Question 1

An effective nutrition screening program:

Accepted Answer

An effective nutrition screening program is based on the principles of sensitivity and specificity. Sensitivity helps ensure that a nutrition screening program picks up individuals at nutritional risk, while specificity helps to exclude individuals not at nutritional risk. Nutrition screening programs may use different types of tools to collect dietary information, and are used in populations of all ages, not just children.

Question 2

Which of the following gastrointestinal surgeries has the most detrimental effect on nutritional status?

Accepted Answer

Ileal resection, removal of part or all of the ileum, has the most detrimental effect on nutritional status because it causes decreased absorption of many nutrients, including fat-soluble vitamins, and interferes with bile salt activity needed for fat metabolism. In jejunal resection surgery, the ileum is able to compensate and take over some of the jejunum's absorptive functions. The Billroth I and Billroth II surgeries are gastric resections in which part of the stomach is removed for the purpose of promoting weight loss. In both of these surgeries the small intestine is able to compensate and handle activities related to digestion and absorption.

Question 3

The DASH diet is often used to treat:

Accepted Answer

The Dietary Approaches to Stop Hypertension, or DASH, diet was developed to treat hypertension by promoting intake of fruits and vegetables rich in potassium and magnesium, minerals which help lower blood pressure.

Question 4

The National Health and Nutrition Examination Survey (NHANES) has which of the following objectives?

Accepted Answer

The National Health and Nutrition Examination Survey (NHANES) collects dietary data using 24-hour recalls, from Americans aged 2 months to 65+ years of age. NHANES objectives do not include identification of low birth weight infants or treatment for elevated lipid levels.

Question 5

Dumping syndrome is associated with:

Accepted Answer

Dumping syndrome is associated with the movement of water into the jejunum due to the presence of carbohydrate. It often accompanies gastric resection surgery and leads to diarrhea. Reactive hypoglycemia may result when carbohydrate in the gut is rapidly digested and absorbed, leading to over-secretion of insulin.

Question 6

Clinical signs of cirrhosis of the liver are:

Accepted Answer

Clinical signs of cirrhosis of the liver are ascites (abdominal edema) and hypoalbuminemia, resulting from the replacement of healthy liver cells with fibrous connective tissue. This buildup of abnormal tissue disrupts normal blood flow, eventually leading to portal hypertension, expansion of esophageal veins, hypernatremia, and increased hepatic plasma volume. The end result of these changes is decreased serum albumin and fat malabsorption, with eventual nutrient deficiencies.

Question 7

The Guthrie test is used to diagnose:

Accepted Answer

The Guthrie test is a blood assay used to diagnose phenylketonuria in newborn infants. It detects bacterial growth in an agar culture that is due to the presence of excess phenylalanine.

Question 8

Treatment goals for cystic fibrosis include:

Accepted Answer

Treatment goals for cystic fibrosis include pancreatic enzyme replacement and increased intakes of energy, protein, and fat. Cystic fibrosis is a wasting disease characterized by increased need for all nutrients, including sodium, which is lost through excessive sweating. Because the pancreatic duct may be blocked by mucous, supplementation with pancreatic enzymes is usually part of treatment.

Question 9

Which of the following is not true about a low serum albumin level?

Accepted Answer

A low serum albumin level is not seen in esophageal reflux. Low serum albumin levels often accompany ascites in liver disease, may be an indicator of the protein-calorie malnutrition of kwashiorkor, and are commonly seen in nephritic syndrome, in which large amounts of protein are lost in the urine.

Question 10

Maple-syrup urine disease (MSUD) is an autosomal recessive disorder in infants caused by:

Accepted Answer

Maple-syrup urine disease (MSUD) in an autosomal recessive disorder in infants caused by the inability of the body to metabolize the branched-chain amino acids leucine, isoleucine, and valine. The inability to break down branched-chain amino acids is due to a mutation in the gene that controls the activity of the enzyme alpha-keto acid dehyrogenase. Plasma levels of leucine exceeding 10 mg/dl are associated with the symptoms of MSUD, including lethargy, vomiting, and neurologic changes.

Question 11

Impaired glucose tolerance is defined as:

Accepted Answer

Impaired glucose tolerance is defined as a 2-hour postprandial blood glucose between 140-199 mg/dl. Impaired glucose tolerance is also characterized by a fasting plasma glucose of 100-125 mg/dl. A casual plasma glucose level of 200 mg/dl or greater is diagnostic of diabetes.

Question 12

A 16-year old teenage girl with Type I diabetes seeks counseling for erratic blood glucose levels. She is on the school track team and works out in the afternoons for 1 ½ hours. Her meal plan consists of 3 meals, a pre-exercise snack of one fruit, and a bedtime snack of ½ cup cereal and 1 cup of milk. Her insulin regimen is 3 units of regular insulin before breakfast and 2 units of regular insulin before dinner, and equal amounts of NPH mid-morning and at bedtime. Lately her pre-dinner blood glucose levels have been low. What would be the most effective nutrition intervention for her?

Accepted Answer

The most effective intervention would be to reduce the mid-morning NPH insulin by one unit and add protein exchange to the afternoon snack. NPH is an intermediate-acting insulin which has its peak effect in the afternoon. Reducing the amount of NPH by one unit and adding protein to the pre-exercise snack will help eliminate low blood glucose levels before the evening meal.

Question 13

The digestive hormone gastrin exerts all of the following effects except:

Accepted Answer

The digestive hormone gastrin increases pepsinogen production by the stomach, in response to the presence of protein foods. Gastrin also increases esophageal sphincter pressure, increases gallbladder contraction, an dincreases HCL production by the parietal cells of the stomach.

Question 14

Which of the following nutrition assessment methods is used to collect dietary information from a community?

Accepted Answer

A food frequency questionnaire is the nutrition assessment method used to collect dietary information from a community, since validation studies have shown that it provides the best estimate of the nutrient intake of a group.

Question 15

Which of the following nutrients produces an RQ (Respiratory Quotient) of 1.0, as measured by indirect calorimetry?

Accepted Answer

Carbohydrate produces an RQ of 1.0 using indirect calorimetry. This is because the number of molecules of carbon dioxide produced during carbohydrate metabolism is equal to the number of molecules of oxygen consumed.

Question 16

The most common pediatric food allergies are:

Accepted Answer

The most common pediatric food allergies are milk, soy, and peanuts. Allergic reactions to the other foods listed have been reported but are much less common.

Question 17

Level Two of the National Dysphagia Diet permits which of the following foods?

Accepted Answer

Level Two of the National Dysphagia Diet permits finely minced or chopped cooked meats and soft-textured cooked vegetables. Level Two Dysphagia diet, also known as the Mechanical Altered Diet, is intended for use by those with minimal chewing ability. Raw fruits and vegetables as well as hard-to-chew foods and hard-to-swallow foods are prohibited.

Question 18

Nutritional therapy for AIDS/HIV infection includes which of the following?

Accepted Answer

Nutritional care for AIDS/HIV infection includes avoidance of raw fruits and vegetables, since they may be contaminated with pathogens. Increasing protein intake to 1.5-2 g/kg per day is recommended to prevent muscle wasting. Use of ginseng and other herbal supplements is not recommended, since they may interfere with the activity of drugs used to treat AIDS. Use of milk-based shakes may cause diarrhea due to lactose intolerance.

Question 19

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) uses which of the following criteria to qualify participants?

Accepted Answer

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) uses nutritional risk (low birth weight, underweight, anemia, poor maternal weight gain, etc.) and income to qualify potential recipients. Proof of US citizenship is not a requirement.

Question 20

The level of sodium restriction recommended for congestive heart failure (CHF):

Accepted Answer

The level of sodium restriction recommended for congestive heart failure depends on the level of cardiac decompensation; as cardiac output decreases, the level of sodium restriction becomes stricter. The maximum sodium load tolerated by individuals with acute CHF is usually 1-2 grams a day. One to grams of sodium equals 43 to 87 mEq (milliequivalents).

Quiz 1: Nutrition Support Clinician