entire meal.

D : They are overwhelmingly preferred over the foods obtained by students through on-site vending machines and snack bars.

Correct Answer : A 45 : How do competing influences undermine healthful food intake and food selection at schools?

A : They discourage participation in the USDA-sponsored school lunch program.

B : They encourage students to bring unhealthful lunches to school.

C : They promote short lunch periods and long waiting lines in the cafeteria.

D : They offer cheaper but less nutritious meals to low-income students who qualify for reducedprice school lunches.

Correct Answer : A 46 : The adolescent growth spurt .

A : primarily affects the brain B : decreases total nutrient needs C : affects every organ except the brain D : begins and ends earlier in girls than in boys Correct Answer : D 47 : What best describes a characteristic of the adolescent period?

A : Obesity occurs more often in African American females.

B : Appetite for red meat increases in females to meet iron needs.

C : More nutrient-dense foods are needed by males because of their faster development.

D : The risk for calcium insufficiency is greatest in males due to their high intake of soft drinks.

Correct Answer : A 48 : What is menarche?

A : a females time of first menstruation B : the adolescent growth spurt in males C : the adolescent growth spurt in females D : a borderline anemic state in adolescents Correct Answer : A 49 : To ensure adequate calcium, children aged 9 and older should consume fat or fat-free milk or milk products each day.

A : 1½

cups of low-

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B:2 C:3 D:4 Correct Answer : C 50 : Several of the vitamin recommendations for adolescents are similar to those for adults, including .

A : vitamin D B : iron C : calcium D : chloride Correct Answer : A 51 : What describes a feature of beverage intake in adolescents?

A : Juice intake is spread throughout the day.

B : Milk intake occurs primarily between meals.

C : Males typically drink less milk than females.

D : Four standard colas a day provides enough caffeine to impact behavior.

Correct Answer : D 52 : Approximately what fraction of an average teenagers daily energy intake is derived from snacks?

A : 1/4 B : 1/3 C : 1/2 D : 2/3 Correct Answer : A 53 : About what percentage of meals each week is eaten outside the home by adolescents?

A:3 B : 10 C : 20 D : 33 Correct Answer : D 54 : The problems of obesity become ever more apparent in adolescence, especially for which ethnicity?

A : Asian Americans B : African Americans C : Caucasian Americans D : Native Hawaiian/Pacific Islanders Correct Answer : B 55 : What is the approximate duration of the adolescent growth spurt?

A : 6 months B : 1 year C : 1½ years 9 / 14

D : 6 years Correct Answer : C 56 : What best explains why the needs for iron increase in adolescent girls?

A : They burn more kcalories than adolescent boys.

B : Their intakes of vitamin C are usually higher.

C : They lose iron through menstruation.

D : They are less likely to engage in team sports.

Correct Answer : C 57 : What outcomes are most commonly associated with adolescents who frequently eat meals with their families?

A : They are more likely to snack between meals.

B : They eat more fruits, vegetables, and grains.

C : They are less active in sports and exercise.

D : They have higher energy needs.

Correct Answer : B 58 : Caffeine intake by adolescents seems to be relatively harmless when used in moderate doses, or about three 12-ounce cola beverages a day. Approximately how much caffeine does this amount to?

A : 50 milligrams B : 100 milligrams C : 200 milligrams D : 500 milligrams Correct Answer : B 59 : About the only time that teens select fruit juices is A : at breakfast B : at school C : at supper D : after school

.

Correct Answer : A 60 : Which statement describes characteristics in the development of atherosclerosis?

A : Fatty streaks may begin to form within the first 10 years of life.

B : Once plaque is formed, it can be contained but cannot regress.

C : It is impossible for people to age without arterial plaque formation.

D : Heart disease rates due to atherosclerosis rise most dramatically at around age 30 in males and 40 in females.

Correct Answer : A 61 : The association of cholesterol to the health of children is best described by which statement?

A : Cholesterol intake should be limited beginning at 2 years of age.

B : Cholesterol concentrations change with age in children and adolescents.

C : Among children, a rise in LDL levels is correlated with a rise in HDL levels.

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D : Cholesterol values at birth are higher in African Americans than in any other ethnic group.

Correct Answer : B 62 : What value is consistent with a borderline total blood cholesterol level for children and adolescents?

A : 140159 mg/dL B : 160169 mg/dL C : 170199 mg/dL D : 210210 mg/dL Correct Answer : C 63 : Which statement is among the dietary recommendations for children?

A : Children ages 418 years should consume approximately 25 percent fat energy.

B : Children with high blood cholesterol should be treated first with statin drugs.

C : Children should consume less than 25 percent of fat as saturated fat.

D : Children should strive to consume less than 500 milligrams of cholesterol per day.

Correct Answer : A 64 : Which statement is consistent with the American Heart Association Dietary Guidelines and Strategies for Children?

A : Include 56 servings of fish per week, especially fatty fish.

B : Choose chicken or turkey in place of legumes or tofu for some meals.

C : Limit or avoid the use of artificial sweeteners.

D : Balance dietary kcalories with physical activity to maintain normal growth.

Correct Answer : D 65 : Each day nearly first time.

A : 500 B : 1000 C : 2500 D : 4000

young people between the ages of 12 and 17 start smoking for the

Correct Answer : D

MATCHING 66 : Match each value or term with the most appropriate definition or explanation.

A : expected weight at one year, in pounds, of A : 48 an infant with a birthweight of seven pounds B : typical daily energy need, in kcalories per B : 90 kilogram body weight, of an infant C : essential fatty acid in breast milk C : 21 D : chief protein in human breast milk D : 80 E : chief protein in cows milk E : 100 F : iron F : nutrient that is low in human milk but adequate in infant formulas 11 / 14

G : premilk substance from the breast, G : casein containing antibodies H : folate H : substance in breast milk that promotes growth of beneficial bacteria in the intestines I : honey I : substance in breast milk that deprives intestinal bacteria of iron J : sucrose J : a substance that inhibits pathogen attachment to the intestinal mucosa K : puberty K : process whereby breast milk is gradually replaced by formula or semi-solid foods L : low content of this nutrient makes goats milk L : linoleic inappropriate for infants M : typical energy source in infant soy formulas M : weaning N : possible source of infant botulism N : vitamin D O : deficiency of this nutrient in children causes O : colostrum symptoms similar to mild lead toxicity P : approximate percentage of young children P : lactoferrin diagnosed with food allergies Q : lactadherin Q : substance given to prevent anaphylactic shock in people with food allergies R : percent chance of becoming an obese adult R : epinephrine for an obese teen with one obese parent S : period in life when an individual becomes S : bifidus factors physically capable of reproduction T : approximate percent of adult smokers who T : alpha-lactalbumin began smoking before age 18 Correct Answer : A:C B:E C : A11 D : A19 E:G F : A13 G : A14 H : A18 I : A15 J : A16 K : A12 L:H M:J 12 / 14

N:I O:F P:A Q : A17 R:D S:K T:B

ESSAY 67 : Discuss the importance of breast milk banks. What steps are taken to exclude breast milk that may contain undesirable substances?

Correct Answer : ?Similar to blood banks that collect blood from individuals to give to others in need, breast milk banks receive milk from lactating women who have an abundant supply to give to infants whose own mothers’ milk is unavailable or insufficient. The women who donate breast milk are carefully screened to exclude those who smoke cigarettes, use illicit drugs, take medications (including high doses of dietary supplements), drink more than two alcoholic beverages a day, or have communicable diseases. The breast milk from several donors is pooled to ensure an even distribution of all components, pasteurized to destroy bacteria, checked for contamination, and frozen before being shipped overnight to hospitals, where it is dispensed by physician prescription.

68 : Why is preterm breast milk suitable to meet the special needs of the preterm infant?

Correct Answer : ?Preterm breast milk is well suited to meet a preterm infant’s needs. During early lactation, preterm breast milk contains higher concentrations of protein and is lower in volume than term breast milk. The low milk volume is advantageous because preterm infants consume small quantities of milk per feeding, and the higher protein concentration allows for better growth. In many instances, supplements of nutrients specifically designed for preterm infants are added to the mother’s expressed breast milk and fed to the infant from a bottle.

When fortified with a preterm supplement, preterm breast milk supports growth at a rate that approximates the growth rate that would have occurred within the uterus.?

69 : What is the relationship between nutrition and hyperactivity in children?

Correct Answer : ?Research on hyperactivity has focused on several nutritional factors as possible causes or treatments. Parents often blame sugar. They mistakenly believe that simply eliminating candy and other sweet treats will solve the problem. This dietary change will not solve the problem, however, and studies have consistently found no convincing evidence that sugar causes hyperactivity or worsens behavior. Food additives have also been blamed for hyperactivity and other behavior problems in children, but scientific evidence to substantiate the connection has been elusive. Limited research suggests that food additives such as artificial 13 / 14

colors or sodium benzoate preservative (or both) may exacerbate hyperactive symptoms such as inattention and impulsivity in some children. Additional studies are needed to confirm the findings and to determine which additives might be responsible for specific negative behaviors.

A Food and Drug Administration (FDA) review determined that evidence linking color additives to hyperactivity is lacking. The FDA did not rule out the possibility that some food additives, including food colorings, may aggravate hyperactivity and other behavioral problems in some susceptible children.

70 : Describe the psychological consequences of children who become overweight.

Correct Answer : ?In addition to the physical consequences, childhood obesity brings a host of emotional and social problems. Because people frequently judge others on appearance more than on character, overweight and obese children are often victims of prejudice and bullying.

Many suffer discrimination by adults and rejection by their peers. They may have poor selfimages, a sense of failure, and a passive approach to life. Television shows, which are a major influence in children’s lives, often portray the fat person as the bumbling misfit. Overweight children may come to accept this negative stereotype in themselves and in others, which can lead to additional emotional and social problems. Researchers investigating children’s reactions to various body types find that both normal-weight and underweight children respond unfavorably to overweight bodies.

71 : Discuss the role of peer pressure in shaping food preferences of adolescents.

Correct Answer : ?Physical maturity and growing independence present adolescents with new choices. The consequences of those choices will influence their health and nutrition status both today and throughout life. Many of the food and health choices adolescents make reflect the opinions and actions of their peers. When others perceive milk as “babyish,” a teen may choose soft drinks instead; when others skip lunch and hang out in the parking lot, a teen may join in for the camaraderie, regardless of hunger. Some teenagers begin using drugs, alcohol, and tobacco; others wisely refrain. Adults can set up the environment so that nutritious foods are available and can stand by with reliable information and advice about health and nutrition, but the rest is up to the adolescents. Ultimately, they make the choices.

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MULTIPLE CHOICE 1 : Approximately what fraction of the U.S. population is at least 65 years old?

A : 1/100 B : 1/30 C : 1/8 D : 1/3 Correct Answer : C 2 : Which is the fastest growing age group in the United States?

A : 21 to 30 years B : 35 to 50 years C : Over 65 years D : Over 85 years Correct Answer : D 3 : What is the life expectancy of black males and females in the United States?

A : 72 (males), 78 years (females) B : 78 (males), 85 years (females) C : 85 (males), 89 years (females) D : 90 (males), 93 years (females) Correct Answer : A 4 : What was the average life expectancy of a person born in the year 1900?

A : 47 years B : 55 years C : 61 years D : 68 years Correct Answer : A 5 : A persons age as estimated from his or her bodys health and probable life expectancy is known as .

A : quality of life B : physiological age C : longevity D : chronological age Correct Answer : B 6 : Approximately how many years is the maximum human life span?

A : 75 B : 100 C : 115 D : 130 Correct Answer : D 7 : What is an accurate statement about strength training in older adults?

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A : Older adults can practice strength training exercises until age 85, when the effects damage muscle mass.

B : Strength training in older adults decreases energy expenditure and energy intake.

C : Strength training helps older adults to maintain independence by improving muscle strength to perform tasks.

D : Older adults who practice strength training must also perform aerobic exercise to prevent weight gain.

Correct Answer : C 8 : Longevity is defined as .

A : long duration of life B : a persons age in years from date of birth C : the maximum number of years of life attainable by a species D : the average number of years lived by people in a given society Correct Answer : A 9 : What is an example of an activity that would improve balance in an older adult?

A : Attach 2-pound ankle weights and perform leg lifts.

B : Walk 6 blocks at a brisk pace.

C : Hold onto a chair and stand on one foot.

D : Reach down and touch the toes, holding the stretch for 10 seconds.

Correct Answer : C 10 : Body weight, body fat, inflammatory proteins, and blood pressure drop when people cut back on their usual energy intake by percent.

A : 1 to 3 B:5 C : 7 to 10 D : 10 to 20 Correct Answer : D 11 : Which statement best describes a feature of the stress response in men and women?

A : Womens general reactions to stress are different than those of men.

B : The ability to respond is weaker in older women compared with older men.

C : The secretion of epinephrine is suppressed in elderly women compared with elderly men.

D : Psychological stressors such as divorce or death of a loved one are handled better by older women than by older men.

Correct Answer : A 12 : For adults older than 65, the lowest mortality correlates with a BMI of A : 18.5 to 20.5 B : 21 to 25 C : 23.5 to 27.5 D : 28 to 30

.

Correct Answer : C 13 : What is sarcopenia?

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A : loss of central visual activity B : loss of muscle mass and strength C : aging-induced chronic inflammation of the stomach D : intestinal dysmotility from excessive use of laxatives Correct Answer : B 14 : What is a characteristic of aging and the immune system?

A : Immunity in older people does not seem to be affected by regular exercise.

B : In the United States, infectious diseases are a minor cause of deaths in the elderly.

C : Immune function does not decline with age in people who maintain good nutrition.

D : Antibiotics are often ineffective in treating infections in older people who have deficient immune systems.

Correct Answer : D 15 : Which condition in older adults causes an inflamed stomach, bacterial overgrowth, and a lack of hydrochloric acid and intrinsic factor?

A : chronic constipation B : gastroesophageal reflux C : atrophic gastritis D : diverticulitis Correct Answer : C 16 : Which statement best describes the relationship between late-life depression and nutrition?

A : Depressed people frequently lose their appetites and motivation to cook.

B : The neurotransmitter fluctuations with depression impact how the body digests food.

C : Depression in older age and its associated malnutrition is often inevitable.

D : Increased intake of vitamins A and E has been shown to improve symptoms of depression.

Correct Answer : A 17 : What fraction of eligible seniors participates in the SNAP? A : 1/3 B : 1/2 C : 3/4 D : 9/10 Correct Answer : A 18 : Malnutrition due to social changes is most likely to develop in which group of older adults?

A : those in assisted living facilities B : those with the most education C : those who own their own homes or apartments D : those who live in federally funded housing Correct Answer : A 19 : A person with a pressure ulcer has damage to his or her A : skin B : colon C : mouth

.

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D : stomach Correct Answer : A 20 : The basal metabolic rate declines 1 to 2 percent per decade in part because A : lean muscle mass and thyroid hormones decrease B : blood pressure generally increases C : lipid oxidation is increased D : the immune system becomes more active

.

Correct Answer : A 21 : What describes the nutrient needs of older people?

A : They vary according to individual histories.

B : They remain the same as in young adult life.

C : They increase; therefore, supplementation is required.

D : They decrease for vitamins and minerals due to changes in body composition.

Correct Answer : A 22 : Older adults with atrophic gastritis are more likely to develop vitamin B12 deficiency because the .

A : bacterial overgrowth that accompanies this condition uses up the vitamin B : condition almost always reduces exposure to sunlight C : medication to treat atrophic gastritis destroys the vitamin D : condition leads to decreased food intake and subsequent vitamin B12 intake Correct Answer : A 23 : John is 60 years old and has been experiencing numbness in his hands for the past 3 months. His doctor suspects that John is not producing enough hydrochloric acid and intrinsic factor and encourages him to eat more foods containing vitamin B12. What is wrong with this suggestion?

A : People missing intrinsic factor cannot digest foods containing vitamin B12 and will develop diarrhea.

B : Intrinsic factor is not associated with vitamin B12 and eating more foods containing it would have no effect on Johns health.

C : It is improbable that a lack of hydrochloric acid production and intrinsic factor are associated with the numbness that John is experiencing.

D : Because John has no intrinsic factor, he cannot efficiently utilize vitamin B12 from natural sources and would need a vitamin B12-fortified food or supplement.

Correct Answer : D 24 : Which describes a research finding on vitamin D nutrition in the elderly?

A : Self-synthesis capacity is high.

B : The skins capacity to synthesize the vitamin is reduced.

C : The presence of atrophic gastritis reduces bioavailability of the vitamin.

D : Symptoms of deficiency include dermatitis and diminished taste acuity.

Correct Answer : B 25 : What is a feature of calcium nutrition in the elderly?

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A : The DRI is 800 to 1000 mg.

B : Calcium intakes are well below recommendations.

C : Calcium supplements are not effective sources of calcium due to poor digestibility.

D : Calcium from food is not well absorbed due to the intake of calcium-binding laxatives.

Correct Answer : B 26 : Which factor increases the risk of iron deficiency in older adults?

A : increased antacid use B : menopause in older women C : increased intake of vitamin C-rich foods D : minimal outdoor activity Correct Answer : A 27 : What is a feature of zinc nutrition in the elderly?

A : Zinc intake is insufficient in older people.

B : Excess zinc from supplements blunts the taste buds.

C : Zinc deficiency stimulates the appetite for high-fat foods.

D : Most medications affect zinc excretion but not absorption.

Correct Answer : A 28 : Older adults are less likely to drink enough water because A : they have less access to clean, uncontaminated water B : the changes in their senses alters how water tastes C : they find it bothersome to get to the bathroom D : they prefer coffee, tea, or colas to water

.

Correct Answer : C 29 : Erica is an 81-year-old woman who lives in an assisted living facility. Her caregivers report that Erica does not seem to drink enough fluid and she has said that she does not like to drink plain water because of the taste. What alternative is an example that would most increase her fluid intake?

A : a bowl of cereal and a slice of toast B : a cup of coffee with 2 cookies C : a glass of wine with crackers and cheese D : a bowl of vegetable soup with a slice of watermelon Correct Answer : D 30 : What statement best describes the relationship between supplement use and older adults?

A : Supplements should replace nutritious foods whenever possible.

B : Supplements of vitamin K may prevent atrophic gastritis in some older adults.

C : Supplements are usually more likely to cause harm than to be beneficial in older adults.

D : Supplements of calcium and vitamin D may be recommended for osteoporosis in older adults.

Correct Answer : D 31 : What describes a characteristic of nutrition and cataract formation?

A : Obese and lean people have the same risk for cataracts.

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B : Adequate intakes of biotin and inositol seem to delay the onset of cataract formation.

C : Nutrition is known to play little, if any, role in the onset or progression of cataracts.

D : Vitamin C supplements in doses of 1000 mg for several years appear to raise the risk for cataracts.

Correct Answer : D 32 : The elderly are especially vulnerable to suffer from reduced vision due to thickenings that occur to the lenses of the eye known as .

A : retinitis B : keratoids C : cataracts D : rhodolipids Correct Answer : C 33 : What factor increases the risk for macular degeneration?

A : oxidative stress from sunlight B : excess vitamin C intake C : obesity D : viral infections Correct Answer : A 34 : Which food seems to relieve rheumatoid arthritis in some people?

A : milk B : olive oil C : iodized salt D : refined cereal Correct Answer : B 35 : Which type of diet has been shown to prevent or reduce arthritis inflammation?

A : high in simple sugars, low in canned fruit B : high in animal protein, low in canned fruit C : low in polyunsaturated fat, high in oleic acid D : low in saturated fat, high in omega-3 fatty acids Correct Answer : D 36 : What disorder is associated with the bodys breakdown of purines?

A : gout B : dysphagia C : sarcopenia D : senile dementia Correct Answer : A 37 : What is the chief risk factor for Alzheimers disease?

A : age B : gender C : low antioxidant intake D : body weight 6 / 14

Correct Answer : A 38 : What is thought to be the most important nutrition concern for people with Alzheimers disease?

A : maintenance of appropriate body weight B : adequate intakes of antioxidant nutrients and DHA C : intake of medications that may interfere with nutrient bioavailability D : treatment for iron overload to prevent formation of new neurofibrillary tangles Correct Answer : A 39 : Which sign seen with aging would most likely be a sign of developing Alzheimers disease?

A : confusion with time, including the current season B : making an error when balancing the checkbook C : experiencing visual changes due to cataracts D : being unable to find the right word to use Correct Answer : A 40 : What is a characteristic of alcohol use in the elderly?

A : Adults aged 65 and older are most likely to binge drink.

B : The prevalence of regular alcohol intake is two-fold higher for women versus men.

C : Treatment for alcohol abuse in the elderly of both sexes is less effective than for young adults.

D : Excessive use impairs memory and cognition in ways much different than for standard agerelated dementia.

Correct Answer : A 41 : Approximately what percentage of U.S. adults is affected by Alzheimers disease after age 65?

A : 0.5 B:5 C : 12 D : 33 Correct Answer : C 42 : What is a characteristic of Alzheimers disease?

A : It affects 95 percent of those over 80 years of age.

B : It is responsive to dietary choline supplementation.

C : It is associated with stability of brain nerve cell number.

D : It is associated with clumps of beta-amyloid protein in the brain.

Correct Answer : D 43 : What is thought to promote the development of brain senile plaques and neurofibrillary tangles?

A : oxidative stress B : excess acetylcholine C : dietary deficiency of choline D : low blood levels of homocysteine 7 / 14

Correct Answer : A 44 : What term is descriptive of most older people?

A : mentally lucid B : unhappy and unhealthy C : dependent on caregivers D : longing for isolation Correct Answer : A 45 : What is the main reason for dieting in the elderly?

A : to economize when food prices increase B : to improve appearance among their peers C : to pursue a medical goal such as reducing blood glucose D : to reduce risks for development of atrophic gastritis and pernicious anemia Correct Answer : C 46 : Which describes a feature of food choices and eating habits of older people?

A : The quality of life among older people has not improved since 1995.

B : Older people spend less money on foods to eat at home than younger people.

C : People over 65 are less likely to diet to lose weight than are younger people.

D : Most older people think of themselves as generally unhappy and in poor health.

Correct Answer : C 47 : Familiarity, taste, and are most influential on older peoples food choices.

A : individual nutrient composition B : ethnicity C : chewing abilities D : health beliefs Correct Answer : D 48 : What is a congregate meal?

A : a meal provided for the elderly in a place such as a community center B : a meal prepared for the elderly that meets one-third of the Dietary Recommended Intakes C : a meal prepared for disadvantaged people of all ages to encourage communal gathering of diverse groups D : a meal provided through the Nutrition Screening Initiative for the elderly and served primarily to church congregations Correct Answer : A 49 : The Meals on Wheels program .

A : is administered by paid professionals B : operates at least 2 days a week C : provides the same social benefits as congregate meals D : serves only those over 60 years of age Correct Answer : D 8 / 14

50 : A principal reason that congregate meals are preferable to Meals on Wheels is that A : the cost of administering congregate meals is lower B : there are more social benefits to congregate meals C : nutritional benefits are greater with congregate meals D : more meals per week are served with congregate meals

.

Correct Answer : B 51 : Rose is a 73-year-old energetic woman who is wheelchair bound. She cannot go to the grocery store and has no family nearby. What would be the most appropriate suggestion for ensuring that Rose obtains adequate nutrition?

A : Suggest she attend congregate meals.

B : Sign her up for the Meals on Wheels program.

C : Suggest that Rose enter a nursing home that will cater to her every need.

D : Have a volunteer buy in bulk from a grocery warehouse once a month and deliver the food to Rose.

Correct Answer : B 52 : What is a program that provides low-income older adults with coupons that are exchangeable for fresh vegetables and fruits at community-supported farmers markets and roadside stands?

A : Senior Farmers Market Nutrition Program B : Food Security for the Disadvantaged Elderly C : Old Age and Survivors Health Benefits Program D : Elderly Nutrition and Maintenance Food Co-Op Correct Answer : A 53 : Which statement is accurate regarding foodborne illness and older adults?

A : Older adults are less likely to get foodborne illnesses because they eat most meals at home.

B : Older adults have the same risks of foodborne illness as any other age group.

C : The risk of older adults getting a foodborne illness is greater than that for other adults.

D : The risk of older adults getting a foodborne illness is less because of the greater prevalence of atrophic gastritis in this population.

Correct Answer : C 54 : Which tactic should an older adult employ to spend wisely on food when he lives alone?

A : Shop at convenience stores instead of large, warehouse grocery chains.

B : Always shop on an empty stomach.

C : Make a grocery list and take it to the store when shopping.

D : Avoid buying food from the very low or very high areas of grocery shelves.

Correct Answer : C 55 : What would be the most effective substitute for fresh milk for the elderly person living alone?

A : UHT milk B : low-cost expired milk C : calcium carbonate tablets D : greens with highly bioavailable calcium 9 / 14

Correct Answer : A 56 : When buying fruits and vegetables for a single person, what would be the best option for an older adult to reduce waste?

A : Buy fruits and vegetables in bulk to store for later.

B : Buy fruits and vegetables at various stages of ripeness.

C : Ask the grocer to break open a package of frozen fruit or vegetables to make it smaller.

D : Buy a large can of fruit or vegetable and store it in the refrigerator for frequent use.

Correct Answer : B 57 : Limited or doubtful availability of nutritionally adequate and safe foods is termed food A : insecurity B : insufficiency C : vulnerability D : precariousness Correct Answer : A 58 : Melissa works two jobs to support her three children. Her financial priorities are to pay the rent and utilities and provide food and medical necessities for the children. Melissa does not often eat three meals a day and worries about how and where she will get the next meal for herself. Melissa is experiencing which circumstance?

A : food insufficiency B : food mismanagement C : nonsustainable lifestyle D : misallocation of resources Correct Answer : A 59 : What is the primary cause for hunger in the United States?

A : poverty B : high cost of food C : excessive food waste D : lack of nutrition education Correct Answer : A 60 : What percentage of the U.S. population lives in poverty?

A:5 B : 15 C : 19 D : 25 Correct Answer : B 61 : What fraction of the U.S. population receives food assistance of some kind?

A : 1/25 B : 1/15 C : 1/5 D : 1/3 Correct Answer : C 10 / 14

.

62 : What is the largest federal food assistance program in the United States?

A : Women, Infants, and Children (WIC) B : Older Americans Act (OAA) C : National Food Resource Program (NFRP) D : Supplemental Nutrition Assistance Program (SNAP) Correct Answer : D 63 : Feeding America coordinates the efforts of 200 food banks across the country that feed an estimated million people a year.

A:1 B:5 C : 13 D : 25 Correct Answer : C 64 : Approximately what fraction of the worlds food supply outside of the home is wasted?

A : 1/5 B : 1/4 C : 1/3 D : 1/2 Correct Answer : C 65 : What is the name of the largest U.S. national food recovery program?

A : Feeding America B : Goodwill Food Assistance C : Salvation Army Ready-to-Eat Meals D : Food Salvage and Rescue Organization Correct Answer : A

MATCHING 66 : Match each value or term with the most appropriate definition or explanation.

A : average life expectancy in years for white A : 5 women in the United States B : dietary restriction of this extends lifespan in B : 81 animals C : loss of muscle mass C : 33 D : percentage of people over age 60 with D : 50 atrophic gastritis E : term that describes difficulty swallowing E : energy F : a condition characterized, in part, by an F : cataracts inflamed stomach and abundant bacteria G : vitamin D G : lack of this substance is a symptom of atrophic gastritis H : stomach bacterial utilization of this nutrient H : dysphagia increases risk for deficiency 11 / 14

I : compounds of nitrogen-containing bases I : beta-amyloid such as adenine, guanine, and caffeine J : percent decline per decade in energy needs J : sarcopenia from age 50 and on K : purines K : low intake of milk by elderly people contributes to deficiency of this nutrient L : thickening of the eye lenses that occurs with L : vitamin B12 aging M : type of arthritis resulting in deterioration of M : food insufficiency joint cartilage N : acetylcholine N : nutrient that may reduce inflammation of rheumatoid arthritic joints O : osteoarthritis O : type of arthritis involving a defective immune system P : approximate percentage of U.S. adults age P : hunger 85 years and older with Alzheimers disease Q : substance that is essential to the memory Q : atrophic gastritis process R : substance found in the brains of people with R : hydrochloric acid Alzheimers disease S : an inadequate amount of food due to lack of S : omega-3 fatty acids resources T : consequence of food insecurity that, T : rheumatoid arthritis because of prolonged, involuntary lack of food, results in discomfort, illness, weakness, or pain that goes beyond the usual uneasy sensation Correct Answer : A:B B:E C:J D:C E:H F : A16 G : A17 H : A11 I:K J:A K:G L:F M : A14 12 / 14

N : A18 O : A19 P:D Q : A13 R:I S : A12 T : A15

ESSAY 67 : Describe the benefits of physical activity in the elderly.

Correct Answer : Compared with those who are inactive, older adults who are active weigh less; have greater flexibility, more endurance, better balance, and better health; and they live longer.

Physical activity also increases blood flow to the brain, thereby preserving mental ability, alleviating depression, supporting independence, and improving quality of life. Regular physical activity tones, firms, and strengthens muscles, helping to improve balance, restore confidence, reduce the risk of falling, and lessen the risk of injury should a fall occur.?

68 : Discuss the role of tooth loss and gum disease in maintenance of nutritional status.

Correct Answer : ?Regular dental care over a lifetime protects against tooth loss and gum disease, which are common in old age. These conditions make chewing difficult or painful.

Dentures are less effective than natural teeth, and inefficient chewing can cause choking.

Inefficient chewing leaves larger pieces of food moving from the stomach into the small intestine, thus limiting enzyme accessibility. Simple changes in food texture might improve chewing efficiency and benefit digestion. People with tooth loss, gum disease, and ill-fitting dentures tend to limit their food selections to soft foods. If foods such as corn on the cob and apples are replaced by creamed corn and applesauce, then nutrition status may not be greatly affected. However, when food groups are eliminated and variety is limited, poor nutrition follows.

69 : List the factors that increase the risk for vitamin B12 and iron deficiency in older adults.

Correct Answer : ?An estimated 10 to 30 percent of adults older than 50 have atrophic gastritis; these people are particularly vulnerable to vitamin B12 deficiency. The bacterial overgrowth that accompanies this condition uses up the vitamin, and without hydrochloric acid and intrinsic factor, digestion and absorption of vitamin B12 are inefficient. Given the poor cognition, anemia, and devastating neurological effects associated with a vitamin B12 deficiency, an adequate intake is imperative. The iron needs of men remain unchanged throughout adulthood. For women, iron needs decrease substantially at menopause when blood loss through menstruation ceases. Consequently, iron-deficiency anemia is less common in older adults than in younger people. Nevertheless, iron deficiency may develop in older adults, especially when their food energy intakes are low. Aside from diet, two other factors may lead to iron deficiency in older 13 / 14

people: chronic blood loss from diseases and medicines and poor iron absorption due to reduced stomach acid secretion and antacid use. Iron deficiency impairs immunity and leaves older adults vulnerable to infectious diseases. Anyone concerned with older people’s nutrition should keep these possibilities in mind.

70 : Discuss the role of nutrition in the prevention and treatment of cataracts and macular degeneration.

Correct Answer : ?Oxidative stress appears to play a significant role in the development of cataracts, but supplements of the antioxidant nutrients (vitamin C, vitamin E, and carotenoids) do not seem to prevent or slow the progression. By comparison, a healthy diet that includes plenty of fruits and vegetables rich in these antioxidant nutrients does seem to slow the progression or reduce the risk of developing cataracts. Vitamin C supplements in high doses (1000 milligrams) and long duration (several years) may increase the risk of cataracts. One other diet-related factor may play a role in the development of cataracts— obesity. Risk factors that typically accompany obesity, such as inactivity, diabetes, or hypertension, do not explain the association. The leading cause of visual loss among older people is age-related macular degeneration, a deterioration of the macular region of the retina. As with cataracts, risk factors for age-related macular degeneration include oxidative stress from sunlight. Preventive factors may include supplements of the omega-3 fatty acids, some B vitamins (folate, vitamin B6, and vitamin B12), antioxidants, zinc, and the carotenoids lutein and zeaxanthin.

71 : List four common hunger relief organizations and their purposes.

Correct Answer : ?Various hunger relief organizations are at work around the world, providing hunger relief efforts and taking time to provide food and assistance to those who do not get enough to eat. Examples include Bread for the World, a nonpartisan, Christian citizens’ movement seeking to influence reform in policies, programs, and conditions that allow hunger and poverty to persist globally; Food First, a North American organization dedicated to building strong, sustainable, local and regional food systems that ensure access to affordable, nutritious, and culturally appropriate food for all people at all times; the Congressional Hunger Center, a bipartisan organization training and inspiring leaders with the intent to end hunger, and advocating public policies to create a food-secure world, and Feeding America, a domestic charity organization providing food assistance through a nationwide network of member food banks and facilitating education to end hunger nationally.

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MULTIPLE CHOICE 1 : Estimates indicate that approximately malnourished.

A : 15 to 60 B : 35 to 70 C : 45 to 80 D : 50 to 90

percent of hospitalized patients are

Correct Answer : A 2 : Which statement is accurate regarding malnutrition among hospitalized patients?

A : Although common among chronic care patients, malnutrition is rare among acute care patients.

B : Malnutrition among hospitalized patients is extremely rare and an indication of seriously flawed care.

C : Only patients who are terminally ill and expected to die within months are at risk of malnutrition.

D : Even acute care patients who are not malnourished upon admission may become malnourished.

Correct Answer : D 3 : Impaired nutrient digestion and absorption that affects nutritional status would most likely be manifested as .

A : insufficient excretion of digestive enzymes B : anorexia due to illness C : prolonged immobilization D : use of diuretics Correct Answer : A 4 : Changes in hydration, as well as diarrhea due to illness, affect nutrition status primarily by .

A : reducing nutrient and food intake B : altering metabolism and excretion C : impairing digestion and absorption D : impairing cognition Correct Answer : B 5 : A patient who has had surgery for colostomy placement has been put on bowel rest and only has an IV for nutrition. In what way would these treatments affect this patients nutrition status?

A : reduced food intake B : impaired digestion C : altered nutrient excretion D : impaired absorption Correct Answer : A 6 : Maisie Green is a frail, elderly widow who lives in a nursing home and has been confined to her bed for some time. What is most likely to increase her metabolic stress and cause increased 1 / 15

kcalorie and protein needs?

A : weakened immunity B : medications causing GI discomfort C : poor emotional health D : pressure sores Correct Answer : D 7 : Specific instructions regarding dietary management for a patient are known as A : clinical pathways B : nutrition care plans C : diet orders D : nutrition screenings

.

Correct Answer : C 8 : The provision of a clients nutrient and nutrition education needs based on a complete nutrition assessment is .

A : medical nutrition therapy B : the nutrition care process C : a nutrition screening D : a medical history Correct Answer : A 9 : A nutrition care plan is .

A : the clients diet prescription ordered by the physician B : the dietitians strategies for meeting an individuals nutritional needs C : the nurses documentation of how well the client is eating D : nutritional formulas showing minimum daily requirements Correct Answer : B 10 : In a health care facility, who holds the ultimate responsibility for ensuring that all the patients nutritional needs are met?

A : clinical dietitians B : physicians C : nurses D : pharmacists Correct Answer : B 11 : Which health care professional is expected to have extensive knowledge about foods and human nutrition?

A : physician B : registered dietitian C : nurse D : social worker Correct Answer : B 12 : A new patient is admitted to the rehabilitation unit. Who is most likely to visit the patient to compile a list of his or her food preferences?

2 / 15

A : nurse B : physician C : dietitian D : dietetic technician Correct Answer : D 13 : The physician asks the staff to encourage the patient to eat at all meals. Who is most often responsible for doing this?

A : the nurse B : the dietitian C : the dietetic technician D : the social worker Correct Answer : A 14 : Coordinated programs of treatment that merge the care plans of different health care professionals are called .

A : critical pathways B : clinical integrative plans C : diagnosis related groups D : treatment plans Correct Answer : A 15 : Clinical judgments about actual or potential health problems that provide the basis for selecting appropriate nursing interventions are called .

A : potential diagnoses B : nursing diagnoses C : treatment objectives D : nursing goals Correct Answer : A 16 : Which statement most accurately describes nutrition assessments?

A : Screenings should be conducted within 24 hours of admission.

B : Screening questions are the same from facility to facility.

C : Assessments must be conducted by physicians.

D : Laboratory tests are not included.

Correct Answer : A 17 : What is an example of a screening tool to assess nutritional status in a newly admitted patient?

A : Subjective Global Assessment B : Patient Education Materials Assessment Tool C : Continuity Assessment and Record Evaluation (CARE) D : Mini Objective Nutrition Evaluation Correct Answer : A 18 : Patient height and weight represent which type of data?

A : admission data 3 / 15

B : anthropometric data C : functional assessment data D : laboratory test results Correct Answer : B 19 : A patients ability to feed him or herself represents which type of data?

A : admission data B : anthropometric data C : functional assessment data D : laboratory test results Correct Answer : C 20 : A brief assessment for quickly identifying clients at risk for malnutrition so that they can receive complete nutrition assessments is called a .

A : nutrition questionnaire B : health history C : health screening D : nutrition screening Correct Answer : D 21 : A nutritional assessment involves .

A : collecting data and using it to evaluate a patients nutrition status B : implementing a nutrition care plan C : identifying existing and potential nutrition problems D : obtaining approval from insurance providers Correct Answer : A 22 : A registered dietitian performed a Subjective Global Assessment on a newly admitted patient to the hospital. The dietitian gives several C ratings for the patients assessment variables. This most likely means that the patient is .

A : obese and needs to lose weight B : well nourished C : at risk of malnutrition D : severely malnourished Correct Answer : D 23 : The neuropsychological problems assessed in the Mini Nutritional Assessment include .

A : dementia B : depression C : anxiety D : schizophrenia Correct Answer : A 24 : An individual with a body mass of Nutritional Assessment.

A : less than 19

would receive one point for BMI in the Mini

4 / 15

B : 19 to 21 C : 21 to 22 D : 23 or higher Correct Answer : B 25 : Lee is a 78-year-old woman with mild loss of muscle mass, loss of about 7 percent of body weight over the past 6 months, and mild feeding difficulties associated with rheumatoid arthritis.

Using the Subjective Global Assessment, she is most likely to be classified in which category?

A : well nourished B : mild malnutrition C : moderate malnutrition D : severe malnutrition Correct Answer : C 26 : An example of a behavioral-environmental diagnosis given following a nutrition assessment might be .

A : altered blood potassium levels B : inadequate energy intake C : unintended weight gain D : disordered eating pattern Correct Answer : D 27 : What is a social factor that can affect food choices?

A : methamphetamine use B : dependence on a family member to prepare food C : mental illness D : prescription medications Correct Answer : B 28 : What is an example of food and nutrition history information that would be included as part of the nutrition assessment?

A : ongoing medical treatments B : high educational level C : recent weight changes D : low socioeconomic status Correct Answer : C 29 : What technique is preferred when using the 24-hour recall method?

A : multiple-pass method B : direct observation C : use of a checklist D : free recall Correct Answer : A 30 : If a client is asked to recount everything eaten in a typical day, the assessor is using to collect the data.

A : a food record 5 / 15

B : a kcalorie count C : a 24-hour recall D : direct observation Correct Answer : C 31 : A 24-hour recall is used to collect a food and nutrition history. The client states that she didnt eat breakfast. She had a soft drink and an apple for lunch, and for dinner, she had a slice of pizza. What is the best question the health care professional could ask next regarding this finding?

A : Is this a usual days food intake?

B : What was on the slice of pizza?

C : What kinds of foods do you like to eat?

D : Are you on a busy schedule?

Correct Answer : A 32 : What is a limitation to the value of a 24-hour recall?

A : The process is time consuming.

B : Clients often keep poor records.

C : The method excludes recording of beverages.

D : A 24-hour period may not be typical.

Correct Answer : D 33 : What best describes a food record?

A : a survey of food consumed in the past year B : a written account of food consumed during a specified period C : direct observation of how much a person eats D : an interview discussing food intake in the last day Correct Answer : B 34 : Why might food frequency questionnaires be less accurate than 24-hour recalls?

A : There can be too many or too few foods to choose from.

B : Dietary supplements cant be included.

C : They typically list only common foods.

D : It may be difficult to estimate average portion sizes of foods eaten less frequently.

Correct Answer : C 35 : An extensive, accurate log of foods eaten over a period of several days or weeks is called a .

A : food-frequency checklist B : food record C : usual intake D : 24-hour recall Correct Answer : B 36 : Danny is undergoing a health assessment. What should the clinician do that would most likely result in an accurate assessment of Dannys weight?

A : Ask Danny how much he weighs.

6 / 15

B : Use a scale that is calibrated and checked for accuracy.

C : Measure Dannys weight three times and take an average of the measurements.

D : Use a bathroom scale to weigh Danny.

Correct Answer : B 37 : Head circumference is used to A : monitor infant growth B : help detect overnutrition C : evaluate muscle size D : calculate infant BMI

.

Correct Answer : A 38 : For children, a sharp drop in a previously steady growth pattern suggests A : malnutrition B : obesity C : a growth spurt D : a medical error

.

Correct Answer : A 39 : Which calculation is most useful in evaluating weight loss in an overweight person?

A : UBW B : IBW C : %UBW D : %IBW Correct Answer : C 40 : Growth charts with BMI-for-age percentiles can be used to assess risk of underweight using the percentile as the cutoff.

A : 5th B : 10th C : 15th D : 20th Correct Answer : A 41 : A BMI-for-age above the A : 25th B : 50th C : 75th D : 85th

percentile indicates that the child may be overweight.

Correct Answer : D 42 : Mrs. Falwell is 54 and weighs 110 lbs. During the interview, she mentions she has lost a lot of weight over the past 5 months. She usually weighs 135 lbs. What is her %UBW? A : 25 B : 81 C : 120 D : 123 7 / 15

Correct Answer : B 43 : What %IBW indicates a risk for moderate malnutrition?

A : 90 to 100 B : 85 to 90 C : 80 to 85 D : 70 to 79 Correct Answer : D 44 : An individual who is at risk of mild malnutrition has a %UBW of A : < 75 B : 75 to 84 C : 85 to 95 D : > 95

percent.

Correct Answer : C 45 : An individual who is at risk of moderate malnutrition has a %UBW of A : < 70 B : 70 to 75 C : 75 to 84 D : 85 to 90

percent.

Correct Answer : B 46 : Fluid accumulation typically results in A : deceptively low lab results B : deceptively high lab results C : unintentional weight loss D : unintentional muscle loss

.

Correct Answer : A 47 : After blood is centrifuged to remove cells, the fluid that remains is called A : plasma B : serum C : electrolytes D : platelets

.

Correct Answer : A 48 : Which protein is the most abundant plasma protein?

A : transferrin B : albumin C : transthyretin D : retinol-binding protein Correct Answer : B 49 : Which nutrition assessment technique is a measure of protein status?

A : serum albumin 8 / 15

B : body mass index C : mean corpuscular volume D : plasma creatinine Correct Answer : A 50 : A serum albumin of 2.5 g/dL in an adult male with malnutrition suggests A : iron deficiency B : a normal finding C : liver damage D : slow to respond improvement

.

Correct Answer : D 51 : Which test has different ranges of normal values for males and females?

A : hematocrit B : mean corpuscular volume C : mean corpuscular hemoglobin concentration D : white blood cell (WBC) count Correct Answer : A 52 : The half-life of albumin is approximately A : 12 hours B : 2 to 3 days C : 8 to 10 days D : 14 to 20 days

.

Correct Answer : D 53 : Where do clinical signs of malnutrition appear most rapidly?

A : hair B : eyes C : urinary tract D : cardiovascular system Correct Answer : A 54 : What clinical effects of PEM would most likely be seen in an individuals hair?

A : hair falling out easily B : thickened hair C : corkscrew hair D : shiny hair Correct Answer : A 55 : Elevated levels of may indicate liver damage.

A : lactate dehydrogenase B : mean corpuscular hemoglobin concentration C : mean corpuscular volume D : alanine aminotransferase Correct Answer : D 9 / 15

56 : Which test is primarily used for monitoring kidney function?

A : glycated hemoglobin B : C-reactive protein C : blood urea nitrogen D : alanine aminotransferase Correct Answer : C 57 : Physical signs of fluid retention include A : dark-colored urine B : reduced skin tension C : facial puffiness D : thirst

.

Correct Answer : C 58 : Immunity against a specific antigen is called A : adaptive B : innate C : systemic D : complementary

immunity.

Correct Answer : A 59 : Large globular proteins produced by B cells that function as antibodies are known as A : antigens B : immunoglobulins C : antibodies D : lysozymes

.

Correct Answer : B 60 : White blood cells that have the ability to engulf and destroy pathogens are known as A : phagocytes B : immunoglobulins C : lymphocytes D : lysozymes

.

Correct Answer : A 61 : A non-specific response to illness or injury is called A : an allergy B : cell-mediated immunity C : humoral immunity D : inflammation

.

Correct Answer : D 62 : Which type of cell releases proteins that damage parasites?

A : basophils B : monocytes C : eosinophils 10 / 15

D : neutrophils Correct Answer : C 63 : An example of an antigen is a A : monocyte B : NK cell C : virus D : T cell

.

Correct Answer : C 64 : Which tissue is a type of lymphoid tissue?

A : spleen B : lungs C : appendix D : brain Correct Answer : A 65 : A foreign antigen has entered the body, which has elicited the immune response. A helper T cell binds to an antigen fragment on an antigen-presenting cell. What happens next?

A : B cells produce more antibodies.

B : A cytotoxic T cell destroys the antigen.

C : Free antibodies attach to the antigens.

D : A macrophage engulfs the target antigen.

Correct Answer : B

MATCHING 66 : Match each word or phrase with the most appropriate definition or explanation.

A : specific instructions for dietary management A : food and nutrition history B : detailed log of food eaten during a specified B : kcalorie counts time period, usually several days C : survey of foods routinely consumed; C : Subjective Global Assessment provides quantitative or qualitative data D : diet order D : strategies for meeting an individuals nutritional needs E : critical pathways E : comprehensive record of a persons food intake and dietary practices F : the estimation of food energy consumed by F : nutrition care plans patients for one or more days G : food record G : the abnormal retention of fluid in body tissues H : edema H : a brief assessment of health-related variables to identify patients who are malnourished I : nutrition diagnosis I : approach to nutrition care consisting of assessing, diagnosing, intervening, monitoring and evaluating the patients nutrition problems 11 / 15

and progress J : technique for nutrition screening that uses J : food-frequency questionnaire historical and physical information K : states the nutrition problem, its etiology, and K : 3.4 to 4.8 g/dL the signs/symptoms that evidence the problem L : nutrition care process L : coordinated programs of treatment that merge the care plans of different health practitioners M : acceptable laboratory range for albumin M : 200 to 360 mg/dL N : acceptable laboratory range for transferrin inN : 20 to 40 mg/dL an individual <60 years old O : acceptable laboratory range for prealbumin O : nutrition screening (transthyretin) Correct Answer : A:D B:G C:J D:F E:A F:B G:H H : A14 I : A11 J:C K:I L:E M:K N : A12 O : A13

ESSAY 67 : Describe the effects of illness on nutrition status and list two examples of conditions associated with malnutrition.

12 / 15

Correct Answer : ?Illnesses and their treatments may lead to malnutrition by causing a reduction in food intake, interfering with digestion and absorption, or altering nutrient metabolism and excretion. For example, the nausea caused by some illnesses or treatments can diminish appetite and reduce food intake; similarly, an inflamed mouth or esophagus may cause discomfort when the patient consumes food. Some medications can cause anorexia or gastrointestinal (GI) discomfort, or interfere with nutrient function and metabolism. Prolonged bed rest often results in pressure sores, which increase metabolic stress and raise protein and energy needs.

68 : Discuss the role of nurses on the nutrition care team and list five nutrition-related nursing diagnoses.

Correct Answer : ?Nurses interact closely with patients and thus are in an ideal position to identify people who would benefit from nutrition services. Nurses may screen patients for nutrition problems and participate in nutrition and dietary assessments. Nurses also provide direct nutrition care, such as encouraging patients to eat, finding solutions to food-related problems, monitoring food intakes, and answering questions about special diets. As members of nutrition support teams, nurses are responsible for administering tube and intravenous feedings.

In facilities that do not employ registered dietitians, nurses often assume responsibility for much of the nutrition care. Examples of nutrition-related nursing diagnoses include constipation, disturbed body image, impaired oral mucous membranes, nausea, and risk for deficient fluid volume.

69 : Discuss the different types of historical data collected for a nutrition assessment.

Correct Answer : ?The medical history describes the patient’s current and ongoing medical issues; this information is helpful because numerous medical problems and their treatments can interfere with food intake or require dietary changes. The medical history generally includes the family medical history as well; this information may reveal genetic susceptibilities for diseases that can potentially be prevented with dietary and lifestyle changes. Many different medications can have detrimental effects on nutrition status, and various components of foods and dietary supplements can interact with medications. Personal and social factors influence food choices as well as a person’s ability to manage health and nutrition problems. For example, cultural background or religious beliefs can affect food preferences, whereas financial concerns may restrict access to health care and nutritious foods. A food and nutrition history is a detailed account of a person’s dietary practices. It includes information about food intake, lifestyle habits, and other factors that affect food choices, such as food allergies or beliefs about nutrition and health. The procedure often includes an interview about recent food intake and a survey about usual food choices. The food and nutrition history may help the dietitian uncover current or potential nutrition problems or patterns of behavior that contribute to health problems.

70 : List two advantages and two disadvantages of each of the four methods of obtaining food intake data.

Correct Answer : ?The 24-hour dietary recall does not influence dietary choices and the information is obtained quickly, but the process relies on memory and food items that are embarrassing may be omitted. A food-frequency questionnaire is not affected by day-to-day variability and it is inexpensive, but food lists often include common foods only and calculated nutrient intakes may not be accurate. The food record process records foods as they are consumed and is useful for controlling intake, but portion size errors are common and the process is time consuming. Direct observation does not rely on memory and does not influence food intake, but it is labor intensive and it is only available in residential situations.

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71 : Describe the use of anthropometric measurements in infants and children.

Correct Answer : ?To evaluate growth patterns, the clinician takes periodic measurements of height (or length), weight, and head circumference and plots them on growth charts. The most commonly used growth charts compare height (or length) to age, weight to age, head circumference to age, weight to length, and BMI to age. Although individual growth patterns vary, a child’s growth will generally stay at about the same percentile throughout childhood; a sharp drop in a previously steady growth pattern suggests malnutrition. Growth patterns that fall below the 5th percentile may also be cause for concern, although genetic influences must be considered when interpreting low values. Growth charts with BMI-for-age percentiles can be used to assess the risk of underweight and overweight in children over 2 years of age: the 5th and 85th percentiles are used as cutoffs to identify children who may be malnourished or overweight, respectively.

72 : Explain why serum proteins are used as part of biochemical assessment measurements and list three examples.

Correct Answer : ?Serum protein levels can aid in the assessment of protein-energy status, but the levels may fluctuate for other reasons as well. Because serum proteins are synthesized in the liver, blood levels of these proteins can reflect liver function. Metabolic stress alters serum proteins because the liver responds by increasing its synthesis of some proteins and reducing the synthesis of others. Values are also influenced by hydration status, pregnancy, kidney function, zinc status, blood loss, and some medications. Because serum proteins are affected by so many factors, their values must be considered along with other data to evaluate health and nutrition status. Examples of serum proteins that might be measured include albumin, transferrin, and retinol-binding protein.

73 : Describe clinical signs of malnutrition in an individuals eyes, lips, skin, and nails.

Correct Answer : ?Signs of malnutrition tend to appear most often in parts of the body where cell replacement occurs at a rapid rate, such as the hair, skin, and digestive tract (including the mouth and tongue). The eyes may have pale membranes, spots, dryness, or redness in the corners. The lips may appear dry, cracked, or with sores in the corners. The skin manifests poor wound healing, it may be dry and rough and may bruise easily. The nails can be ridged, spoon shaped, and pale.

74 : Describe the differences between fluid retention and dehydration.

Correct Answer : ?Fluid retention (also called edema) may be caused by PEM, severe infection or injury, and some medications. It can also result from heart failure, disorders of the liver or kidneys, and obstructions in the veins or lymphatic system. Physical signs of fluid retention include weight gain, facial puffiness, tissue swelling, abdominal distention, and tight-fitting shoes. Dehydration may be caused by vomiting, diarrhea, fever, excessive urination, blood loss, and wounds or burns (due to fluid loss through skin lesions). The risk of dehydration is especially high in older adults, who have a reduced thirst response and various other impairments in fluid regulation. Signs or symptoms include thirst, weight loss, dry skin or mouth, reduced skin tension, dark-colored urine, and low urine volume.

75 : Describe how malnutrition impacts the bodys immune response.

Correct Answer : ?Malnutrition affects all aspects of immunity, including both innate and adaptive immune defenses. For example, both protein-energy malnutrition (PEM) and vitamin A deficiency can result in damage to the skin and mucous membranes, allowing microorganisms 14 / 15

to more easily enter the body. Deficiencies of protein and various micronutrients can affect the synthesis of hydrolytic enzymes, complement, antibodies, and other proteins important for immune function. Cell-mediated immunity is impaired in numerous ways by both PEM and zinc deficiencies. Because PEM is usually associated with multiple micronutrient deficiencies, it has been difficult for researchers to separate out the influences of individual nutrients. Nevertheless, zinc, iron, and vitamin A deficiencies are among the most common micronutrient deficiencies worldwide, and a large body of research has demonstrated that each has a strong, independent influence on immunity. Of note, correcting deficiencies of various micronutrients (especially zinc and vitamin A) in malnourished populations has been found to reduce the incidence and severity of illness.

76 : Discuss the undesirable impacts of immune responses on nutrition.

Correct Answer : ?The body’s immune function can sometimes create problems. Exaggerated or inappropriate immune reactions, referred to as hypersensitivity, can lead to discomfort or illness. Allergy is an example of an exaggerated response to an allergen, a harmless protein fragment that may be eaten or inhaled. As another example, the immune complexes formed from antigens and antibodies can cause damage to tissues if not readily cleared by phagocytes.

Autoimmune diseases, including such familiar diseases as type 1 diabetes mellitus and pernicious anemia, develop when immune responses are mounted against the body’s own cells. Although the effects of the immune system are lifesaving when directed at harmful pathogens, they can be life-threatening when turned against the body.

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MULTIPLE CHOICE 1 : What type of nutrition intervention provides referrals to local agencies and arranges transfer of nutrition care to another location?

A : nutrition counseling B : coordination of nutrition care C : nutrition education D : nutrition delivery Correct Answer : B 2 : Which element of nutrition interventions would be accomplished while planning nutrition care?

A : documenting the care plan in the medical record B : individualizing treatment as warranted C : consulting dietetics practice guidelines D : discussing the care plan with the patient Correct Answer : C 3 : The two interrelated components of nutrition education are A : monitoring and evaluation B : examining and supervision C : planning and implementation D : observation and modification

.

Correct Answer : C 4 : Mike needs to make long-term changes to his diet because of a chronic illness. What approach would be most successful in helping Mike implement long-term dietary changes?

A : Determine Mikes readiness to change.

B : Emphasize what to avoid, rather than what to eat.

C : Suggest only five to six changes at a time.

D : Draw up the plan, leaving little room for change or suggestions.

Correct Answer : A 5 : Providing information about a modified diet is an example of A : food/nutrient delivery B : nutrition education C : nutrition counseling D : coordination of nutrition care

.

Correct Answer : B 6 : Solving problems that interfere with the nutrition care plan is an example of A : food/nutrient delivery B : nutrition education C : nutrition counseling D : coordination of nutrition care

.

Correct Answer : C 1 / 14

7 : Which statement describes an important benefit of follow-up care?

A : It allows evaluation and, if necessary, modification of the nutrition care plan.

B : It allows updating of basic patient data such as address and phone number.

C : It is typically required by insurance companies to qualify for payment.

D : It allows clinicians to sharpen their skills.

Correct Answer : A 8 : Nutrition education allows a patient to .

A : evaluate the effectiveness of his nutrition care plan B : determine whether his health plan needs to be updated C : decide if he needs a referral to another health professional D : learn about the dietary factors that affect his medical condition Correct Answer : D 9 : A document or electronic file used to record a clients history, assessment, treatment, and results of therapy is a(n) .

A : medical record B : informal record C : diagnosis D : nutrition care plan Correct Answer : A 10 : Electronic data systems used to house medical records are characterized by A : a lack of popularity among health care facilities B : reliance on handwritten chart notes C : flexibility in language used D : standardized templates

.

Correct Answer : D 11 : What information is included in the A section of the ADIME documentation format?

A : nutrition diagnoses B : expected outcomes C : relevant assessment results D : changes to the care plan Correct Answer : C 12 : The ADIME format for documenting nutrition care A : closely reflects the nutrition care process B : is the oldest charting method for nutrition care used C : uses a D to stand for diet prescription D : focuses on subjective information

.

Correct Answer : A 13 : What does the S stand for in the SOAP note charting format?

A : symptom B : standard 2 / 14

C : subjective D : selective Correct Answer : C 14 : Which part of the SOAP note would include recommendations?

A:S B:O C:A D:P Correct Answer : D 15 : What data is included in the O section of the SOAP note?

A : the chief medical problem B : referrals to appropriate agencies C : the nutrition prescription D : anthropometric data Correct Answer : D 16 : Which section of the ADIME format would contain PES statements?

A:A B:D C:I D : ME Correct Answer : B 17 : In what section of an ADIME chart note would the dietitian record his or her plans for treating the patients nutrition problems?

A:A B:D C:I D : ME Correct Answer : C 18 : The P of PES stands for A : problem B : prescription C : plan D : possible cause

.

Correct Answer : A 19 : The I of ADIME stands for A : intervention B : implementation C : integration D : insurance

.

Correct Answer : A 3 / 14

20 : In which section of ADIME would the treatment goals and expected outcomes be found?

A:A B:D C:I D : ME Correct Answer : C 21 : The clinical dietitian uses A : RMR B : PES C : CBW D : IBW

and stress factors to estimate energy needs.

Correct Answer : A 22 : What is the most accurate method to determine resting metabolic rate?

A : Harris-Benedict equation B : Mifflin-St. Jeor equation C : indirect calorimetry D : bomb calorimeter Correct Answer : C 23 : What is the most accurate method to determine kcalorie needs in overweight or obese patients who are not critically ill?

A : Harris-Benedict equation B : Mifflin-St. Jeor equation C : indirect calorimetry D : bomb calorimeter Correct Answer : B 24 : Use the Harris-Benedict equation (presented below) to estimate daily energy needs for a 32-year-old woman who is 165 cm tall and weighs 46 kg. Use a stress factor of 1.2.RMR = 655.1 + [9.563 × weight (kg)] + [1.85 × height (cm)] - [4.676 × age (years)] A : 1250 kcal B : 1500 kcal C : 1750 kcal D : 2000 kcal Correct Answer : B 25 : Health practitioners should monitor the patients food intake and energy needs regularly during the hospital stay.

A : body weight B : height C : blood pressure D : albumin levels

and reevaluate

Correct Answer : A 4 / 14

26 : The final result of indirect calorimetry is to determine the .

A : amount of energy the patient needs to take in per 24 hours B : number of kcalories burned during a period of study C : factors associated with illness that contribute to high energy intake D : adjustments to make in the patients diet to improve carbohydrate intake Correct Answer : B 27 : Indirect calorimetry is most ideal for which group of patients?

A : bedridden patients B : children C : ambulatory patients D : obese patients Correct Answer : A 28 : What describes a disadvantage of using indirect calorimetry?

A : It requires certification and advanced training.

B : It causes pain for the patient.

C : It is labor intensive.

D : It requires at least 24 hours for accurate results.

Correct Answer : C 29 : A quick way of estimating a persons energy needs is to multiply appropriate for the patients medical condition.

A : 24-hour kcalorie intake B : body weight C : waist circumference D : percent of body fat

by a factor

Correct Answer : B 30 : One of the characteristics of a standard diet is that it A : results in reduced intake of fat and saturated fat B : includes a limited number of foods C : meets the nutrient needs of a normal, healthy individual D : is unlikely to provoke intolerances

.

Correct Answer : C 31 : When a regular diet fails to meet the nutrient needs of a client, a A : standard diet B : nutrition care plan C : modified diet D : nursing diagnosis

is used.

Correct Answer : C 32 : A diet is changed to meet the nutritional and medical needs of a client.

A : modified B : standard C : progressive 5 / 14

D : liquid Correct Answer : A 33 : Jackie is preparing to undergo a colonoscopy in the hospital. What would be the most appropriate diet for Jackie?

A : blenderized diet B : clear liquid diet C : high kcalorie-high protein diet D : low sodium diet Correct Answer : B 34 : Why are diets for dysphagia highly individualized?

A : because of best practice standards B : because swallowing difficulties can vary greatly over time C : to challenge the patient to improve swallowing ability D : to eliminate patient boredom Correct Answer : B 35 : Which food could be included in a blenderized liquid diet?

A : apricots B : Swiss cheese C : yogurt D : corn Correct Answer : C 36 : Liquid diets are often prescribed A : following oral or facial surgeries B : for individuals with edema C : based on personal preference D : to assist with weight loss

.

Correct Answer : A 37 : Which food can be included in a mechanically-altered, ground, or minced diet?

A : cereal bars B : apricot nectar C : pretzels D : granola Correct Answer : B 38 : Which food could be included in a clear liquid diet?

A : cream of potato soup B : tea C : ice cream D : orange juice Correct Answer : B 6 / 14

39 : After surgery, the physician ordered Tina to be put on a clear liquid diet. The first food Tina would receive could be .

A : bread B : eggs C : gelatin D : milk Correct Answer : C 40 : A patient on a sodium-controlled diet has been observed ordering Chinese take-out only a few hours after his nutrition consult. The patient reports that a little salt wont hurt me. The dietitian .

A : decides that the patient needs a stricter sodium-controlled diet B : concludes that providing a list of high sodium foods will help him C : suggests that he also add an exercise plan and more fiber to his current diet D : concludes that the patient is not ready to learn and implement the diet changes Correct Answer : D 41 : Which patient would most likely need a low-fiber diet?

A : a patient in rehabilitation after a burn injury B : a patient who tolerates a clear liquid diet C : a patient who is getting ready for surgery D : a patient who has an allergy to wheat Correct Answer : C 42 : What food would most likely be restricted in a low residue diet?

A : fish B : winter squash C : pudding D : bananas Correct Answer : B 43 : Most foods included in a fat-controlled diet have less than A:1 B : 1/2 C : 1/4 D : 1/10

gram of fat per serving.

Correct Answer : A 44 : For which client would diet progression be appropriate?

A : Betty, who just had gallbladder surgery and is being discharged on a standard diet B : Jim, who has been on a clear liquid diet and now is ready to start eating solid foods again C : Susan, who has been diagnosed with celiac disease and must exclude gluten from her diet D : David, whose cancer has returned and has been transferred to hospice care Correct Answer : B 45 : The process of changing the clients diet as his/her tolerance to food permits is called A : NPO 7 / 14

.

B : diet progression C : nutrition education D : a manual diet Correct Answer : B 46 : What food would most likely be included in a high kcalorie-high protein diet?

A : cranberry juice B : pancakes C : coleslaw D : boiled potatoes Correct Answer : B 47 : Mrs. Greenbaum is suffering from kidney disease and experiencing edema. Which modified diet would be appropriate for her based on this information?

A : fat-controlled diet B : sodium-controlled diet C : high-kcalorie, high-protein diet D : liquid diet Correct Answer : B 48 : Which food would be permitted on a fiber-restricted diet?

A : whole-wheat bread B : chunky peanut butter C : buttermilk D : winter squash Correct Answer : C 49 : A sodium-controlled diet is often used to prevent fluid retention and may be recommended for the treatment of .

A : hyperglycemia B : congestive heart failure C : cancer D : hyperthyroidism Correct Answer : B 50 : In most cases, on a sodium-controlled diet, the sodium level is restricted to per day.

A : 250500 B : 5001000 C : 20003000 D : 40005000

milligrams

Correct Answer : C 51 : Mr. Whitaker is 58, weighs 145 pounds, and has been diagnosed with esophageal cancer.

His hematocrit is 28 percent and his albumin level is 3.1 g/dL. Which diet would assist in improving his nutrition status?

A : mechanical soft diet 8 / 14

B : fat-controlled diet C : high-kcalorie, high-protein diet D : lactose-free diet Correct Answer : C 52 : Delivery of nutrient solutions directly into the vein is called A : enteral nutrition B : modified nutrition C : parenteral nutrition D : tube feeding

.

Correct Answer : C 53 : In which case would a tube feeding be preferred over parenteral nutrition?

A : if the patient has an infection B : if the patient needs extra kcalories C : if the GI tract is functioning normally D : if the patient is deficient in vitamin A Correct Answer : C 54 : A nurse is receiving new orders written in the patient chart. The order reads, NPO, which means that the patient will receive .

A : only beverages and medications B : only medications C : nothing by mouth D : all foods orally Correct Answer : C 55 : In which case would a patient most likely have an order to be NPO? A : a patient who had knee surgery yesterday B : a patient preparing for endoscopy C : a patient who is 85 years old D : a patient who is obese Correct Answer : B 56 : Your client is on a 1200-kcalorie, 2 gram sodium diet. You find each diet in the diet manual but not the combined diet. Where could you best find information regarding this diet?

A : the National Formulary B : the clients physician C : the clients dietitian D : the hospital pharmacy Correct Answer : C 57 : A client has just been admitted to your unit at 11:30 PM on Saturday. He states he is hungry and wants something to eat. You note that he is on a fat-controlled diet, but have questions regarding what exactly is allowed. Your best resource at this time of night is the A : diet manual B : clients physician 9 / 14

.

C : clients dietitian D : nursing supervisor Correct Answer : A 58 : What is a benefit of using a selective menu?

A : Patients can decide whether or not to follow their nutrition plans.

B : Patients become more familiar with the foods included in modified diets.

C : The foodservice department saves money because fewer foods are served.

D : Risks associated with noncompliance are reduced.

Correct Answer : B 59 : What is a problem associated with the use of selective menus?

A : Patients are unable to get the foods they really prefer.

B : Patients may be too ill or too disinterested to make menu selections.

C : Patients often get bored with options.

D : Patients may order far more food than they can consume.

Correct Answer : B 60 : The nurse is preparing one of her patients for lunchtime. She opens the tray and sees the patients pureed food. The nurse should .

A : tell the patient, I hope you know what this is... it all looks like mush to me B : ask visitors to leave, as they are distracting the patient C : ask the patient if he needs help with his meal D : turn off the lights and turn on the television Correct Answer : C 61 : What information is included in a diet manual?

A : kcalorie counts for patients recovering from surgery B : the exact items to avoid when a patient is NPO C : preparation methods to include in modified diets D : food choices that the patient is most likely to eat Correct Answer : C 62 : What intervention would most likely help to improve intake for a hospitalized patient at mealtime?

A : Suggest foods that require little effort to eat.

B : Turn down the lights in the room.

C : Place the patients bed in the highest position.

D : Select all foods for the patient from his menu.

Correct Answer : A 63 : A positive skin-prick test result correctly identifies an allergen A : 50 to 60 B : 60 to 70 C : 70 to 80 D : 80 to 90

percent of the time.

10 / 14

Correct Answer : A 64 : A negative skin-prick test result .

A : is typically incorrect B : indicates it is very unlikely that an allergy exists C : is valid for physical but not psychological symptoms D : is rarely clinically meaningful Correct Answer : B 65 : Blood antibody testing for food allergies .

A : is the most accurate method B : predicts lack of allergy better than actual allergy C : should be considered with other types of evidence D : is rarely clinically meaningful Correct Answer : C 66 : What refers to a systemic (whole-body) reaction characterized by breathing difficulty and a dangerous fall in blood pressure?

A : hives B : oral allergy syndrome C : anaphylaxis D : acute allergic response Correct Answer : C 67 : Because allergic responses may persist after allergens are removed from the diet, A : elimination testing is no longer used B : patients must be cautioned to be scrupulously careful with their diets C : patients are generally inaccurate in identifying foods to which they are allergic D : an elemental formula diet may be needed to stabilize the patient

.

Correct Answer : D 68 : Elemental formula diets .

A : contain no intact proteins B : contain only one type of protein C : are used to provoke allergic responses D : help identify safe foods Correct Answer : A 69 : When properly performed, A : oral food challenges B : skin testing C : blood antibody testing D : food elimination diets

is/are the gold standard for diagnosis of food allergies.

Correct Answer : A 70 : Breaded meats and vegetables are known to be a hidden source of A : eggs

.

11 / 14

B : milk C : peanuts D : shellfish Correct Answer : A

MATCHING 71 : Match each word or phrase with the most appropriate definition or explanation.

A : diet that includes all foods and meets the A : modified diet nutrient needs of healthy people B : selective menu B : diet adjusted in consistency, in level of energy or nutrients, or by the inclusion or elimination of certain foods C : difficulty swallowing C : hives D : liquid formulas delivered through a tube D : standard diet placed in the stomach or intestine E : provision of nutrients through a vein, E : mechanically altered diet bypassing the intestine F : menu with two or more choices in some or F : clear liquid diet all categories G : book that specifies the foods allowed and G : diet manual restricted on modified diets H : menu that only lists pre-selected food items H : tube feedings I : raised, swollen patches of skin or mucous I : anaphylaxis membranes J : modified-texture diet for people with difficulty J : fiber-restricted diet swallowing or oral hypersensitivity K : a severe allergic reaction that may lead to K : parenteral nutrition shock L : sodium-controlled diet L : diet for preparation for bowel surgery, colonoscopy, or acute gastrointestinal illnesses or as a transition diet after intravenous feedings M : diet for acute phases of intestinal disorders M : blenderized liquid diet or to reduce fecal output before surgery N : nonselective menu N : diet for prevention or correction of fluid retention O : diet for persons who cannot chew, swallow, O : dysphagia or tolerate solid foods Correct Answer : A:D B:A C : A14 D:H E:K

12 / 14

F:B G: G H : A13 I:C J:E K:I L:F M:J N : A11 O : A12

ESSAY 72 : Describe the importance of instituting follow-up care after nutrition education.

Correct Answer : ?For optimal results, dietitians should monitor the patient’s progress and periodically evaluate the effectiveness of the nutrition care plan. Doing so usually involves comparing relevant outcome measures (such as the results of blood tests) with initial values and meeting with the patient to learn whether the plan has been satisfactory from the patient’s point of view. Such follow-up efforts can reveal whether the care plan needs to be revised or updated, as is often the case when a person’s medical condition or situation changes. (For example, after a woman delivers a baby, she may need instructions on how to feed her infant or, if she is breastfeeding, how to modify her diet to support lactation). If a follow-up meeting with a dietitian is not possible, a dietetic technician or other qualified health practitioner should provide additional guidance and education.

73 : List the types of modified diets that alter food texture and consistency and explain the appropriate uses of each type.

Correct Answer : ?Modified diets that alter food texture or consistency are often used for those who need assistance with the process of eating or for those who will have procedures that affect how food is eaten or digested. Mechanically altered diets, such as pureed and soft food diets are for people with swallowing difficulties, poor tongue control, or oral hypersensitivity. They are appropriate for those with limited chewing abilities or swallowing impairments. Blenderized liquid diets are for people who cannot chew, swallow easily, or tolerate solid foods. Clear liquid diets are for preparation for bowel surgery or colonoscopy, for acute GI disturbances, or as a transition diet after intravenous feeding.

74 : Compare and contrast tube feeding and parenteral nutrition.

Correct Answer : ?Tube feedings are nutritionally complete formulas that can be delivered 13 / 14

through a tube placed directly into the stomach or intestine. Tube feedings are preferred to parenteral nutrition if the GI tract is functioning normally. A person’s medical condition sometimes prohibits the use of the GI tract to deliver nutrients. If the person is malnourished and the GI tract cannot be used for a significant period of time, parenteral nutrition, in which nutrients are supplied intravenously, can meet nutritional needs.

75 : Discuss the advantages of selective menus and methods used to improve patient satisfaction with food service.

Correct Answer : ?Most hospitals provide selective menus from which patients can select their meals. The use of selective menus allows patients to choose foods they prefer and are most likely to eat. If a patient is following a modified diet, the menu includes only foods that are permitted on that diet. An advantage of this system is that patients following modified diets can become familiar with the foods permitted on their particular diet. To improve patient satisfaction with foodservice as well as patients’ perceptions of their overall hospital experience, many hospitals are moving toward a room service, cook-to-order system similar to what an individual might experience in a hotel. In these facilities, the menus list more food choices than usual and include more fresh foods, seasonal ingredients, and local specialties. Entrées are prepared as they are ordered, and food delivery hours are expanded to better accommodate patients’ varied schedules.

76 : List three common food allergies, and discuss the challenges in managing each.

Correct Answer : ?Eggs and egg proteins are common ingredients in many recipes and processed foods. People with egg allergy should avoid eggs from all birds to prevent crossreactivity. Because vaccines for influenza, rabies, and yellow fever are prepared using egg embryos, people with egg allergies need to check with their physicians before being vaccinated.

Milk and the proteins derived from milk are common ingredients in many prepared and packaged foods. In addition, individuals with milk allergies need to avoid milk from all animals because of the potential for cross-reactivity. Obtaining sufficient calcium and vitamin D from nonmilk sources may be difficult, and supplementation is often warranted. A milk allergy may be difficult to differentiate from lactose intolerance because both conditions can produce gastrointestinal symptoms.Some people with peanut allergies have severe reactions, including anaphylaxis, to even the smallest quantities of peanuts. Although peanut allergy is not necessarily associated with other nut allergies, patients may be advised to avoid all nuts (and seeds, such as sunflower seeds) because of potential contamination from food-processing equipment. People with peanut allergies may also react to lupine flour (produced from seeds of the lupine plant), which is sometimes used as a wheat flour additive in Europe and Australia.

14 / 14

MULTIPLE CHOICE 1 : What organization is responsible for approving sales of new medications and inspecting facilities where drugs are manufactured?

A : Department of Health and Human Services (DHHS) B : Food and Drug Administration (FDA) C : United States Department of Agriculture (USDA) D : Centers for Disease Control and Prevention (CDC) Correct Answer : B 2 : Prescription drugs are given over-the-counter (OTC) status when .

A : 20 years have passed since the drug was first released B : they are considered safe enough for self-medication C : the bioavailability of the drug is similar to that of a generic preparation D : their mechanism of action outweighs their side effects Correct Answer : B 3 : To gain FDA approval, a generic drug must .

A : be less expensive than the original drug B : have the exact bioavailability as the brand-name drug C : have a similar name as the brand-name drug D : contain the same ingredients as the original drug Correct Answer : D 4 : Alexander is administering a medication via injection to his patient. Therefore, his patient is receiving the drug .

A : transdermally B : intramuscularly C : sublingually D : orally Correct Answer : B 5 : What is the purpose of MedWatch?

A : to monitor the need for new medications, especially those for rare illnesses B : to identify and monitor the use of prescription drugs that can be abused or misused C : to set the prices for prescription medications D : to encourage healthcare professionals and consumers to report problems with medications Correct Answer : D 6 : Most drugs are administered through which route?

A : orally B : sublingually C : transdermally D : by injection Correct Answer : A

1 / 15

7 : Loss of drug potency associated with metabolism by liver enzymes is referred to as A : hepatic degradation B : first-pass elimination C : enzymatic elimination D : unavoidable loss

.

Correct Answer : B 8 : Any preventable event that causes inappropriate drug use or patient harm due to mistakes made by the health professional, patient, or caregiver is known as a(n) .

A : diet-drug interaction B : adverse reaction C : drug-drug interaction D : medication error Correct Answer : D 9 : What is a policy that has been developed to reduce the risk of mistakes when administering medications?

A : bar codes on medications B : increased off-label medication use C : mandatory reporting of side effects D : monitored drug disposal in pharmacies Correct Answer : A 10 : Which measurement is written correctly?

A : 7.0 B : .70 C : 0.7 D : .77 Correct Answer : C 11 : Which medical abbreviation can be mistaken for every day?

A : TWA B : TIW C : TID D : QOD Correct Answer : D 12 : What is a prohibited term in clinical documentation?

A : IU B : mg C : unit D : 0.1 mL Correct Answer : A 13 : Why are the elderly more vulnerable to adverse effects from medications than other populations?

A : impaired function of the liver or kidneys 2 / 15

B : inability to afford multiple medications C : the focus on older adults among clinical trials D : susceptibility to acute infections Correct Answer : A 14 : What intervention would most likely reduce the risk of adverse effects from medications?

A : Advise patients to take the drugs on a continuous schedule.

B : Tell the patient to write down side effects after he has finished the prescription.

C : Encourage a patient to call the physician or nurse prior to taking each dose of the medication.

D : Obtain a list of all drugs and herbal supplements the patient is taking.

Correct Answer : D 15 : A drug that alters taste and smell may interact with diet by altering A : food intake B : motivation to take the drug C : nutrient absorption D : nutrient excretion

.

Correct Answer : A 16 : A drug that alters digestive tract acidity may interact with diet by altering A : food intake B : motivation to take the drug C : nutrient absorption D : nutrient excretion

.

Correct Answer : C 17 : Food substances and drugs may interact and cause toxicity by A : increasing side effects of the drug B : causing diarrhea and vomiting C : damaging mucosal cells D : interfering with the sense of smell

.

Correct Answer : A 18 : Charbroiled meats may increase the metabolism of A : tetracycline B : warfarin C : amphetamine D : phenobarbital

.

Correct Answer : B 19 : Bile acid binders may also bind to A : water-soluble vitamins B : trace minerals C : fat-soluble vitamins D : protein analogs

.

3 / 15

Correct Answer : C 20 : In which way can a diet-drug interaction alter nutrient excretion?

A : by acting as structural analogs B : by increasing drug action to excessive levels C : by causing diarrhea or vomiting D : by damaging mucosal cells Correct Answer : C 21 : Excretion of calcium and potassium may be increased by some A : diuretics B : antihistamines C : antidepressants D : psychotropics

.

Correct Answer : A 22 : The antifungal agent ketoconazole is absorbed better A : with meals B : on an empty stomach C : immediately upon awakening D : just prior to bed

.

Correct Answer : A 23 : Which medication would most likely cause nutrient malabsorption because of damage to the gastrointestinal tract?

A : anticonvulsants B : antineoplastics C : antivirals D : antihypertensives Correct Answer : B 24 : Which central nervous system-acting drug is affected by grapefruit juice?

A : carbamazepine B : haloperidol C : lorazepam D : risperidone Correct Answer : A 25 : A person who takes phenobarbital regularly may need supplements of which nutrient?

A : vitamin D B : magnesium C : potassium D : vitamin C Correct Answer : A 26 : Methotrexate resembles converts it to its active form.

in structure and competes with it for the enzyme that 4 / 15

A : iron B : folate C : phosphorus D : calcium Correct Answer : B 27 : Mr. White has been prescribed corticosteroids. He should expect A : suppression of appetite B : weight loss C : reduced depression D : increased appetite

.

Correct Answer : D 28 : Mr. Ahmed has bladder cancer. His appetite, intake, and weight have declined over the past few weeks. The doctor prescribes to increase his intake.

A : methotrexate B : megestrol acetate C : amphetamines D : liver enzymes Correct Answer : B 29 : A possible side effect of some antibiotics, such as ciprofloxacin, is A : dry mouth B : reduced calcium absorption C : reduced iron absorption D : enhanced tumor growth

.

Correct Answer : B 30 : The amount of lithium reabsorbed in the kidneys is similar to the amount of reabsorbed, so dehydration can result in lithium retention.

A : sodium B : folate C : magnesium D : phosphorus

that is

Correct Answer : A 31 : Betty has been prescribed an antiulcer agent. Her physician will monitor Bettys side effects.

A : iron status B : GI comfort C : renal function D : sodium excretion

for

Correct Answer : A 32 : A person who takes an MAOI and consumes food that contains tyramine could suffer from .

A : hearing loss 5 / 15

B : peripheral edema C : hallucinations D : severe headache Correct Answer : D 33 : Glenn has been on corticosteroids for many years. This long-term use may cause A : weight loss B : osteoporosis C : hypoglycemia D : appetite suppression

.

Correct Answer : B 34 : Altered excretion of potassium, magnesium, and calcium are side effects associated with the use of .

A : narcotics B : antihypertensives C : diuretics D : laxatives Correct Answer : C 35 : Dietary and herbal supplements that can interact with warfarin include A : dong quai B : vitamin D C : vitamin C D : Echinacea

.

Correct Answer : A 36 : A patient who is taking an MAOI should avoid which lunchtime entrée?

A : Reuben sandwich B : split pea soup C : lettuce salad with ranch dressing D : pork chops with steamed carrots Correct Answer : A 37 : Mrs. Appleton has been diagnosed with depression and her physician has prescribed a monoamine oxidase inhibitor. He instructs her to avoid consuming large amounts of tyramine.

Which food should be safe for Mrs. Appletons diet?

A : aged cheese B : oranges C : mushrooms D : sausage Correct Answer : B 38 : Ms. Holmes is taking an MAO inhibitor. She is at the food court and needs to pick the best meal. Which food would contain the largest amount of tyramine?

A : chocolate B : scrambled eggs 6 / 15

C : hot dogs D : Swiss cheese Correct Answer : D 39 : The scientific name for black cohosh is A : Cimicifuga racemosa B : Tanacetum parthenium C : Zingiber officinale D : Serenoa repens

.

Correct Answer : A 40 : What describes a potential adverse effect of using St. Johns wort?

A : skin photosensitivity B : heartburn C : liver damage D : weight gain Correct Answer : A 41 : Which herb is correctly paired with its common use among consumers?

A : feverfewtreatment of mild-to-moderate depression B : black cohoshrelief of menopausal symptoms C : saw palmettoprevention of migraine headaches D : gingerwound healing (topical use) Correct Answer : B 42 : Which herbal preparation may be taken to reduce blood clotting?

A : St. Johns wort B : garlic C : ginseng D : valerian Correct Answer : B 43 : Which herbal preparation may be taken to treat erectile dysfunction?

A : saw palmetto B : feverfew C : ginseng D : yohimbe Correct Answer : D 44 : Which herbal preparation has been associated with the occurrence of mouth and tongue sores?

A : saw palmetto B : feverfew C : ginseng D : yohimbe Correct Answer : B 7 / 15

45 : Consumers rarely find listed on supplement labels.

A : adverse effects of herbs B : the name of the manufacturer C : ambiguous statements about health benefits D : incorrect information about herb species or potency Correct Answer : A 46 : In a university study that evaluated the authenticity of 44 single-herb supplements, percent of the products were found to contain a completely different plant species than was listed on the label.

A : 12 B : 32 C : 49 D : 61 Correct Answer : B 47 : Chamomile has been shown to have an interaction with which type of drug?

A : anticoagulants B : immunosuppressants C : antiarrhythmics D : diuretics Correct Answer : A 48 : When goldenseal is used with anticoagulants, which side effect is the patient at risk for?

A : hypotension B : cardiac arrhythmias C : blood clots D : aortic aneurysm Correct Answer : C 49 : What best explains why older adults are at higher risk of drug interactions with herbal supplements?

A : Older adults are more likely to take more than three different medications at a time.

B : The bodies of older adults cannot process herbal supplements at all.

C : Older adults do not always understand how to buy the correct supplements for what they need.

D : The herbal supplements provided to older adults are more likely to have fillers and toxic agents.

Correct Answer : A 50 : What are the most common adverse effects of herbs?

A : diarrhea, nausea, and vomiting B : liver damage C : renal failure D : seizures and heart palpitations Correct Answer : A 8 / 15

51 : Physicians who refer patients for complementary therapies while continuing to provide standard treatments are practicing what is known as medicine.

A : integrative B : complementary C : alternative D : conventional Correct Answer : A 52 : Homeopathic medicine and naturopathic medicine are examples of A : mind-body interventions B : manual healing methods C : alternative systems of medical practice D : pharmacological treatments

.

Correct Answer : C 53 : An example of a mind-body intervention is A : Ayurveda B : faith healing C : ozone therapy D : homeopathy

.

Correct Answer : B 54 : The complementary/alternative approach that proposes that a persons natural life force can foster self-healing is called .

A : chiropractic B : homeopathy C : biofeedback D : naturopathic medicine Correct Answer : D 55 : Which method is based on the theory that like cures like?

A : chiropractic B : homeopathy C : biofeedback D : naturopathic medicine Correct Answer : B 56 : Emma Wiseman is an 85-year-old widow and retired elementary school teacher. She lives alone and her closest relatives live about an hour away. She has a past medical history of breast cancer, hypertension, and osteoporosis. Emma currently takes six medications. She has been having difficulty opening her medication bottles and decided to put all of her pills into one container. After doing this she realizes that some of them look the same and she is unsure which medication she should take with her dinner.Emma should .

A : take any pill B : contact her pharmacist C : stop her medications D : purchase OTC medications instead 9 / 15

Correct Answer : B 57 : Emma Wiseman is an 85-year-old widow and retired elementary school teacher. She lives alone and her closest relatives live about an hour away. She has a past medical history of breast cancer, hypertension, and osteoporosis. Emma currently takes six medications. She has been having difficulty opening her medication bottles and decided to put all of her pills into one container. After doing this she realizes that some of them look the same and she is unsure which medication she should take with her dinner.Emma reports that she has had decreased appetite and weight loss over the last three days. She may be suffering from .

A : a medication error B : medication side effects C : anorexia D : cross reactivity Correct Answer : B 58 : Emma Wiseman is an 85-year-old widow and retired elementary school teacher. She lives alone and her closest relatives live about an hour away. She has a past medical history of breast cancer, hypertension, and osteoporosis. Emma currently takes six medications. She has been having difficulty opening her medication bottles and decided to put all of her pills into one container. After doing this she realizes that some of them look the same and she is unsure which medication she should take with her dinner.Upon further examination, one of Emmas medications is identified as an herbal supplement that may treat dementia and memory deficits.

This medication is most likely .

A : garlic B : ginger C : gingko D : ginseng Correct Answer : C 59 : Emma Wiseman is an 85-year-old widow and retired elementary school teacher. She lives alone and her closest relatives live about an hour away. She has a past medical history of breast cancer, hypertension, and osteoporosis. Emma currently takes six medications. She has been having difficulty opening her medication bottles and decided to put all of her pills into one container. After doing this she realizes that some of them look the same and she is unsure which medication she should take with her dinner.This situation may have been prevented by identifying Emma as .

A : part of a low-risk group B : one who takes multiple medications C : one who needs herbal products D : one who should consider alternative medicine Correct Answer : B 60 : Emma Wiseman is an 85-year-old widow and retired elementary school teacher. She lives alone and her closest relatives live about an hour away. She has a past medical history of breast cancer, hypertension, and osteoporosis. Emma currently takes six medications. She has been having difficulty opening her medication bottles and decided to put all of her pills into one container. After doing this she realizes that some of them look the same and she is unsure which medication she should take with her dinner.Which condition and its medication/treatment could cause Emma to have mouth sores?

10 / 15

A : cancer B : osteoporosis C : depression D : hypertension Correct Answer : A 61 : Ralph Mitchell is a 53-year-old male. He is happily married with three children and has his own business. Today, he is having his yearly physical. He lists the following medications on his "Patient History" paperwork: aspirin, lovastatin, hydrochlorothiazide, warfarin, garlic, and vitamin C.Upon reviewing his medications, we can assume that Ralph suffers from .

A : obesity B : diabetes C : osteoporosis D : cardiovascular disease Correct Answer : D 62 : Ralph Mitchell is a 53-year-old male. He is happily married with three children and has his own business. Today, he is having his yearly physical. He lists the following medications on his "Patient History" paperwork: aspirin, lovastatin, hydrochlorothiazide, warfarin, garlic, and vitamin C.Which of Ralphs medications is an OTC drug?

A : aspirin B : lovastatin C : warfarin D : hydrochlorothiazide Correct Answer : A 63 : Ralph Mitchell is a 53-year-old male. He is happily married with three children and has his own business. Today, he is having his yearly physical. He lists the following medications on his "Patient History" paperwork: aspirin, lovastatin, hydrochlorothiazide, warfarin, garlic, and vitamin C.Given the medications he is taking, Ralph needs to control his intake of .

A : chocolate B : charbroiled meats C : chicken wings D : applesauce Correct Answer : B 64 : Ralph Mitchell is a 53-year-old male. He is happily married with three children and has his own business. Today, he is having his yearly physical. He lists the following medications on his "Patient History" paperwork: aspirin, lovastatin, hydrochlorothiazide, warfarin, garlic, and vitamin C.Which of Ralphs medications requires a prescription?

A : aspirin B : lovastatin C : garlic D : vitamin C Correct Answer : B 65 : Ralph Mitchell is a 53-year-old male. He is happily married with three children and has his own business. Today, he is having his yearly physical. He lists the following medications on his 11 / 15

"Patient History" paperwork: aspirin, lovastatin, hydrochlorothiazide, warfarin, garlic, and vitamin C.Ralph shouldnt drink .

A : water B : milk C : grapefruit juice D : orange juice Correct Answer : C

MATCHING 66 : Match each word or phrase with the most appropriate definition or explanation.

A : medications given to treat serious conditionsA : herbal supplements that may cause severe side effects B : any preventable action that causes B : National Center for Complementary and inappropriate drug use or patient harm due to Alternative Medicine mistakes made by a health professional or patient C : agency responsible for approving sales of C : megestrol acetate new medications and inspecting facilities where drugs are manufactured D : prescription drugs D : drugs that can be used safely and effectively without medical supervision E : process whereby substances in the diet alterE : isoniazid the effectiveness of drugs and drugs may affect food intake or nutrient metabolism F : botanical products such as garlic and ginkgo F : Food and Drug Administration G : drugs that can combat tumor growth G : cortisol H : an antituberculosis medication H : drug-drug interactions I : process whereby one drug alters the effects I : over-the-counter drugs of another drug and the risk of side effects increases J : a steroid hormone secreted by the adrenal J : diet-drug interactions cortex K : generic drugs K : agency whose mission is to investigate complementary and alternative therapies by funding well-designed scientific studies L : versions of brand-name drugs that can be L : antineoplastic sold after the patent protection of brand-name drugs expires M : a traditional medical system from India that M : Ayurveda promotes the use of diet, herbs, meditation, massage, and yoga for preventing and treating illness N : an appetite enhancer N : tyramine O : compound in some foods that can cause a O : medication error sudden release of accumulated norepinephrine Correct Answer : A:D

12 / 15

B : A14 C:F D:I E:J F:A G : A11 H:E I:H J:G K:B L:K M : A12 N:C O : A13

ESSAY 67 : In what ways are over-the-counter and prescription medications different?

Correct Answer : ?Prescription drugs are usually given to treat serious conditions and may cause severe side effects. For these reasons, they are sold by prescription only, which ensures that a physician has evaluated the patient’s medical condition and determined that the benefits of using the medication outweigh the risks of incurring side effects. Over-the-counter (OTC) drugs are those that individuals can use safely and effectively without medical supervision.

People use them to treat less serious illnesses that are easily self-diagnosed. Examples include aspirin to treat headaches or pain and antacids to combat acid reflux. The FDA regulates labels on OTC drugs to make sure they provide accurate information about the drugs’ appropriate uses and dosages and potential adverse effects. Prescription drugs considered safe enough for self- medication are often given OTC status, sometimes in smaller doses than are available by prescription.

68 : Explain how policies are being improved in the health care community to reduce instances of medication errors.

Correct Answer : ?Several policies are helping to reduce medication errors. The bar codes currently used on medications and patient identification bracelets allow health practitioners to verify that the correct medication and dosage are administered: error messages alert personnel 13 / 15

if the drug, dose, or timing of administration is inappropriate. In addition, a national education campaign is attempting to eliminate one of the most common but preventable sources of medication errors—the use of ambiguous medical abbreviations. Because terms such as these are easily misread or misinterpreted, they should no longer be used in clinical documentation related to patient care.

69 : Explain why some patients are at higher risk of adverse effects from medications when compared to others.

Correct Answer : ?Health care professionals should be aware that some patients are more vulnerable than others to adverse effects from drugs. This category includes the populations that rarely participate in clinical trials that determine product safety: pregnant and lactating women, children, and people with medical conditions that are not the main focus of the study. In these groups, side effects may be discovered only after a drug has been marketed. Children may react in different ways to drugs than adults do, and the appropriate dosage for their age and size is often unknown. Also, limited data are available on drug safety in older adults. Elderly people with chronic diseases that require multiple medications are especially susceptible to adverse effects. They are also more likely to have impaired function of the liver or kidneys—the two organs critical for metabolizing drugs and eliminating drugs from the body.

70 : Provide examples of drug-induced side effects that can limit food intake.

Correct Answer : ?Drugs can produce side effects that impact various mechanisms of how the body takes in and uses nutrients, including by limiting food intake. Ways that drug interactions alter food intake include altering the appetite, interfering with taste or smell, inducing nausea or vomiting, interfering with oral functioning, or causing sores or inflammation in the mouth.

71 : Explain how stomach acidity can affect drug absorption.

Correct Answer : ?Some drugs are absorbed better in an acidic environment, whereas others are absorbed better under alkaline conditions. For example, reduced stomach acidity (due to secretory disorders or antacid medications) may reduce the absorption of ketoconazole (Nizoral, an antifungal medication) and atazanavir (an antiretroviral medication), but increase the absorption of digoxin (Lanoxin, which treats heart failure) and alendronate (Fosamax, which treats osteoporosis). Some drugs can be damaged by acid and are available in coated forms that resist the stomach’s acidity.

72 : How can metabolism be affected in relation to diet-drug interactions?

Correct Answer : ?Some food components alter the activities of enzymes that metabolize drugs or may counteract drug effects in other ways. Compounds in grapefruit juice (or whole grapefruit) have been found to inhibit or inactivate enzymes that metabolize a number of different drugs. As a result of the reduced enzyme action, blood concentrations of the drugs increase, leading to stronger physiological effects. The effect of grapefruit juice can last for a substantial period, possibly as long as several days after the juice is consumed; thus, the interaction cannot be avoided just by separating grapefruit juice consumption from drug administration.

73 : What are some safety concerns associated with the use of herbal products?

Correct Answer : ?Consumers often assume that because plants are “natural,” herbal products must be harmless. Many herbal remedies have toxic effects, however. The most common adverse effects of herbs include diarrhea, nausea, and vomiting. The popular herbs chaparral, 14 / 15

germander, green tea, kava, and pennyroyal have caused liver damage. Contamination of herbal products is another safety concern. Many products have been found to contain lead and other toxic metals in excessive amounts. Other contaminants frequently found in herbal supplements include molds, bacteria, and pesticides that have been banned for use on food crops. Adulteration of imported products is a serious concern; for example, chemical analyses have frequently identified synthetic drugs that were not declared on the label. Illnesses or fatalities sometimes result from the intentional or accidental substitution of one plant species for another. Some herbal products have been found to contain unlisted fillers made from rice, soybean, or wheat that may pose a health risk for persons with allergies to these substances.

74 : Describe how using herbal supplements to treat illnesses can cause safety concerns.

Correct Answer : ?When people self-medicate or ask the advice of store clerks instead of seeking effective medical treatment, the consequences are sometimes serious and irreversible.

Purchasing an herbal remedy may be less stressful than a visit to the doctor, but it may delay getting appropriate treatment and allow an illness to progress. Although retailers are not legally permitted to provide medical advice, sellers of herbal products routinely make improper claims that the products are able to treat, prevent, or cure specific illnesses. Patients are often unaware that herbal products may be unsafe or can interact with medications.

75 : Briefly describe the concept of traditional Chinese medicine (TCM).

Correct Answer : ?Traditional Chinese medicine (TCM) includes a large number of folk practices that originated in China. TCM is based on the theory that the body has pathways (called meridians) that conduct energy (called qi). The interrupted flow of qi is believed to cause illness.

TCM practices allegedly improve the flow of qi and include acupuncture, qi gong, herbal remedies, dietary practices, and massage.

76 : Describe a manipulative or body-based therapy. Include a discussion of its effectiveness and validity.

Correct Answer : ?Massage therapy is the manipulation of muscle and connective tissue to improve muscle function, reduce pain, or promote relaxation. Massage therapists may also apply heat or cold and give advice about exercises that may improve muscle tone and range of motion. Massage is often integrated into conventional physical therapy, although some massage therapists may incorrectly suggest that massage is a valid treatment for a wide range of medical conditions.

15 / 15

MULTIPLE CHOICE 1 : Lora, age 57, is receiving chemotherapy and radiation for cancer and will soon have surgery.

She is in need of oral supplementation to help improve her nutritional status prior to the surgery.

What might be done to help her accept oral supplements?

A : Allow her to try several formulations to find one she likes.

B : Warn her that her surgery will have to be delayed if she does not accept them.

C : Give her a trial of tube feeding so she will prefer the oral supplements.

D : Acknowledge that they taste terrible but tell her they are better than the alternative.

Correct Answer : A 2 : Alan has been diagnosed with cancer and needs oral supplements to prevent weight loss.

What oral supplement that can be purchased over-the-counter should be recommended for Alan?

A : Special K® B : Nutrisystem® C : SlimFast® D : Ensure® Correct Answer : D 3 : What is a good guideline for serving oral supplements to hospitalized patients?

A : Serve beverages in the can they come in, so that the patient can recognize them.

B : Serve beverages as cold as possible to minimize the often-unpleasant taste.

C : Serve the supplements attractively, in a glass on a plate, which may help patients consume them.

D : Serve the same flavor every day so that the patient will get used to them.

Correct Answer : C 4 : Which element is necessary for the use of enteral nutrition?

A : a functional GI tract B : a good appetite C : good peripheral venous access D : minimal nutritional needs Correct Answer : A 5 : A general-purpose enteral formula that contains intact proteins is a(n) A : standard B : elemental C : modular D : hydrolyzed

formula.

Correct Answer : A 6 : Which condition or treatment may indicate the need for tube feedings?

A : obesity B : mechanical ventilation C : systemic infection D : potassium depletion 1 / 15

Correct Answer : B 7 : Standard formulas are used for clients who A : require large amounts of kcalories B : are able to digest and absorb nutrients C : are severely malnourished D : require intravenous feedings

.

Correct Answer : B 8 : If a patient is going to be tube fed for longer than be necessary.

A : 1 week B : 4 weeks C : 2 months D : 6 months

, a gastrostomy or jejunostomy may

Correct Answer : B 9 : In which patient should gastric feedings be avoided?

A : a pediatric patient B : a patient at risk of aspiration C : a patient with extremely high nutrient requirements D : a patient with severe malnutrition Correct Answer : B 10 : An opening in the abdomen through which a feeding tube can be passed to the stomach is called a(n) .

A : ileostomy B : endoscopic jejunostomy C : gastrostomy D : duodenostomy Correct Answer : C 11 : A(n) feeding tube placement may be preferred for infants because it allows normal breathing.

A : nasoduodenal B : nasogastric C : orogastric D : nasoenteric Correct Answer : C 12 : Which feeding tube placement may require a surgical procedure?

A : nasogastric B : nasojejunal C : enterostomy D : nasoduodenal Correct Answer : C 2 / 15

13 : The type of feeding tube that requires the most difficult insertion procedure is a(n) tube.

A : orogastric B : nasoduodenal C : nasojejunal D : jejunostomy Correct Answer : D 14 : Mr. Heiman has suffered a stroke and now has dysphagia (difficulty swallowing). He is 58 and weighs 127 pounds. The most appropriate method of nutrition support for him would be .

A : gastrostomy feedings B : nasojejunal feedings C : liquid supplements D : jejunostomy feedings Correct Answer : A 15 : Which feeding site is most appropriate for clients requiring long-term nutrition support?

A : enterostomy B : nasoenteric C : nasogastric D : orogastric Correct Answer : A 16 : A disadvantage of transnasal tube placement is that A : it is not an effective means for tube feeding B : the tube can be easily pulled out C : the tube is inserted through the skin D : the tube can be passed to the jejunum

.

Correct Answer : B 17 : Standard formulas are also referred to as A : polymeric B : MCT C : elemental D : modular

formulas.

Correct Answer : A 18 : Elemental formulas are also called A : polymeric B : specialty C : hydrolyzed D : disease-specific

formulas.

Correct Answer : C 19 : The protein content of enteral formulas is usually

percent of total kcalories.

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A : 2 to 10 B : 12 to 20 C : 22 to 30 D : 32 to 40 Correct Answer : B 20 : The fat content of enteral formulas is usually A : 5 to 10 B : 15 to 30 C : 35 to 50 D : 55 to 60

percent of total kcalories.

Correct Answer : B 21 : What is a carbohydrate source used in many standard formulas?

A : aldose B : maltodextrin C : amylopectin D : cellulose Correct Answer : B 22 : Most enteral formulas have energy density of A : 1.0 to 2.0 B : 2.0 to 3.0 C : 3.0 to 4.0 D : 4.0 to 5.0

kcalories per milliliter of fluid.

Correct Answer : A 23 : A formula with an osmolality greater than that of blood serum is known as a(n) formula.

A : isotonic B : hypertonic C : enteral D : complete Correct Answer : B 24 : A patient with fluid, electrolyte, and protein restrictions would most likely need which type of formula?

A : carbohydrate-modified B : high-kcalorie C : renal or hepatic insufficiency D : standard formula with moderate fiber content Correct Answer : C 25 : The vast majority of patients use which type of enteral formula?

A : standard B : hydrolyzed C : specialized 4 / 15

D : modular Correct Answer : A 26 : A health care provider is preparing to administer a tube feeding to a patient with a nasogastric tube. To best reduce the risk of formula contamination, the caregiver should perform which step first?

A : Clean the lid of the can with an alcohol wipe.

B : Warm the can in a pan of hot water.

C : Pour the contents of the can into a clean container.

D : Label the can with the date and time of its opening.

Correct Answer : A 27 : What can happen when medications are infused along with enteral feedings?

A : The osmotic load can increase substantially and may contribute to diarrhea.

B : Fluid overload can occur due to the additional need for water flushes.

C : Risk of aspiration increases due to the need for additional water flushes.

D : The medication can reach toxic levels in the body more easily.

Correct Answer : A 28 : Proper sterile techniques should be used during preparation and delivery of formulas to protect patients from .

A : receiving the wrong formula B : exposure to foodborne illness C : malnutrition D : dehydration Correct Answer : B 29 : Health care facilities have protocols for handling food products and formulas based on the potential hazards and critical control points in food preparation, which are called .

A : HACCP systems B : Joint Commission mandates C : MSDS requirements D : AHA standards Correct Answer : A 30 : What is a characteristic of an open feeding system?

A : A greater variety of formulas can be used.

B : The formula must be transferred from its original container.

C : An aseptic technique is not necessary.

D : This system costs more initially.

Correct Answer : B 31 : What is a characteristic of a closed feeding system?

A : The formula can hang for a longer period of time.

B : It is more expensive in the long run.

C : Aseptic technique is not necessary.

D : It requires far more nursing time.

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Correct Answer : A 32 : Open containers of formula that are unused should be disposed of within A : 6 to 8 B : 8 to 12 C : 12 to 24 D : 24 to 48

hours.

Correct Answer : D 33 : When an open feeding system is used, the nurse should hang no more than a(n) supply.

A:6 B:8 C : 12 D : 16

hour

Correct Answer : B 34 : A fasting gastric secretion sample typically has a pH of A : 5 or lower B : 6 to 7 C : 8 to 9 D : 10 or higher

.

Correct Answer : A 35 : A respiratory secretion sample typically has a pH of A : 3 or lower B:4 C:5 D : 6 or higher

.

Correct Answer : D 36 : To reduce the risk of aspiration, the patients upper body is elevated to a during the feeding.

A : 5 to 10 B : 15 to 30 C : 30 to 45 D : 45 to 60

degree angle

Correct Answer : C 37 : Intermittent tube feedings are best tolerated when they are administered over A : 5 to 10 minutes B : 30 to 45 minutes C : 1 to 2 hours D : 4 to 6 hours

.

Correct Answer : B 6 / 15

38 : Iris has an order for continuous tube feedings through her nasogastric tube. She is to receive 2500 mL of formula on a continuous basis over 24 hours. What hourly rate should the healthcare provider set the pump at?

A : 25 mL B : 58 mL C : 104 mL D : 250 mL Correct Answer : C 39 : The delivery of up to 500 mL of formula within 10 minutes is termed a(n) A : minimal residual feeding B : intermittent feeding C : bolus feeding D : a continuous drip

.

Correct Answer : C 40 : Intermittent feeding using the gravity drip is suitable for the delivery of no more than how much formula over 30 minutes?

A : 100 mL B : 200 mL C : 300 mL D : 400 mL Correct Answer : D 41 : A patient who does not tolerate a bolus feeding would most likely develop what symptoms?

A : abdominal discomfort and nausea B : headache and blurred vision C : confusion and anxiety D : constipation and edema Correct Answer : A 42 : Which tube feeding delivery method is done every 3 to 4 hours using a syringe?

A : continuous feedings B : bolus feedings C : sustainable feedings D : cyclic feedings Correct Answer : B 43 : Tom is a 15-year-old who is eating some but must also receive enteral feedings for malnutrition associated with Crohns disease. To help Tom carry on normal activities, the health care team might try .

A : continuous feedings B : intermittent feedings C : a neon-colored feeding tube D : brightly colored formulas Correct Answer : B 7 / 15

44 : Mr. Simpson is receiving formula intermittently six times a day. He needs 1500 mL every 24 hours. How many milliliters of formula is Mr. Simpson receiving at each feeding?

A : 120 B : 250 C : 333 D : 900 Correct Answer : B 45 : Why are bolus feedings used only in patients who are not critically ill?

A : Bolus feedings restrict the patients movements for long periods of time.

B : Risk of aspiration is greater than with other delivery methods.

C : Bolus feedings wouldnt be adequate to meet the patients nutrition needs in this situation.

D : Bolus feedings require the use of an infusion pump.

Correct Answer : B 46 : For what purpose would a nurse measure the gastric residual volume in a patients feeding tube?

A : to check that the stomach is emptying properly B : to ensure that the patient is receiving adequate water C : to prevent dumping syndrome and diarrhea D : to ensure that medications have been digested Correct Answer : A 47 : Typically, adults require A : 5 to 8 B : 10 to 12 C : 15 to 20 D : 30 to 40

mL/kg of water daily.

Correct Answer : D 48 : Samuel is an 88-year-old patient with a gastrostomy tube. The healthcare provider knows that Samuel will not always recognize thirst, even though he may need extra water. To evaluate Samuels hydration status, the provider will check his .

A : white blood cell count B : respiratory rate C : blood urea nitrogen D : waist circumference Correct Answer : C 49 : A nurse determines that his patients jejunostomy tube is clogged. What is a possible cause?

A : using liquid medications B : using a viscous energy-dense formula C : excessive water flushing D : using a low-fiber formula Correct Answer : B 8 / 15

50 : What is a potential metabolic complication of tube feedings?

A : elevated heart rate B : hyperglycemia C : increased vitamin C levels D : redness and irritation at the tube insertion site Correct Answer : B 51 : How often should the feeding tube placement be checked if the patient is on intermittent feedings?

A : before each feeding is initiated B : after each feeding C : every 6 hours D : every 12 hours Correct Answer : A 52 : How often should the feeding tube be flushed if the patient is on continuous feedings?

A : every 4 to 6 hours B : every 8 hours C : every 12 hours D : daily Correct Answer : A 53 : A patient with a jejunostomy tube has developed an infection around the tubes insertion site. What measure would most likely correct this situation?

A : Use a small-bore tube.

B : Ensure that medication doses are appropriate.

C : Apply a protective dressing.

D : Remove the tube for 24 hours.

Correct Answer : C 54 : Nausea, vomiting, and cramps in a patient with a feeding tube are most likely caused by .

A : an inappropriate size feeding tube B : inadequate fiber intake C : a lack of exercise D : delayed stomach emptying Correct Answer : D 55 : In the United States, phenylketonuria (PKU) affects approximately 1 out of annually.

A : 5,000 B : 12,700 C : 34,500 D : 150,000

births

Correct Answer : B 56 : The only current treatment for phenylketonuria (PKU) is a diet that

.

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A : restricts phenylalanine and tyrosine B : supplies tyrosine and valine C : supplies valine and restricts phenylalanine D : supplies tyrosine and restricts phenylalanine Correct Answer : D 57 : Nondietary therapies can treat some inborn errors of metabolism. In some cases, the missing protein is infused, such as in the case of .

A : PKU B : cystic fibrosis C : hemophilia D : galactosemia Correct Answer : C 58 : Dietary changes may be able to improve outcomes of some inborn errors by A : promoting the accumulation of metabolites B : providing a diet that supports growth and development C : altering hormone levels to improve organ function D : minimizing or eliminating symptoms of disease

.

Correct Answer : B 59 : The main focus of the dietary treatment for galactosemia is the A : exclusion of galactose B : provision of galactose C : exclusion of protein D : provision of essential fatty acids

.

Correct Answer : A 60 : Kristina is a 4-year-old with galactosemia. Her caregivers must ensure adequate intake of .

A : vitamin C B : calcium C : vitamin E D : potassium Correct Answer : B 61 : Eighty-year-old Antonio Hernandez has a past medical history of hypertension, elevated cholesterol, and diabetes. He suffers a massive stroke and is stabilized in the CCU (coronary care unit). It is determined that it is unsafe to feed him orally and a tube feeding will be started immediately.Which feeding route would be the most appropriate for Antonio?

A : orogastric B : nasogastric C : gastrostomy D : jejunostomy Correct Answer : B 62 : Eighty-year-old Antonio Hernandez has a past medical history of hypertension, elevated 10 / 15

cholesterol, and diabetes. He suffers a massive stroke and is stabilized in the CCU (coronary care unit). It is determined that it is unsafe to feed him orally and a tube feeding will be started immediately.For the first 24 hours, Antonios tube feeding should be delivered by a(n) feeding method.

A : continuous B : daily C : intermittent D : bolus Correct Answer : A 63 : Eighty-year-old Antonio Hernandez has a past medical history of hypertension, elevated cholesterol, and diabetes. He suffers a massive stroke and is stabilized in the CCU (coronary care unit). It is determined that it is unsafe to feed him orally and a tube feeding will be started immediately.The nurse will determine whether Antonio is tolerating the tube feeding by .

A : diluting the formula B : adding dye to the formula C : checking gastric residuals D : adding drug therapy Correct Answer : C 64 : Eighty-year-old Antonio Hernandez has a past medical history of hypertension, elevated cholesterol, and diabetes. He suffers a massive stroke and is stabilized in the CCU (coronary care unit). It is determined that it is unsafe to feed him orally and a tube feeding will be started immediately.Which nutrient(s) must be supplemented in order to meet Antonios nutritional needs?

A : protein B : vitamins and minerals C : MCT D : water Correct Answer : D 65 : Eighty-year-old Antonio Hernandez has a past medical history of hypertension, elevated cholesterol, and diabetes. He suffers a massive stroke and is stabilized in the CCU (coronary care unit). It is determined that it is unsafe to feed him orally and a tube feeding will be started immediately.Which formula would be the most appropriate for Antonio?

A : modular B : blenderized C : specialized D : elemental Correct Answer : C 66 : Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over three years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 pounds) in one month.What may have caused Maureen to become dehydrated?

A : dysphagia B : food allergy C : tube feeding rate D : diarrhea 11 / 15

Correct Answer : D 67 : Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over three years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 pounds) in one month.Maureen obtains 100 percent of her nutrients via her tube feeding. However, she is found to have food poisoning (Salmonella). What is the most plausible cause?

A : closed system feeding B : open system feeding C : improper hand washing D : improper tube placement Correct Answer : C 68 : Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over three years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 pounds) in one month.Which type of tube feeding does Maureen most likely have?

A : nasogastric B : orogastric C : gastrostomy D : double lumen Correct Answer : C 69 : Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over three years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 pounds) in one month.While reviewing the nursing homes medical record, the nurse discovers that Maureens weight loss can be linked to the addition of phenytoin, a medication that requires the tube feeding to be .

A : halted B : increased C : diluted D : bolused Correct Answer : A 70 : Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over three years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 pounds) in one month.In order to prevent further weight loss and to better meet nutritional needs, the dietitian will recommend a(n) formula for Maureen.

A : standard B : energy-dense C : low-fiber D : isotonic Correct Answer : B

MATCHING 12 / 15

71 : Match each word or phrase with the most appropriate definition or explanation.

A : dietary formulas that contain only one or two A : enteral nutrition macronutrients B : dietary formulas that contain macronutrients B : phenylketonuria that have been partially or fully hydrolyzed C : hypertonic formula C : general-purpose dietary formulas that contain intact proteins and polysaccharides D : feeding tube inserted through the nose D : modular formulas E : provision of nutrients using the GI tract E : isotonic formula F : inherited disorder that affects conversion of F : transnasal the essential amino acid phenylalanine to the amino acid tyrosine G : an opening into the GI tract through which a G : elemental formulas feeding tube can be passed H : an inherited trait that causes a deficiency or H : enterostomy the absence of a protein that has a critical metabolic role I : slow delivery of formula at a constant rate I : parenteral nutrition over an 8- to 24-hour period J : formula with an osmolality greater than that J : standard formulas of blood serum K : continuous feeding K : intravenous provision of nutrients that bypasses the gastrointestinal tract L : formula with an osmolality similar to that of L : intermittent feeding blood serum M : delivery of about 250400 mL of formula overM : bolus feeding 2040 minutes N : delivery of about 250500 mL of formula in N : galactosemia less than 15 minutes O : inborn error of metabolism O : inherited disorder that affects galactose metabolism Correct Answer : A:D B:G C:J D:F E:A F:B G:H H : A14 I:K J:C 13 / 15

K:I L:E M : A11 N : A12 O : A13

ESSAY 72 : Differentiate among standard formulas, elemental formulas, and specialized formulas.

Correct Answer : ?Most enteral formulas are categorized according to their macronutrient sources. Standard formulas, also called polymeric formulas, are provided to individuals who can digest and absorb nutrients without difficulty. They contain intact proteins extracted from milk or soybeans or a combination of such proteins. Carbohydrate sources include hydrolyzed cornstarch, glucose polymers, and sugars. A few formulas, called blenderized formulas, are produced from whole foods such as chicken, vegetables, fruit, and oil, along with some added vitamins and minerals. Elemental formulas, also called hydrolyzed, chemically defined, or monomeric formulas, are prescribed for patients who have compromised digestive or absorptive functions. Elemental formulas contain proteins and carbohydrates that have been partially or fully broken down to fragments that require little (if any) digestion. The formulas are often low in fat and provide fat from medium-chain triglycerides (MCT) to ease digestion and absorption.

Specialized formulas, also called disease-specific or specialty formulas, are intended to meet the nutrient needs of patients with particular illnesses. Products have been developed for individuals with liver, kidney, and lung diseases; glucose intolerance; severe wounds; and metabolic stress. Specialized formulas are generally expensive, and their effectiveness is controversial.

73 : Explain how health care professionals select the appropriate enteral formula for an individual patient.

Correct Answer : ?The formula is selected after careful assessment of the patient’s medical problems, fluid and nutrition status, and ability to digest and absorb nutrients. Although the vast majority of patients can use standard formulas, a person with a functional but impaired GI tract may require an elemental formula. As with patients consuming regular diets, the tube-fed patient may require adjustments in nutrient and energy intakes. For example, patients with diabetes may need to control carbohydrate intake, critical-care patients may have high protein and energy requirements, and patients with chronic kidney disease may need to limit their intakes of protein and several minerals. High nutrient needs must be met using the volume of formula a patient can tolerate. If fluids need to be restricted, the formula should have adequate nutrient and energy densities to provide the required nutrients in the volume prescribed. Formulas that provide fiber may be helpful for managing problems such as diarrhea, constipation, and hyperglycemia. Nearly all formulas are lactose-free and gluten-free and can accommodate the needs of patients with lactose intolerance or gluten sensitivity.

74 : Describe the factors to consider when selecting a feeding route for a patient who needs tube feedings.

14 / 15

Correct Answer : ?Transnasal access is usually preferred when the tube-feeding duration is expected to be less than 4 weeks, and enterostomies are often appropriate when tube feedings are planned for longer periods. Gastric feedings (nasogastric and gastrostomy routes) are preferred whenever possible. These feedings are more easily tolerated and less complicated to deliver than intestinal feedings because the stomach controls the rate at which nutrients enter the intestine. Gastric feedings are not possible, however, if patients have gastric obstructions, motility disorders that impair stomach emptying, or inadequate stomach volume due to prior gastric surgery. Gastric feedings are often avoided in patients at high risk of aspiration.

Aspiration pneumonia may result. Although clinicians frequently administer nasoduodenal or nasojejunal feedings to reduce the likelihood of aspiration, clinical studies have not found an increased incidence of pneumonia in patients who receive gastric feedings.

75 : Explain how mechanical complications can develop with tube feedings. How are these complications corrected?

Correct Answer : ?Mechanical problems include clogged feeding tubes, malfunctioning feeding pumps, and feeding tubes that become dislodged after placement. The feeding tube itself may be a physical irritant and may warrant a change to a different type of tubing or a different feeding route. Transnasal routes are associated with a number of side effects, such as dry mouth from increased mouth breathing and reduced salivary secretions, sinus or middle ear infections due to blocked sinuses or Eustachian tubes, and injury to GI tissues. In ostomy patients, leakages of GI secretions sometimes develop at tube insertion sites. They can be corrected by ensuring that the tube size is appropriate and flushing tubing with water before and after giving formula. Remedies to unclog feeding tubes include flushes with warm water or solutions that contain pancreatic enzymes and sodium bicarbonate; consult the pharmacist for more options.

76 : Discuss the medical nutrition therapy for galactosemia and possible long-term complications of this disorder.

Correct Answer : ?Patients with galactosemia must consume a galactose-restricted diet. The diet is much simpler than the diet for PKU because galactose is not an essential nutrient and is not in a metabolic pathway that produces a required substance. In addition, dietary galactose is primarily obtained from lactose, so the main focus of dietary treatment is the exclusion of milk and milk products. Other foods that contain galactose in substantial amounts, such as organ meats and some legumes, fruits, and vegetables, must also be avoided or restricted. Prepared foods and medications that include lactose as an additive must be avoided as well.

Galactosemia patients or their caregivers are generally given food lists that identify common sources of galactose.

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MULTIPLE CHOICE 1 : Delivery of nutrient solutions directly into the vein is called A : standard nutrition B : enteral nutrition C : parenteral nutrition D : tube feeding

.

Correct Answer : C 2 : Parenteral nutrition would most likely be contraindicated in which condition?

A : paralytic ileus B : GI bleeding C : severe hyperglycemia D : intractable vomiting Correct Answer : C 3 : The large-diameter central veins are located near the A : extremities B : heart C : liver D : lungs

.

Correct Answer : B 4 : Redness, swelling, and tenderness at the insertion site is described as A : hematoma B : phlebitis C : infiltration D : nerve damage

.

Correct Answer : B 5 : PPN is most often used in patients who require nutrition support for less than A : 2 weeks B : 6 weeks C : 3 months D : 6 months

.

Correct Answer : A 6 : Joan Sussman is in her second trimester of pregnancy and has experienced hyperemesis gravidarum (excessive vomiting, possible fluid and electrolyte imbalances) for 14 days. At this point, she is a candidate for .

A : a clear liquid diet B : a tube feeding C : peripheral parenteral nutrition D : total parenteral nutrition Correct Answer : D

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7 : Candidates for TPN are patients who .

A : are unable to use their GI tracts for long periods (> 10 days) B : are malnourished and exhibit anorexia C : have high nutrient needs that they may otherwise meet orally D : have severe swallowing disorders Correct Answer : A 8 : A client receiving greater than 2000 kcalories per day via parenteral nutrition should A : have it administered via peripheral vein B : receive dextrose and amino acids only C : have it administered in bolus form D : be given nutrition by the central venous route

.

Correct Answer : D 9 : The movement of water across biological membranes is known as A : osmosis B : peripheral transport C : diffusion D : absorption

.

Correct Answer : A 10 : What describes a benefit of peripheral insertion of a central catheter?

A : decreased risk of infection B : less pain for the patient C : lower cost D : decreased risk of electrolyte imbalance Correct Answer : C 11 : Osmolarity refers to milliosmoles of ions and molecules per A : liter of solution (mOsm/L) B : kilogram of solvent (mOsm/kg) C : kilogram of solution (mOsm/kg) D : liter of solvent (mOsm/L)

.

Correct Answer : A 12 : Osmolality is usually derived by using .

A : equations that account for the nutrients and electrolytes B : the weights of the nutrients and solution C : an instrument called an osmometer D : an instrument called a spectrometer Correct Answer : C 13 : What is an advantage of TPN? A : Nutrient concentrations do not need to be limited.

B : It accesses only peripheral veins.

C : Patients who require only brief support (7 to 10 days) can use it.

D : It is less invasive.

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Correct Answer : A 14 : To prevent phlebitis, the osmolarity of parenteral solutions used for PPN is generally kept below milliosmoles per liter.

A : 300 B : 600 C : 900 D : 1200 Correct Answer : C 15 : The use of PPN is not possible in a patient with A : a partially functioning GI tract B : a low pain tolerance C : weak peripheral veins D : a swallowing disorder

.

Correct Answer : C 16 : Which form of glucose is available in parenteral solutions?

A : dextrose B : fructose C : lactose D : galactose Correct Answer : A 17 : Traditionally, central catheters enter the circulation at the vein and are threaded into the superior vena cava with the tip of the catheter lying close to the heart.

A : brachial B : right subclavian C : basilic D : cephalic Correct Answer : B 18 : How much energy does dextrose provide?

A : 3.4 kcal/g B : 4.0 kcal/g C : 4.4 kcal/g D : 5.0 kcal/g Correct Answer : A 19 : Dextrose concentrations of A : 10 B : 30 C : 50 D : 70

percent or lower can be used for PPN solutions.

Correct Answer : A 3 / 15

20 : The protein in a TPN solution is primarily in the form of A : amino acids B : protein hydrolysate C : short-chain fatty acids D : intact protein

.

Correct Answer : A 21 : A physician writes an order for Mrs. Wilson to receive parenteral lipids twice a week. The purpose of this order is to .

A : provide essential fatty acids B : provide nonessential amino acids C : provide excessive energy D : suppress the immune response Correct Answer : A 22 : Which type of oil most commonly makes up the triglycerides in lipid emulsions?

A : corn oil B : sunflower oil C : soybean oil D : coconut oil Correct Answer : C 23 : What is usually the main source of energy provided by parenteral nutrition?

A : carbohydrate B : protein C : fat D : amino acids Correct Answer : A 24 : Caution should be taken when administering parenteral lipids to people with which condition?

A : hypertriglyceridemia B : hyperglycemia C : diabetes D : kidney failure Correct Answer : A 25 : Which trace mineral is excluded from parenteral solutions because it alters the stability of the other ingredients in the solution?

A : zinc B : copper C : iron D : selenium Correct Answer : C 26 : Which vitamin is omitted from parenteral solutions designed for patients on warfarin therapy?

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A:C B:D C:E D:K Correct Answer : D 27 : How many grams of amino acids would be provided to a client receiving 2,000 mL of a 5 percent amino acid solution?

A : 50 B : 100 C : 200 D : 400 Correct Answer : B 28 : How many kcalories are provided by 3 liters of a 5 percent dextrose solution?

A : 150 B : 510 C : 600 D : 660 Correct Answer : B 29 : The administration of a second solution using a separate port is called a A : Y-connector B : piggyback C : double lumen tube D : distal port

.

Correct Answer : B 30 : To prevent bacterial contamination and maintain stability, parenteral solutions are A : warmed to room temperature prior to infusion B : exposed to light C : pasteurized D : compounded in the pharmacy under aseptic conditions

.

Correct Answer : D 31 : A 3-in-1 solution that contains amino acids, lipids, and dextrose is also called a A : hydrolyzed solution B : total nutrient admixture C : elemental suspension D : isotonic solution

.

Correct Answer : B 32 : Although the administration of 3-in-1 solutions is simpler because only one infusion pump is required, what can occur when lipid emulsions have been added?

A : The solution is too dense to use in a central vein.

B : The solution causes platelet aggregation.

C : The solution often becomes contaminated.

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D : The solution can form large lipid droplets.

Correct Answer : D 33 : Daily fluid needs range from A : 5 to 15 B : 15 to 25 C : 25 to 35 D : 35 to 45

milliliters per kilogram of body weight in most adults.

Correct Answer : C 34 : PPN solutions are limited in their osmolarity and TPN solutions A : can be as nutrient dense as necessary B : may be deficient in other components C : are required to be of a certain osmolarity D : are also limited in their osmolarity

.

Correct Answer : A 35 : Why are few medications added to parenteral solutions?

A : to avoid potential drug-nutrient interactions B : to avoid clogging the tubing C : because they are unnecessary if the solution is properly balanced D : because it is not possible to do so Correct Answer : A 36 : The benefits of cyclic infusion of TPN include A : maintenance of high insulin levels B : increase in fat stores C : flexibility in the daily scheduling of activities D : achievement of a negative nitrogen balance

.

Correct Answer : C 37 : A person on cyclic parenteral nutrition receives an infusion at a constant rate for hours per day.

A : 3 to 6 B : 6 to 8 C : 8 to 16 D : 12 to 18 Correct Answer : C 38 : What best describes the insertion of a central line for parenteral nutrition?

A : The procedure requires local anesthesia.

B : The patient is typically asleep during the procedure.

C : The insertion can only be done by a nurse or qualified technician.

D : The patient who is anxious usually receives sedatives.

Correct Answer : A 6 / 15

39 : Which type of parenteral nutrition is provided at night so patients can participate in routine activities during the day?

A : continuous B : cyclic C : peripheral D : piggyback Correct Answer : B 40 : The health care team has just ordered Mr. Carter to begin TPN. He is a 58-year-old man who is suffering from intractable diarrhea. Before Mr. Carter starts TPN, what procedure should be performed?

A : X-ray to confirm catheter placement B : body mass index assessment C : calcium balance D : hand grip strength Correct Answer : A 41 : What best describes the role of the nurse on the nutrition support team?

A : diagnosing nutrition problems B : recommending the appropriate diet C : performing direct patient care D : recommending appropriate drug therapy Correct Answer : C 42 : Greg Thomas is a 12-year-old who is being weaned off of TPN. In addition to TPN, Greg is on a soft diet. Greg is 52 and weighs 110 pounds. His energy needs are estimated to be approximately 2100 kcal/day. His calorie count reveals he is consuming 1700 kcal/day. Which intervention is appropriate at this time?

A : Discontinue TPN. B : Double his oral feedings.

C : Consider enteral feedings.

D : Increase TPN to provide an additional 1100 kcal.

Correct Answer : A 43 : Before parenteral nutrition is discontinued, oral intake, tube feeding, or a combination should provide at least what proportion of the estimated energy needs?

A : 40 to 50 B : 55 to 60 C : 60 to 75 D : 90 to 95 Correct Answer : C 44 : A patient on TPN for longer than a few and gall stone formation.

A : hours B : days C : weeks D : months

is at risk for sludge buildup in the gallbladder

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Correct Answer : C 45 : Kristin Sullivan is on long-term parenteral nutrition. This places her at risk for A : type 1 diabetes B : osteoporosis C : liver cancer D : heart disease

.

Correct Answer : B 46 : Liver enzymes should be monitored A : hourly B : daily C : weekly D : every two weeks

during parenteral support.

Correct Answer : C 47 : Refeeding syndrome is characterized by fluid and electrolyte imbalances and A : systemic infection B : hypothyroidism C : severe weight loss D : hyperglycemia

.

Correct Answer : D 48 : How often should the fluid intake and output of a patient on TPN be checked?

A : before starting B : every 4 to 8 hours C : daily D : once a week Correct Answer : C 49 : Which condition describes a catheter-related complication of parenteral nutrition?

A : refeeding syndrome B : gallbladder disease C : air embolism D : nutrient deficiencies Correct Answer : C 50 : In which situation would home TPN be an appropriate means for maintaining adequate nutrition status?

A : an individual with dysphagia B : an individual with an intestinal obstruction C : an individual with head and neck cancer D : an individual with neurological impairment affecting the esophagus Correct Answer : B 51 : Maria is a home health dietitian. She is evaluating a new TPN patient. She expects that the 8 / 15

patient will want to change his regimen to A : continuous infusion B : cyclic infusion C : NPO D : bolus infusion

.

Correct Answer : B 52 : Karly is on home TPN and is having trouble adjusting to the changes in her life. Which organization does the text recommend as a good source of support and information for her?

A : Oley Foundation B : P-CAN C : Livestrong D : ACS Correct Answer : A 53 : The formula used for home nutrition is most often influenced by cost and A : taste B : availability C : efficiency with administration D : appearance

.

Correct Answer : B 54 : When refrigerated, ready-made parenteral solutions may be stable for A : one week B : ten days C : two weeks D : three weeks

.

Correct Answer : A 55 : Among social issues, one of the greatest concerns of patients who use home nutrition support is the .

A : inability to consume meals with friends B : appearance of the tube C : risks of the tube becoming clogged D : inability to choose the type and amount of formula delivered Correct Answer : A 56 : A patient should be fully informed of a treatments benefits and risks in a fair and honest manner. If the patient agrees to the proposed treatment, it is referred to as .

A : autonomy B : informed consent C : beneficence D : distributive justice Correct Answer : B 57 : The potential good that can come from a proposed treatment is referred to as A : autonomy

.

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B : informed consent C : beneficence D : distributive justice Correct Answer : C 58 : When providers consider whether treatment for one patient may cause harm to another patient, is being considered.

A : autonomy B : informed consent C : beneficence D : distributive justice Correct Answer : D 59 : Which statement is true of Terris Law? A : It allows hospitals to withdraw life-sustaining treatment against the wishes of the family.

B : It allowed the governor to order hospitals to withdraw life-sustaining treatment against the wishes of the family, but was found unconstitutional.

C : It allows hospitals to continue life-sustaining treatment against the wishes of the family.

D : It allowed the governor to intervene and act against a familys wishes in order to continue lifesustaining treatment, but was found unconstitutional.

Correct Answer : D 60 : The DNR order is most often used in patients for whom A : death is expected and inevitable B : treatment is excessively costly and not reimbursable C : organ procurement is in progress D : families have requested it

.

Correct Answer : A 61 : Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor s appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.Upon admission, what diet is most appropriate for Marc until he receives further testing?

A : NPO B : low sodium C : low fiber D : high protein/high kcalorie Correct Answer : A 62 : Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor s appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.Marcs nausea and vomiting continued after he was admitted. Nasogastric decompression has been started. Which diet should be recommended to completely meet his nutritional needs?

A : clear liquid B : elemental formula C : low fiber D : TPN 10 / 15

Correct Answer : D 63 : Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor s appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.Marc will need intestinal surgery and will be NPO for 10 to 14 days. How can his medical team meet his nutritional needs?

A : regular diet B : elemental formula C : PPN D : TPN Correct Answer : D 64 : Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor s appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.After surgery, Marc remains on ventilator support but his gut function is improving. The doctor should initiate .

A : a soft diet B : a clear liquid diet C : an elemental tube feeding D : PPN Correct Answer : C 65 : Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor s appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.What should the nutritional support team do to ensure that Marc can consume enough food orally to meet his energy needs?

A : Send double portions.

B : Discontinue the tube feeding.

C : Discontinue the TPN. D : Switch to nocturnal, cyclic feedings.

Correct Answer : D 66 : Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support.

She is being transferred to a sub-acute nursing facility for therapy.Upon admission, Julia tells her nurse that she has a lot of fear in regards to nutrition support due to a vein blowout at a previous admission. What is the most likely cause of this incident?

A : high glucose in the TPN B : low amino acids in the TPN C : low vitamin K in the PPN D : high osmolarity of the PPN Correct Answer : D 67 : Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 11 / 15

times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support.

She is being transferred to a sub-acute nursing facility for therapy.The registered dietitian completing Julias initial assessment should expect which result?

A : high albumin B : weight loss C : high iron D : low insulin Correct Answer : B 68 : Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support.

She is being transferred to a sub-acute nursing facility for therapy.The nutrition support team decides to increase the kcal in Ms. Reynoldss TPN slowly to prevent .

A : hypoglycemia B : an elevated white blood cell count C : refeeding syndrome D : weight gain Correct Answer : C 69 : Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support.

She is being transferred to a sub-acute nursing facility for therapy.Laboratory values indicate that Julias blood glucose is extremely high. Which nutrient component of her TPN must be adjusted?

A : water B : dextrose C : amino acids D : chromium Correct Answer : B 70 : Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support.

She is being transferred to a sub-acute nursing facility for therapy.After six weeks of intense nutrition support, her liver enzymes are elevated. The dietitian recommends .

A : a low-fat diet B : elemental tube feedings C : cyclic TPN D : continuous TPN Correct Answer : C

MATCHING 71 : Match each word or phrase with the most appropriate definition or explanation.

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A : type of nutrition support in which the nutrient A : peripheral veins concentrations do not need to be limited B : administration of a second solution using a B : central veins separate port in an intravenous catheter C : peripheral parenteral nutrition C : continuous administration of parenteral solution over 24 hours D : total parenteral nutrition D : refers to the concentration of solutes per kilogram of water E : small-diameter veins that carry blood from E : osmolarity the arms and legs F : large-diameter veins close to the heart F : osmolality G : parenteral solution that contains dextrose, G : piggyback amino acids, and lipids H : written statement that specifies the medical H : total nutrient admixture procedures desired or not desired in the event that a person is unable to communicate or is incapacitated I : administration of a parenteral solution over I : 2-in-1 solution an 8- to 16-hour period J : type of nutrition support that usually has a J : continuous parenteral nutrition maximum of 900 mOsm/L K : parenteral solution that contains dextrose K : cyclic parenteral nutrition and amino acids, and excludes lipids L : refers to the concentration of solutes per literL : refeeding syndrome of solution M : exhibited by severely malnourished patients M : durable power of attorney who are fed aggressively; characterized by fluid and electrolyte imbalances N : legal document that gives legal authority to N : advance directive another to make medical decisions in the event of incapacitation O : written or oral instruction regarding ones O : living will preferences for medical treatment to be used in the event that a person becomes incapacitated Correct Answer : A:D B:G C:J D:F E:A F:B G:H H : A14 I:K 13 / 15

J:C K:I L:E M : A11 N : A12 O : A13

ESSAY 72 : Compare and contrast peripheral parenteral nutrition and total parenteral nutrition.

Correct Answer : In peripheral parenteral nutrition, nutrients are delivered using only the peripheral veins. The peripheral veins can be damaged by overly concentrated solutions, though. To prevent complications, the osmolarity of PPN is kept below 900 milliosmoles per liter, a concentration that limits the amounts of energy and protein the solution can provide. PPN is most often used in patients who require short-term nutrition support and who do not have high nutrient needs or fluid restrictions. Most patients meet their nutrient needs using the larger, central veins, where blood volume is greater and nutrient concentrations do not need to be limited. This method can reliably provide all of a person’s nutrient requirements and therefore is called total parenteral nutrition (TPN). Because the central veins carry a large volume of blood, the parenteral solutions are rapidly diluted; thus, patients with high nutrient needs or fluid restrictions can receive the nutrient-dense solutions they require. TPN is also preferred for patients who require long-term parenteral nutrition.

73 : Define refeeding syndrome. Why does it occur, and how can it be prevented?

Correct Answer : ?Severely malnourished patients who are aggressively fed may develop refeeding syndrome, characterized by fluid and electrolyte imbalances and hyperglycemia.

These effects occur because dextrose infusions raise levels of circulating insulin, which promotes anabolic processes that quickly remove phosphate, potassium, and magnesium from the blood. The altered electrolyte levels can lead to fluid retention and life-threatening changes in various organ systems. Heart failure and respiratory failure are possible consequences.

Refeeding syndrome generally develops within 2 weeks of beginning parenteral infusions. The patients at highest risk are those who have experienced chronic malnutrition or substantial weight loss. Symptoms include edema, cardiac arrhythmias, muscle weakness, and fatigue. To prevent refeeding syndrome, health practitioners may provide only half of the patient’s energy requirement when they initiate nutrition support and gradually advance the dose over several days while monitoring (and possibly correcting) electrolyte levels.

74 : Discuss possible metabolic complications associated with intravenous nutrition and possible corrections of these complications.

Correct Answer : ?Hyperglycemia most often occurs in patients who are glucose intolerant, receiving excessive energy or dextrose, undergoing severe metabolic stress, or receiving 14 / 15

corticosteroid medications. It can be prevented by providing insulin along with parenteral solutions, avoiding overfeeding or overly rapid infusion rates, and restricting the amount of dextrose in the solution. Although uncommon, hypoglycemia sometimes occurs when parenteral nutrition is interrupted or discontinued or if excessive insulin is given. In patients at risk, such as young infants, feedings may be tapered off over several hours before discontinuation. Another option is to infuse a dextrose solution at the same time that parenteral nutrition is interrupted or stopped. Hypertriglyceridemia may result from dextrose overfeeding or overly rapid infusions of lipid emulsion. Patients at risk include those with severe infection, liver disease, kidney failure, or hyperglycemia and those using immunosuppressant or corticosteroid medications. If blood triglyceride levels exceed 400 milligrams per deciliter, lipid infusions should be reduced or stopped.

75 : Discuss the quality of life issues that need to be addressed with patients receiving longterm nutrition support at home.

Correct Answer : ?Although home nutrition support can help to improve health and extend life, users of these services and their families may struggle with the lifestyle adjustments required. In addition to the high costs of nutrition support, home infusions are often time consuming and inconvenient. Activities and work schedules must be planned around feedings. Extra planning is necessary and precautions must be taken when a person wants to travel or participate in sports activities. Explaining one’s medical needs to friends and acquaintances may be embarrassing.

Among physical difficulties, people receiving nocturnal feedings often cite disturbed sleep as a major problem. Disruptions may be due to multiple nighttime bathroom visits, noisy infusion pumps, or difficulty finding a comfortable sleeping position when “hooked up.” People using parenteral support sometimes prefer infusing solutions during the day to improve their sleeping patterns. Among social issues, the inability to consume meals with family and friends is often a great concern. Many individuals miss the enjoyment, comfort, and socialization they previously experienced from food and mealtimes. Joining friends at restaurants and attending certain types of social events may become a source of stress for individuals who cannot consume food.

76 : Discuss the use of carbohydrates in parenteral nutrition.

Correct Answer : ?Glucose is the main source of energy in parenteral solutions. It is provided in the form of dextrose monohydrate, in which each glucose molecule is associated with a single water molecule. Dextrose monohydrate provides 3.4 kcalories per gram, slightly less than pure glucose, which provides 4 kcalories per gram. Commercial dextrose solutions are available in concentrations between 2.5 and 70 percent; concentrations higher than 10 percent are usually used only in TPN solutions.

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MULTIPLE CHOICE 1 : A disruption to the bodys chemical environment that threatens its normal and healthy functioning is called stress.

A : metabolic B : severe C : physiological D : dysfunctional Correct Answer : A 2 : In response to metabolic and respiratory stress, the body experiences A : hypometabolism B : a breakdown of muscle mass C : a decrease in carbon dioxide in the blood D : only minor complications

.

Correct Answer : B 3 : What effect does an increase in the release of catecholamines have on the body?

A : sodium excretion from the kidneys B : glycogen breakdown in the liver C : storage of fatty acids in the adipose cells D : water reabsorption in the kidneys Correct Answer : B 4 : Long-term use of pharmaceutical forms of cortisol (cortisone, prednisone) results in A : thickening of the skin B : dehydration C : hypothyroidism D : early osteoporosis

.

Correct Answer : D 5 : Which hormone(s) is/are referred to as the fight-or-flight hormone(s)?

A : catecholamines B : glucagon C : cortisol D : aldosterone Correct Answer : A 6 : The inflammatory response begins with A : removal of cellular debris B : dilation of arterioles and capillaries C : destruction of microorganisms D : release of inflammatory mediators

.

Correct Answer : B 7 : Which hormones promote glycogen breakdown?

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A : catecholamines and antidiuretic hormone B : catecholamines and glucagon C : cortisol and aldosterone D : aldosterone and catecholamines Correct Answer : B 8 : What is a metabolic effect of hormones released during the stress response?

A : glycogenesis B : gluconeogenesis C : lipogenesis D : protein synthesis Correct Answer : B 9 : Effects of prolonged elevated cortisol levels include A : impaired wound healing B : increased protein synthesis C : increased risk of hypoglycemia D : improved immune response

.

Correct Answer : A 10 : Chemical mediators that control the inflammatory process are released from A : the central nervous system B : damaged tissues C : the adrenal glands D : adipose tissue

.

Correct Answer : B 11 : Ryans knee was injured in a basketball game. When he gets home he notices swelling, redness, heat, and pain in his knee. What is causing the redness?

A : accumulation of fluid at the site of the injury B : dilation of small blood vessels in the injured area C : the release of chemical mediators D : edema within the damaged tissues Correct Answer : B 12 : Cytokines are proteins that help regulate A : immune system B : oxygen C : hormonal D : GI tract

development and activity.

Correct Answer : A 13 : Which substance is the precursor for the eicosanoids?

A : amino acids B : fatty acids C : thiamin D : vitamin D 2 / 16

Correct Answer : B 14 : What is a function of C-reactive protein?

A : regulating blood pressure B : regulating iron metabolism C : producing and releasing histamine D : binding dead or dying cells to activate certain immune responses Correct Answer : D 15 : Which substance is an acute-phase protein?

A : glucagon B : hepcidin C : aldosterone D : eicosanoids Correct Answer : A 16 : Shock is characterized by A : increased blood pressure B : decreased heart rate C : increased oxygenation D : increased respiratory rate

.

Correct Answer : D 17 : The accumulation of pus is known as A : erysipelas B : impetigo C : an abscess D : cellulitis

.

Correct Answer : C 18 : The complication that results when adequate nutrition is reintroduced rapidly is A : hypotension B : refeeding syndrome C : ketoacidosis D : tachycardia

.

Correct Answer : B 19 : Complications that result from refeeding syndrome include A : hyperglycemia B : weight gain C : hypoxemia D : hypovolemia

.

Correct Answer : A 20 : When determining resting metabolic rate, a patients energy needs would generally be increased by which condition?

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A : receiving intravenous fluids B : having open wounds C : being bedridden D : having a nasogastric tube Correct Answer : B 21 : Brandon is critically ill and is in the ICU. How many kcalories can be factored to determine Brandons daily energy needs?

A : 1520 kcal/kg body weight B : 2530 kcal/kg body weight C : 3035 kcal/kg body weight D : 3538 kcal/kg body weight Correct Answer : B 22 : An estimate of the energy needs of a 70-kg man who is critically ill would be A : 1050 to 1400 B : 1750 to 2100 C : 2450 to 2800 D : 3150 to 3500

kcalories.

Correct Answer : B 23 : How many grams of protein would a 120-lb. woman require after major physiological stress?

A : 65109 grams B : 82109 grams C : 156173 grams D : 144240 grams Correct Answer : A 24 : What is the suggested kcalorie intake for hypocaloric feedings for obese patients who are critically ill?

A : 58 kcal/kg actual body weight B : 810 kcal/kg actual body weight C : 1114 kcal/kg actual body weight D : 1518 kcal/kg actual body weight Correct Answer : C 25 : Which substances are nonessential amino acids that are sometimes supplemented in patients undergoing metabolic stress?

A : aspartic acid and arginine B : arginine and glutamine C : glycine and glutamine D : alanine and glycine Correct Answer : B 26 : When parenteral nutrition is necessary for critically ill patients, dextrose is limited to milligrams per kilogram of body weight per minute to prevent hyperglycemia.

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A:3 B:5 C : 10 D : 15 Correct Answer : B 27 : Which classification of burns involves both the epidermis and dermis and is characterized by a wet, red, and blistery appearance?

A : 1st degree B : 2nd degree C : 3rd degree D : 4th degree Correct Answer : B 28 : Which classification of burns destroys both the epidermis and dermis and may also damage underlying tissues?

A : 1st degree B : 2nd degree C : 3rd degree D : 4th degree Correct Answer : C 29 : Burn size in adults is often estimated by dividing the body into 11 parts, each part representing about percent of the total body surface area (TBSA).

A:9 B : 12 C : 15 D : 19 Correct Answer : A 30 : Protein intake should average than 10 percent TBSA. A : 10 B : 15 C : 25 D : 30

percent of total calories for clients with burns greater

Correct Answer : C 31 : Dave has 2nd degree burns on his back torso, left arm, and left leg. This represents about percent of his total body surface area (TBSA).

A : 27 B : 36 C : 45 D : 72 Correct Answer : C 32 : For acutely ill patients with a functional GI tract, enteral feedings started in the first 5 / 16

hours after hospitalizations are associated with fewer complications and shorter hospital stays.

A : 1224 B : 2448 C : 4872 D : 7296 Correct Answer : B 33 : Which condition is characterized by persistent inflammation and excessive secretions of mucus in the main airways of the lungs?

A : asthma B : chronic bronchitis C : emphysema D : pneumonia Correct Answer : B 34 : What best describes why weight loss and malnutrition occurs in the presence of chronic respiratory diseases?

A : Damaged lung tissues use more vitamins and minerals.

B : Excessive carbon dioxide in the blood causes a person to sleep more.

C : Labored breathing requires more energy.

D : Hypoxemia causes the body to excrete excess glycogen.

Correct Answer : C 35 : The primary risk factor for COPD is A : smoking B : vehicle exhaust C : genetic factors D : pollution from coal-fired power plants

.

Correct Answer : A 36 : What percentage of persons with COPD is affected by malnutrition?

A : 20 B : 40 C : 60 D : 80 Correct Answer : C 37 : Patients with ARDS may require A : 0.5 to 1.0 B : 1.0 to 1.5 C : 1.5 to 2.0 D : 2.0 to 2.5

grams of protein per kilogram body weight daily.

Correct Answer : C 38 : Shortness of breath is also called A : cyanosis B : hypercapnia

.

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C : dyspnea D : hypoxia Correct Answer : C 39 : Maggie, newly diagnosed with COPD, might benefit from which recommendations to help her increase her food intake?

A : eating large meals B : consuming liquids with meals rather than between meals C : eating quickly D : using oxygen at meal times Correct Answer : D 40 : What metabolic effect is most commonly seen with inhaled corticosteroids?

A : altered taste sensation B : hypokalemia C : hyperphosphatemia D : low bone density Correct Answer : D 41 : Enteral formulas specifically for patients with COPD often contain more formulas.

A : carbohydrates B : potassium C : iron D : fat

than standard

Correct Answer : D 42 : Mr. Ferell has ARDS. His nurse notices an increase in body weight and edema. The dietitian is consulted. She recommends .

A : a change to parenteral nutrition support B : a change to a nutrient-dense formula C : that they continue the current nutrition care plan D : a change to bolus feedings Correct Answer : B 43 : A patient with respiratory failure and fluid restrictions would require nutrient-dense formulas of kcal/mL. A : 0.5 to 1.0 B : 1.0 to 1.2 C : 1.2 to 1.5 D : 1.5 to 2.0 Correct Answer : D 44 : To decrease the risk of aspiration in patients with respiratory failure who need nutrition support, the healthcare provider should .

A : utilize gastric feedings B : utilize intestinal feeding 7 / 16

C : decrease the amount of free water in the tube feeding D : select a formula enriched with vitamins A, C, and E Correct Answer : B 45 : Which symptom is associated with systemic inflammatory response syndrome (SIRS)?

A : abnormal body temperature B : reduced heart and respiratory rates C : abnormal red blood cell counts D : impaired inflammatory response Correct Answer : A 46 : Multiple organ dysfunction syndrome most often affects the kidneys, lungs, and A : brain B : heart C : liver D : stomach

.

Correct Answer : C 47 : What effects are most commonly seen when MODS causes lung failure?

A : hemoptysis B : poor gas exchange C : chronic cough D : increased oxygen saturations Correct Answer : B 48 : In what way do blood transfusions contribute to development of MODS? A : Blood transfusions are immunosuppressive.

B : Transfusion reactions cause systemic sepsis.

C : Blood transfusions raise the patients temperature.

D : The transfusion process requires more energy.

Correct Answer : A 49 : The principle infection associated with MODS is A : gastroenteritis B : acute kidney infection C : a pressure ulcer D : pneumonia

.

Correct Answer : D 50 : Patients who have SIRS that persists for more than A : 4 hours B : 1 day C : 48 hours D : 3 days

are more likely to develop MODS.

Correct Answer : D 8 / 16

51 : In what way does advancing age contribute to development of MODS? A : Older adults do not understand what measures to take to prevent MODS. B : Older adults take more medications that can cause side effects that lead to MODS. C : Older adults are prone to infection because of increased skin thickening.

D : Older adults bodies are less able to deal with the stress of critical illness.

Correct Answer : D 52 : Signs of sepsis include .

A : increased blood pressure B : bradycardia C : abnormal body temperature D : abnormal red blood cell count Correct Answer : C 53 : Which treatment is most often used to manage MODS? A : surgery B : mechanical ventilation C : induced hypothermia D : extra-corporeal membrane oxygenation Correct Answer : B 54 : Support of heart and blood vessel function during treatment of MODS is characterized by .

A : medications to maintain blood pressure B : surgery to remove excess atherosclerosis C : central venous access to administer antibiotics D : medications to dissolve blood clots Correct Answer : A 55 : Nutrition support as part of treatment for MODS A : promotes weight gain B : reduces obesity C : prevents wasting D : eliminates infection

.

Correct Answer : C 56 : Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area).What is the main nutritional goal for Joseph?

A : Increase intake to 75 percent of meals.

B : Increase arginine production.

C : Increase arginine intake.

D : Achieve nitrogen balance and minimize tissue losses.

Correct Answer : D 57 : Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical 9 / 16

history is unremarkable with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area).The most appropriate way to meet Josephs nutritional needs is via .

A : tube feedings B : TPN C : a high-kcalorie/high-protein diet with six small meals/day D : a high-kcalorie/high-protein diet with three large meals/day Correct Answer : C 58 : Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area).The registered dietitian is completing her initial assessment for Mr. Delgado. When estimating his energy needs she selects for his stress factor.

A : 1.0 B : 1.4 C : 1.8 D : 2.2 Correct Answer : B 59 : Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area).The nurse orders a nutrition consult due to Josephs poor intake. What is unlikely to be related to his low intake?

A : pain B : sedation C : feeding problems D : positive nitrogen balance Correct Answer : D 60 : Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area).Having burns increases Josephs risk for what condition?

A : osteoporosis B : intestinal ileus or gastrointestinal malfunction C : bronchitis D : overhydration Correct Answer : B 61 : Margaret Chen is a 73-year-old widow and mother of 3 adult children. She visits her physician due to decreased appetite, lethargy, weight loss, and a productive cough for the past 2 weeks. Her past medical history includes osteoporosis, sinusitis, respiratory infections, and smoking.Margaret is diagnosed with COPD. What is the primary cause?

A : osteoporosis B : smoking C : poor appetite D : sinusitis 10 / 16

Correct Answer : B 62 : Margaret Chen is a 73-year-old widow and mother of 3 adult children. She visits her physician due to decreased appetite, lethargy, weight loss, and a productive cough for the past 2 weeks. Her past medical history includes osteoporosis, sinusitis, respiratory infections, and smoking.Margaret is prescribed to improve airflow.

A : bronchodilators B : corticosteroids C : oxygen D : an influenza vaccine Correct Answer : A 63 : Margaret Chen is a 73-year-old widow and mother of 3 adult children. She visits her physician due to decreased appetite, lethargy, weight loss, and a productive cough for the past 2 weeks. Her past medical history includes osteoporosis, sinusitis, respiratory infections, and smoking.Many of the medications used to treat COPD can cause gastrointestinal effects such as .

A : dry mouth B : ulcers C : diarrhea D : constipation Correct Answer : A 64 : Margaret Chen is a 73-year-old widow and mother of 3 adult children. She visits her physician due to decreased appetite, lethargy, weight loss, and a productive cough for the past 2 weeks. Her past medical history includes osteoporosis, sinusitis, respiratory infections, and smoking.What is an example of a corticosteroid that may be prescribed for Margaret?

A : albuterol B : ipratropium C : salmeterol D : fluticasone Correct Answer : D 65 : Margaret Chen is a 73-year-old widow and mother of 3 adult children. She visits her physician due to decreased appetite, lethargy, weight loss, and a productive cough for the past 2 weeks. Her past medical history includes osteoporosis, sinusitis, respiratory infections, and smoking.The physician makes several recommendations for Margaret. What would be among these recommendations?

A : high-energy supplements B : low-protein diet C : extremely limited exercise D : reduced fiber intake Correct Answer : A

MATCHING 11 / 16

66 : Match each word or phrase with the most appropriate definition or explanation.

A : failure of more than one organ system that A : metabolic stress occurs during intensive care; often results in death B : nonspecific responses of the immune B : respiratory stress system to infection or injury C : wasting C : a severe reduction in blood flow that deprives the bodys tissues of oxygen and nutrients D : cells within connective tissue that produce D : multiple organ dysfunction syndrome and release histamine E : counterregulatory hormones E : a disruption in the bodys chemical environment due to the effects of disease or injury; characterized by changes in metabolic rate, heart rate and blood pressure, hormonal status, and nutrient metabolism F : inadequate gas exchange between the air F : mast cells and blood, resulting in lower oxygen and higher carbon dioxide levels G : changes in body chemistry resulting from G : inflammatory response infection, inflammation, or injury; characterized by alterations in plasma proteins H : low amount of oxygen in body tissues H : acute-phase response I : group of lung diseases characterized by I : systemic inflammatory response syndrome persistent obstructed airflow through the lungs (SIRS) and airways J : shock J : the breakdown of lean tissue that results from disease or malnutrition K : a whole-body response to illness or trauma; K : chronic obstructive pulmonary disease characterized by raised heart and respiratory rates, abnormal white blood cell counts, and abnormal body temperature L : hormones that have metabolic actions that L : acute respiratory distress syndrome (ARDS) oppose those of insulin M : medical emergency that causes dyspnea M : hypoxemia and pulmonary edema; usually requires assisted (mechanical) ventilation N : low level of oxygen in the blood N : hypercapnia O : excessive carbon dioxide in the blood O : hypoxia Correct Answer : A:D B:G C:J D:F E:A F:B 12 / 16

G:H H : A14 I:K J:C K:I L:E M : A11 N : A12 O : A13

ESSAY 67 : Describe the factors associated with hormonal responses to severe stress.

Correct Answer : ?The stress response is mediated by several hormones, which are released into the blood soon after the onset of injury. The catecholamines stimulate heart muscle, raise blood pressure, and increase metabolic rate. Epinephrine also promotes glucagon secretion from the pancreas, prompting the release of nutrients from storage. The steroid hormone cortisol enhances muscle protein degradation, raising amino acid levels in the blood and making amino acids available for conversion to glucose. All of these hormones have similar effects on glucose and fat metabolism, causing the breakdown of glycogen, the production of glucose from amino acids, and the breakdown of triglycerides in adipose tissue. Thus, the combined effects of these hormones contribute to hyperglycemia, which often accompanies critical illness. Two other hormones induced by stress, aldosterone and antidiuretic hormone, help to maintain blood volume by stimulating the kidneys to reabsorb more sodium and water, respectively. Cortisol’s effects can be detrimental when stress is prolonged. In excess, cortisol causes the depletion of protein in muscle, bone, connective tissue, and the skin. It impairs wound healing, so high cortisol levels may be especially dangerous for a patient with severe injuries. Because cortisol inhibits protein synthesis, consuming more protein cannot easily reverse tissue losses. Excess cortisol also leads to insulin resistance, contributing to hyperglycemia, and suppresses immune responses, increasing susceptibility to infection.

68 : Describe the acute inflammatory process in response to an injury or illness.

Correct Answer : The inflammatory response begins with the dilation of arterioles and capillaries at the site of injury, which increases blood flow to the affected area. The capillaries within the damaged tissue become more permeable, allowing some blood plasma to escape into the tissue and cause local edema. The various changes in blood vessels attract immune cells that can destroy foreign agents and clear cellular debris. Among the first cells to arrive are the phagocytes, which slip through gaps between the endothelial cells that form the blood vessel walls. The phagocytes engulf microorganisms and destroy them with reactive forms of oxygen and hydrolytic enzymes. When inflammation becomes chronic, these normally useful products 13 / 16

of phagocytes can damage healthy tissue.

69 : Discuss the systemic effects of inflammation.

Correct Answer : ?The cytokines released during acute inflammation produce a number of systemic effects. Within hours after inflammation, infection, or severe injury, the liver steps up its production of certain plasma proteins, including C-reactive protein, complement proteins, hepcidin, blood-clotting proteins such as fibrinogen and prothrombin, and others. At the same time, plasma concentrations of albumin, iron, and zinc fall. The acute-phase response is accompanied by muscle catabolism to make amino acids available for glucose production, tissue repair, and immune protein synthesis; consequently, negative nitrogen balance (and wasting) frequently results. Other clinical features of the acute-phase response may include fever, an elevated metabolic rate, increased pulse rate and blood pressure, increased blood neutrophil levels, lethargy, and anorexia. If inflammation does not resolve, the continued production of pro-inflammatory cytokines may lead to the systemic inflammatory response syndrome (SIRS), which is diagnosed when the patient’s signs and symptoms include substantial increases in heart rate and respiratory rate, abnormal white blood cell counts, and/or fever. If these effects result from a severe infection, the condition is called sepsis. Complications associated with severe cases of SIRS or sepsis include fluid retention and tissue edema, low blood pressure, and impaired blood flow. If the reduction in blood flow is severe enough to deprive the body’s tissues of oxygen and nutrients, multiple organs may fail simultaneously.

70 : Discuss the micronutrient needs in patients with metabolic stress, including the increased need for certain nutrients and their specific role in the healing process.

Correct Answer : ?Notable metabolic changes in patients undergoing metabolic stress include hypermetabolism, negative nitrogen balance, insulin resistance, and hyperglycemia.

Hypermetabolism and negative nitrogen balance can lead to wasting, which may impair organ function and delay recovery. Hyperglycemia increases the risk of infection, which can lead to complications and higher mortality risk. Therefore, the principal goals of nutrition therapy are to preserve lean (muscle) tissue, maintain immune defenses, and promote healing. The amounts of protein and energy to provide during acute illness are controversial and still under investigation. Research results have been mixed, in part because various conditions are associated with metabolic stress and each patient’s situation is somewhat different. Moreover, protein and energy needs can vary substantially over the course of illness, requiring frequent reevaluation. The guidelines presented here are subject to change as new findings help to resolve the complex issues related to nutrient intakes and delivery methods. To help guide their decisions about treatment, clinicians need to closely observe patients’ responses to feedings and readjust nutrient intakes as necessary.

71 : Explain the need for carbohydrate and fat intakes during acute stress.

Correct Answer : Most of the energy required is supplied by carbohydrate and fat. Carbohydrate is usually the main source of energy, providing about 50 to 60 percent of total energy requirements. When parenteral nutrition is necessary for critically ill patients, dextrose is limited to 5 milligrams per kilogram of body weight per minute to prevent hyperglycemia. In patients with severe hyperglycemia, fat may supply up to 50 percent of kcalories, although high fat intakes may suppress immune function and increase the risks of developing infections and hypertriglyceridemia. Patients with blood triglyceride levels above 500 milligrams per deciliter may require fat restriction.

72 : Explain how nutrition therapy is used in burn patients.

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Correct Answer : ?The nutrition prescription for burn patients is typically a high-kcalorie, highprotein diet, although overfeeding must be avoided because it can result in hyperglycemia, fatty liver, and infectious complications. Ideally, energy needs should be measured using indirect calorimetry; alternatively, the energy requirement can be estimated. Some clinicians use predictive equations intended for burn patients, which may include factors for burn severity, number of days’ post-injury, ventilator use, or other relevant variables. The suggested protein intake is 1.5 to 2.0 grams per kilogram of body weight; supplementation with glutamine and arginine may help to improve recovery. Micronutrient supplements are typically provided and may include high amounts of vitamin A, vitamin C, and zinc, which are thought to support immunity and promote wound healing. Fluid and electrolyte needs must be monitored carefully during the recovery period; the patient’s hydration status can be evaluated by monitoring urine output and serum electrolyte levels.

73 : Describe factors that decrease food intake in patients with lung disease.

Correct Answer : ?Some medical problems upset the process of gas exchange between the air and blood and result in respiratory stress, which is characterized by a reduction in the blood’s oxygen supply and an increase in carbon dioxide levels. Excessive carbon dioxide in the blood may disturb the breathing pattern enough to interfere with food intake. Moreover, the labored breathing caused by many respiratory disorders entails a higher energy cost than normal breathing does, raising energy needs and increasing carbon dioxide production further. Lung diseases make physical activity difficult and can lead to muscle wasting. Weight loss and malnutrition therefore become dangerous outcomes of some types of respiratory illnesses.

74 : Describe nutrition care for patients with respiratory failure; include estimation of energy needs and fluids for nutrition support.

Correct Answer : ?Patients with lung injuries or ARDS are frequently hypermetabolic and/or catabolic and at high risk of muscle wasting. The primary concerns are therefore to provide enough energy and protein to sustain muscle tissue and lung function without overtaxing the respiratory system. Fluid restrictions may be necessary to help correct pulmonary edema. As usual, when nutrition support is necessary, enteral nutrition is preferred over parenteral nutrition.

Energy needs can be estimated using either indirect calorimetry or predictive equations; the body weight used in predictive equations may need to be corrected for pulmonary edema.

Overfeeding should be avoided because it can cause excessive carbon dioxide production and worsen respiratory function. Protein requirements are increased in patients with lung inflammation or ARDS. For mild or moderate lung injury, protein recommendations range from 1.0 to 1.5 grams of protein per kilogram of body weight per day. Patients with ARDS may require 1.5 to 2.0 grams of protein per kilogram of body weight daily. Although most patients have normal fluid requirements, fluid status should be monitored daily to prevent fluid imbalances. Some patients may require fluid restriction to prevent edema in lung tissue, whereas others may become dehydrated because of diuretic therapy, an increase in bronchial secretions, or a low fluid intake. The presence of edema can make it difficult to assess whether a critically ill patient is maintaining weight.

75 : Discuss the factors that influence the development of multiple organ failure.

Correct Answer : ?Shock can impair numerous organ systems. The abnormal delivery of oxygen and nutrients to tissues and insufficient removal of wastes result in irreversible injury to cells and tissues. Although each organ system is affected differently, ultimately one or more organs may begin to fail. The failure of one organ may place excessive demands on another, causing the second to fail as well. The progression of SIRS to MODS reflects the inability of the body’s defenses and medical treatments to counter the detrimental effects of a sustained and potent 15 / 16

inflammatory response. Although the clinical course of MODS differs substantially among patients, the sequence of organ dysfunction often follows a similar pattern: first the lungs fail, then the heart, and finally the liver, kidneys, and GI tract. Other organs or systems may also become involved, and each additional failure reduces the likelihood of survival.

76 : List the common therapies that are used to treat multiple organ failure and the function of each therapy.

Correct Answer : ?Once MODS has developed, extensive medical support is needed until the inflammatory response has abated. Unfortunately, aggressive treatments can have damaging effects of their own and may cause further injury to organs that are already weakened by illness.

Health practitioners should therefore be aware of the adverse effects of aggressive therapies and remain alert to a patient’s responses to treatments. Mechanical ventilation is used to assist injured lungs and sustain gas exchange. Fluids and electrolytes are supplied to restore blood volume and maintain electrolyte balance. Medications help to sustain or increase cardiac output and maintain adequate blood pressure. Hemofiltration or dialysis helps to prevent the buildup of toxic metabolites in the blood. Antibiotic therapy may reverse or prevent infections. Enteral and parenteral nutrition support provide nutrients, help to prevent excessive wasting, and promote recovery.

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MULTIPLE CHOICE 1 : A sign of oropharyngeal dysphagia is .

A : a sensation of food sticking in the esophagus B : nasal regurgitation C : achalasia D : heartburn Correct Answer : B 2 : Sam has been diagnosed with esophageal dysphagia. This means that he has A : difficulty passing a bolus of food through the esophagus into the stomach B : coughing during swallowing C : an inability to initiate swallowing D : excessive secretion of saliva

.

Correct Answer : A 3 : Which condition would most likely be a cause of esophageal dysphagia?

A : cleft palate B : muscular dystrophy C : stroke D : achalasia Correct Answer : D 4 : A degenerative nerve condition affecting the esophagus, characterized by impaired peristalsis and incomplete relaxation of the lower esophageal sphincter when swallowing, is called .

A : achalasia B : achlorhydria C : hypochlorhydria D : stricture Correct Answer : A 5 : One of the most common complications from dysphagia is A : duodenal ulcers B : esophageal spasm C : aspiration D : gastroesophageal reflux

.

Correct Answer : C 6 : Which beverage is most appropriate for a client with dysphagia with an order for nectar-like liquids?

A : water B : chicken broth C : iced tea D : tomato juice Correct Answer : D 1 / 14

7 : When evaluating dysphagia, peristalsis and sphincter pressure are measured by A : a manometer B : X-ray C : an echocardiogram D : fluoroscopy

.

Correct Answer : A 8 : An example of a strategy used by dietitians to encourage clients on mechanically altered diets to eat is to .

A : allow them to eat all desired foods B : identify a persons favorite foods and foods that have pleasant smells C : restrict all their favorite foods D : allow them to eat just one meal a day Correct Answer : B 9 : What food should be avoided in Level 3 of the National Dysphagia Diet?

A : clam chowder B : poached eggs C : canned fruit salad D : fruit yogurt Correct Answer : A 10 : The backflow of gastric contents from the stomach into the mouth is A : an esophageal stricture B : heartburn C : reflux D : achalasia

.

Correct Answer : C 11 : Eric has developed dysphagia after having a stroke. He requires mechanically altered foods that are easier to swallow. His caregiver is assisting him with eating so that he will not become malnourished. What strategy can the caregiver perform that would most likely help Eric to accept his mechanically altered foods?

A : Substitute white vegetables for brightly colored ones.

B : Serve the foods on an attractive plate.

C : Blend all foods and serve with a straw.

D : Heavily season the foods with salt and pepper.

Correct Answer : B 12 : Frequent reflux of highly acidic gastric fluids results in A : inflammation and scarring of the esophagus B : stomach ulcers C : the inability to swallow D : an inability to use medications

.

Correct Answer : A 2 / 14

13 : Interventions that can help eliminate distress from GERD include A : lying down for 30 minutes after meals B : fluid intake with meals C : small, frequent feedings D : a pureed diet

.

Correct Answer : C 14 : A potential long-term consequence of unresolved esophageal reflux and Barretts esophagus is .

A : esophageal cancer B : liver disease C : peptic ulcer disease D : kidney failure Correct Answer : A 15 : The function of the lower esophageal sphincter is to A : direct food from the mouth to the esophagus B : protect the airway during swallowing C : prevent backflow from the esophagus D : prevent backflow from the stomach

.

Correct Answer : D 16 : Which food might be included on a Level 1 National Dysphagia Diet menu?

A : slurried crackers B : moistened puffed rice cereal C : tender cooked meat D : moist pancakes Correct Answer : A 17 : Thomas received eggnog with his meal. What type of liquid is this?

A : thin B : nectarlike C : honeylike D : spoon-thick Correct Answer : B 18 : What increases risk of GERD by increasing pressure in the stomach?

A : chocolate B : wearing tight clothing C : diazepam D : cigarette smoking Correct Answer : B 19 : Pain, bloating, or discomfort in the upper abdominal area is termed A : dysphagia B : dyspepsia C : epigastria

.

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D : achalasia Correct Answer : B 20 : To minimize symptoms of dyspepsia, patients might be advised to do which activity?

A : Consume large meals.

B : Eat only raw foods.

C : Avoid overly seasoned foods.

D : Drink coffee rather than fruit juice.

Correct Answer : C 21 : Ellen is suffering from abdominal bloating. What practice should Ellen avoid that would most likely resolve some of her symptoms?

A : drinking bottled water B : chewing gum C : taking estrogen D : eating chocolate Correct Answer : B 22 : Karen has intractable vomiting. Which type of diet would be most appropriate for her?

A : gastric tube feeding B : intestinal tube feeding C : parenteral nutrition D : clear liquid Correct Answer : C 23 : A client suffering from chronic nausea should eat A : a hot breakfast in the morning B : a tuna salad sandwich at lunch C : dry toast or crackers D : bagels with jalapeno cream cheese

.

Correct Answer : C 24 : The dietary management of acute gastritis includes A : avoiding antacids B : eating dry crackers C : increasing aspirin for pain D : avoiding alcohol

.

Correct Answer : D 25 : Peptic ulcer patients should avoid food consumption for at least A : 30 minutes B : one hour C : two hours D : three hours

before bedtime.

Correct Answer : C 4 / 14

26 : What percentage of individuals with chronic H. pylori infection actually develops a peptic ulcer?

A : 5 to 15 B : 45 to 50 C : 60 to 65 D : 75 to 80 Correct Answer : A 27 : Gastroparesis most often develops as a consequence of what condition?

A : cardiomyopathy B : Kawasaki disease C : diabetes D : hepatitis Correct Answer : C 28 : What is a potential side effect associated with antacids?

A : hyperglycemia B : decreased absorption of fat C : decreased iron absorption D : decreased absorption of B6 Correct Answer : C 29 : An individual with gastritis and hypochlorhydria is most at risk of what nutrient deficiency?

A : vitamin C B : vitamin B12 C : sodium D : phosphorus Correct Answer : B 30 : Nutrition care and treatment of peptic ulcers includes A : quitting smoking B : consuming dry, starchy foods C : avoiding tight clothing D : eating meals 30 minutes before bedtime

.

Correct Answer : A 31 : The primary goals of nutrition after gastrectomy are to A : promote healing of stomach tissue B : prevent dehydration C : support nutrient excretion D : avoid peptic ulcer development

.

Correct Answer : A 32 : In a partial gastrectomy, only part of the stomach is removed and the remaining portion is connected to the .

A : pyloric sphincter B : ileum 5 / 14

C : duodenum D : lower esophageal sphincter Correct Answer : C 33 : What meets the guidelines for a post-gastrectomy diet?

A : unlimited liquids with meals B : unlimited simple sugar intake C : small, frequent meals D : infrequent, normally-sized meals Correct Answer : C 34 : Dumping syndrome occurs when .

A : nutrients are absorbed too quickly from the duodenum B : fluids are transitioned too rapidly through the large intestine C : food and fluids are quickly emptied from the stomach D : food enters the stomach through the lower esophageal sphincter too quickly Correct Answer : C 35 : The postgastrectomy diet includes .

A : fluid with meals B : refined carbohydrates C : foods high in fat D : supplementation with calcium and vitamin D Correct Answer : D 36 : Anemia may develop after a gastrectomy because A : surgery alters B6 absorption B : folate-rich foods are avoided C : iron is absorbed poorly D : lactose is absorbed poorly

.

Correct Answer : C 37 : Which nutrient is often needed in supplemental amounts after gastric surgeries?

A : vitamin D B : selenium C : magnesium D : vitamin C Correct Answer : A 38 : Austin is a 42-year-old obese male. He is researching surgical options to lose weight.

Which type of bariatric surgery is reversible?

A : gastric banding B : gastric bypass C : gastroduodenostomy D : total gastrectomy Correct Answer : A 6 / 14

39 : Which beverage is recommended on a postgastrectomy diet?

A : decaffeinated coffee B : honey-sweetened beverages C : regular cola D : alcohol Correct Answer : A 40 : What is a symptom of early dumping syndrome?

A : anxiety B : headache C : palpitations D : flushing Correct Answer : D 41 : An obese individual is considered to be a candidate for bariatric surgery if he or she has a BMI greater than , regardless of whether they have any serious obesity-associated problems.

A : 25 B : 30 C : 35 D : 40 Correct Answer : D 42 : Following bariatric surgery, what food would need to be avoided?

A : shellfish B : ice cream C : popcorn D : coffee Correct Answer : C 43 : Long-term complications following bariatric surgery include A : peptic ulcer disease B : pressure ulcers C : heart failure D : bone disease

.

Correct Answer : D 44 : Amy is recovering from gastric bypass surgery and needs to learn new dietary habits. What intervention can best help Amy to promote weight loss and healing after surgery?

A : Eat meals over the course of only 510 minutes at a time.

B : Snack throughout the day to feel satisfied.

C : Consume drinks only 1 hour before or after meals.

D : Chew food thoroughly.

Correct Answer : D 45 : To avoid dumping syndrome after bariatric surgery, a patient should

.

7 / 14

A : consume liquids with meals B : avoid foods high in sugars C : avoid lying down for at least 30 minutes after eating D : choose foods that are high in starch Correct Answer : B 46 : As plaque invades the space below the gumline of the teeth, that hold the tooth in place.

A : toxic bacterial by-products B : calculus C : caries D : salivary amylase

can damage the tissues

Correct Answer : A 47 : What is a risk factor for the development of periodontal disease?

A : wearing dentures B : tobacco smoking C : history of cardiovascular disease D : excessive salivation Correct Answer : B 48 : Why is a person with diabetes mellitus at higher risk for periodontal disease?

A : impaired immune response B : increased rigidity of the collagen structure of tissues C : decreased dental plaque D : increased salivation Correct Answer : A 49 : What suggestion would most likely help to manage xerostomia?

A : Consume foods with high fluid content, such as soup.

B : Take frequent sips of carbonated beverages.

C : Avoid wearing clothes that are too tight around the waist.

D : Chew gum or chewing tobacco to stimulate saliva.

Correct Answer : A 50 : The inflammatory process induced by periodontal pathogens may A : slow the progression of rheumatoid arthritis B : decrease insulin resistance C : improve immune responses D : accelerate the progression of atherosclerosis

.

Correct Answer : D 51 : Cassandra Lyons is a 73-year-old retired administrative assistant. She has had recurrent episodes of pneumonia with weight loss for the past 5 months. Her past medical history includes high cholesterol and diabetes. Once again she is admitted to the hospital.The nurse documents that Cassandra has a productive cough and a hoarse voice. She most likely has .

A : oropharyngeal dysphagia 8 / 14

B : esophageal dysphagia C : achalasia D : strictures Correct Answer : A 52 : Cassandra Lyons is a 73-year-old retired administrative assistant. She has had recurrent episodes of pneumonia with weight loss for the past 5 months. Her past medical history includes high cholesterol and diabetes. Once again she is admitted to the hospital.Possible causes of Cassandras condition include .

A : stroke B : achalasia C : emphysema D : esophageal cancer Correct Answer : A 53 : Cassandra Lyons is a 73-year-old retired administrative assistant. She has had recurrent episodes of pneumonia with weight loss for the past 5 months. Her past medical history includes high cholesterol and diabetes. Once again she is admitted to the hospital.The nurse suspects a swallowing problem and recommends an evaluation that involves direct visualization of the esophagus, which will most likely be performed by .

A : a barium swallow test B : an endoscopy C : a neurological exam D : surgery Correct Answer : B 54 : Cassandra Lyons is a 73-year-old retired administrative assistant. She has had recurrent episodes of pneumonia with weight loss for the past 5 months. Her past medical history includes high cholesterol and diabetes. Once again she is admitted to the hospital.What may have caused Cassandras diagnosis to be delayed?

A : respiratory infection B : abnormal cough reflex C : dehydration D : weight loss Correct Answer : B 55 : Cassandra Lyons is a 73-year-old retired administrative assistant. She has had recurrent episodes of pneumonia with weight loss for the past 5 months. Her past medical history includes high cholesterol and diabetes. Once again she is admitted to the hospital.Cassandra is placed on a modified diet for her swallowing problem. Which food would you expect her to have the most difficulty with?

A : mashed potatoes B : pureed meat C : cream cheese D : slurried cookies Correct Answer : C 56 : James Hammond is a 37-year-old business executive. He travels worldwide and has a very 9 / 14

stressful schedule. He self-diagnosed an episode of food poisoning. However, after 5 days of nausea, vomiting, and blood in his stool, he visits his physician and is diagnosed with gastritis.Mr. Hammonds gastritis may have been caused by .

A : infection B : intake of acidic foods C : antibodies D : intake of high-fiber foods Correct Answer : A 57 : James Hammond is a 37-year-old business executive. He travels worldwide and has a very stressful schedule. He self-diagnosed an episode of food poisoning. However, after 5 days of nausea, vomiting, and blood in his stool, he visits his physician and is diagnosed with gastritis.Mr. Hammond is prescribed antibiotics. Based on that, which is most likely to be the primary cause of his gastritis?

A : intake of alcohol B : Helicobacter pylori C : radiation therapy D : bile reflux Correct Answer : B 58 : James Hammond is a 37-year-old business executive. He travels worldwide and has a very stressful schedule. He self-diagnosed an episode of food poisoning. However, after 5 days of nausea, vomiting, and blood in his stool, he visits his physician and is diagnosed with gastritis.Which beverage should Mr. Hammond consume while being treated for gastritis?

A : coffee B : tea C : cola D : apple juice Correct Answer : D 59 : James Hammond is a 37-year-old business executive. He travels worldwide and has a very stressful schedule. He self-diagnosed an episode of food poisoning. However, after 5 days of nausea, vomiting, and blood in his stool, he visits his physician and is diagnosed with gastritis.Mr. Hammond is placed on for 2448 hours to rest the stomach.

A : a mechanical soft diet B : a bland diet C : NPO D : enteral nutrition support Correct Answer : C 60 : James Hammond is a 37-year-old business executive. He travels worldwide and has a very stressful schedule. He self-diagnosed an episode of food poisoning. However, after 5 days of nausea, vomiting, and blood in his stool, he visits his physician and is diagnosed with gastritis.The doctor writes an order to supplement Mr. Hammond with due to his blood loss.

A : iron B : vitamin B12 C : vitamin C D : folic acid 10 / 14

Correct Answer : A

MATCHING 61 : Match each word or phrase with the most appropriate definition or explanation.

A : upper portion of the stomach protrudes A : oropharyngeal dysphagia above the diaphragm B : esophageal dysphagia B : drugs that suppress acid secretion by inhibiting receptors on acid-producing cells C : gastric mucosa is acutely injured, often by C : achalasia the toxic effects of chemical substances or radiation treatment D : hiatal hernia D : drugs that inhibit the enzyme that pumps hydrogen ions (protons) into the stomach E : an inability to transfer food from the mouth E : Barretts esophagus and pharynx to the esophagus; usually due to a neurological or muscular disorder F : an inability to move a food bolus through the F : proton-pump inhibitors esophagus; usually due to an obstruction or a motility G : the feeling of indigestion; refers to pain, G : histamine-2 receptor blockers bloating, or discomfort in the upper abdominal area H : gastritis characterized by destruction of H : dyspepsia gastric mucosal tissue due to chronic inflammation I : abnormally low gastric acid secretions I : Helicobacter pylori J : an esophageal disorder characterized by J : acute gastritis weakened peristalsis and impaired relaxation by the lower esophageal sphincter K : bacteria that colonize the gastric mucosa; a K : hypochlorhydria major cause of gastritis and peptic ulcer disease L : esophageal cells that have been damaged L : achlorhydria by chronic exposure to stomach acid are replaced by cells that resemble those in the stomach or small intestine M : gastric outlet obstruction M : dry mouth; due to a reduction in salivary secretions N : bariatric surgery N : a blockage that prevents the normal emptying of stomach contents into the duodenum O : surgery that treats obesity O : atrophic gastritis P : disease that affects the connective tissue P : gastrectomy structures that support the teeth Q : absence of gastric acid secretion Q : gastroparesis R : inflammation of the gums, characterized by R : dumping syndrome redness, swelling, and bleeding S : abnormal narrowing of a passageway S : stricture T : delayed gastric emptying, most often T : xerostomia 11 / 14

because of diabetes or neurological disorders U : autoimmune disease characterized by the U : dental calculus destruction of secretory glands, especially those that produce saliva and tears V : mineralized dental plaque, often associated V : peptic ulcer with inflammation and bleeding W : surgery in which diseased portions of the W : periodontal disease stomach are removed X : gingivitis X : symptoms that result from rapid stomach emptying: nausea, abdominal cramps, weakness, diarrhea, and hypoglycemia Y : an open sore in the gastrointestinal mucosa Y : Sjögrens syndrome Correct Answer : A:D B:G C:J D:F E:A F:B G:H H : A14 I:K J:C K:I L:E M : A19 N : A12 O : A13 P : A22 Q : A11 R : A23 S : A18 T : A16 12 / 14

U : A24 V : A20 W : A15 X : A17 Y : A21

ESSAY 62 : Discuss the complications of dysphagia and explain how dietary interventions can help with dysphagia management.

Correct Answer : ?Health practitioners should be alert to the various complications that may accompany dysphagia. If the condition restricts food consumption, weight loss and malnutrition may develop. Individuals who cannot swallow liquids are at increased risk of dehydration. If aspiration occurs, it may cause choking, airway obstruction, or respiratory infections, including pneumonia. If a person lacks a normal cough reflex, aspiration is more difficult to diagnose and may go unnoticed. To compensate for swallowing difficulties, a person with dysphagia may need to consume foods and beverages that have been physically modified so that they are easier to swallow. Because a wide variety of defects can cause dysphagia, finding the best diet is often a challenge. Furthermore, a person’s swallowing ability can fluctuate over time, so the dietary plan needs frequent reassessment. The National Dysphagia Diet, developed in 2002 by a panel of dietitians, speech and language therapists, and a food scientist, has helped to standardize the nutrition care of dysphagia patients. After the appropriate dietary level is selected, the diet must be adjusted to suit the person’s swallowing abilities and tolerances. In many cases, the most appropriate foods may be determined only by trial and error. A consultation with a swallowing expert, such as a speech and language therapist, is often necessary.

63 : Discuss the dietary interventions to help decrease nausea and vomiting.

Correct Answer : ?Sometimes nausea can be prevented or improved with dietary measures. To minimize stomach distention, patients should consume small meals and drink beverages between meals rather than during a meal. Dry, starchy foods such as toast, crackers, and pretzels may help to reduce nausea, whereas fatty or spicy foods and foods with strong odors may worsen symptoms. Foods that are cold or at room temperature may be better tolerated than hot foods. Individuals often have strong food aversions when nauseated, and tolerances vary greatly.

64 : Describe the potential complications of gastritis and dietary recommendations for control of the condition.

Correct Answer : ?The extensive tissue damage that develops in long-term gastritis may disrupt gastric secretory functions and increase the risk of cancer. When autoimmune disease is the cause of atrophic gastritis, it frequently leads to destruction of the stomach cells that produce hydrochloric acid and intrinsic factor. If hydrochloric acid secretions become abnormally low or 13 / 14

absent, absorption of nonheme iron and vitamin B12 can be impaired, increasing the risk of deficiency. Lack of intrinsic factor can result in vitamin B12 malabsorption and the vitamin B12– deficiency condition known as pernicious anemia; possible consequences include macrocytic anemia and neurological damage. Dietary recommendations depend on an individual’s symptoms. In asymptomatic cases, no dietary adjustments are needed. If pain or discomfort is present, the patient should avoid irritating foods and beverages; these often include alcohol, coffee (including decaffeinated), cola beverages, spicy foods, and fried or fatty foods. If food consumption increases pain or causes nausea and vomiting, food intake should be avoided for 24 to 48 hours to rest the stomach. If hypochlorhydria or achlorhydria is present, supplementation of iron and vitamin B12 may be warranted.

65 : Discuss the risk factors for periodontal disease and potential strategies for reducing risk.

Correct Answer : ?Dental plaque is the primary risk factor associated with periodontal disease, and the severity of disease is related to the amount of plaque present. Tobacco smoking is another factor, possibly because of its destructive effects on cellular immune responses. The likelihood of developing periodontal disease is increased if a person has a chronic illness that impairs immune status, such as diabetes mellitus or HIV infection. Other risk factors include stress, pregnancy, use of certain medications (including oral contraceptives, antiepileptic drugs, and anticancer drugs), and dental conditions that increase plaque accumulation, such as poorly aligned teeth or ill-fitting bridges. Strategies for reducing risk focus on improving oral hygiene (proper brushing and flossing) and encouraging smoking cessation.

66 : Discuss the relationship between oral health and diabetes mellitus, atherosclerosis, and respiratory illnesses.

Correct Answer : ?Dental diseases may have adverse effects on health beyond their effects on teeth. The bacteria that reside on dental tissues can enter the bloodstream and travel to other tissues; therefore, they may be able to trigger immune responses or cause infections elsewhere in the body. The inflammatory process induced by periodontal pathogens may increase levels of cytokines and other mediators that accelerate the progression of atherosclerosis. In addition, periodontal bacteria may enter the bloodstream and contribute to the processes of arterial plaque formation or blood clotting. The chronic inflammation caused by periodontal disease can exacerbate insulin resistance and provoke events leading to type 2 diabetes. Severe periodontal disease has also been linked to poor glycemic control in persons with diabetes.

Clinical studies suggest a link between pneumonia and poor oral health. In addition, dental treatment and improvements in oral health have been associated with significant reductions in respiratory diseases in institutionalized older adults.

14 / 14

MULTIPLE CHOICE 1 : What organ of the gastrointestinal tract produces enzymes that digest energy-yielding nutrients to smaller nutrient particles?large intestine A : stomach B : small intestine C : liver D : large intestine Correct Answer : B 2 : The risk of constipation is increased under what condition?

A : increased food intake B : low-fiber diet C : increased intake of carbonated beverages D : lactase deficiency Correct Answer : B 3 : The food that is most likely to produce gas is A : bananas B : dried beans and peas C : brown rice D : coffee

.

Correct Answer : B 4 : Consequences of severe diarrhea include A : weight gain B : dehydration C : hemorrhoids D : paradoxical constipation

.

Correct Answer : B 5 : Medications that stimulate colonic contractions are called A : antispasmodic drugs B : cholinergic agonists C : antiemetic medications D : prokinetic agents

.

Correct Answer : D 6 : Antidiarrheal agents .

A : slow GI motility or reduce intestinal secretions B : increase GI motility or increase intestinal secretions C : slow GI motility and may help fight infectious agents D : increase GI motility and reduce intestinal secretions Correct Answer : A 7 : Mrs. Thomas has been suffering from a mild case of diarrhea for the past four days. What 1 / 15

should Mrs. Thomas be given to replace fluid and electrolytes?

A : a commercial sports drink B : low-fat milk C : caffeine-free carbonated beverage D : regular coffee Correct Answer : C 8 : Liana is four years old and suffering from diarrhea. Which food should her mother let her eat to thicken her stool?

A : applesauce B : milk C : grape juice D : green beans Correct Answer : A 9 : In , unabsorbed nutrients or other substances attract water to the colon and increase fecal water content.

A : osmotic diarrhea B : secretory diarrhea C : diarrhea associated with motility disorders D : inflammatory diarrhea Correct Answer : A 10 : What type of laxative may cause watery stools or diarrhea?

A : fiber B : osmotic, nonabsorbable salts C : chloride channel activators D : stimulant Correct Answer : B 11 : Nutritional consequences of fat malabsorption include A : weight gain and malnutrition B : increase in essential amino acids C : increased risk of bone loss D : decreased risk of oxalate stone formation

.

Correct Answer : C 12 : When calcium is unable to bind oxalate, A : enteric hypoxaluria B : kidney stones C : hypercalcemia D : a decreased risk of osteoporosis

can result.

Correct Answer : B 13 : MCT oil is commonly used in malabsorption syndromes because A : it is high in essential fatty acids B : its absorption occurs in the large intestine

.

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C : it does not require bile for absorption D : it can be delivered parenterally Correct Answer : C 14 : A condition classified as an intestinal disorder that can lead to malabsorption is A : giardiasis B : bile insufficiency C : cystic fibrosis D : radiation enteritis

.

Correct Answer : D 15 : Which food should be excluded from a 50-gram fat-controlled diet?

A : whole milk B : tofu C : starchy vegetables D : avocado Correct Answer : A 16 : Foods to avoid from the category of breads and cereals while on a fat-restricted diet include .

A : granola B : bagels C : pretzels D : English muffins Correct Answer : A 17 : Which menu best meets the objectives of a fat-controlled diet for a client with steatorrhea?

A : tuna fish salad, crackers, ice cream, tea B : baked chicken, macaroni and cheese, biscuits, milk C : pork tenderloin, plain baked potato, applesauce, tea D : sirloin steak, potato salad, broccoli au gratin, milk Correct Answer : C 18 : Which food would be the best dessert for a client on a fat-controlled diet?

A : cookies B : ice cream C : cherry pie D : sherbet Correct Answer : D 19 : What condition would most likely lead to bacterial overgrowth in the gastrointestinal tract?

A : gastroesophageal reflux B : intestinal strictures C : dyspepsia D : celiac disease Correct Answer : B 3 / 15

20 : How does bacterial overgrowth sometimes lead to fat malabsorption?

A : The bacteria dismantle the bile acids needed for fat emulsification.

B : The bacteria compete for the sites that absorb fat.

C : The bacteria cause the formation of soaps that disrupt the fat.

D : The bacteria themselves consume the fat.

Correct Answer : A 21 : Pancreatitis is defined as .

A : production of a thick mucus that affects the pancreas B : an inflammatory disorder of the pancreas C : ulceration along the wall of the pancreas D : excessive secretion of pancreatic enzymes Correct Answer : B 22 : Severe cases of acute pancreatitis could lead to what complication?

A : liver disease B : systemic inflammatory response syndrome C : intestinal obstruction D : colon cancer Correct Answer : B 23 : Which nutrient has the greatest stimulating effect on pancreatic secretions?

A : carbohydrates B : fat C : protein D : vitamins Correct Answer : B 24 : What describes appropriate initial nutrition care for cases of mild-to-moderate acute pancreatitis?

A : a full liquid diet B : MCT oil and iron supplements C : a low-fiber diet D : NPO Correct Answer : D 25 : What is the most frequent cause of chronic pancreatitis?

A : repeated episodes of acute pancreatitis B : alcohol consumption C : liver disease D : cystic fibrosis Correct Answer : B 26 : Although all macronutrients are maldigested during chronic pancreatitis, the symptoms of malabsorption are typically the most severe.

A : iron 4 / 15

B : fat C : sodium D : protein Correct Answer : B 27 : What is a potential side effect of pancreatic enzyme replacements?

A : diarrhea B : hematemesis C : bloody stool D : constipation Correct Answer : D 28 : The most appropriate diet therapy for clients with cystic fibrosis is to A : reduce fat to less than 35 grams per day B : limit kcalories to 1200 per day C : supply missing enzymes D : restrict sodium

.

Correct Answer : C 29 : The fat intake of patients with acute pancreatitis should be less than A : 30 B : 50 C : 70 D : 90

grams per day.

Correct Answer : B 30 : The protein needs of patients with acute pancreatitis are between of body weight per day.

A : 1.0 and 1.2 B : 1.2 and 1.5 C : 1.5 and 1.7 D : 1.7 and 2.0

grams per kilogram

Correct Answer : B 31 : What causes malabsorption in patients with cystic fibrosis?

A : lack of pancreatic enzymes reaching the small intestine B : abnormal structure of the small intestine C : severe anorexia associated with the respiratory problems D : side effects of most effective medications Correct Answer : A 32 : The protein fraction in wheat gluten that has toxic effects in celiac disease is called A : glutathione B : gliadin C : casein D : whey

.

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Correct Answer : B 33 : Which food is a potential source of gluten?

A : soy sauce B : buttermilk C : tofu D : marshmallows Correct Answer : A 34 : An appropriate food for a client with celiac disease is A : a peanut butter and jelly sandwich on wheat bread B : oatmeal cookies C : applesauce D : cheese and rye crackers

.

Correct Answer : C 35 : Betsey, a client with celiac disease, asks the dietitian whether she can include oats in her diet. How should the dietitian respond?

A : You should limit your intake to about ½ cup dry rolled oats per day and monitor your tolerance.

B : You must exclude oats from your diet.

C : You can consume oats freely because they dont contain gluten like wheat or barley.

D : You should compare labels and select oats in baked form or mixed with other grains.

Correct Answer : A 36 : Ulcerative colitis involves which section(s) of the gastrointestinal tract?

A : large intestine B : small intestine C : jejunum and rectum D : biliary tract Correct Answer : A 37 : What type of drug would most likely be prescribed for a patient with inflammatory bowel disease?

A : antivirals B : antispasmodics C : immunosuppressants D : stool softeners Correct Answer : C 38 : Matthew has been diagnosed with mild ulcerative colitis. He should be aware of what complication(s)?

A : inflammation of the ileum B : fistulas C : risk of cancer D : retroperitoneal abscess Correct Answer : C 6 / 15

39 : Severe exacerbations of inflammatory bowel disease would require which type of diet?

A : high-kcalorie and high-protein diet B : lactose-free diet C : total parenteral nutrition D : clear liquid diet Correct Answer : C 40 : What is the malabsorption syndrome that results after surgery when the absorptive capacity of the remaining intestine is insufficient for meeting nutritional needs?

A : celiac disease B : short bowel syndrome C : irritable bowel syndrome D : inflammatory bowel disease Correct Answer : B 41 : What is a potential nutritional consequence following resection of the ileum?

A : sodium malabsorption B : reduced calcium and zinc absorption C : lactose malabsorption D : reduced potassium and phosphorus absorption Correct Answer : B 42 : Individuals with are gluten-sensitive but react to gluten by developing a severe, itchy rash and have few GI symptoms.

A : dermatitis herpetiformis B : cutaneous celiac disease C : dermal dystrophy D : gluten dermatitis Correct Answer : A 43 : Which item is a potential source of gluten?

A : buttermilk B : cottage cheese C : chocolate milk D : cream cheese Correct Answer : C 44 : Nutrition therapy for irritable bowel syndrome would most likely include A : administering parenteral nutrition B : avoiding food three hours before bedtime C : increasing fluid intake with meals D : consuming a low-FODMAP diet

.

Correct Answer : D 45 : In Western societies, diverticula occur most often in which location?

A : the sigmoid colon 7 / 15

B : at the ileocecal valve C : the transverse colon D : the ascending colon Correct Answer : A 46 : A surgical procedure that creates a stoma from the final segment of the colon that remains after a colectomy is a(n) .

A : ileostomy B : colostomy C : gastrostomy D : port Correct Answer : B 47 : People with ileostomies need to follow which nutrition practice?

A : chewing food thoroughly B : drinking 4 to 6 cups of fluid per day C : taking an antacid prior to meals D : checking blood glucose levels frequently Correct Answer : A 48 : Which practice may increase gas formation in patients with ostomies?

A : drinking carbonated beverages B : drinking buttermilk C : eating parsley D : eating yogurt Correct Answer : A 49 : Mallory has a colostomy and has been suffering from frequent diarrhea. What food would be most appropriate to help thicken stool output?

A : ice cream B : green beans C : oatmeal D : dried apricots Correct Answer : C 50 : Intestinal bacteria can benefit our health by A : increasing bacterial overgrowth B : decreasing fatty acid production C : stimulating the immune system D : stimulating malabsorption

.

Correct Answer : C 51 : Which is a subdominant type of intestinal bacteria?

A : Enterococci B : Bacteroides C : Eubacteria D : Clostridia 8 / 15

Correct Answer : A 52 : Over A : 100 B : 500 C : 1000 D : 5000

different species of bacteria reside in the colon.

Correct Answer : B 53 : Researchers are interested in the effects of bacterial probiotics on gastrointestinal disorders and .

A : congenital heart disease B : prematurity C : cancer D : renal failure Correct Answer : C 54 : A serving of usually provides enough probiotic bacteria to survive in sufficient numbers to influence bacterial populations in the large intestine.

A : kimchee B : sauerkraut C : yogurt D : beer Correct Answer : C 55 : Although adverse effects are rare, one concern related to probiotic bacteria is A : the increase in resistant strains B : infection in immunocompromised individuals C : the association between probiotics and heart disease D : increased rates of contamination among products

.

Correct Answer : B 56 : Three-year-old Jenny is on antibiotics for 10 days. In order to prevent complications, her mother was advised to add to her diet.

A : fruit punch B : sugar-free gelatin C : saltines D : yogurt Correct Answer : D 57 : Which patient should be cautious about consuming probiotics?

A : a person with diabetes B : a person with dementia C : a person receiving chemotherapy D : a person with influenza Correct Answer : C 9 / 15

58 : Research with probiotics has shown that certain strains may .

A : shorten the duration of rotavirus-associated diarrhea in infants and children B : prevent the need for ostomies in some patients C : shorten the duration of exacerbations of Crohns disease D : prevent peptic ulcer development in older adults Correct Answer : A 59 : Ms. Betty Bell is a new resident to Lake Nursing Home. She has a history of osteoporosis, depression, and memory loss. She tells her admitting nurse that she has not had a bowel movement since 1967. Her nurse questions her further to determine that she has had irregular bowel movements for the past 40 plus years.What is a potential cause of Ms. Bells constipation?

A : dehydration B : a high-fiber diet C : increased food intake D : high levels of physical activity Correct Answer : A 60 : Ms. Betty Bell is a new resident to Lake Nursing Home. She has a history of osteoporosis, depression, and memory loss. She tells her admitting nurse that she has not had a bowel movement since 1967. Her nurse questions her further to determine that she has had irregular bowel movements for the past 40 plus years.Ms. Bell is given an order for a high-fiber diet to maintain normal bowel movements. What could prevent her intake of high-fiber foods (e.g., raw apples, salads)?

A : low acid production B : lack of fiber enzymes C : poor dentition D : short-term memory problems Correct Answer : C 61 : Ms. Betty Bell is a new resident to Lake Nursing Home. She has a history of osteoporosis, depression, and memory loss. She tells her admitting nurse that she has not had a bowel movement since 1967. Her nurse questions her further to determine that she has had irregular bowel movements for the past 40 plus years.A potential side effect of a high-fiber diet is .

A : diarrhea B : diverticulosis C : flatulence D : ostomy Correct Answer : C 62 : Ms. Betty Bell is a new resident to Lake Nursing Home. She has a history of osteoporosis, depression, and memory loss. She tells her admitting nurse that she has not had a bowel movement since 1967. Her nurse questions her further to determine that she has had irregular bowel movements for the past 40 plus years.Ms. Bells constipation could be related to which condition?

A : depression B : confusion C : memory loss 10 / 15

D : anxiety Correct Answer : A 63 : Ms. Betty Bell is a new resident to Lake Nursing Home. She has a history of osteoporosis, depression, and memory loss. She tells her admitting nurse that she has not had a bowel movement since 1967. Her nurse questions her further to determine that she has had irregular bowel movements for the past 40 plus years.Ms. Bell is ordered a high-fiber, mechanical soft diet. Which food would most likely be included on her dinner tray?

A : chunky peanut butter B : ground meat C : grapes D : raw vegetables Correct Answer : B 64 : Mr. Rogelio Martinez is a healthy 79-year-old, retired factory worker. His past medical history includes arthritis and irregular bowel movements. His wife urges him to go to the emergency department of the local hospital after three episodes of blood in his stool.Mr. Martinez is found to have infection in the diverticula. What will his immediate treatment include?

A : antibiotics B : high-fiber diet C : laxatives D : antidiarrheals Correct Answer : A 65 : Mr. Rogelio Martinez is a healthy 79-year-old, retired factory worker. His past medical history includes arthritis and irregular bowel movements. His wife urges him to go to the emergency department of the local hospital after three episodes of blood in his stool.What describes the diet progression for Mr. Martinez?

A : NPO, clear liquid, high fiber, low residue B : NPO, high fiber, low residue, clear liquid C : high fiber, low residue, NPO, clear liquid D : NPO, clear liquid, low residue, high fiber Correct Answer : D 66 : Mr. Rogelio Martinez is a healthy 79-year-old, retired factory worker. His past medical history includes arthritis and irregular bowel movements. His wife urges him to go to the emergency department of the local hospital after three episodes of blood in his stool.Four weeks later, Mr. Martinez returns to the hospital. After an extensive work-up, he is found to need surgery due to extensive damage in a portion of his colon. What type of surgery will he have?

A : diverticulosis B : colostomy C : ileostomy D : gastric bypass Correct Answer : B 67 : Mr. Rogelio Martinez is a healthy 79-year-old, retired factory worker. His past medical history includes arthritis and irregular bowel movements. His wife urges him to go to the emergency department of the local hospital after three episodes of blood in his stool.A home 11 / 15

health nurse visits Mr. Martinez and his wife. She reinforces the importance of consuming A : nuts, seeds, and corn B : 8 cups of liquid per day C : celery D : a high-protein, high-kcalorie oral supplement

.

Correct Answer : B 68 : Mr. Rogelio Martinez is a healthy 79-year-old, retired factory worker. His past medical history includes arthritis and irregular bowel movements. His wife urges him to go to the emergency department of the local hospital after three episodes of blood in his stool.Six months have passed and Mr. Martinez is back in the hospital to have his colon reconnected. After recovery, what type of diet should he follow to ensure regular bowel movements?

A : clear liquid B : bland C : low residue D : high fiber Correct Answer : D

MATCHING 69 : Match each word or phrase with the most appropriate definition or explanation.

A : a substance that is capable of causing A : bacterial overgrowth disease B : cystic fibrosis B : condition characterized by an abnormal immune reaction to wheat gluten that causes severe intestinal damage and nutrient malabsorption C : removal of a portion or all of the colon C : celiac disease D : chronic inflammatory disease of the D : dermatitis herpetiformis gastrointestinal tract E : process of intestinal recovery after resection E : inflammatory bowel disease that leads to improved absorptive capacity F : live bacteria provided in foods and dietary F : Crohns disease supplements G : ulcerative colitis G : a surgically created passage through the intestinal wall into the ileum H : gluten-sensitive disorder characterized by a H : short bowel syndrome severe skin rash; gastrointestinal symptoms may be mild or absent I : surgically created opening in a body tissue or I : intestinal adaptation organ J : abnormal passage between body tissues or J : colectomy organs K : stoma K : excessive bacterial colonization of the stomach and small intestine; may be caused by low gastric acidity, altered gastrointestinal motility, mucosal damage, or contamination L : colostomy L : inflammatory bowel disease that usually occurs in the lower portion of the small intestine 12 / 15

and the colon; inflammation may pervade the entire intestinal wall M : a surgically created passage through the M : ileostomy abdominal wall into the colon N : prebiotics N : malabsorption syndrome following small intestine resection; results from insufficient absorptive capacity in the remaining intestine O : flora O : nondigestible substances in foods that stimulate the growth of nonpathogenic bacteria within the large intestine P : inherited disease involving exocrine glands, P : probiotics characterized by respiratory disease and pancreatic insufficiency Q : inflammatory bowel disease that involves Q : fistula the colon; inflammation affects the mucosa and submucosa Correct Answer : A : A14 B:C C:J D:E E:I F : A15 G : A12 H:D I:K J : A16 K:A L:F M : A11 N:H O : A13 P:B Q:G

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ESSAY 70 : Discuss possible diet and lifestyle modifications for the treatment of constipation.

Correct Answer : ?In individuals with a low fiber intake, the primary treatment for constipation is a gradual increase in fiber intake to at least 20–25 grams per day. High-fiber diets increase stool weight and fecal water content and promote a more rapid transit of materials through the colon.

The transition to a high-fiber diet may be difficult for some people because it can increase intestinal gas, so high-fiber foods should be added gradually, as tolerated. Fiber supplements such as methylcellulose (Citrucel), psyllium (Metamucil, Fiberall), and polycarbophil (Fiber-Lax) are also effective; these supplements can be mixed with beverages and taken several times daily. Unlike other fibers, methylcellulose and polycarbophil do not increase intestinal gas.

Consuming adequate fluid enhances the effect of an increased fiber intake on stool frequency, and an appropriate fluid intake prevents excessive reabsorption of water from the colon, resulting in wetter stools. Consuming prunes or prune juice is often recommended because prunes contain compounds that have a mild laxative effect. Skipping breakfast is discouraged, as colonic motility is highest after a morning meal. Inactive individuals are generally encouraged to increase physical activity, although clinical studies have not confirmed that increasing exercise improves constipation symptoms.

71 : What is cystic fibrosis, and how is nutrition therapy used to minimize its symptoms?

Correct Answer : ?Cystic fibrosis is the most common life-threatening genetic disorder among Caucasians. The condition is characterized by a mutation in the protein that regulates chloride transport across epithelial cell membranes. The abnormality alters the ion concentration and/or viscosity of exocrine secretions, causing a broad range of serious complications. Cystic fibrosis is characterized by abnormal chloride and sodium levels in exocrine secretions. These altered secretions ultimately disrupt the functioning of multiple tissues and organs. Common complications of cystic fibrosis involve the lungs, pancreas, and sweat glands. Energy requirements may range from 120–150 percent of DRI values; however, intakes are often much lower than these levels. To achieve normal growth and appropriate weight, patients are encouraged to eat a high-kcalorie, high-protein diet, consume high-fat foods freely, eat frequent meals and snacks, and supplement meals with milkshakes or oral supplements. Supplemental tube feedings can help to improve nutrition status if energy intakes are inadequate.

72 : Describe the use of oats in a gluten-free diet for celiac disease.

Correct Answer : ?Although most people with celiac disease can safely consume moderate amounts of oats, most oats grown in the United States are contaminated with wheat, barley, or rye. Oats are usually grown in rotation with other grains and may become contaminated during harvesting or processing. Some oat manufacturers now produce oats in dedicated facilities and test the products to ensure that they are gluten-free. Individuals who wish to include oats in their diet should purchase only uncontaminated oats and limit intakes to the amounts found to be safe (about 1?2 cup of dry rolled oats or 1?4 cup dry steel-cut oats per day).

73 : Explain the effects of short bowel syndrome. What consequences most often occur after small bowel surgery?

Correct Answer : ?Short bowel syndrome is the malabsorption syndrome that results when the absorptive capacity of the remaining intestine is insufficient for meeting nutritional needs.

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Without appropriate dietary adjustments, short bowel syndrome can result in fluid and electrolyte imbalances and multiple nutrient deficiencies. Symptoms of short bowel syndrome include diarrhea, steatorrhea, dehydration, weight loss, and growth impairment in children.

Generally, up to 50 percent of the small intestine can be resected without serious nutritional consequences. More extensive resections lead to generalized malabsorption, and patients may need lifelong parenteral nutrition to supplement oral intakes. Other problems that may develop include kidney stones and gallstones. Furthermore, loss of the ileocecal valve increases the likelihood that colonic bacteria will infiltrate the small intestine and cause bacterial overgrowth.

74 : Discuss the causes of irritable bowel syndrome and how diet modification can be used for treatment.

Correct Answer : ?Although the causes of irritable bowel syndrome remain elusive, people with the disorder tend to have excessive colonic responses to meals, GI hormones, and psychological stress. Intestinal transit may be accelerated, leading to diarrhea, or be delayed, causing constipation. Many individuals exhibit hypersensitivity to a normal degree of intestinal distention and feel discomfort when experiencing normal meal transit or typical amounts of intestinal gas. Some patients show signs of low-grade intestinal inflammation; others may have had a bacterial infection that initiated their GI problems. Many patients have coexisting psychiatric disorders, such as anxiety and depression, which can exacerbate symptoms.

Nutrition therapy aims to identify food intolerances that may worsen symptoms and help patients establish dietary patterns that ensure nutrient adequacy. The foods that aggravate symptoms vary considerably among patients, and tolerances are best determined by trial and error.

Examples of problematic foods include gas-producing foods, wheat and other grains, milk products, caffeine-containing beverages, and carbonated beverages. Some individuals have less discomfort when they consume small, frequent meals instead of larger ones.

Supplementation with psyllium (Metamucil or Fiberall) may help to improve constipation and, possibly, other symptoms.

15 / 15

MULTIPLE CHOICE 1 : The primary symptom of new-onset liver disease that often goes unnoticed is A : anorexia B : weight loss C : fatigue D : weight gain

.

Correct Answer : C 2 : Which blood vessel is responsible for returning blood to the heart from the liver?

A : hepatic artery B : hepatic vein C : GI tract vein D : portal vein Correct Answer : B 3 : Fatty liver disease associated with inflammation is known as A : hepatomegaly B : steatohepatitis C : steatorrhea D : hepatic encephalopathy

.

Correct Answer : B 4 : Laboratory findings associated with fatty liver include A : decreased creatinine B : elevated blood urea nitrogen C : decreased white blood cells D : elevated alanine aminotransferase

.

Correct Answer : D 5 : The usual treatment for fatty liver is .

A : eliminating causative factors B : surgically resecting the damaged portions of the liver C : administering anti-inflammatory drugs D : administering frequent transfusions of packed red blood cells Correct Answer : A 6 : The normal range for bilirubin in the bloodstream is A : 02.0 B : 3.44.8 C : 1545 D : > 55

mg/dL.

Correct Answer : A 7 : What percentage of U.S. adults is affected by fatty liver?

A:5 1 / 15

B : 10 C : 15 D : 33 Correct Answer : D 8 : A number of herbal remedies are reported to cause hepatitis, including A : St. Johns wort B : ma huang C : Echinacea D : ginseng

.

Correct Answer : B 9 : When foodservice workers dont follow good hygiene practices, which strain of hepatitis virus can be transmitted?

A : hepatitis A virus B : hepatitis B virus C : hepatitis C virus D : hepatitis D virus Correct Answer : A 10 : The characteristic yellowing of the skin associated with jaundice is caused by the accumulation of in the blood.

A : bilirubin B : bile C : triglycerides D : alkaline phosphatase Correct Answer : A 11 : What diet recommendation is most appropriate for a patient with hepatitis who is experiencing abdominal discomfort?

A : regular diet B : small, frequent meals C : high-kcalorie tube feedings D : NPO Correct Answer : B 12 : Hepatitis B has infected A : less than 10 percent B : one-quarter C : one-third D : one-half

of the worlds population.

Correct Answer : C 13 : An example of a drug that may be used to treat hepatitis C is A : lamivudine B : acyclovir C : fomivirsen

.

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D : ritonavir Correct Answer : A 14 : Outbreaks of hepatitis A:A B:B C:C D:D

are often associated with natural disasters such as floods.

Correct Answer : A 15 : Diets for persons with hepatitis who are experiencing steatorrhea should limit fat to less than percent of total kcalories.

A : 10 B : 20 C : 30 D : 40 Correct Answer : C 16 : Diets for persons with cirrhosis should include weight each day.

A : 0.5 to 0.8 B : 0.8 to 1.0 C : 1.0 to 1.5 D : 1.5 to 1.9

grams of protein per kilogram of body

Correct Answer : C 17 : One of the two most common causes of cirrhosis in the United States is A : bile duct blockage B : heart disease C : environmental toxins D : hepatitis C infection

.

Correct Answer : D 18 : Normal blood ammonia levels are A : 15 to 45 B : 45 to 60 C : 60 to 75 D : greater than 75

µg N/dL.

Correct Answer : A 19 : If bile obstruction occurs with cirrhosis, the patient will most likely develop A : hypertension B : pruritus C : diaphoresis D : urinary retention

.

Correct Answer : B 3 / 15

20 : The hepatic portal vein and hepatic arteries together supply approximately blood to the liver each minute.

A : 100 B : 500 C : 900 D : 1500

mL of

Correct Answer : D 21 : In a cirrhotic liver, portal hypertension is the result of A : increased pressure in the hepatic artery B : increased pressure in the portal vein C : normal pressure D : blood flow through the liver

.

Correct Answer : B 22 : When blood flow through the portal vein is obstructed, blood travels through smaller vessels around the liver called .

A : ascites B : collaterals C : bypass D : varices Correct Answer : B 23 : Mild hepatic encephalopathy is characterized by A : forgetfulness B : a shortened attention span C : inappropriate behavior D : staggering gait

.

Correct Answer : B 24 : Within 10 years of onset of cirrhosis, approximately ascites.

A : 10 B : 35 C : 50 D : 80

percent of patients will develop

Correct Answer : C 25 : What condition is thought to play a key role in hepatic encephalopathy?

A : elevated blood ammonia levels B : prolonged plasma prothrombin time C : decreased levels of alkaline phosphatase D : increased blood urea nitrogen levels Correct Answer : A 26 : Branched-chain amino acids may be supplemented in the diets of clients with hepatic 4 / 15

encephalopathy because they .

A : increase the synthesis of albumin B : reduce bilirubin levels C : may improve neurological functioning D : prevent a false positive test for occult blood in stool Correct Answer : C 27 : Which nutritional intervention should be encouraged for a client with cirrhosis and steatorrhea?

A : Increase intake of polyunsaturated fat.

B : Reduce kcalorie intake by 20 percent.

C : Limit vitamin B intake.

D : Limit fat intake and use MCT oil.

Correct Answer : D 28 : A patient with ascites should decrease his intake of A : sodium B : potassium C : calcium D : magnesium

in his diet.

Correct Answer : A 29 : John has severe ascites due to advanced cirrhosis. He is scheduled to undergo a procedure that will use a surgical puncture to draw excess fluid out of his abdomen. What is this procedure called?

A : shock-wave lithotripsy B : paracentesis C : peritoneovenous shunt D : peristenotic aspiration Correct Answer : B 30 : Vitamin A:C B:A C : B12 D : B6

status may be affected by steatorrhea related to liver damage.

Correct Answer : B 31 : In patients with cirrhosis, the restricted blood flow within the liver stimulates the release of in nearby blood vessels.

A : vasodilators B : bile acids C : insulin D : pancreatic enzymes Correct Answer : A 32 : Which measure may be normal or decreased in patients with liver disease?

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A : ammonia B : gamma-glutamyl transpeptidase C : blood urea nitrogen D : alanine aminotransferase Correct Answer : C 33 : Which type of medication would most likely be administered to a patient with cirrhosis to control ascites?

A : diuretics B : anti-inflammatories C : antibiotics D : pancreatic enzyme supplements Correct Answer : A 34 : The blood loss associated with ruptured varices in patients with liver disease is A : rarely serious B : common and rarely clinically important C : less problematic given current treatment regimens D : exacerbated by the livers reduced production of clotting factors

.

Correct Answer : D 35 : Which condition is associated with stage 3 hepatic encephalopathy?

A : somnolence B : depression C : tremor D : mood changes Correct Answer : A 36 : What type of dietary interaction has been seen with appetite stimulants such as dronabinol?

A : Licorice root interferes with its effects.

B : It may potentiate the effects of alcohol.

C : Grapefruit juice can raise its concentrations.

D : Its effectiveness may be reduced by calcium and magnesium supplements.

Correct Answer : B 37 : Patients with stable cirrhosis usually require A : 5 to 15 B : 15 to 25 C : 25 to 35 D : 35 to 45

kcal/kg of energy per day.

Correct Answer : C 38 : Isabella is being evaluated for liver transplant surgery. The dietitian finds it difficult to assess her nutritional needs because .

A : she may have fluid retention B : her intake may be inadequate due to esophageal varices C : she is receiving nutrients via parenteral nutrition 6 / 15

D : she is suffering from steatorrhea Correct Answer : A 39 : Elizabeth had a liver transplant two weeks ago. She is on immunosuppressive therapy.

What side effect of these medications might interfere with her nutrition status?

A : steatorrhea B : orthostatic hypotension C : gastroesophageal reflux D : abdominal pain Correct Answer : D 40 : In what ways do immunosuppressant drugs given after liver transplant impact nutrition?

A : by increasing sodium excretion B : by causing gastroparesis C : by causing abdominal pain and mouth sores D : by altering calcium absorption Correct Answer : C 41 : The dietitian evaluates a patient whose status is post liver transplant. Her education plan should include .

A : food safety B : blood glucose monitoring C : portion control D : hepatitis information Correct Answer : A 42 : The five-year survival rate for patients with liver transplantation may be as high as percent.

A : 60 B : 70 C : 80 D : 90 Correct Answer : D 43 : The majority of gallstones are composed primarily of A : cholesterol B : bile pigment C : chloride salts D : uric acid

.

Correct Answer : A 44 : Pigment gallstones are primarily made up of which substance?

A : the calcium salt of bilirubin B : excess pancreatic enzymes C : phospholipids D : inorganic salts 7 / 15

Correct Answer : A 45 : Black pigment gallstones are caused primarily by A : bacterial infection B : collections of concentrated bile C : excessive red blood cell breakdown D : rapid weight loss following gastric bypass

.

Correct Answer : C 46 : Gallstone pain is most frequently described as A : steady, severe abdominal pain B : intermittent, burning pain C : pain that radiates to the chest, jaw, or head D : excruciating pain that limits activities of daily living

.

Correct Answer : A 47 : Which ethnicity is at much higher risk of developing cholesterol gallstones than any other?

A : Asian American B : Native Hawaiian/Pacific Islander C : African American D : Native American Correct Answer : D 48 : Recurrence rates after pharmacologic dissolution of stones are as high as within 5 years after treatment.

A : 10 B : 30 C : 50 D : 70

percent

Correct Answer : C 49 : Which substance has been shown to reduce the risk of gallstone formation during rapid weight loss?

A : mucin proteins B : bile salts C : statin medications D : estrogen Correct Answer : B 50 : Pharmacological management of gallstones with ursodeoxycholic acid may require until the cholesterol crystals dissolve.

A : 3 to 6 weeks B : 6 to 10 weeks C : 3 to 6 months D : 6 to 18 months Correct Answer : D 8 / 15

51 : A patient who has undergone cholecystectomy is at risk for amount of bile in the large intestine.

A : constipation B : dyspepsia C : diarrhea D : jaundice

due to an increased

Correct Answer : C 52 : Where does erythropoiesis take place?

A : in the stomach B : in the small intestines C : in the bone marrow D : in the large intestine Correct Answer : C 53 : What is the role of stem cells?

A : to differentiate into red blood cells B : to secrete erythropoietin C : to aid in the production of additional vitamin B12 D : to carry hemoglobin and oxygen to body tissues Correct Answer : A 54 : A type of anemia that results in premature destruction of red blood cells is A : aplastic anemia B : anemia of chronic disease C : macrocytic anemia D : hemolytic anemia

.

Correct Answer : D 55 : The most common type of anemia affecting hospitalized patients and those with long-term illness is .

A : aplastic anemia B : macrocytic anemia C : anemia of chronic disease D : iron-deficiency anemia Correct Answer : C 56 : Which type of anemia is characterized by failure of stem cells to develop into RBCs and may be due to immune disease, viruses, drugs and toxins, or genetic defects?

A : aplastic anemia B : macrocytic anemia C : hemolytic anemia D : thalassemia Correct Answer : A 57 : What test is used to study the number and shapes of red blood cells?

A : peripheral blood smear 9 / 15

B : hemoglobin C : mean corpuscular volume D : hematocrit Correct Answer : A 58 : Karen Bauman is a 27-year-old employed in the cosmetic and fashion industry. Lately, she has reported feeling fatigued. She feels her long hours and hectic schedule are the main contributors. Her past medical history includes type 1 diabetes. She returns to her doctor due to abnormal lab results from her last physical.Ms. Bauman is surprised to be diagnosed with fatty liver disease. Which laboratory value would you expect to be elevated?

A : potassium B : triglycerides C : albumin D : essential fatty acids Correct Answer : B 59 : Karen Bauman is a 27-year-old employed in the cosmetic and fashion industry. Lately, she has reported feeling fatigued. She feels her long hours and hectic schedule are the main contributors. Her past medical history includes type 1 diabetes. She returns to her doctor due to abnormal lab results from her last physical.Ms. Baumans doctor explains that she will need to .

A : control her blood glucose B : have gastric bypass surgery C : increase her alcohol intake D : start TPN Correct Answer : A 60 : Karen Bauman is a 27-year-old employed in the cosmetic and fashion industry. Lately, she has reported feeling fatigued. She feels her long hours and hectic schedule are the main contributors. Her past medical history includes type 1 diabetes. She returns to her doctor due to abnormal lab results from her last physical.If liver damage and scarring develop, Ms. Bauman will be at risk for .

A : amputation B : cancer C : hepatitis D : immune suppression Correct Answer : B 61 : Karen Bauman is a 27-year-old employed in the cosmetic and fashion industry. Lately, she has reported feeling fatigued. She feels her long hours and hectic schedule are the main contributors. Her past medical history includes type 1 diabetes. She returns to her doctor due to abnormal lab results from her last physical.Although Ms. Bauman has shown few symptoms of fatty liver, some people have symptoms of .

A : ascites B : steatohepatitis C : steatohepatitis D : hepatic encephalopathy Correct Answer : B 10 / 15

62 : Karen Bauman is a 27-year-old employed in the cosmetic and fashion industry. Lately, she has reported feeling fatigued. She feels her long hours and hectic schedule are the main contributors. Her past medical history includes type 1 diabetes. She returns to her doctor due to abnormal lab results from her last physical.To improve her health status, Karen will need to .

A : adjust her diet and exercise regimen B : avoid travel to areas in which HBV is common C : change her job to one that involves fewer hours D : get on a liver transplant list as soon as possible Correct Answer : A 63 : Veronica Riley-OBrien is a 30-year-old mother of two young boys (Tyler, 4 years old, and Ethan, 6 weeks old). Veronica is 5 feet, 4 inches tall and weighs 126 pounds. She is having difficulty sleeping due to pain in her abdomen and back. She calls her doctor this morning because the pain has intensified.Riley-OBrien is diagnosed with gallstones. In addition to abdominal pain, what other symptom might she experience?

A : edema B : confusion C : headache D : vomiting Correct Answer : D 64 : Veronica Riley-OBrien is a 30-year-old mother of two young boys (Tyler, 4 years old, and Ethan, 6 weeks old). Veronica is 5 feet, 4 inches tall and weighs 126 pounds. She is having difficulty sleeping due to pain in her abdomen and back. She calls her doctor this morning because the pain has intensified.What is a complication of gallstones that can lead to infection?

A : cirrhosis B : ascites C : edema D : cholecystitis Correct Answer : D 65 : Veronica Riley-OBrien is a 30-year-old mother of two young boys (Tyler, 4 years old, and Ethan, 6 weeks old). Veronica is 5 feet, 4 inches tall and weighs 126 pounds. She is having difficulty sleeping due to pain in her abdomen and back. She calls her doctor this morning because the pain has intensified.Which factor places Ms. Riley-OBrien most at risk for gallstones?

A : African American race B : relatively young age C : recent pregnancy D : normal weight Correct Answer : C 66 : Veronica Riley-OBrien is a 30-year-old mother of two young boys (Tyler, 4 years old, and Ethan, 6 weeks old). Veronica is 5 feet, 4 inches tall and weighs 126 pounds. She is having difficulty sleeping due to pain in her abdomen and back. She calls her doctor this morning because the pain has intensified.Ms. Riley-OBriens gallstone risk was high during her recent pregnancy due to hormonal changes that affect the conversion of cholesterol into .

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A : bile B : estrogen C : progesterone D : bilirubin Correct Answer : A 67 : Veronica Riley-OBrien is a 30-year-old mother of two young boys (Tyler, 4 years old, and Ethan, 6 weeks old). Veronica is 5 feet, 4 inches tall and weighs 126 pounds. She is having difficulty sleeping due to pain in her abdomen and back. She calls her doctor this morning because the pain has intensified.An appropriate treatment for Ms. Riley-OBriens gallbladder disease would be .

A : hormone replacement B : a low-fat/low-cholesterol diet C : surgery D : cholesterol-lowering medications Correct Answer : C

MATCHING 68 : Match each word or phrase with the most appropriate definition or explanation.

A : formation of gallstones A : jaundice B : abnormal accumulation of fluid in the B : portal hypertension abdominal cavity C : collaterals C : advanced stage of liver disease in which extensive scarring replaces healthy liver tissue D : elevated blood pressure in the portal vein D : varices often caused by obstructed blood flow through the liver E : inflammation of the gallbladder E : hepatic encephalopathy F : crystalline deposits that form in the F : gallstones gallbladder from cholesterol or bilirubin G : accumulation of triglycerides in the liver G : cholelithiasis H : abnormally dilated blood vessels H : sludge I : cholecystitis I : a semisolid mass made up of mucus, cholesterol crystals, and bilirubin granules J : cholecystectomy J : removal of excess fluid with a surgical puncture and aspirator K : inflammation of the liver K : hepatitis L : condition characterized by altered L : sinusoids neurological functioning, including personality changes, reduced mental abilities, and disturbances in motor function M : the small capillary-like passages that carry M : fatty liver blood through liver tissue N : yellow discoloration of skin and eyes due to N : ascites an accumulation of bilirubin O : blood vessels that enlarge in order to allow O : paracentesis an alternate pathway for diverted blood P : surgical removal of the gallbladder P : cirrhosis 12 / 15

Q : a procedure that uses a small incision and Q : laparoscopic video camera R : loss of consciousness resulting from severe R : hepatic coma liver disease Correct Answer : A:G B : A13 C : A15 D:B E:I F:F G : A12 H:D I:H J : A14 K:K L:E M : A11 N:A O:C P:J Q : A16 R : A17

ESSAY 69 : Identify the etiology of the three common strains of the hepatitis virus. Describe the treatments and medical nutrition therapy for hepatitis.

Correct Answer : ?Hepatitis A virus (HAV) is primarily spread via fecal-oral transmission, which usually involves the ingestion of foods or beverages that have been contaminated with fecal material. HAV infection usually resolves within a few months and does not cause chronic 13 / 15

infection or permanent liver damage. Hepatitis B virus (HBV) is transmitted by infected blood or needles, by sexual contact with an infected person, and from mother to infant during childbirth.

Hepatitis C virus (HCV) is spread via infected blood or needles but is not readily spread by sexual contact or childbirth. Hepatitis is treated with supportive care, such as bed rest (if necessary) and an appropriate diet. Hepatitis patients should avoid substances that irritate the liver, such as alcohol, drugs, and dietary supplements that cause liver damage. Hepatitis A infection usually resolves without the use of medications. Antiviral agents may be used to treat HBV and HCV infections; examples include lamivudine and ribavirin, which block viral replication, and interferon alpha, which both inhibits viral replication and enhances immune responses. Nonviral forms of hepatitis may be treated with anti-inflammatory and immunosuppressant drugs. Hospitalization is not required for hepatitis unless other medical conditions or complications hamper recovery.

70 : Explain how cirrhosis leads to portal hypertension, esophageal varices, and ascites.

Correct Answer : ?The scarred tissue of a cirrhotic liver impedes the flow of blood, three-fourths of which is supplied by the hepatic portal vein. The restricted blood flow within the liver stimulates the release of vasodilators (and therefore, increased blood flow) in nearby arterioles, leading to a greater volume of portal blood. The increased portal blood coupled with resistance to blood flow within the liver causes a rise in blood pressure within the hepatic portal vein, called portal hypertension. As portal pressure builds, some of these collaterals can become enlarged and engorged with blood, forming varices. The varices that develop in the esophagus and stomach are vulnerable to rupture because they have thin walls and often bulge into the lumen.

If ruptured, they can cause massive bleeding that is sometimes fatal. The blood loss is exacerbated by the liver’s reduced production of blood-clotting factors. Within 10 years of disease onset, about 50 percent of cirrhosis patients develop ascites, a large accumulation of fluid in the abdominal cavity. Ascites is primarily a consequence of portal hypertension, sodium and water retention in the kidneys, and reduced albumin synthesis in the diseased liver. As a result of portal hypertension, the distorted blood flow elsewhere in the body alters kidney function, leading to sodium and water retention and an accumulation of body fluid. The elevated pressure within the liver’s small blood vessels causes fluid to leak into lymphatic vessels and, ultimately, the abdominal cavity. The movement of water into the abdomen is exacerbated by low levels of serum albumin, a protein that helps to retain fluid in blood vessels.

71 : Explain the importance of adequate nutrition support for patients before and following a liver transplant.

Correct Answer : ?Advanced liver disease is usually associated with malnutrition, which can increase the risk of complications following a liver transplant. Evaluating nutrition status in transplant candidates can be difficult, however, because liver dysfunction and malnutrition often have similar metabolic effects. In addition, the presence of edema or ascites can alter anthropometric values and mask weight loss. Correcting malnutrition prior to transplant surgery can help to speed recovery after the surgery. The stress associated with transplant surgery increases protein and energy requirements. High-kcalorie, high-protein snacks and oral supplements can help the transplant patient meet postsurgical needs. Vitamin and mineral supplementation is also an integral part of nutrition care. To help transplant patients avoid developing foodborne illnesses, health practitioners should provide information about food safety measures, such as cooking foods adequately, washing fresh produce, and avoiding foods that may be contaminated.

72 : List the complications of gallstones that are not well managed or treated.

Correct Answer : ?If a gallstone remains lodged in the cystic duct, it can obstruct bile flow to the 14 / 15

duodenum and cause cholecystitis—distention and inflammation of the gallbladder. Cholecystitis can lead to infection or to more severe complications, including perforation of the gallbladder, peritonitis, and fistulas. If gallstones obstruct the common bile duct, they can block bile flow from the liver, resulting in jaundice or damage to liver tissue. An impacted stone within the bile ducts may lead to infection and bacterial cholangitis, which causes severe pain, sepsis, and fever and is often a medical emergency. Gallstones can block the pancreatic duct as well—a primary cause of acute pancreatitis. Because these complications are potentially dangerous, individuals should seek medical attention if gallstone pain does not resolve over time or if fever, jaundice, or persistent nausea and vomiting develop.

73 : Discuss the types of blood-related drug-nutrient interactions and anemias that can occur as a result of medication use. List some examples of the effects of medications and resulting anemia.

Correct Answer : ?Anemia is among the adverse effects that may result from medication use.

Various medications can disrupt nutrient metabolism, impair blood coagulation and erythropoiesis, or increase red blood cell destruction. Because the life span of red blood cells is about 120 days, the long-term use of such medications is more likely to result in anemia than short-term use. Anticoagulants, which are prescribed specifically to reduce blood clotting, sometimes lead to excessive bleeding. The anticoagulant effects may be augmented if several of these drugs are used simultaneously. The slow, chronic bleeding that sometimes develops may go unnoticed until excessive blood loss has occurred. Many classes of drugs are associated with aplastic anemia, the anemia that occurs when the bone marrow fails to produce adequate numbers of blood cells. The categories of drugs that can inhibit erythropoiesis include antibiotics, anticancer agents, anticonvulsants, antihistamines, anti-inflammatory drugs, and diuretics. Aplastic anemia can also be caused by viral infections, exposure to toxins, and genetic defects. Some patients may develop hemolytic anemia as a result of drug interactions with red blood cells. For example, a drug may bind to the red blood cell membrane and elicit an antibody response that destroys the cell. Drugs that may cause this response include cephalosporin and fludarabine. Withdrawal of these drugs can eventually reverse the anemia, and sometimes medications are given to suppress the immune response.

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MULTIPLE CHOICE 1 : The renal threshold is described as .

A : a decrease in erythropoietin production because of insulin imbalance B : nutrient depletion in the renal tubules caused from deficient insulin C : hemoglobins exposure to glucose within the kidneys D : the concentration at which the kidneys begin to pass glucose into the urine Correct Answer : D 2 : About A:7 B : 17 C : 28 D : 37

percent of persons with diabetes are unaware that they have it.

Correct Answer : C 3 : The pancreatic hormone that promotes glucose production in the liver is A : glycogen B : estrogen C : glucagon D : leptin

.

Correct Answer : C 4 : What best describes polydipsia?

A : increased thirst B : increased urination C : increased glucose in the urine D : increased hunger Correct Answer : A 5 : Glycosuria usually occurs when blood glucose exceeds A : 140 B : 160 C : 180 D : 200

mg/dL.

Correct Answer : D 6 : A blood glucose level between 100 and 125 mg/dL after an 8-hour fast would be classified as .

A : impaired fasting glucose B : hypoglycemia C : impaired glucose tolerance D : normal Correct Answer : A 7 : A fasting blood glucose level above

mg/dL is classified as diabetes.

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A : 90 B : 100 C : 116 D : 126 Correct Answer : D 8 : Normal fasting plasma glucose levels are approximately A : 60 to 74 B : 75 to 100 C : 110 to 125 D : 126 to 140

mg/dL.

Correct Answer : B 9 : Type 1 diabetes accounts for A : 5 to 10 B : 10 to 25 C : 50 to 75 D : 90 to 95

percent of diabetes cases in the United States.

Correct Answer : A 10 : People with type 1 diabetes need insulin because they A : have become insulin resistant B : have developed hyperinsulinemia C : no longer synthesize sufficient insulin D : digest insulin with GI enzymes

.

Correct Answer : C 11 : Which intervention would most likely contribute to prevention of type 2 diabetes?

A : sustained weight loss of 1 to 4 percent of body weight B : routine monitoring for diabetes at least once per year C : at least 90 minutes of moderate-intensity exercise per week D : increased intake of whole grains, red wine, and unsaturated fats Correct Answer : B 12 : Ketoacidosis is characterized by severe acidosis and A : renal failure B : hallucinations C : dehydration D : myocardial ischemia

.

Correct Answer : C 13 : Which ethnic population has the lowest relative risk for developing type 2 diabetes?

A : Pacific Islanders B : Mexican American C : European Americans D : Native Americans 2 / 16

Correct Answer : C 14 : Diabetic ketoacidosis can develop when blood glucose is greater than A : 250 B : 450 C : 650 D : 700

mg/dL.

Correct Answer : A 15 : Symptoms of hypoglycemia include A : confusion and slurred speech B : increased thirst and polyuria C : acetone breath D : warm, flushed skin

.

Correct Answer : A 16 : What is the standard treatment for hyperosmolar hyperglycemic syndrome?

A : intravenous electrolyte replacement and insulin B : intravenous administration of ketones C : surgical resection of the pancreas D : a low-carbohydrate, low-fat diet Correct Answer : A 17 : What is a sign or symptom of diabetic neuropathy?

A : pain or burning in the feet B : blurred vision C : reduced urine output D : diarrhea Correct Answer : A 18 : Which condition is a microvascular complication of diabetes?

A : peripheral vascular disease B : diabetic retinopathy C : intermittent claudication D : hypertriglyceridemia Correct Answer : B 19 : The oral glucose tolerance test uses a glucose load of A : 25 B : 50 C : 75 D : 100

grams.

Correct Answer : C 20 : Using the intensive therapy approach, blood glucose is monitored at least day for people with type 1 diabetes.

A : one

time(s) a

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B : two C : three D : four Correct Answer : C 21 : What is an advantage seen with intensive glucose monitoring therapy?

A : delayed progression of retinopathy and neuropathy B : improved weight control C : greater stability noted in fructosamine results D : decreased cost when compared to conventional therapy Correct Answer : A 22 : What test may be used to determine glycemic control over the preceding 2 to 3 week period?

A : fructosamine B : ketone C : glucose tolerance D : insulin antibody Correct Answer : A 23 : Hemoglobin A1c can best be described as a(n) .

A : by-product of fat metabolism B : reflection of mean blood glucose concentration over two to three months C : end-product of protein metabolism formed in the liver D : summary of hemoglobin rates for type 1 diabetes Correct Answer : B 24 : The goal of diabetes treatment is an HbA1c value under A:5 B:7 C:9 D : 10

percent.

Correct Answer : B 25 : Mr. Jacobs has high blood lipids. The physician would instruct him to limit dietary intake of which substance from sweeteners but not from whole foods (i.e., fruits and vegetables)?

A : fructose B : sucrose C : glucose D : sucralose Correct Answer : A 26 : Insulin is most often administered by A : subcutaneous injection B : oral administration C : intramuscular injection D : intravenous administration

.

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Correct Answer : A 27 : Approximately therapy.

A : 20 B : 30 C : 50 D : 75

percent of people diagnosed with type 2 diabetes benefit from insulin

Correct Answer : B 28 : Mrs. Barclay has type 2 diabetes and you are preparing her for discharge. She tells you that she loves red beans and rice and knows that she must eliminate them from her diet because they will elevate her blood glucose level. You should explain to her that .

A : on a carbohydrate-counting meal plan, these foods can fit within her carbohydrate allowance at meals B : red beans are eliminated because they are high in complex carbohydrates C : red beans are high in water-soluble fiber and should be avoided D : peas are a better choice than red beans Correct Answer : A 29 : Hector Martinez is a 70-year-old Hispanic man recently diagnosed with type 2 diabetes. He is having difficulty understanding the exchange system and has limited financial resources.

Which strategy is most likely to help him control his diabetes?

A : Emphasize how important it is to follow only the exchange list.

B : Try an alternate diet approach that might be more successful.

C : Give him a printed exchange list of traditional Hispanic foods.

D : Encourage him to join a spa and exercise.

Correct Answer : B 30 : Which antidiabetic drug is classified as a biguanide?

A : acarbose B : pramlintide C : metformin D : nateglinide Correct Answer : C 31 : Short-acting insulin begins to act A : 15 minutes B : 30 minutes C : 13 hours D : 24 hours

after it is injected.

Correct Answer : B 32 : Mr. Lilly, a 42-year-old male, tells you that he used to take pills for his diabetes but is now taking insulin. What is the most likely reason that he no longer takes oral antidiabetic agents?

A : Oral agents are only effective in type 1 diabetes.

B : His body now stimulates enough insulin to meet his needs.

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C : Oral agents suppress insulin release.

D : The oral agents were not controlling his blood glucose.

Correct Answer : D 33 : What is a metabolic effect that may occur with taking thiazolidinediones?

A : fluid retention B : weight loss C : allergic skin reactions D : vitamin B12 deficiency Correct Answer : A 34 : Hyperglycemia that results from the release of counterregulatory hormones following nighttime hypoglycemia is known as .

A : fasting hyperglycemia B : rebound hyperglycemia C : dawn phenomenon D : nocturnal hyperglycemia Correct Answer : B 35 : What intervention is most appropriate as part of sick-day management of diabetes?

A : Discontinue all antidiabetic medications and insulin.

B : Measure blood glucose and urine ketones once a day.

C : Discontinue antidiabetic drugs and only use insulin.

D : Consume the usual diet, if possible.

Correct Answer : D 36 : Approximately percent of women who do not have diabetes prior to pregnancy develop gestational diabetes.

A : 4 to 14 B : 14 to 24 C : 24 to 34 D : 34 to 44 Correct Answer : A 37 : Which recommendation is not advised for pregnant women with diabetes?

A : insulin therapy B : 10 percent weight loss C : physical activity D : low-carbohydrate breakfast Correct Answer : B 38 : Women with gestational diabetes are at greater risk of which condition later in life?

A : obesity B : type 2 diabetes C : metabolic syndrome D : chronic kidney disease 6 / 16

Correct Answer : B 39 : The newborn of a mother with diabetes is at greater risk of which condition?

A : hypocalcemia B : sepsis C : transient tachypnea of the newborn D : congenital heart disease Correct Answer : A 40 : What maternal complication has been associated with diabetes in pregnancy?

A : preeclampsia B : obesity C : hyperemesis gravidarum D : miscarriage Correct Answer : D 41 : Macrosomia develops as a result of .

A : insulins stimulatory effect on fat synthesis B : excessive insulin production by the fetal pancreas C : poor maternal kidney function due to excess glucose D : the enzymatic glycation of serum proteins Correct Answer : B 42 : Which patient would have the most risk factors for gestational diabetes?

A : Rita, who has a prepregnancy BMI of 24 B : Zhu, who just moved to the United States from China C : Amy, who once had an 8 pound baby D : Sarah, whose father has type 1 diabetes Correct Answer : D 43 : Regina is at her first prenatal visit after recently discovering that she is pregnant. She is a low-risk patient with no history of diabetes. At what point will her physician test Regina for gestational diabetes?

A : 1216 weeks B : 1620 weeks C : 2428 weeks D : 2832 weeks Correct Answer : C 44 : Emily has gestational diabetes and a BMI of 33. What nutrition recommendation should be made for Emily for weight control during her pregnancy?

A : Strive to lose 11 to 14 pounds by the end of her pregnancy.

B : Increase carbohydrate intake to 55 to 60 percent of total energy.

C : Reduce kcalorie intake by 30 percent to slow further weight gain.

D : Continue with a normal diet and strive to lose weight after pregnancy.

Correct Answer : C 7 / 16

45 : Which antidiabetic drug has been shown to be safe to use during pregnancy?

A : glimepiride B : nateglinide C : repaglinide D : glyburide Correct Answer : D 46 : Diagnostic criteria for metabolic syndrome include a fasting plasma glucose of or higher.

A : 80 B : 90 C : 100 D : 110

mg/dL

Correct Answer : C 47 : Diagnostic criteria for metabolic syndrome include waist circumference of greater than inches in women.

A : 33 B : 35 C : 38 D : 40 Correct Answer : B 48 : Diagnostic criteria for metabolic syndrome include VLDL levels of A : 100 B : 125 C : 150 D : 175

mg/dL or higher.

Correct Answer : C 49 : Diagnostic criteria for metabolic syndrome include blood pressure of A : 110/80 B : 130/85 C : 150/90 D : 170/95

mm Hg or higher.

Correct Answer : B 50 : Diagnostic criteria for metabolic syndrome include HDL levels of less than men.

A : 30 B : 35 C : 40 D : 50

mg/dL in

Correct Answer : C 51 : An estimated percent of adults meet the criteria for metabolic syndrome in the United States.

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A:6 B : 12 C : 23 D : 34 Correct Answer : C 52 : What describes the relationship of obesity and hypertriglyceridemia?

A : Insulin causes adipose cells to store more triglycerides.

B : HDL competes with VLDL for cholesterol binding sites.

C : The liver increases more VLDL in response to more fatty acids in the blood.

D : Fatty acids in the bloodstream resist excretion by HDL. Correct Answer : C 53 : The hyperinsulinemia that typically accompanies obesity promotes sodium reabsorption in the kidneys, resulting in .

A : increased abdominal obesity B : hypertension C : atherosclerosis D : hypertriglyceridemia Correct Answer : B 54 : Inflammation of endothelial tissue, obesity, and insulin resistance can all contribute to blood clots by promoting the increased production of procoagulant proteins such as .

A : hirudin B : fibronectin C : dicoumarol D : andexanet alfa Correct Answer : B 55 : What dietary recommendation is advised for individuals with hypertriglyceridemia?

A : Reduce intake of added sugars and refined grain products.

B : Decrease sodium intake and improve intake of dairy products.

C : Eliminate polyunsaturated fatty acids in the diet.

D : Reduce kcalorie intake by 45 percent daily.

Correct Answer : A 56 : Michael Fern is a 21-year-old college student majoring in electrical engineering. His past medical history is unremarkable. He comes back to his family doctor for the second time this month due to symptoms of lethargy, fatigue, weight loss, and frequent thirst and urination.Michael is rushed to the hospital after a simple blood test determines a blood glucose of 600 mg/dL. He is most likely suffering from .

A : hypoglycemia B : hyperglycemia C : dehydration D : infection Correct Answer : B 9 / 16

57 : Michael Fern is a 21-year-old college student majoring in electrical engineering. His past medical history is unremarkable. He comes back to his family doctor for the second time this month due to symptoms of lethargy, fatigue, weight loss, and frequent thirst and urination.Michael has been diagnosed with diabetic ketoacidosis. In addition to severely elevated blood glucose levels, what other symptom is associated with this condition?

A : fruity odor on the breath B : fluid retention C : high blood pressure D : vision loss Correct Answer : A 58 : Michael Fern is a 21-year-old college student majoring in electrical engineering. His past medical history is unremarkable. He comes back to his family doctor for the second time this month due to symptoms of lethargy, fatigue, weight loss, and frequent thirst and urination.Michaels ketoacidosis leads to a diagnosis of type 1 diabetes. Which medication will Michael need to take to treat his diabetes?

A : sulfonyureas B : metformin C : insulin injections D : alpha-glucosidase inhibitors Correct Answer : C 59 : Michael Fern is a 21-year-old college student majoring in electrical engineering. His past medical history is unremarkable. He comes back to his family doctor for the second time this month due to symptoms of lethargy, fatigue, weight loss, and frequent thirst and urination.The registered dietitian visits with Michael to instruct him on his diabetic diet. What is it important for Michael to know about consuming alcohol?

A : He should not consume any alcohol.

B : He should consume food when he ingests alcoholic beverages to avoid hypoglycemia.

C : He should limit his food intake prior to consuming alcohol in order to avoid hyperglycemia.

D : Excessive alcohol intake will likely cause severe hypoglycemia.

Correct Answer : B 60 : Michael Fern is a 21-year-old college student majoring in electrical engineering. His past medical history is unremarkable. He comes back to his family doctor for the second time this month due to symptoms of lethargy, fatigue, weight loss, and frequent thirst and urination.After 6 months, Michaels endocrinologist orders an insulin pump. Which best describes the use of an insulin pump with type 1 diabetes?

A : Hyperglycemia is not a concern with the insulin pump.

B : Hypoglycemia can occur with insulin treatment.

C : Michael does not need to follow a modified diet.

D : Michael no longer needs to worry about exercising.

Correct Answer : B 61 : Ruth Ann Glebowski is an active 68 year old. She has a past medical history of gestational diabetes, high cholesterol, hypothyroidism, and depression. She is 5 feet 4 inches tall and weighs 170 pounds. She has an appointment with her physician for her annual check-up.Ruth Ann is diagnosed with type 2 diabetes. Which risk factor puts her at risk?

A : weight 10 / 16

B : depression C : high cholesterol D : hypothyroidism Correct Answer : A 62 : Ruth Ann Glebowski is an active 68 year old. She has a past medical history of gestational diabetes, high cholesterol, hypothyroidism, and depression. She is 5 feet 4 inches tall and weighs 170 pounds. She has an appointment with her physician for her annual check-up.What can Ruth Ann do to help control her blood glucose?

A : lose weight B : try a low-carbohydrate diet C : take chromium supplements D : start glucagon injections Correct Answer : A 63 : Ruth Ann Glebowski is an active 68 year old. She has a past medical history of gestational diabetes, high cholesterol, hypothyroidism, and depression. She is 5 feet 4 inches tall and weighs 170 pounds. She has an appointment with her physician for her annual check-up.Ruth Ann meets with a registered dietitian and is provided sample menus. A month later she returns for a follow-up: she has gained weight and her blood sugar is still high. Ruth Ann states that she is being compliant. What is the possible cause for the weight gain?

A : misuse of diabetic medications B : incorrect portion size C : poor cooking techniques D : carbohydrate counting Correct Answer : B 64 : Ruth Ann Glebowski is an active 68 year old. She has a past medical history of gestational diabetes, high cholesterol, hypothyroidism, and depression. She is 5 feet 4 inches tall and weighs 170 pounds. She has an appointment with her physician for her annual check-up.Ruth Anns doctor can best evaluate long-term diabetic compliance by checking her .

A : fasting blood glucose B : urine ketones C : blood pressure D : glycated hemoglobin Correct Answer : D 65 : Ruth Ann Glebowski is an active 68 year old. She has a past medical history of gestational diabetes, high cholesterol, hypothyroidism, and depression. She is 5 feet 4 inches tall and weighs 170 pounds. She has an appointment with her physician for her annual check-up.Fifteen years pass and Ruth Ann is experiencing some visual impairments. Her eye doctor explains that it could be diabetic.

A : nephropathy B : hypoglycemia C : retinopathy D : gastroparesis Correct Answer : C 11 / 16

MATCHING 66 : Match each word or phrase with the most appropriate definition or explanation.

A : excessive thirst A : diabetes mellitus B : usually results from autoimmune destruction B : macrosomia of pancreatic beta-cells; little or no insulin is produced in the pancreas C : compounds formed when glucose combines C : polyuria with proteins; can damage tissues and lead to diabetic complications D : blood glucose levels are higher than normal D : polydipsia but not high enough to be diagnosed as diabetes; considered a major risk factor for future cardiovascular disease E : group of metabolic disorders characterized E : polyphagia by hyperglycemia and disordered insulin metabolism F : prediabetes F : hemoglobin molecules with glucose attached; used to evaluate long-term glycemic control G : type 1 diabetes G : usually results from insulin resistance coupled with insufficient insulin secretion H : type 2 diabetes H : cluster of interrelated clinical symptoms, including obesity, insulin resistance, high blood pressure, and abnormal blood lipids, which together increase cardiovascular disease risk two- to three-fold I : the condition of having an abnormally large I : hyperosmolar hyperglycemic syndrome body J : excessive urine production J : advanced glycation end products K : extreme hyperglycemia that is associated K : glycated hemoglobin with hyperosmolar blood, dehydration, and altered mental status L : excessive appetite or eating L : diabetic retinopathy M : kidney damage associated with diabetes M : diabetic nephropathy N : retinal damage associated with diabetes N : diabetic neuropathy O : metabolic syndrome O : nerve degeneration associated with diabetes Correct Answer : A:D B:G C:J D:F E:A

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F:K G:H H : A14 I:B J:C K:I L:E M : A12 N : A11 O : A13

ESSAY 67 : Describe the criteria that are currently used to diagnose diabetes.

Correct Answer : ?The diagnosis of diabetes is based primarily on plasma glucose levels, which can be measured under fasting conditions or at random times during the day. In some cases, an oral glucose tolerance test is given: the individual ingests a 75-gram glucose load, and plasma glucose is measured at one or more time intervals following glucose ingestion. Glycated hemoglobin (HbA1c) levels, which reflect hemoglobin’s exposure to glucose over the preceding 2–3 months, are an indirect assessment of blood glucose levels. The following criteria are currently used to diagnose diabetes: the plasma glucose concentration is 126 mg/dL or higher after a fast of at least 8 hours (normal fasting plasma glucose levels are 75–100 mg/dL); in a person with classic symptoms of hyperglycemia, the plasma glucose concentration of a random, or casual, blood sample is 200 mg/dL or higher; the plasma glucose concentration measured 2 hours after a 75-gram glucose load is 200 mg/dL or higher; and/or the HbA1c level is 6.5 percent or higher. Overt symptoms of hyperglycemia help to confirm the diagnosis. Otherwise, a diagnosis of diabetes is confirmed only if a subsequent test yields similar results.

68 : Illustrate the acute complications of uncontrolled diabetes.

Correct Answer : ?A severe lack of insulin causes diabetic ketoacidosis. Without insulin, glucagon’s effects become more pronounced, leading to the unrestrained breakdown of the triglycerides in adipose tissue and the protein in muscle. As a result, an increased supply of fatty acids and amino acids arrives in the liver, fueling the production of ketone bodies and glucose.

Ketone bodies, which are acidic, can reach dangerously high levels in the bloodstream and spill into the urine. Blood pH typically falls below 7.30. Blood glucose levels usually exceed 250 mg/dL and rise above 1000 mg/dL in severe cases. The main features of diabetic ketoacidosis therefore include severe ketosis, acidosis, and hyperglycemia. The hyperosmolar hyperglycemic syndrome is a condition of severe hyperglycemia and dehydration that develops in the absence of significant ketosis. The hyperglycemia that develops in poorly controlled diabetes leads to 13 / 16

polyuria, which results in substantial fluid and electrolyte losses. In the hyperosmolar hyperglycemic syndrome, patients are unable to recognize thirst or adequately replace fluids because of age, illness, sedation, or incapacity. The profound dehydration that eventually develops exacerbates the rise in blood glucose levels, which often exceed 600 mg/dL and may climb above 1000 mg/dL. Blood plasma may become so hyperosmolar as to cause neurological abnormalities, such as confusion, speech and vision impairments, muscle weakness, abnormal reflexes, and seizures; about 10 percent of patients lapse into coma. Hypoglycemia is the most frequent complication of type 1 diabetes and may occur in type 2 diabetes as well. It is due to the inappropriate management of diabetes rather than to the disease itself, and is usually caused by excessive dosages of insulin or antidiabetic drugs, prolonged exercise, skipped or delayed meals, inadequate food intake, or the consumption of alcohol without food.

69 : Describe the different types of neuropathy that may develop in patients with diabetes.

Correct Answer : ?Diabetic neuropathy most often involves the peripheral nerves (peripheral neuropathy) or nerves that control body organs and glands (autonomic neuropathy). Peripheral neuropathy—the most common form of neuropathy in diabetes—may be experienced as pain, numbness, or tingling in the hands, feet, and legs or weakness of the limbs. Pain and cramping in the legs are often severe during the night and may interrupt sleep. Peripheral neuropathy also contributes to the development of foot ulcers because cuts and bruises may go unnoticed until wounds are severe. Autonomic neuropathy may be evidenced by sweating abnormalities, disturbed bladder function, erectile dysfunction, delayed stomach emptying (gastroparesis), constipation, and cardiac arrhythmias. Neuropathy occurs in about 50 percent of patients with diabetes; the extent of nerve damage depends on the severity and duration of hyperglycemia.

70 : Compare and contrast conventional and intensive type 1 diabetes therapy, including the advantages and disadvantages of each.

Correct Answer : ?The main goal of diabetes treatment is to maintain blood glucose levels within a desirable range to prevent or reduce the risk of complications. Several multicenter clinical trials have shown that intensive diabetes treatment, which keeps blood glucose levels tightly controlled, can greatly reduce the incidence and severity of some chronic complications.

Therefore, maintenance of near-normal glucose levels has become the fundamental objective of diabetes care plans. Note that intensive therapy is recommended only if the benefits of therapy outweigh the potential risks. Intensive therapy involves blood glucose monitoring at least three times per day and three or more daily injections of glucose or an external insulin pump.

Landmark studies conducted in the 1980s and 1990s suggested that keeping blood glucose levels as close to normal as possible offers clear advantages over less rigorous diabetes treatment. The participants undergoing intensive therapy had delayed onset and reduced progression of retinopathy, nephropathy, and neuropathy; however, they also experienced more frequent episodes of severe hypoglycemia and gained more weight.Conventional therapy requires daily glucose monitoring, and one or two daily injections without dose adjustments.

Conventional therapy is associated with fewer incidences of severe hypoglycemia and less weight gain, but it may lead to more rapid progression of neuropathy, nephropathy, and retinopathy.

71 : Discuss how the intakes of protein, carbohydrate, fat, sodium, and alcohol are modified for a patient with diabetes.

Correct Answer : ?The amount of carbohydrate consumed has the greatest influence on blood glucose levels after meals—the more grams of carbohydrate ingested, the greater the glycemic response. The carbohydrate recommendation is based in part on the person’s metabolic needs (which are related to the type of diabetes, degree of glucose tolerance, and blood lipid levels), 14 / 16

the type of insulin or other medications used to manage the diabetes, and individual preferences. For optimal health, the carbohydrate sources should be vegetables, fruits, whole grains, legumes, and milk products, whereas foods made with refined grains and added sugars should be limited. Recommendations for whole grain and fiber intakes are similar to those for the general population. People with diabetes are encouraged to include fiber-rich foods such as whole-grain cereals, legumes, fruits, and vegetables in their diet. Although some studies have suggested that very high intakes of fiber may improve glycemic control, many individuals have difficulty enjoying such large amounts of fiber. A Mediterranean-style dietary pattern that emphasizes monounsaturated fats may benefit both glycemic control and cardiovascular disease risk. In addition, increased intakes of omega-3 fatty acids from fatty fish or plant sources may improve the lipoprotein profile and various other CVD risk factors. Other guidelines related to fat intake are similar to those suggested for the general population: saturated fat should be less than 10 percent of total kcalories and trans fat intake should be as low as possible. Protein recommendations for people with diabetes are similar to those for the general population. Although several small, short-term studies have suggested that protein intakes above 28 percent of total kcalories may improve glycemic control or lipoprotein levels in diabetic individuals, other studies did not show any benefit. Guidelines for alcohol intake are similar to those for the general population, which recommend that women and men limit their average daily intakes of alcohol to 1 drink and 2 drinks per day, respectively. In addition, individuals using insulin or medications that promote insulin secretion should consume food when they ingest alcoholic beverages to avoid hypoglycemia. Conversely, an excessive alcohol intake (3 or more drinks per day) can worsen hyperglycemia and raise triglyceride levels in some individuals.

72 : Explain the relationship of body weight and type 2 diabetes.

Correct Answer : ?Because excessive body fat can worsen insulin resistance, weight loss is recommended for overweight or obese individuals who have diabetes. Even moderate weight loss (5–10 percent of body weight) can help to improve insulin resistance, glycemic control, blood lipid levels, and blood pressure. Weight loss is most beneficial early in the course of diabetes, before insulin secretion has diminished. Not all persons with type 2 diabetes are overweight or obese. Older adults and those in long-term care facilities are often underweight and may need to gain weight. Low body weight increases risks of morbidity and mortality in these individuals.

73 : Describe the variations in insulin preparations available for the treatment of diabetes.

Correct Answer : ?The forms of insulin that are commercially available differ by their onset of action, timing of peak activity, and duration of effects. Insulin preparations vary in how they are classified: they may be rapid acting (lispro, aspart, glulisine, and inhaled insulin), short acting (regular), intermediate acting (NPH), or long acting (glargine, detemir), thereby allowing substantial flexibility in establishing a suitable insulin regimen. The rapid- and short-acting insulins are typically used at mealtimes, whereas the intermediate- and long-acting insulins provide basal insulin for the periods between meals and during the night. Mixtures of several types of insulin can produce greater glycemic control than any one type alone. Some premixed formulations are also available.

74 : Describe the different methods of insulin delivery available to people with diabetes.

Correct Answer : ?Insulin is most often administered by subcutaneous injection, either selfadministered or provided by caregivers (note that insulin is a protein, and would be destroyed by digestive processes if taken orally). Disposable syringes, which are filled from vials that contain multiple doses of insulin, are the most common devices used for injecting insulin. Another option 15 / 16

is to use insulin pens, injection devices that resemble permanent marking pens. Disposable insulin pens are prefilled with insulin and used one time only, whereas reusable pens can be fitted with prefilled insulin cartridges and replaceable needles. To eliminate the need for multiple punctures, injection ports for insulin are sometimes inserted through the skin and left in place for several days. Some individuals use insulin pumps, computerized devices that infuse insulin through thin, flexible tubing that remains in the skin; the pump can be attached to a belt or kept in a pocket. Some of the newer insulin pumps include built-in continuous glucose monitoring systems.A rapid-acting inhalation powder (called Afrezza) is available for use before meals.

Because it cannot be used by individuals with lung disease, patients may require serial lung function testing prior to and after starting therapy with this form of insulin.

75 : Discuss sick-day management for people with diabetes.

Correct Answer : ?Illness, infection, or injury can cause hormonal changes that raise blood glucose levels and increase the risk of developing diabetic ketoacidosis or the hyperosmolar hyperglycemic syndrome. During illness, patients with diabetes should measure blood glucose and ketone levels several times daily. They should continue to use antidiabetic drugs, including insulin, as prescribed; adjustments in dosages may be necessary if they alter their diet or have persistent hyperglycemia. If patients use over-the-counter drugs, they should be cautioned that some types of drugs may raise blood glucose levels or interact with antidiabetic drugs. During illness, individuals with diabetes should consume their usual diet, if possible. If appetite is poor, they should select easy-to-manage foods and beverages that provide the prescribed amount of carbohydrate at each meal. Foods that are easily tolerated include toast, crackers, soup, yogurt, fruit, fruit juices, frozen juice bars, and carbohydrate-sweetened beverages. To prevent dehydration, especially if vomiting or diarrhea is present, patients should make sure they consume adequate amounts of liquids throughout the day.

76 : Discuss how diabetes develops as a consequence of pregnancy and the potential consequences for both mother and fetus.

Correct Answer : ?Women with diabetes face new challenges during pregnancy. Due to hormonal changes, pregnancy increases insulin resistance and the body’s need for insulin, so maintaining glycemic control may be more difficult. In addition, 4 to 14 percent of nondiabetic women in the United States develop gestational diabetes (the prevalence depends on the patient population). Women with gestational diabetes are at greater risk of developing type 2 diabetes later in life, and their children are at increased risk of developing obesity and type 2 diabetes as they enter adulthood. A pregnancy complicated by diabetes increases health risks for both mother and fetus. Uncontrolled diabetes is linked with increased incidences of miscarriage, birth defects, and fetal deaths. Newborns are more likely to suffer from respiratory distress and to develop metabolic problems such as hypoglycemia, hypocalcemia, and jaundice.

Women with diabetes often deliver babies with macrosomia, which makes delivery more difficult and can result in birth trauma or the need for a cesarean section. Macrosomia results because maternal hyperglycemia induces excessive insulin production by the fetal pancreas, which stimulates growth and fat deposition.

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MULTIPLE CHOICE 1 : What is the term for an accumulation of fatty deposits, smooth muscle cells, and fibrous connective tissue in blood vessels?

A : plaque B : platelets C : thrombosis D : embolism Correct Answer : A 2 : When a portion of a clot travels through the bloodstream, lodges in a narrow artery, and causes sudden tissue death, it is called a(n) .

A : embolism B : platelet C : aneurysm D : thrombus Correct Answer : A 3 : The subtle damage caused by disturbed blood flow initially leads to which response when atherosclerosis begins to develop?inflammation A : inflammation B : platelet aggregation C : enzyme accumulation D : foam cell development Correct Answer : A 4 : Cholesterol carried by oxidized A : chylomicrons B : MCT C : LDL D : HDL

is embedded in artery walls.

Correct Answer : C 5 : Factors that generally worsen atherosclerosis or lead to complications are those that cause plaque rupture or .

A : severe bleeding B : red blood cell formation C : blood coagulation D : decreased inflammation Correct Answer : C 6 : The stress of blood flow along the artery walls is known as A : shear stress B : metabolic stress C : inflammatory stress D : thrombotic stress

.

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Correct Answer : A 7 : What best describes lipoprotein(a)?

A : a lipoprotein that transports triglycerides to the liver B : a variant form of LDL that speeds the progression of atherosclerosis C : a lipoprotein that removes cholesterol from the bloodstream D : a compound that is formed after glucose combines with protein Correct Answer : B 8 : Arterial macrophages engulf oxidized LDL and become A : foam cells B : a thrombus C : an embolus D : clots

.

Correct Answer : A 9 : Impaired blood circulation in the legs that can cause fatigue and pain while walking is called .

A : angina pectoris B : shearing C : intermittent claudication D : an aneurysm Correct Answer : C 10 : The most common cause of aneurysms is A : genetic defects B : external injury C : advancing age D : atherosclerosis

.

Correct Answer : D 11 : In women, high risk of CHD occurs when HDL levels are below A : 50 B : 125 C : 175 D : 200

.

Correct Answer : A 12 : What is a nonmodifiable risk factor for CHD? A : diabetes mellitus B : male gender C : alcohol overconsumption D : low HDL cholesterol Correct Answer : B 13 : Ms. Thomas has blood work done as ordered by her physician. Her total cholesterol level is 240 mg/dL and HDL is 35 mg/dL. Ms. Thomas total cholesterol and HDL indicate she .

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A : has a desirable blood lipid profile B : is at borderline risk for CHD C : is at high risk for CHD D : requires more testing Correct Answer : C 14 : What condition that is associated with atherosclerosis and diabetes is most likely to lead to HDL dysfunction and increased CHD risk?

A : elevated glucose levels B : decreased liver enzymes C : chronic inflammation D : platelet aggregation and thrombosis Correct Answer : C 15 : Medications used to reduce LDL levels include A : aspirin B : antihypertensives C : statins D : diuretics

.

Correct Answer : C 16 : About of plant sterols daily can lower cholesterol by up to 10 percent.

A : 500 milligrams B : 2 grams C : 5 grams D : 8 grams Correct Answer : B 17 : Martha has been advised to limit trans fats in her diet. Which snack food would this most likely include?

A : chocolate B : skim milk C : French fries D : pretzels Correct Answer : C 18 : What type of physical activity would provide the greatest benefits in lowering risk factors for CHD? A : horseback riding B : brisk walking C : bicep curls D : sit-ups Correct Answer : B 19 : The American Heart Association recommends eating at least week for CHD risk reduction.

A : two

servings of fatty fish per

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B : three C : four D : five Correct Answer : A 20 : What describes the relationship of over-the-counter (OTC) fish oil supplements to the treatment of hypertriglyceridemia?

A : OTC supplements typically provide 4 grams of combined EPA and DHA. B : OTC supplements require 1013 pills daily to get enough EPA and DHA. C : OTC supplements contain so much EPA and DHA that the patient would be at risk of toxicity.

D : OTC supplements provide enough EPA and DHA, but they are also often contaminated and should be avoided.

Correct Answer : B 21 : Patients taking warfarin should be told to .

A : avoid St. Johns wort, as it may increase the effects of warfarin B : consume a moderate amount (one drink for women, two for men) of alcohol daily C : keep their vitamin K intake consistent D : avoid glucosamine, as it may decrease the effectiveness of warfarin Correct Answer : C 22 : What is an example of a bile acid sequestrant medication?

A : Lipitor B : Repatha C : Colestid D : Crestor Correct Answer : C 23 : Following a heart attack, what type of diet would a patient most likely require?

A : low-carbohydrate diet B : high-protein, high-energy diet C : low-fiber diet D : sodium-restricted diet Correct Answer : D 24 : The main source of trans fat in baked goods is A : milk or other dairy products B : eggs C : partially hydrogenated vegetable oil D : tropical oils

.

Correct Answer : C 25 : Which item is a good source of unsaturated fats?

A : avocados B : tropical oils C : cheese 4 / 15

D : organ meats Correct Answer : A 26 : Hemorrhagic strokes occur in about A:5 B : 13 C : 56 D : 87

percent of cases.

Correct Answer : B 27 : Which individual is at the highest risk for stroke?

A : a 65-year-old Caucasian with family history of heart disease B : a 65-year-old obese African American with a history of hypertension C : a 55-year-old African American with family history of hypertension D : a 45-year-old Caucasian with family history of diabetes Correct Answer : B 28 : Harry has a doctors appointment for his annual physical. The doctor has determined that he is at risk for a stroke and prescribes a(n) .

A : anticoagulant B : statin C : diuretic D : low-sodium diet Correct Answer : A 29 : Prior to feeding someone who has had a stroke, the health care professional should assess the client for .

A : food intolerance B : salt sensitivity C : swallowing ability D : hydration status Correct Answer : C 30 : Which type of rehabilitation service would most likely be included for therapy after a stroke?

A : physical therapy B : smoking cessation classes C : fitness training D : stress management Correct Answer : A 31 : Ideally, thrombolytic drugs should be used within A : 4.5 B : 5.5 C : 6.5 D : 7.5

hours following an ischemic stroke.

Correct Answer : A 5 / 15

32 : Following stroke, rehabilitation programs begin A : within 24 hours of the stroke B : as soon as possible after stabilization C : 48 hours after stabilization D : 72 hours after stabilization

.

Correct Answer : B 33 : What is the significance of a transient ischemic attack (TIA)?

A : It is a warning sign that a severe stroke will follow.

B : It causes permanent damage to the neurological system.

C : It requires intravenous tissue plasminogen activator.

D : It requires frequent monitoring, but no other treatment.

Correct Answer : A 34 : Which blood pressure reading is indicative of prehypertension?

A : 117/80 mm Hg B : 125/80 mm Hg C : 140/90 mm Hg D : 140/80 mm Hg Correct Answer : B 35 : Hypertension affects nearly A : one-fourth B : one-third C : one-half D : two-thirds

of adults in the United States.

Correct Answer : B 36 : Which condition has been identified as a nonmodifiable contributing risk factor for hypertension?

A : obesity B : BMI > 30 C : genetics D : alcoholism Correct Answer : C 37 : Dietary guidelines for the management of hypertension emphasize A : avoidance of calcium-rich foods B : a diet rich in fresh fruits and vegetables C : 6 oz. wine per day D : avoidance of starchy foods

.

Correct Answer : B 38 : Hypertension caused by a known physical or metabolic disorder is termed hypertension.

A : primary 6 / 15

B : secondary C : essential D : regulatory Correct Answer : B 39 : Which medication is prescribed to treat hypertension?

A : nicotinic acid B : diuretics C : thrombolytics D : biguanides Correct Answer : B 40 : What is a primary risk factor associated with development of hypertension?

A : age over 45 years B : female gender C : Asian ethnicity D : heavy alcohol intake Correct Answer : D 41 : Which medication reduces blood pressure by reducing blood volume?

A : diuretics B : ACE inhibitors C : beta-blockers D : calcium channel blockers Correct Answer : A 42 : Which medication reduces blood pressure by inhibiting vasoconstriction?

A : diuretics B : ACE inhibitors C : beta-blockers D : calcium channel blockers Correct Answer : D 43 : Moderate-to-vigorous aerobic activity, lasting 40 minutes per session, 3 to 4 times per week can potentially result in a decrease in systolic blood pressure of mm Hg. A : 12 B : 25 C : 58 D : 810 Correct Answer : B 44 : The DASH Eating Plan limits total cholesterol to less than A : 150 B : 200 C : 300 D : 350

mg per day.

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Correct Answer : A 45 : According to the DASH Eating Plan, a person on a 2000 kcalorie diet should include how many servings of milk products each day?

A : 2 to 3 B : 3 to 4 C : 4 to 5 D : 5 to 6 Correct Answer : A 46 : Which intervention would be most successful in reducing sodium intake with eating and preparing foods?

A : Select mostly packaged foods and canned goods.

B : Drink 1 to 3 glasses of water each night before bed.

C : Substitute chicken broth for wine, milk, or water in recipes.

D : Avoid putting salt on foods while at the table.

Correct Answer : D 47 : Left-sided heart failure often leads to A : pulmonary edema B : ascites C : esophageal varices D : gastroparesis

.

Correct Answer : A 48 : The term for malnutrition associated with chronic heart failure is A : cardiac cachexia B : anorexia nervosa C : dyspnea D : tachycardia

.

Correct Answer : A 49 : When clients have edema associated with chronic heart failure, physicians usually order .

A : cholesterol restriction and bile acid sequestrants B : saturated fat restriction and corticosteroids C : sodium restriction and diuretics D : carbohydrate restriction and insulin Correct Answer : C 50 : Generally, patients with heart failure benefit from a daily sodium restriction of A:1 B:2 C:3 D:4

gram(s).

Correct Answer : B 8 / 15

51 : Ms. Conley has congestive heart failure with cardiac cachexia. What should she avoid?

A : liquid supplements B : high-fiber foods C : alcohol D : exercise Correct Answer : C 52 : Mr. Silvestri is not able to grasp his utensils, nor can he feed himself. Which professional can best help him?

A : registered dietitian B : registered nurse C : occupational therapist D : physical therapist Correct Answer : C 53 : Which of the following health care professionals evaluates the chewing and swallowing abilities of patients?

A : occupational therapist B : registered dietitian C : speech-language pathologist D : physical therapist Correct Answer : C 54 : What feeding intervention would be most appropriate for a patient with impaired vision?

A : Help the patient assume correct posture while eating.

B : Place foods between teeth to promote chewing.

C : Provide plates with food guards to prevent spilling.

D : Make sure the patients lips and jaw are closed while chewing.

Correct Answer : C 55 : Which type of utensil may be helpful for an individual with extreme muscle weakness?

A : rocker or roller knives B : flatware with built-up handles C : flatware with utensil holders D : weighted utensils Correct Answer : C 56 : Michael, who was right handed, suffered the traumatic amputation of his right arm below the elbow in an industrial accident. Which item may help him feed himself independently?

A : rocker or roller knives B : flatware with built-up handles C : flatware with utensil holders D : weighted utensils Correct Answer : A 57 : Tina has an uncontrolled tremor as a result of traumatic brain injury. Which item may help her feed herself independently?

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A : rocker or roller knives B : flatware with built-up handles C : flatware with utensil holders D : weighted utensils Correct Answer : D 58 : Doyle experiences great difficulty moving his neck because of degenerative disc disease.

Which item may help him drink beverages?

A : cut-out plastic cup B : slotted cup C : two-handed cup D : covered cup Correct Answer : A 59 : Monica is extremely weak following a bone marrow transplant to treat her cancer. She is anxious to regain her independence. Which item may help her drink beverages?

A : cut-out plastic cup B : slotted cup C : two-handed cup D : covered cup Correct Answer : C 60 : Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a past medical history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She complains of decreased appetite and disinterest in food.Ms. Leland is admitted to the cardiac unit with shortness of breath and fluid retention in her extremities. What is the most likely diagnosis?

A : stroke B : heart failure C : COPD D : myocardial infarction Correct Answer : B 61 : Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a past medical history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She complains of decreased appetite and disinterest in food.Which medication is appropriate to improve Ms. Lelands fluid status?

A : diuretic B : vasodilator C : insulin D : anticoagulant Correct Answer : A 62 : Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a past medical history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She complains of decreased appetite and disinterest in food.Ms. Leland has developed constipation. What nutrition intervention is most appropriate?

A : high-calorie, high-protein diet 10 / 15

B : low-sodium diet C : low-carbohydrate diet D : high-fiber diet Correct Answer : D 63 : Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a past medical history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She complains of decreased appetite and disinterest in food.Ms. Leland is discharged from the hospital and returns for her follow-up appointment complaining of continued constipation. What is likely contributing to her change in bowel pattern?

A : increased activity B : diuretic usage C : increased intake of food D : increased intake of water Correct Answer : B 64 : Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a past medical history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She complains of decreased appetite and disinterest in food.Over time, Ms. Leland suffers from cardiac cachexia and must decide whether she will have to help meet her nutritional needs.

A : tube feedings B : dialysis C : a liver transplant D : parenteral nutrition Correct Answer : A 65 : Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a past medical history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She complains of decreased appetite and disinterest in food.The prognosis for cardiac cachexia is .

A : generally good B : fair C : fair, with prompt intervention D : poor Correct Answer : D 66 : Brian Schmidt is a 58-year-old lawyer with a history of hypertension. His blood pressure has been under fairly good control with prescription medication. His secretary notices that he had a period of confusion and difficulty speaking at a meeting. She advises him to see his doctor.What best explains Brians symptoms?

A : transient ischemic attack B : myocardial infarction C : hypoglycemia D : thrombosis Correct Answer : A 67 : Brian Schmidt is a 58-year-old lawyer with a history of hypertension. His blood pressure has 11 / 15

been under fairly good control with prescription medication. His secretary notices that he had a period of confusion and difficulty speaking at a meeting. She advises him to see his doctor.Brian ignores these warning signs and does not see his physician. Eight months later, Brians son finds him lying on the floor of his bathroom. Brian most likely has .

A : heart failure B : angina C : suffered a stroke D : an acutely bleeding ulcer Correct Answer : C 68 : Brian Schmidt is a 58-year-old lawyer with a history of hypertension. His blood pressure has been under fairly good control with prescription medication. His secretary notices that he had a period of confusion and difficulty speaking at a meeting. She advises him to see his doctor.The physician informs the family that Brian has an obstruction of blood flow to the brain, also known as .

A : a myocardial infarction B : angina C : a hemorrhagic stroke D : an ischemic stroke Correct Answer : D 69 : Brian Schmidt is a 58-year-old lawyer with a history of hypertension. His blood pressure has been under fairly good control with prescription medication. His secretary notices that he had a period of confusion and difficulty speaking at a meeting. She advises him to see his doctor.Brian is stable and will be transferred to a rehabilitation center. He has developed dysphagia as a result of his stroke. What is the best way to meet his nutritional needs?

A : Apply downward pressure to the tongue with a spoon.

B : Provide plates with food guards.

C : Provide thickened liquids and pureed foods.

D : Place foods in similar locations on the plate at each meal.

Correct Answer : C 70 : Brian Schmidt is a 58-year-old lawyer with a history of hypertension. His blood pressure has been under fairly good control with prescription medication. His secretary notices that he had a period of confusion and difficulty speaking at a meeting. She advises him to see his doctor.Brians diet has been advanced. However, he has lost twenty pounds since his admission into the hospital. What is a likely cause?

A : an inability to voice his food preferences B : cardiac cachexia C : family interference D : poorly prepared food Correct Answer : A

MATCHING 71 : Match each word or phrase with the most appropriate definition or explanation.

A : the obstruction of a blood vessel by an A : myocardial infarction 12 / 15

embolus, causing sudden tissue death B : causes damage when bleeding within the B : cerebrovascular accident brain destroys or compresses brain tissue C : plaque C : severe malnutrition associated with heart failure that causes weight loss and tissue wasting D : an abnormal accumulation of fatty deposits, D : thrombosis smooth muscle cells, and fibrous connective tissue in blood vessels E : sudden tissue death caused by blockages ofE : embolism vessels that feed the heart muscle F : an abnormal particle, like a blood clot or air F : ischemia bubble, that travels in the blood G : abnormal enlargement or bulging of a blood G : angina pectoris vessel (usually an artery) caused by damage to or weakness in the blood vessel wall H : causes injury when blood flow within brain H : aneurysm tissue is obstructed I : heart failure I : temporary reduction in blood flow to the brain, which causes temporary symptoms that vary depending on the part of the brain affected J : cardiac cachexia J : inadequate blood supply to tissues due to obstructed blood flow through arteries K : transient ischemic attack K : an injury to brain tissue due to disturbed blood flow through arteries that supply blood to the brain L : the formation or presence of a blood clot in L : ischemic stroke vessels M : hemorrhagic stroke M : a blood clot formed within a blood vessel that remains attached to its place of origin N : condition caused by ischemia in the heart N : embolus muscle that results in discomfort or dull pain in the chest region; the pain often radiates to the left shoulder and arm, or to the back, neck, and lower jaw O : failure of the heart to pump adequate blood, O : thrombus resulting in fluid congestion in tissues and veins leading to the heart Correct Answer : A:E B : A12 C:J D:C E:A F : A13 G:H 13 / 15

H : A11 I:K J:F K:B L:D M : A14 N:G O:I

ESSAY 72 : What is the interrelationship between atherosclerosis and hypertension?

Correct Answer : ?The stress of blood flow along artery walls—called shear stress—can cause physical damage to arteries. (Disturbed blood flow can be harmful to endothelial cells, whereas regular blood flow is protective.) Hypertension intensifies the stress of blood flow on arterial tissue, provoking a low-grade inflammatory state that may stimulate plaque formation or progression.

73 : Describe when it might be appropriate to initiate drug therapy for people with CHD. What types of drug therapy are used?

Correct Answer : ?Individuals who cannot improve CHD risk with dietary and lifestyle changes alone may be prescribed one or more medications. The drugs most often prescribed for lowering LDL levels are the statins (such as Lipitor and Crestor), which reduce cholesterol synthesis in the liver. The medication ezetimide (Zetia) reduces cholesterol levels by inhibiting cholesterol absorption. Bile acid sequestrants (such as Colestid or Questran) reduce LDL levels by interfering with bile acid reabsorption in the small intestine. PCSK9 inhibitors (such as Praluent and Repatha) are injectable medications that lower LDL by enhancing the liver’s ability to remove cholesterol from the blood. For lowering triglyceride levels and increasing HDL, both fibrates (such as Lopid and Tricor) and nicotinic acid (a form of niacin) are effective; nicotinic acid can also reduce LDL and lipoprotein(a) levels. Individuals using these medications should continue their dietary and lifestyle modifications so that they can use the minimum effective doses of the drugs they require.

74 : Discuss the nutritional concerns associated with patients who have suffered a stroke.

Correct Answer : ?The focus of nutrition care is to help patients maintain nutrition status and overall health despite the disabilities caused by the stroke. The initial assessment should determine the nature of the patient’s self-feeding difficulty (if any) and the adjustments required for appropriate food intake. Some patients may need to learn about dietary treatments that improve blood lipid levels and blood pressure. Dysphagia (difficulty swallowing) is a frequent 14 / 15

complication and is associated with a poorer prognosis. Difficulty with speech may prevent patients from communicating food preferences or describing the problems they may be having with eating. Coordination problems can make it hard for patients to grasp utensils or bring food from table to mouth. In some cases, tube feedings may be necessary until the patient has regained these skills.

75 : Describe risk factors for stroke that can be modified and how.

Correct Answer : ?Stroke is largely preventable by recognizing its risk factors and making lifestyle choices that reduce risk. Many of the risk factors are similar to those for heart disease and include hypertension, elevated LDL cholesterol, diabetes mellitus, cigarette smoking, physical inactivity, aging, and previous cardiovascular disease. Medications that suppress blood clotting reduce the risk of ischemic stroke, especially in people who have suffered a first stroke or a TIA. The drugs prescribed are usually antiplatelet drugs (including aspirin) and anticoagulants such as warfarin (Coumadin). Anticoagulant therapy requires regular follow-up and occasional adjustments in dosage to prevent excessive bleeding.

76 : List four feeding-related problems and describe corresponding interventions.

Correct Answer : ?Adaptive feeding devices can make a remarkable difference in a person’s ability to eat independently.A person with an inability to suck may use squeeze bottles to express liquids into the mouth; the tongue can also be stimulated by applying downward pressure or slow, rhythmic strokes. Someone with an inability to chew may try different textures of foods or eat very soft foods that require minimal chewing. A person with dysphagia can use thickened liquids to facilitate easier swallowing; sitting upright with correct posture can help to promote swallowing as well. Someone with difficulties grasping items or coordinating movements can use utensils with modified handles or plates with food guards to make feeding easier.

15 / 15

MULTIPLE CHOICE 1 : What best describes the function of the ureter?

A : storing urine before it is excreted B : conducting urine from the kidneys to the bladder C : transporting urine from the bladder to outside of the body D : carrying blood from the kidneys back to the heart Correct Answer : B 2 : What hormone secreted by the kidneys stimulates the production of red blood cells?

A : erythropoietin B : renin C : aldosterone D : vasopressin Correct Answer : A 3 : To regulate blood pressure, the kidneys secrete A : aldosterone B : erythropoietin C : renin D : vasopressin

.

Correct Answer : C 4 : The cuplike component of the nephron that surrounds the glomerulus and collects the filtrate is called the .

A : Bowmans capsule B : ureter C : collecting duct D : tubule Correct Answer : A 5 : In the nephrotic syndrome, the kidneys ability to excrete edema.

A : potassium B : sodium C : renin D : calcium

is impaired, contributing to

Correct Answer : B 6 : A consequence of the nephrotic syndrome is the loss of plasma proteins in the urine, which contributes to .

A : an increased risk of blood clotting B : a fluid shift from interstitial spaces to blood plasma C : an increased risk of vitamin D toxicity D : anemia Correct Answer : A 1 / 15

7 : Daniel is a 10-year-old boy who has just been diagnosed with the nephrotic syndrome.

Which condition might he develop as a result?

A : beriberi B : pellagra C : anemia D : rickets Correct Answer : D 8 : Nutrition therapy for the nephrotic syndrome focuses on A : increasing the fat content in the diet B : preventing protein malnutrition and alleviating edema C : high-protein and high-kcalorie intake D : high sodium intake

.

Correct Answer : B 9 : A high-protein diet for a client with the nephrotic syndrome is contraindicated because A : protein foods are usually high in fat B : energy requirements are decreased with nephrotic syndrome C : high protein intakes may exacerbate urinary protein losses D : protein levels in nephrotic syndrome are not altered

.

Correct Answer : C 10 : For patients with nephrotic syndrome, the recommended daily protein intake is body weight.

A : 0.4 to 0.6 B : 0.6 to 0.8 C : 0.8 to 1.0 D : 1.0 to 1.2

g/kg

Correct Answer : C 11 : What is the most abundant plasma protein?

A : albumin B : immunoglobulins C : vitamin D binding protein D : transferrin Correct Answer : A 12 : Billy Lewis is a 20-year-old man admitted to the hospital with the nephrotic syndrome. He is 511, weighs 192 pounds, and has edema. His blood values include albumin 1.7 g/dL, K+ 3.3 mEq/L, and LDL cholesterol 192 mg/dL. He is complaining of hunger and wants a snack. The most appropriate food choice is .

A : a sausage biscuit B : a grilled chicken sandwich with lettuce and tomato C : peanut butter and crackers D : cottage cheese and canned fruit Correct Answer : B 2 / 15

13 : Diets high in vitamin D and calcium are recommended for children with nephrotic syndrome to prevent .

A : beriberi B : marasmus C : nephrosclerosis D : rickets Correct Answer : D 14 : Daily sodium intake should be restricted to about syndrome.

A : 0.5 to 1.0 B : 1.0 to 2.0 C : 2.0 to 3.0 D : 3.0 to 4.0

grams for patients with the nephrotic

Correct Answer : B 15 : The nephrotic syndrome is associated with accelerated atherosclerosis and a sharply increased risk of heart disease and .

A : liver disease B : stomach cancer C : stroke D : hypertension Correct Answer : C 16 : In the nephrotic syndrome, urinary protein losses generally average about daily.

A:3 B:5 C:9 D : 16

grams

Correct Answer : A 17 : Patients with the nephrotic syndrome may benefit from calcium supplementation of milligrams daily.

A : 500 to 1000 B : 1000 to 1500 C : 1500 to 2000 D : 2000 to 2500 Correct Answer : B 18 : In patients with the nephrotic syndrome, energy intake of about of body weight daily will sustain weight and spare protein.

A : 15 B : 25 C : 35 D : 45

kcalories per kilogram

3 / 15

Correct Answer : C 19 : One large egg contains about A : 10 B : 40 C : 60 D : 200

milligrams of sodium.

Correct Answer : C 20 : A decline in immunoglobulins associated with the nephrotic syndrome would most likely lead to .

A : edema B : infection C : wasting D : hypertriglyceridemia Correct Answer : B 21 : In the nephrotic syndrome, the liver attempts to compensate for the loss in protein by A : decreasing its synthesis of various plasma proteins B : decreasing glomerular permeability C : increasing albumin levels D : increasing its synthesis of various plasma proteins

.

Correct Answer : D 22 : Why might patients with the nephrotic syndrome be advised to eat foods that are high in potassium?

A : Treatment with certain diuretics results in potassium loss.

B : Protein loss is typically accompanied by potassium loss.

C : They are unable to properly absorb potassium.

D : They are not; they are advised to avoid high-potassium foods.

Correct Answer : A 23 : Normal urine volume is approximately A : 500 to 1000 B : 1000 to 1500 C : 1500 to 2000 D : 2000 to 2500

mL per day.

Correct Answer : B 24 : Reduced kidney function can cause nitrogen-containing waste products, such as accumulate in the blood.

A : ammonia B : creatinine C : amino acids D : lipids

, to

Correct Answer : B 4 / 15

25 : In some patients, recovery from acute kidney injury begins with a period of large amounts of fluid are excreted.

A : catabolism B : uremia C : diuresis D : oliguria

, in which

Correct Answer : C 26 : Hyperkalemia occurs when there is excessive A : calcium B : potassium C : phosphorus D : vitamin D

in the blood.

Correct Answer : B 27 : Edema that develops with acute kidney injury is most often treated with which type of medication?

A : potassium-exchange resins B : phosphate binders C : diuretics D : insulin Correct Answer : C 28 : Which diuretic is usually used to mobilize fluids when a patient has edema?

A : hydrochlorothiazide B : furosemide C : aldactone D : spironolactone Correct Answer : B 29 : Depending on individual condition and laboratory results with acute kidney injury, phosphorus would most likely be restricted to mg/kg per day.

A : 8 to 15 B : 20 to 35 C : 50 to 60 D : 70 to 75 Correct Answer : A 30 : What is a prerenal cause of acute kidney injury?

A : heart failure B : sickle cell disease C : diabetes mellitus D : pregnancy Correct Answer : A 31 : What is a postrenal cause of acute kidney injury?

A : infection 5 / 15

B : nephrotoxic drugs C : renal vein thrombosis D : heart attack Correct Answer : C 32 : What is an intrarenal cause of acute kidney injury?

A : transfusion reaction B : pregnancy C : renal artery stenosis D : bladder rupture Correct Answer : A 33 : Diabetes mellitus causes about United States.

A : 34 B : 44 C : 54 D : 64

percent of cases of chronic kidney disease in the

Correct Answer : B 34 : Which symptom is associated with early stages of chronic kidney disease?

A : exercise intolerance B : confusion and mental impairments C : metabolic acidosis D : osteodystrophy Correct Answer : A 35 : The rate at which filtrate is formed within the kidney is normally about A : 15 B : 60 C : 100 D : 125

mL/min.

Correct Answer : D 36 : GFR of A : less than 15 B : 15 to 29 C : 30 to 59 D : 60 to 89

mL/min is characteristic of kidney failure.

Correct Answer : A 37 : What condition most often develops as a result of acidbase imbalance associated with chronic kidney disease?

A : fatty liver disease B : gastroesophageal reflux C : dumping syndrome D : bone disease 6 / 15

Correct Answer : D 38 : A type of skin change that develops due to uremia from chronic kidney disease is A : maceration B : pruritus C : hives D : diaphoresis

.

Correct Answer : B 39 : The removal of excess fluids and wastes from the blood using the peritoneum as a semipermeable membrane is called .

A : chronic dialysis B : hemodialysis C : peritoneal dialysis D : acute dialysis Correct Answer : C 40 : The glucose absorbed from the dialysate used in peritoneal dialysis can provide as many as kcalories daily.

A : 200 B : 400 C : 800 D : 1000 Correct Answer : C 41 : Which food is high in phosphorus?

A : gelatin B : ham C : chocolate D : fish Correct Answer : D 42 : Supplements of folic acid prescribed for dialysis patients are typically A:1 B:5 C : 10 D : 20

mg daily.

Correct Answer : A 43 : Morgan Simmons, a 74-year-old woman, is on hemodialysis. She wants to continue consuming three cups of non-fat milk per day. What is the most appropriate response?

A : Continue consuming three cups a day; you need calcium and vitamin D. B : Increase your milk intake to four cups per day.

C : Milk contains phosphorus and too much can be harmful for your medical condition.

D : Do not drink milk at all. Take the vitamin D and calcium supplements instead.

Correct Answer : C 7 / 15

44 : Intakes of supplemental vitamin C are restricted in patients with chronic renal failure to prevent .

A : kidney stones B : scurvy C : colds D : hemochromatosis Correct Answer : A 45 : Approximately transplant.

A : 15 B : 30 C : 40 D : 55

percent of patients with end-stage renal disease have a kidney

Correct Answer : B 46 : Prior to his kidney transplant, John Miller was on dialysis and his sodium intake was restricted to 2500 mg daily. His blood pressure levels have averaged 140/90 mmHg. When Mr. Miller inquires if he should continue to restrict his sodium after his transplant, you reply, .

A : Since your renal function has been restored, you will never need to restrict your sodium intake.

B : Since your blood pressure is still elevated, you need to restrict your sodium level to 2.0 to 2.4 g/day.

C : Since you are going to be on diuretics, there is no need to restrict sodium.

D : Once you are off the immunosuppressants, you will no longer need to restrict sodium intake.

Correct Answer : B 47 : Which item is a high-potassium food?

A : honeydew melon B : watermelon C : avocado D : blueberries Correct Answer : C 48 : Intradialytic parenteral nutrition .

A : combines parenteral nutrition with hemodialysis B : substitutes parenteral nutrition for hemodialysis C : substitutes hemodialysis for parenteral nutrition D : delays the need for hemodialysis by manipulating nutrition Correct Answer : A 49 : Which interaction is associated with the use of immunosuppressants?

A : Limit alcohol intake due to the potential for toxic effects.

B : Bioavailability of medication is increased when the drug is taken with food.

C : Grapefruit juice can dangerously decrease serum concentrations of the medication.

D : Calcium and magnesium supplements must be taken separately.

8 / 15

Correct Answer : A 50 : Which factor would most likely predispose a person to development of kidney stones?

A : urinary obstruction B : increased urine volume C : decreased protein intake D : administration of immunosuppressant medications Correct Answer : A 51 : Which item contributes to high uric acid levels?

A : oxalate B : purines C : cystine D : magnesium Correct Answer : B 52 : Struvite stones are mainly composed of A : magnesium ammonium phosphate B : bile acid salts C : urinary citrate D : purines

.

Correct Answer : A 53 : What best describes renal colic?

A : urination urgency as a result of kidney stone obstruction B : sharp stabbing pain as a kidney stone passes through the ureter C : a kidney infection that develops due to struvite kidney stones D : crystallized urine that has backed up into the kidneys Correct Answer : B 54 : The best preventive treatment for all types of kidney stones is to A : drink plenty of fluids B : consume a diet high in berries and juices C : limit animal proteins D : increase vitamin C intake

.

Correct Answer : A 55 : The most common method used to evaluate the adequacy of dialysis treatment is A : blood urea nitrogen B : urea kinetic modeling C : weighing a patient pre and post-dialysis D : self-report of fluid intake and output

.

Correct Answer : B 56 : What is the most common complication of peritoneal dialysis?

A : hypoglycemia B : infection 9 / 15

C : hypotension D : hernia Correct Answer : B 57 : Which treatment is used almost exclusively to dialyze patients with acute kidney injury?

A : peritoneal dialysis B : hemodialysis C : continuous renal replacement therapy D : intermittent dialysis Correct Answer : C 58 : The movement of solutes from an area of high concentration to one of low concentration is known as .

A : osmosis B : diffusion C : permeability D : oncotic pressure Correct Answer : B 59 : What is an advantage of using continuous renal replacement therapy (CRRT)?

A : It can be completed in a very short period of time.

B : It does not cause shifts in fluid balance.

C : It does not lead to blood clots.

D : It prevents patients from developing hypotension.

Correct Answer : B 60 : One of the most common complications associated with hemodialysis is A : hypertension B : blood clots C : hyperglycemia D : joint inflammation

.

Correct Answer : B 61 : Charlie is a 2 ½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency room due to increased lethargy, high fever, and fluid retention in his hands and feet. His laboratory results find a low albumin and high lipid levels.What is Charlie suffering from?

A : cystic fibrosis B : type 1 diabetes C : nephrotic syndrome D : uremic syndrome Correct Answer : C 62 : Charlie is a 2 ½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency room due to increased lethargy, high fever, and fluid retention in his hands and feet. His laboratory results find a low albumin and high lipid levels.Which part of Charlies body is malfunctioning and causing this 10 / 15

condition?

A : beta cells B : neurons C : lymphatic system D : glomerulus Correct Answer : D 63 : Charlie is a 2 ½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency room due to increased lethargy, high fever, and fluid retention in his hands and feet. His laboratory results find a low albumin and high lipid levels.Which diet is the most appropriate for Charlie?

A : high kcalorie, high protein B : high carbohydrate, high fat C : low fat, low carbohydrate D : low sodium, low fat, low cholesterol Correct Answer : D 64 : Charlie is a 2 ½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency room due to increased lethargy, high fever, and fluid retention in his hands and feet. His laboratory results find a low albumin and high lipid levels.Charlie is prescribed calcium and vitamin D supplements to prevent .

A : fluid retention B : rickets C : osteopenia D : renal failure Correct Answer : B 65 : Charlie is a 2 ½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency room due to increased lethargy, high fever, and fluid retention in his hands and feet. His laboratory results find a low albumin and high lipid levels.Which meal is most appropriate for Charlie?

A : low-fat milk, fried chicken strips, ketchup, French fries, and sliced apples B : apple juice, shrimp fried rice, duck sauce, and spring roll C : grape juice, canned chicken noodle soup, cheeseburger with ketchup, and fruit cup D : low-fat milk, grilled pork, rice pilaf, and sliced pears Correct Answer : D 66 : Jasmine Singh is 25 years old. She has had frequent urinary tract infections over the past 3 years. She makes an appointment with her physician after an episode of nausea, vomiting, and abdominal pain.At her doctors office, Jasmine provides a urine sample. Testing confirms blood in her urine. This indicates .

A : renal colic B : hematuria C : acute kidney injury D : ketones Correct Answer : B 11 / 15

67 : Jasmine Singh is 25 years old. She has had frequent urinary tract infections over the past 3 years. She makes an appointment with her physician after an episode of nausea, vomiting, and abdominal pain.Jasmine has been diagnosed with a kidney stone. The blood in Jasmines urine is most likely a result of .

A : damage from the stone passing through the ureter B : irritation of the lining of the bladder C : infection from the stone obstructing the convoluted tubules D : ketones in the urine from elevated glucose Correct Answer : A 68 : Jasmine Singh is 25 years old. She has had frequent urinary tract infections over the past 3 years. She makes an appointment with her physician after an episode of nausea, vomiting, and abdominal pain.Due to her history of urinary tract infections, Jasmine most likely has stones.

A : struvite B : cystine C : uric acid D : calcium oxalate Correct Answer : A 69 : Jasmine Singh is 25 years old. She has had frequent urinary tract infections over the past 3 years. She makes an appointment with her physician after an episode of nausea, vomiting, and abdominal pain.What kind of diet should Jasmine follow to prevent kidney stones?

A : regular diet with plenty of fluids B : high protein/high kcalorie with fluid restriction C : low purine with plenty of fluids D : low protein with fluid restriction Correct Answer : A 70 : Jasmine Singh is 25 years old. She has had frequent urinary tract infections over the past 3 years. She makes an appointment with her physician after an episode of nausea, vomiting, and abdominal pain.In order to prevent further kidney stones, Jasmine should consume how many cups of fluids per day?

A : 8 to 10 B : 10 to 12 C : 12 to 16 D : > 18 Correct Answer : C

MATCHING 71 : Match each word or phrase with the most appropriate definition or explanation.

A : elevated serum potassium levels A : diuresis B : excessive amounts of oxalate in the urine B : renal osteodystrophy C : metabolic disorder that results in excessive C : uremic syndrome uric acid in the blood and urine and deposition of uric acid in and around the joints, causing 12 / 15

acute joint inflammation D : excessive amounts of calcium in the urine D : hyperkalemia E : increased urine production E : hypercalcemia F : bone disorder in patients with chronic renal F : hypercalciuria failure as a result of increased parathyroid hormone secretion, reduced serum calcium, acidosis, and impaired vitamin D activation by the kidney G : hyperoxaluria G : crystals of magnesium ammonium phosphate H : struvite H : slow, continuous method of removing solutes and fluid from blood by gently pumping blood across a filtration membrane over a prolonged period of time I : blood in the urine I : renal colic J : cluster of symptoms associated with J : gout inadequate kidney function, including uremia, anemia, bone disease, hormonal imbalances, bleeding impairment, increased cardiovascular disease risk, and reduced immunity K : severe, stabbing pain that occurs when a K : hematuria kidney stone passes through the ureter L : elevated serum calcium levels L : purines M : end products of nucleotide metabolism that M : hemodialysis eventually degrade to uric acid N : removal of fluids and wastes from blood by N : peritoneal dialysis passing the blood through a dialyzer O : removal of fluids and wastes by using the O : continuous renal replacement therapy peritoneal membrane as a filter Correct Answer : A:D B:G C:J D:F E:A F:B G:H H : A14 I:K J:C K:I 13 / 15

L:E M : A11 N : A12 O : A13

ESSAY 72 : Discuss three of the roles of the kidneys in maintaining our health.

Correct Answer : ?The kidneys help to regulate blood pressure by secreting the enzyme renin.

Renin catalyzes the formation of angiotensin I from the plasma protein angiotensinogen. In the lungs and elsewhere, angiotensin I is converted to angiotensin II, a potent vasoconstrictor that narrows the diameters of arterioles and thereby raises blood pressure. Angiotensin II also stimulates the release of aldosterone, an adrenal hormone that induces the kidneys to increase reabsorption of sodium and water; this increases plasma volume, which raises blood pressure.

The kidneys produce the hormone erythropoietin, which stimulates the production of red blood cells in the bone marrow. The kidneys convert vitamin D to its active form, thereby helping to regulate calcium balance and bone formation.

73 : Explain the nephrotic syndrome and the diet modifications used to treat it.

Correct Answer : ?The nephrotic syndrome is not a specific disease; rather, the term refers to a syndrome caused by significant urinary protein losses that result from severe glomerular damage. The condition arises because damage to the glomeruli increases their permeability to plasma proteins, allowing the proteins to escape into the urine. The loss of these proteins (typically more than 3 to 3.5 grams daily) may cause serious consequences, including edema, blood lipid abnormalities, blood coagulation disorders, and infections. In some cases, the nephrotic syndrome can progress to renal failure. Nutrition therapy can help to prevent PEM, alleviate edema, and correct lipid abnormalities. Meeting protein and energy needs helps to minimize losses of muscle tissue. High-protein diets are not advised, however, because they can exacerbate urinary protein losses and result in further damage to the kidneys. Instead, the protein intake should fall between 0.8 and 1.0 gram per kilogram of body weight per day; at least half of the protein consumed should come from high-quality sources, such as milk products, meat, fish, poultry, eggs, and soy products. An adequate energy intake (up to 35 kcalories per kilogram of body weight daily) sustains weight and spares protein. Controlling sodium intake helps to control edema; therefore, the sodium intake may be limited to 1000 to 2000 milligrams (1 to 2 grams) daily. If diuretics prescribed for the edema cause potassium losses, patients are encouraged to select foods rich in potassium. A diet low in saturated fat, trans fats, and refined sugars may help to control elevated LDL and VLDL levels. Dietary measures are usually inadequate for controlling blood lipids, however, so physicians may prescribe lipid-lowering medications as well. In some cases, treating the underlying cause of nephrotic syndrome is sufficient for correcting the lipid disorders. Multivitamin/mineral supplementation can help patients avoid nutrient deficiencies; nutrients at risk include iron and vitamin D. 74 : Explain how chronic kidney disease can lead to cardiovascular complications.

14 / 15

Correct Answer : ?Fluid and electrolyte imbalances result in hypertension, arrhythmias, and eventual heart muscle enlargement. Excessive parathyroid hormone secretion leads to calcification of arteries and heart tissue. Patients with uremia are at increased risk of stroke, heart attack, and heart failure.

75 : Describe the events leading to the development of bone disease in patients with chronic kidney disease.

Correct Answer : ?Increased secretion of parathyroid hormone helps to prevent elevations in serum phosphate but contributes to bone loss and the development of renal osteodystrophy, a bone disorder common in renal patients. Electrolyte imbalances are likely when the GFR is very low (below 5 milliliters per minute), when hormonal adaptations are inadequate, or when intakes of water or electrolytes are either very restricted or excessive. Because the kidneys are responsible for maintaining acid–base balance, acidosis often develops in chronic kidney disease. Although usually mild, the acidosis exacerbates renal bone disease because compounds in bone (e.g., protein and phosphates) are released to buffer the acid in blood.

76 : A client is diagnosed with calcium oxalate kidney stones. What is the appropriate diet therapy for her treatment?

Correct Answer : ?Most dietary strategies and drug treatments for calcium oxalate stones aim to reduce urinary calcium and oxalate levels. Dietary measures may include adjustments in calcium, oxalate, protein, and sodium intakes. Patients should consume adequate calcium from food sources (about 800 to 1200 milligrams per day) because dietary calcium combines with oxalate in the intestines, reducing oxalate absorption and helping to control hyperoxaluria.

Conversely, low-calcium diets promote oxalate absorption and higher urinary oxalate levels.

Some individuals with hyperoxaluria may benefit from dietary oxalate restriction. Vitamin C intakes should not exceed the RDA (90 and 75 milligrams for men and women, respectively) because vitamin C degrades to oxalate. High intakes of protein (especially from meat, fish, poultry, or eggs) and sodium increase urinary calcium excretion, so moderate protein consumption (0.8 to 1.0 gram per kilogram of body weight per day) and a controlled sodium intake (no more than about 2000 to 3000 milligrams daily) are also advised. Patients with hypocitraturia are usually advised to reduce intakes of animal proteins and increase intakes of fruits and vegetables.

15 / 15

MULTIPLE CHOICE 1 : Cancer ranks number A : one B : two C : three D : four

among the causes of death in the United States.

Correct Answer : B 2 : The type of cancer that arises from white blood cell precursors is A : carcinoma B : glioma C : leukemia D : melanoma

.

Correct Answer : C 3 : Melanoma is a type of cancer that arises from A : pigmented skin cells B : lymph tissues C : epithelial tissues D : glandular tissues

.

Correct Answer : A 4 : A new growth of tissue that forms an abnormal mass with no function is a A : carcinogen B : tumor C : benign mass D : metastasis

.

Correct Answer : B 5 : The result of , the first step in the progression of tumor development, is the formation of genetic mutations that alter gene expression and induce abnormal cell division.

A : carcinogenesis B : promotion C : initiation D : metastasis Correct Answer : C 6 : Toxins found in moldy grains and peanuts are most commonly associated with which type of cancer?

A : liver B : leukemia C : bladder D : breast Correct Answer : A

1 / 15

7 : Which food or beverage may decrease risk for colon cancer?

A : T-bone steak B : beer C : bologna D : nonfat milk Correct Answer : D 8 : Larry has a family history of cancer and wants to decrease his chances of getting it. Which food item may decrease risk of prostate cancer?

A : milk B : pork chops C : tomatoes D : oranges Correct Answer : C 9 : There is evidence that an adequate intake of protects against the development of cancers of the lung, mouth, pharynx, larynx, and esophagus.

A : meat B : fruits and vegetables C : unsaturated fat D : protein Correct Answer : B 10 : About 1 in A:5 B : 10 C : 30 D : 50

cancer deaths can be attributed to alcohol consumption.

Correct Answer : C 11 : To minimize carcinogen formation during cooking, A : use high-heat options, such as an outdoor grill B : marinate meat before cooking C : choose fatty cuts of meat D : cook all meat until well done

.

Correct Answer : B 12 : The main reason cruciferous vegetables are considered cancer fighters is because they .

A : are high in fiber B : are low in fat C : contain phytochemicals D : support the immune system Correct Answer : C 13 : Why do cancer patients tend to reduce their food intake?

A : spasticity 2 / 15

B : foodborne illness C : pain D : bacterial overgrowth Correct Answer : C 14 : Which guideline is appropriate in reducing cancer risk?

A : Strive to maintain a BMI between 22 and 28.

B : Engage in at least 45 minutes of physical exercise 7 days a week.

C : Consume at least ½ cup of starchy vegetables or fruits every day.

D : Limit sedentary activities such as watching television.

Correct Answer : D 15 : Diabetes mellitus is a possible side effect of A : pancreatic B : esophageal C : gastric D : intestinal

resection.

Correct Answer : A 16 : Malabsorption of A : vitamin B12 B : vitamin C C : niacin D : zinc

is associated with gastric resection.

Correct Answer : A 17 : The drugs used during chemotherapy are known as A : antineogenesis drugs B : antispasmodic medications C : antineoplastic agents D : antimetabolite drugs

.

Correct Answer : A 18 : Methotrexate, a medication used for chemotherapy, resembles A : iron B : folate C : vitamin K D : selenium

.

Correct Answer : B 19 : Radiation enteritis is inflammation of the A : skin B : epithelial C : intestinal D : beta

cells.

Correct Answer : C 3 / 15

20 : Hematopoietic stem cell transplants can be used as a primary treatment for A : leukemia B : gliomas C : pancreatic cancer D : breast cancer

.

Correct Answer : A 21 : What best describes the action of immune checkpoint inhibitors?

A : blocking proteins that prevent the immune system from attacking cancer cells B : attacking immune host cells in transplanted tissue C : producing new white blood cells from the bone marrow D : preventing cancer by enhancing immune responses Correct Answer : A 22 : Up to percent of patients with cancer combine one or more complementary and alternative medicine approaches with standard treatment.

A : 36 B : 45 C : 68 D : 83 Correct Answer : D 23 : What intervention is most appropriate for a patient who suffers from frequent nausea related to chemotherapy?

A : Consume liquids only with meals.

B : Avoid foods that have strong odors.

C : Consume the largest meal of the day in the morning.

D : Eat a meal just before chemotherapy treatments.

Correct Answer : B 24 : Daily intake of protein in cancer patients with cachexia should be A : 0.4 to 1.0 B : 1.0 to 1.6 C : 1.6 to 2.2 D : 2.2 to 2.8

g/kg.

Correct Answer : B 25 : Dietary modifications that might be appropriate for a patient with cancer of the brain include .

A : fluid restrictions B : a mechanically altered diet C : total parenteral nutrition D : protein restrictions Correct Answer : B 26 : Which cancer site may require tube feeding, TPN, or a fat- and lactose-restricted diet 4 / 15

prescription?

A : kidneys B : pancreas C : intestine D : brain Correct Answer : C 27 : The best dietary intervention for a cancer patient experiencing a metallic taste is to A : serve meat very warm B : use poultry, fish, or eggs instead of red meat C : avoid all foods containing protein D : provide mouth care after meals

.

Correct Answer : B 28 : What food should a patient with immunosuppression avoid?

A : pasteurized milk products B : smoked or cured meats C : unwashed raw fruits D : baked goods with high-fructose corn syrup Correct Answer : C 29 : Anamaria Kruschenko has been diagnosed with neutropenia. Which meal would be most appropriate?

A : Greek salad with whole milk B : macaroni and cheese with canned fruit cocktail C : tuna sandwich and an apple D : bacon, lettuce, and tomato sandwich and chocolate pudding Correct Answer : B 30 : What is a risk factor for skin cancer?

A : arsenic B : hexavalent chromium C : hepatitis B or C infection D : infection with Helicobacter pylori Correct Answer : A 31 : What is a risk factor for liver cancer?

A : asbestos B : hexavalent chromium C : hepatitis B or C infection D : ultraviolet radiation Correct Answer : C 32 : An estimated have been infected.

A:5 B : 10

percent of persons in the United States who have HIV are unaware they

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C : 15 D : 21 Correct Answer : D 33 : The cells essential for immune function that are affected by HIV infection are A : CD4+ T cells B : red blood cells C : pigmented skin cells D : antibodies

.

Correct Answer : A 34 : Infections from microorganisms that normally do not cause disease in the general population but can cause great harm in people with HIV are called .

A : tissue rejection B : AIDS-defining illnesses C : opportunistic infections D : lipomas Correct Answer : C 35 : Although the global incidence of HIV infection has been declining in recent years, its prevalence continues to be highest in .

A : sub-Saharan Africa B : the United Arab Emirates C : northern Africa D : southeast Asia Correct Answer : A 36 : HIV is most often spread through which route?

A : sexual transmission B : sharing infected needles C : transmission from infected mother to child D : unsafe food handling practices Correct Answer : A 37 : What causes the abnormalities seen in glucose and fat metabolism in patients with HIV? A : disease progression B : side effects of medications C : sedentary lifestyle D : genetic predisposition Correct Answer : B 38 : What is a characteristic of lipodystrophy?

A : breast enlargement B : swelling and edema in the face C : thin, weak extremities D : fat accumulation in the hips 6 / 15

Correct Answer : A 39 : What is a cause of anorexia in patients with HIV infection?

A : constipation B : physical exertion C : respiratory infections D : lipodystrophy Correct Answer : C 40 : A type of cancer that results in skin lesions and that may occur in people with AIDS is A : adenomas B : gliomas C : Kaposis sarcoma D : thrush

.

Correct Answer : C 41 : What is an example of a drug classified as a CCR5 antagonist?

A : maraviroc B : enfuvirtide C : ritonavir D : zidovudine Correct Answer : A 42 : What is a primary objective of nutrition therapy for HIV? A : providing micronutrient supplements B : maintaining lean body mass C : reducing risk of hypolipidemia D : correcting changes in blood glucose Correct Answer : B 43 : What dietary intervention is required with use of didanosine?

A : Avoid magnesium supplements and alcohol.

B : Include folate supplementation.

C : Take all doses with food.

D : Avoid taking with a high-fat meal.

Correct Answer : A 44 : Water can transmit a parasite that causes A : Kaposis sarcoma B : cryptosporidiosis C : pneumonia D : listeriosis

in HIV-infected individuals.

Correct Answer : B 45 : Which type of enteral feeding is preferred in cases of severe malabsorption for patients with HIV? A : energy-dense formulas administered via tube feeding 7 / 15

B : hydrolyzed formulas with MCT administered via tube feeding C : hydrolyzed formulas with MCT administered orally D : high-protein formulas with MCT administered orally Correct Answer : C 46 : People who take antiretroviral drugs are at greater risk of developing which condition?

A : end-stage renal disease B : pancreatitis C : insulin resistance D : cirrhosis Correct Answer : C 47 : Patients taking the NRTI zidovudine should be told to A : take it on an empty stomach B : take it 2 hours before or 3 hours after a meal C : avoid taking it with a high-fat meal D : avoid magnesium supplements while taking it

.

Correct Answer : C 48 : Which type of drug prevents HIV from entering the cells by binding to a viral protein needed for its entry?

A : integrase inhibitors B : nucleoside reverse transcriptase inhibitors C : protease inhibitors D : fusion inhibitors Correct Answer : D 49 : An estimated States.

A : 28 B : 38 C : 48 D : 58

million cases of foodborne illnesses occur each year in the United

Correct Answer : C 50 : Toxicity means that a substance .

A : can cause harm if enough is consumed B : is not safe at any level of consumption C : is likely to cause harm in common, real-life situations D : results in appreciable morbidity and mortality if consumed Correct Answer : A 51 : Among foodborne infections, are the leading causes of hospitalizations and deaths.

A : E.coli and Listeria B : norovirus and Salmonella C : Clostridium perfringens and Campylobacter D : norovirus and Listeria 8 / 15

Correct Answer : B 52 : What is an example of a foodborne infection?

A : E.coli B : botulism C : toxoplasma D : staphylococcal food poisoning Correct Answer : A 53 : The most common food intoxication is A : E.coli B : toxoplasma C : botulism D : staphylococcal food poisoning

.

Correct Answer : D 54 : Campylobacter is most commonly spread through A : unwashed fruits and vegetables B : person-to-person contact C : undercooked poultry D : raw cookie dough

.

Correct Answer : C 55 : Honey may contain dormant bacterial spores, which can awaken in the human body to produce .

A : botulism B : Campylobacter C : Listeria D : E.coli Correct Answer : A 56 : Onset of toxoplasma typically occurs A : 16 hours B : 816 hours C : 13 days D : 721 days

after exposure to the toxin.

Correct Answer : D 57 : When serving hot foods, temperatures should be at least A : 120 B : 130 C : 140 D : 150

oC.

Correct Answer : C 58 : Leftovers should be thoroughly reheated to at least

oC. 9 / 15

A : 125 B : 145 C : 165 D : 185 Correct Answer : C 59 : Ground beef should be cooked to an internal temperature of at least A : 100 B : 120 C : 140 D : 160

oC.

Correct Answer : D 60 : Cold foods should be kept at A : 30 B : 40 C : 50 D : 60

oC or lower.

Correct Answer : B 61 : Sixty-four-year-old Jeffery Thomson has been diagnosed with esophageal cancer. He has experienced a 20-pound weight loss in the past 2 months due to decreased appetite and difficulty eating. He will begin cancer treatment in a week and is visiting with the registered dietitian for nutrition counseling.Possible dietary interventions to better meet Mr. Thomsons nutritional needs include .

A : serving large portions B : tube feeding C : a bland diet D : a high-kcalorie, high-protein diet Correct Answer : B 62 : Sixty-four-year-old Jeffery Thomson has been diagnosed with esophageal cancer. He has experienced a 20-pound weight loss in the past 2 months due to decreased appetite and difficulty eating. He will begin cancer treatment in a week and is visiting with the registered dietitian for nutrition counseling.Factors than can decrease the risk of esophageal cancer include intake of .

A : high-vitamin C foods B : alcohol C : high-calcium foods D : high-sugar foods Correct Answer : A 63 : Sixty-four-year-old Jeffery Thomson has been diagnosed with esophageal cancer. He has experienced a 20-pound weight loss in the past 2 months due to decreased appetite and difficulty eating. He will begin cancer treatment in a week and is visiting with the registered dietitian for nutrition counseling.Mr. Thomson begins . His doctor chooses this treatment because it is better able to target specific parts of the body.

A : radiation therapy 10 / 15

B : chemotherapy C : dietary therapy D : acupuncture Correct Answer : A 64 : Sixty-four-year-old Jeffery Thomson has been diagnosed with esophageal cancer. He has experienced a 20-pound weight loss in the past 2 months due to decreased appetite and difficulty eating. He will begin cancer treatment in a week and is visiting with the registered dietitian for nutrition counseling.Mr. Thomson continues his cancer treatment and is scheduled for esophageal resection. What is a possible complication after surgery?

A : reflux B : urinary incontinence C : inability to taste food D : dumping syndrome Correct Answer : A 65 : Sixty-four-year-old Jeffery Thomson has been diagnosed with esophageal cancer. He has experienced a 20-pound weight loss in the past 2 months due to decreased appetite and difficulty eating. He will begin cancer treatment in a week and is visiting with the registered dietitian for nutrition counseling.If Mr. Thomsons cancer spreads, it will be considered .

A : malignant B : benign C : metastasized D : carcinogenic Correct Answer : C 66 : Fifty-eight-year-old Janet Englewood has been living with HIV for the past 15 years. Today she returns to her physician for a follow-up appointment.Janet should expect the doctor to check her to assess disease progression.

A : viral load B : beta cells C : white blood cells D : albumin Correct Answer : A 67 : Fifty-eight-year-old Janet Englewood has been living with HIV for the past 15 years. Today she returns to her physician for a follow-up appointment.The physician reports that Janets blood glucose, LDL, and total cholesterol are elevated. She has also gained a significant amount of weight. Janet is diagnosed with .

A : HIV cachexia B : AIDS C : HIV lipodystrophy D : ARDS Correct Answer : C 68 : Fifty-eight-year-old Janet Englewood has been living with HIV for the past 15 years. Today she returns to her physician for a follow-up appointment.Which diet is most appropriate for Janet?

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A : high kcalorie, high protein B : clear liquids with TPN C : regular D : no concentrated sweets, low saturated fat, low cholesterol Correct Answer : D 69 : Fifty-eight-year-old Janet Englewood has been living with HIV for the past 15 years. Today she returns to her physician for a follow-up appointment.Which statement explains why Janet does not take a multivitamin-mineral supplement?

A : People with HIV dont need them.

B : My other medications interact with some supplements.

C : They will increase my weight.

D : Supplements can accelerate my disease.

Correct Answer : B 70 : Fifty-eight-year-old Janet Englewood has been living with HIV for the past 15 years. Today she returns to her physician for a follow-up appointment.Janet is taking ritonavir. What instructions should she receive?

A : It should be taken on an empty stomach.

B : It must be taken with food.

C : It should be taken 1.5 hours before or 2 hours after a meal.

D : It is one of the few protease inhibitors that do not interact with alcohol.

Correct Answer : B

MATCHING 71 : Match each word or phrase with the most appropriate definition or explanation.

A : describes tumors that multiply out of control, A : tumor threaten health, and require treatment B : a substance that is capable of causing B : metastasize cancer C : benign C : use of X-rays, gamma rays, or atomic particles to destroy cancer cells D : a foodborne illness caused by the parasite D : malignant Cryptosporidium parvum E : new growth of tissue forming an abnormal E : buffalo hump mass with no function F : cryptosporidiosis F : to spread from one part of the body to another G : cancer-wasting syndrome characterized by G : carcinogen anorexia, muscle wasting, weight loss, and fatigue H : collection of abnormalities in fat and glucoseH : cancer cachexia metabolism that result from drug treatments for HIV, including body fat redistribution, abnormal lipid levels, and insulin resistance I : inflammation of the intestinal tissue caused I : chemotherapy by exposure to radiation 12 / 15

J : describes an abnormal mass of cells that is J : radiation therapy noncancerous K : use of drugs to arrest or destroy cancer cellsK : radiation enteritis L : the accumulation of fatty tissue at the base L : opportunistic infections of the neck M : thrush M : infections from microorganisms that normally do not cause disease in the general population but can cause great harm in people whose immune systems are compromised N : fungal infection of the mucous membranes N : Kaposis sarcoma of the oral cavity and elsewhere O : type of cancer common in people with HIV O : lipodystrophy infections and characterized by skin lesions Correct Answer : A:D B:G C:J D:F E:A F:B G:H H : A14 I:K J:C K:I L:E M : A11 N : A12 O : A13

ESSAY 72 : Describe the possible effects of cancer surgeries on nutritional status in five different regions of the body.

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Correct Answer : ?Surgery is performed to remove tumors, determine the extent of cancer, and protect nearby tissues. Often, surgery must be followed by other cancer treatments to prevent the growth of new tumors. The acute metabolic stress caused by surgery raises protein and energy needs and can exacerbate wasting. Surgery also contributes to pain, fatigue, and anorexia, all of which can reduce food intake at a time when nutritional needs are substantial.

Surgeries to the head and neck can cause dry mouth, reduced chewing and swallowing ability, and an increased risk of aspiration; esophageal surgery reduces swallowing ability and contributes to acid reflux; gastric surgery increases the risk of dumping syndrome and malabsorption of folate and iron; intestinal surgery can lead to diarrhea, malabsorption, and fluid and electrolyte imbalances; and pancreatic surgery increases the risk of diabetes.

73 : Explain the role nutrition therapy plays in the treatment of cancer.

Correct Answer : ?The goals of nutrition therapy for cancer patients are to maintain a healthy weight, preserve muscle tissue, prevent or correct nutrient deficiencies, and provide a diet that patients can tolerate and enjoy despite the complications of illness. Appropriate nutrition care helps patients preserve their strength and improves recovery after stressful cancer treatments.

Moreover, malnourished cancer patients develop more complications and have shorter survival times than patients who maintain good nutrition status. For patients at risk of weight loss and wasting, the focus of nutrition care is to ensure appropriate intakes of protein and energy.

Protein requirements are often between 1.0 and 1.6 grams per kilogram of body weight daily and may be somewhat higher in critically ill patients. Patients should consume adequate energy to prevent weight loss; those who cannot eat enough food may be able to meet their needs by supplementing the diet with nutrient-dense oral supplements. Tube feedings or parenteral nutrition may be necessary for patients who develop complications that interfere with food intake or have long-term or permanent GI impairment. Whenever possible, enteral nutrition is strongly preferred over parenteral nutrition, to preserve GI function and avoid infection.

74 : Discuss common causes of decreased dietary intake among cancer and HIV patients and suggest ways to improve nutrition status or intake.

Correct Answer : ?Anorexia is a major contributor to the weight loss often associated with cancer. Some factors that contribute to anorexia or otherwise reduce food intake include chronic nausea and early satiety, mental stress, fatigue, pain, gastrointestinal obstructions, and the effects of cancer treatments. Poor food intake associated with HIV may result from various factors. Oral infections associated with HIV infection may cause discomfort and interfere with food consumption. Common infections include candidiasis and herpes simplex virus infection.

Oral candidiasis can cause mouth pain, dysphagia, and altered taste sensation; an oral infection with herpes simplex virus may cause painful lesions around the lips and in the mouth. Kaposi’s sarcoma, a type of cancer frequently associated with HIV infection, can cause lesions in the mouth and throat that make eating painful. The medications given to treat HIV infection, other coexisting infections, and cancer often cause anorexia, nausea and vomiting, altered taste sensation, food aversions, and diarrhea. Respiratory infections, including pneumonia and tuberculosis, are common in people with HIV infection. Symptoms may include chest pain, shortness of breath, and cough, which interfere with eating and contribute to anorexia. The physical and social problems that accompany chronic illness may cause fear, anxiety, and depression, which contribute to anorexia. Pain and fatigue, which may be associated with some disease complications, can lead to anorexia and difficulty with eating.

75 : Discuss the key points in safe handling of seafood.

Correct Answer : ?Most seafood available in the United States is safe, but eating it undercooked or raw can cause severe illnesses—hepatitis, worms, parasites, viral intestinal disorders, and 14 / 15

other diseases. Rumor has it that freezing fish will make it safe to eat raw, but this is only partly true. Commercial freezing kills mature parasitic worms, but only cooking can kill all worm eggs and other microorganisms that can cause illness. For safety’s sake, all seafood should be cooked until it is opaque. At least 10 species of bacteria found in raw oysters can cause serious illness and even death. Raw oysters may also carry the hepatitis A virus, which can cause liver disease. Some hot sauces can kill many of these bacteria, but not the virus; alcohol inactivates some bacteria, but not enough to guarantee protection (or to recommend drinking alcohol).

Pasteurization of raw oysters—holding them at a specified temperature for a specified time—holds promise for killing bacteria without cooking the oyster or altering its texture or flavor. Chemical pollution and microbial contamination lurk not only in the water, but also in the boats and warehouses where seafood is cleaned, prepared, and refrigerated. Because seafood is one of the most perishable foods, time and temperature are critical to its freshness, flavor, and safety.

To keep seafood as fresh as possible, people in the industry must “keep it cold, keep it clean, and keep it moving.” Wise consumers eat it cooked.

76 : Identify and discuss one example of foodborne infection and one example of food intoxication.

Correct Answer : ?Foodborne infections are caused by eating foods contaminated by infectious microbes. Among foodborne infections, norovirus and Salmonella are the leading causes of hospitalizations and deaths. Pathogens commonly enter the GI tract in contaminated foods such as undercooked poultry and unpasteurized milk. Symptoms generally include abdominal cramps, fever, vomiting, and diarrhea. Food intoxications are caused by eating foods containing natural toxins or, more likely, microbes that produce toxins. The most common food toxin is produced by Staphylococcus aureus; it affects more than 1 million people each year. Less common, but more infamous, is Clostridium botulinum, an organism that produces a deadly toxin in anaerobic conditions such as improperly canned (especially home-canned) foods and improperly stored foods (such as homemade herb-flavored oils or commercially made, chilled foods stored at room temperature). The botulinum toxin paralyzes muscles, making it difficult to see, speak, swallow, and breathe. Because death can occur within 24 hours of onset, botulism demands immediate medical attention. Even then, survivors may suffer the effects for months or years.

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