Course Introduction
Clinical Nutrition
Pre-Test Questions
Clinical Nutrition examines the role of nutrition in the prevention, diagnosis, and management of various diseases and health conditions. The course explores the physiological basis of nutrient metabolism and the impact of specific nutrients on health outcomes, emphasizing evidence-based dietary interventions. Students learn to assess nutritional status, develop tailored nutrition care plans, and integrate medical nutrition therapy into patient management for conditions such as diabetes, cardiovascular disease, gastrointestinal disorders, and renal impairment. The course combines theoretical knowledge with practical skills through case studies and real-world applications in clinical settings.
Recommended Textbook
Nutrition Therapy and Pathophysiology 3rd Edition by Marcia Nelms
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Page 2
Chapter 1: Role of the Dietitian in the Health Care System
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Sample Questions
Q1) A licensed health professional who compounds and dispenses medications is called a(n) _______________.
Answer: pharmacist
Q2) Which professional would most likely be involved with changing the amount of nutrients delivered via parenteral nutrition support?
A) nurse
B) occupational therapist
C) pharmacist
D) social worker
E) speech-language pathologist
Answer: C
Q3) A patient needs a prescription for total parenteral nutrition to ensure adequate electrolyte balance. This is the responsibility of the:
A) nurse.
B) social worker.
C) occupational therapist.
D) speech-language pathologist.
E) medical doctor.
Answer: E
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Page 3
Chapter 2: The Nutrition Care Process
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Sample Questions
Q1) The desired changes to be achieved over time as a result of nutrition intervention are called:
A) diagnostic indicators.
B) nutrition assessments.
C) screening and referral systems.
D) expected outcomes.
E) outcomes management systems.
Answer: D
Q2) Documentation should be relevant, accurate, and _______________.
Answer: timely
Q3) The dietitian is documenting Ms. S's information using the ADIME method of charting. According to this format, which information is documented under the "A" section?
A) "Potential for inadequate fluid intake"
B) "Addition of vitamins to IV fluids"
C) "Nutrition prescription provided for parenteral feedings"
D) "Risk of electrolyte imbalance"
E) "Nausea and vomiting for two weeks"
Answer: E
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4
Chapter 3: Nutrition Assessment - Foundation of the Nutrition Care Process
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Q1) _______________ include(s) information that is obtained directly from the patient, family members, and any other caregivers, usually during interviews.
Answer: Subjective data, subjective information
Q2) Which laboratory value is normally included as part of a chem-7 panel?
A) albumin
B) AST (aspartate aminotransferase)
C) direct bilirubin
D) total cholesterol
E) serum chloride
Answer: E
Q3) A clinician has calculated a client's creatinine height index with a result of 78% of the suggested standard. Which description best illustrates these results?
A) Sufficient skeletal muscle
B) Mild skeletal muscle depletion
C) Moderate skeletal muscle depletion
D) Severe loss of skeletal muscle
E) Muscle exhaustion
Answer: B
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Chapter 4: Nutrition Intervention and Nutrition Monitoring and Evaluation
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Q1) Eloquence is an essential component to include when writing nutrition educational materials for the community.
A)True
B)False
Q2) As a result of these findings, what would the dietitian most likely prescribe?
A) MCT modular supplement
B) vitamin E
C) LCFA
D) probiotics
E) psyllium
Q3) Which example constitutes coordination of care?
A) Asking the client to maintain copies of his records
B) Referring to a community agency for access to food sources
C) Moving a patient between settings to optimize resources
D) Utilizing the family to act as the patient's advocate
E) Requiring that the client document his own nutrition plan for comparison
Q4) Discuss interventions that can be implemented to improve adequate food consumption through feeding assistance or changing the feeding environment.
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Q5) "Nutrition problem no longer exists" would be recorded as "_______________."
Chapter 5: Enteral and Parental Nutrition Support
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Q1) Which describes a true statement about continuous enteral feedings?
A) They are administered several times a day -- every 30 minutes.
B) They may be administered by gravity from a container suspended above the patient.
C) They consist of the administration of approximately 250 mL of formula at a time.
D) They are usually more time consuming for staff to administer.
E) They require a pump and other equipment to administer.
Q2) Increased permeability to _______________ has been noted when atrophic intestinal cells result from lack of enteral stimulation.
Q3) The outer lumen diameter of a feeding tube is described using a measurement called _______________ size.
Q4) Peripheral parenteral nutrition requires large volumes to meet nutritional needs, which makes this route unacceptable for any fluid-restricted patient.
A)True
B)False
Q5) Excessive _______________ in parenteral nutrition may contribute to hyperglycemia, hepatic steatosis, and excessive carbon dioxide production.
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Chapter 6: Documentation of the Nutrition Care Process
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Q1) Which situation would be considered a violation of a patient's right to confidentiality?
A) Reviewing the patient's care plan with his physician
B) Discussing the patient's condition with the physical therapist involved in the case
C) Talking about medications while the patient's spouse is in the room
D) Discussing the patient's status with a local pharmacist
E) Explaining the goals of treatment for the patient with his nurse
Q2) A physician has ordered 6U of insulin for a patient. Which would be the correct method of writing this order instead?
A) 6 Un
B) Six U
C) Six units
D) 6 units
E) 6 ut
Q3) The Joint Commission recommends that certain abbreviations not be used because they are more likely to contribute to _______________.
Q4) List three examples of guidelines for charting that were stated in the text.
Q5) Name the elements involved with every rhetorical norm.
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Chapter 7: Fluid and Electrolyte Balance
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Q1) Maintenance of fluid balance is significantly integrated with maintenance of _______________ balance.
Q2) What percentage of a typical adult male's body is comprised of water?
A) 40%
B) 50%
C) 60%
D) 70%
E) 80%
Q3) The medication cyclosporine can cause excessive urinary loss of what electrolyte?
A) calcium
B) magnesium
C) potassium
D) phosphorus
E) sodium
Q4) Decreasing hydrostatic pressure stimulates the renin- angiotensin-aldosterone system regulation of fluids and electrolytes.
A)True
B)False
Q5) Explain what factors influence movement of solutes.
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Chapter 8: Acid Base Balance
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Q1) Catecholamines are drugs that can cause what type of acid-base imbalance?
A) lactic acidosis
B) metabolic acidosis
C) metabolic alkalosis
D) respiratory acidosis
E) respiratory alkalosis
Q2) The pH of a substance is measured in a range from 1 to 12.
A)True
B)False
Q3) What is the most predominant base involved in human acid-base balance?
A) bicarbonate
B) alkaline water
C) calcium carbonate
D) magnesium citrate
E) ammonia
Q4) Carbonic _______________ inhibitors such as the drug acetazolamide can result in excessive loss of base while inhibiting production of carbonic acid in the kidney.
Q5) _______________ is the ion that moves in the opposite direction of HCO3-.
Q6) The concentration of _______________ is used to measure acidity.
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Chapter 9: Cellular and Physiological Response to Injury -
the Role of the Immune
System
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Q1) When fibrinogen increases, clotting of erythrocytes _______________, which affect the rate of _______________.
Q2) With _______________ bone marrow transplants, the recipient is also the donor.
Q3) Monocytes and macrophages are highly specialized cells that ingest and destroy cells and microbes via _______________.
Q4) An insufficient oxygen supply (ischemia) interferes with cellular:
A) apoptosis
B) mitosis
C) metabolism
D) differentiation
E) membrane integrity
Q5) Initially, _______________ were called lymphokines because the first ones discovered were produced by lymphocytes.
Q6) What does the term apoptosis mean?
A) spread of cancer cells
B) genetically programmed cell death
C) an antibody to an exotoxin
D) antigen-specific non-responsiveness by a T or B cell
E) reduction in size of muscle cells
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Chapter 10: Nutritional Genomics
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Sample Questions
Q1) What gender and genotype is most likely to be responsive to dietary and other lifestyle interventions to minimize cardiovascular disease risk?
A) male APOE 3 carriers
B) female APOE 3 carriers
C) male APOE 4 carriers
D) female APOE 4 carriers
E) male APOE 5 carriers
Q2) The APOE gene variant that puts an individual at risk for CVD is also associated with a high risk of what other disease?
A) Alzheimer's disease
B) Crohn's disease
C) cystic fibrosis
D) type 1 diabetes
E) phenylketonuria
Q3) Colon cancer risk reduction in humans via intake of cruciferous vegetables is linked to glutathione S-transferase genotype.
A)True
B)False
Q4) Dietary fats interact with various _______________ to influence outcomes.
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Chapter 11: Pharmacology
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Q1) _______________ medication formulations should be used, when available, for administration via enteral feeding tubes.
Q2) What are two blood thinners that should never be taken together?
A) warfarin and digoxin
B) warfarin and NSAIDs
C) lithium and ACE inhibitors
D) digoxin and clarithromycin
E) lithium and NSAIDs
Q3) What is the primary risk of taking COX-2 inhibitors (anti-inflammatory)?
A) Crohn's disease
B) breast cancer
C) heart failure
D) hyperlipidemia
E) rheumatoid arthritis
Q4) Suppository medications can be administered via the _______________ or the vagina.
Q5) Natural products do not cause adverse alterations in glucose metabolism. A)True
B)False
Q6) Calcium supplements are absorbed best in an _______________ environment.
Page 13
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Chapter 12: Diseases and Disorders of Energy Imbalance
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Q1) Children and adolescents having a BMI-for-age >85th percentile, but <95th percentile are considered overweight.
A)True
B)False
Q2) A compensatory survival mechanism intended to conserve energy in the face of starvation is known as _______________.
Q3) Patients with _______________ exhibit a severe and selective restriction of food intake, particularly of those foods that are perceived as fattening, resulting in a marked weight loss.
Q4) _______________, a hormone produced by adipose tissue that is involved in energy balance and fat storage, appears to signal that ample fat has been stored.
Q5) Discuss the physiological consequences of obesity in the following areas: type 2 diabetes, hepatobiliary disorders, cancer, reproductive disorders.
Q6) The term _______________ has been coined to refer to those environments that both promote weight gain and act as barriers to weight loss.
Q7) Describe the basic formula for calculating BMI in adults.
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Page 14
Chapter 13: Diseases of the Cardiovascular System
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Sample Questions
Q1) Signs of right-sided heart failure include distended neck veins, flushing, and:
A) dry mouth.
B) ascites.
C) sunken eyes.
D) decreased urine output.
E) constipation.
Q2) Which condition has been a factor associated with primary hypertension?
A) Decreased secretion of vasopressin
B) Differences in genes that affect sodium retention
C) Increased levels of nitrous oxide in the bloodstream
D) Decreased production of angiotensinogen
E) Type 1 diabetes and diminished insulin production
Q3) Which information is essential as part of educating a client with heart failure about fluid restriction?
A) Increase sodium intake to offset fluid loss
B) Count all beverages and foods such as soups, sherbet, and gelatin within the fluid allowance
C) Use warm or hot foods to control thirst
D) Check body weight 3 times daily
E) Limit fluid intake to 4 quarts per day
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Chapter 14: Diseases of the Upper Gastrointestinal Tract
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Sample Questions
Q1) Which is a correct statement regarding late dumping syndrome?
A) It occurs 30-60 minutes after a meal.
B) It is especially common after eating protein.
C) It increases the risk of hypoglycemia.
D) It causes gas, cramping, and diarrhea.
E) It results in sweating, flushing, and dizziness.
Q2) Partially digested food in a semi-fluid state that enters the stomach and small intestine is called _______________.
Q3) Which is a true statement regarding eosinophilic esophagitis?
A) EoE has only been recognized within the past 20 years.
B) Immune cells involved with EoE include B cells and white blood cells.
C) EoE has no connection to food intake.
D) Symptoms of EoE in adults include nausea, vomiting, and abdominal pain.
E) Metoclopramide is the standard form of treatment for EoE.
Q4) Describe the process of swallowing as food moves from the oral cavity to the stomach; include the processes of the four phases of swallowing.
Q5) The outer layer, or _______________, of tissue for the esophagus is connective tissue and has no additional outer covering.
Q6) List the seven functions of saliva in the oral cavity.
Page 16
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Chapter 15: Diseases of the Lower Gastrointenstinal Tract
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Q1) Briefly describe segmentation associated with digestion in the small intestine.
Q2) Normal osmolality of the gastrointestinal tract is approximately _______________ mOsm/L.
Q3) Which foods would be most appropriate for an infant with diarrhea who has started on solids?
A) fish
B) carrots
C) bananas
D) strained peas
E) beef broth
Q4) It is understood that approximately 50% of the duodenum and jejunum can be resected without significant nutrition deficits. If less than _______________ cm of the small intestine is left, malabsorption is inevitable.
Q5) Bright red blood on the surface of the stool is called:
A) melena.
B) occult blood.
C) hematochezia.
D) steatorrhea.
E) exudate.
Q6) The most common surgical procedure in ulcerative colitis is a _______________.
Page 17
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Chapter 16: Diseases of the Liver - Gallbladder - and Exocrine Pancreas
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Q1) Symptoms associated with acute pancreatitis include:
A) diarrhea, bloody stools, and abdominal cramping.
B) epigastric pain and ascites.
C) flatulence, diarrhea, and abdominal distention.
D) fever and headache.
E) abdominal pain, nausea, vomiting.
Q2) Which condition is most commonly associated with non-alcoholic steatohepatitis (NASH)?
A) obesity
B) high blood glucose
C) celiac disease
D) hypothyroidism
E) anorexia
Q3) Describe the major functions of the pancreas.
Q4) _______________ is the development of renal failure in patients with advanced chronic liver disease.
Q5) Alcohol and acetaldehyde have a hepatotoxic effect that interferes with metabolism and activation of vitamins by liver cells.
A)True
B)False
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Chapter 17: Diseases of the Endocrine System
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Q1) Symptoms of hypothyroidism are generally quite significant and severe.
A)True
B)False
Q2) Define polycystic ovarian syndrome and list the common characteristics.
Q3) Aldosterone directly influences the kidney to retain _______________.
Q4) In its active form, insulin consists of two _______________ chains linked by _______________ bridges.
Q5) Secondary hyposecretion occurs when secretion of a _______________ hormone is inadequate to cause an endocrine organ to secrete adequate amounts of a hormone.
Q6) What adrenal medulla hormone regulates arterial blood pressure and prepares the body for "fight or flight" responses?
A) oxytocin
B) serotonin
C) cortisol
D) epinephrine
E) norepinephrine
Q7) Intensive insulin therapy requires multiple _______________ injections of rapid-acting insulin.
Q8) List the basic types of insulin delivery regimens.
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Chapter 18: Diseases of the Renal System
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Q1) What is a more common term for nephrolithiasis?
A) kidney necrosis
B) kidney cancer
C) kidney stones
D) viral kidney infection
E) bacterial kidney infection
Q2) What is the prevalence of acute kidney injury in all hospitalized patients in the U.S.?
A) 1%
B) 3%
C) 5%
D) 7%
E) 10%
Q3) What type of oral iron supplement causes less GI distress?
A) heme iron polypeptides
B) ferrous gluconate
C) ferrous fumarate
D) ferrous sulfate
E) polysaccharides
Q4) Most commonly, kidney function is measured by the _______________.
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Chapter 19: Diseases of the Hematological System
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Q1) What is the iron rich compound found in breast milk?
A) lactoferrin
B) ferrous glycinate
C) ferric glycinate
D) phytase
E) ferrous fumarate
Q2) What is the main vitamin and mineral involved with the clotting process?
A) vitamin K and magnesium
B) vitamin C and copper
C) vitamin K and calcium
D) vitamin A and copper
E) vitamin C and calcium
Q3) What part of long bones contain the red marrow?
A) spongy bone
B) compact bone
C) medullary cavity
D) diaphysis
E) endosteum
Q4) Describe the main purpose of nutritional therapy for hemochromatosis.
Q5) True primary _______________ anemia is also known as Fanconi's anemia.
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Chapter 20: Diseases and Disorders of the Neurological System
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Q1) What percentage of the population can expect to have a seizure within their lifetime?
A) 5%
B) 10%
C) 20%
D) 30%
E) 50%
Q2) What symptom, visible in the hands, is characteristic of Parkinson's disease?
A) blue discolor
B) red discolor
C) tremor
D) severe edema
E) swollen joints
Q3) Although the exact cause of Parkinson's disease is unclear, it results in the loss of serotonin-producing cells in the thalamus portion of the brain.
A)True
B)False
Q4) The _______________ status of patients at the onset of the injury is an important consideration for a successful recovery.
Page 22
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Chapter 21: Diseases of the Respiratory System
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Q1) Discuss the pathophysiology of lung transplantation and organ rejection.
Q2) Which of the following is an inflammatory (indirect) cause of acute respiratory distress syndrome?
A) pneumonia
B) pulmonary edema
C) fat embolism
D) sepsis
E) inhalation injury
Q3) Define COPD and the two primary problems with airflow.
Q4) According to a meta-analysis examining the relationship between cigarette smoking and nutrient intakes, smokers have lower intakes of _______________ and fiber compared to non-smokers.
Q5) Discuss the nutritional implications of cystic fibrosis (CF).
Q6) Acute respiratory distress syndrome is associated with the production of oxygen free radicals and inflammatory mediators derived from _______________.
Q7) Infants with bronchopulmonary dysplasia (BPD) often require prolonged, intensive hospitalization accompanied by mechanical _______________.
Q8) Gas exchange occurs in the _______________ unit.
Page 23
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Chapter 22: Metabolic Stress and the Critically Ill
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Q1) What enteral formula has the highest percentage of lipids?
A) Perative®
B) Pivot®
C) Crucial®
D) Oxepa®
E) Impact®
Q2) What happens to the basal metabolic rate during starvation?
A) no change
B) increases
C) reduces
D) wildly fluctuates
E) unpredictable
Q3) Describe how severe burn injuries affect the nutrition assessment.
Q4) Parenteral nutrition should be reserved for those cases of prolonged nothing by mouth (NPO) status lasting how long?
A) 7 days
B) 10 days
C) 14 days
D) 21 days
E) 28 days
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Chapter 23: Neoplastic Disease
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Q1) Immune-enhancing enteral formulas containing mixtures of arginine, nucleic acids, and _______________ may be beneficial in malnourished patients undergoing major cancer operations.
Q2) Where does cancer rank in terms of causes of mortality in the United States?
A) 1st
B) 2nd
C) 3rd
D) 4th
E) 5th
Q3) Epidemiologic studies have found that heavy consumption of
increase cancer risk, especially for colorectal, bladder, prostate, breast, gastric, oral, and pancreatic cancers.
Q4) Describe the main causes of dysgeusia.
Q5) What values should be used to estimate AS's caloric requirements?
A) 20-25 kcal/kg IBW
B) 25-30 kcal/kg current body weight
C) 30-35 kcal/kg current body weight
D) 35-40 kcal/kg IBW
E) 40-45 kcal/kg IBW
Q6) Describe the GI side effects of chemotherapy and how they can be managed.
Page 25
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Chapter 24: HIV and Aids
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Q1) What is unique about a retrovirus?
A) it infects host cells
B) it is highly virulent
C) it targets CD4 cells
D) it carries RNA rather than DNA
E) it carries DNA rather than RNA
Q2) Response to ART can vary according to sex, and men and women with HIV infection may experience problems associated with medication interactions differently.
A)True
B)False
Q3) What is the beneficial function of Glitazones for HIV-positive patients?
A) anabolic steroids
B) sleeping aids
C) insulin resistance reducers
D) appetite stimulants
E) energy boosters
Q4) Discuss renal problems associated with HIV infection.
Q5) HIV RNA is transcribed to DNA particles using reverse transcriptase enzymes.
A)True
B)False
26
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Chapter 25: Diseases of the Musculoskeletal System
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Q1) Outline the difference between rickets, osteomalacia and osteoporosis.
Q2) What non-permanent factor is most related to KL's condition?
A) her skin color
B) her gender
C) her physical location
D) physical activity level
E) her weight
Q3) What is the recommended daily amount of vitamin D for women 50 years and older (according to NOF guidelines)?
A) 100 IU
B) 200-500 IU
C) 600 IU
D) 800-1,000 IU
E) 1,500 IU
Q4) Arthritic conditions affect over one in five Americans and nearly one in four with the condition report activity limitation.
A)True
B)False
Q5) Define osteoporosis.
Q6) Describe the treatment for osteomalacia.
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Chapter 26: Metabolic Disorders
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Q1) What is the term used to refer to the variation in the presentation of metabolic disorders?
A) variant
B) genotype
C) haplotype
D) phenotype
E) degree
Q2) A pharmacologic dose of vitamin B12 is given to a newly diagnosed patient with _______________ acidemia to determine whether the enzymatic defect is vitamin responsive.
Q3) What type of glycogen storage disease causes a muscle phosphorylase deficiency?
A) type II
B) type III
C) type IV
D) type V
E) type VI
Q4) In an autosomal recessive disorder, carrier parents have a _______________ percent chance of having an affected child with each pregnancy.
Q5) Describe the causes, symptoms and incidence of galactosemia.
Q6) Describe the etiology of urea cycle disorders.
Page 28
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