Question 1

A 25-year old female patient recovering from surgery to correct an intestinal obstruction needs complete bowel rest which necessitates the use of Total Parenteral Nutrition (TPN). The patient was 10 pounds underweight prior to surgery and is occasionally febrile. Which of the following formulations would be most appropriate for this patient?

Accepted Answer

The formula which would be most appropriate for this patient would contain 45 calories, 2 grams of protein, and 35 ml water per kg of body weight per day, as well as 200 mg of vitamin C and 6 mg of zinc. Starting with an intermediate level of caloric and protein intake, along with moderate vitamin C and zinc to promote healing, allows staff to monitor the patient's progress and determine if adjustment in the formula is needed.

Question 2

Steatorrhea may be caused by:

Accepted Answer

Steatorrhea may be caused by disruption in the activity of pancreatic enzymes that help to digest fat. It may also be caused by inadequate production of bile salts, which are needed for fat absorption.

Question 3

The Thermic Effect of Food (TEF):

Accepted Answer

The Thermic Effect of Food (TEF) is the amount of energy needed to metabolize food. It is affected by the nutritional composition of the diet. The TEF for carbohydrate and fat is around 5%, while the TEF for pure protein may be as high as 25%. In a normal mixed diet the TEF comprises a small percentage of total energy expenditure.

Question 4

Cow's milk is unsuitable for infants less than a year of age due to:

Accepted Answer

Cow's milk is unsuitable for infants less than a year of age due to its high renal solute load, which stresses the infant's kidneys. Cow's milk contains casein protein, which is less digestible than whey, and its percentages of fat and cholesterol are not significantly different from that of breast milk.

Question 5

Addison's disease is caused by the deterioration of the adrenal cortex, and results in hypoglycemia, weight loss, and muscle wasting. Dietary intervention includes:

Accepted Answer

The dietary intervention for Addison's disease includes a high protein diet with liberal sodium intake, as well as frequent meals with 50-60 grams of complex carbohydrates. Muscle wasting and weight loss require high protein intakes, and decreased activity of the adrenal hormone aldosterone causes large losses of sodium. Increasing complex carbohydrates helps stabilize blood glucose.

Question 6

Examples of foods avoided on a low-purine diet are:

Accepted Answer

Examples of foods avoided on a low-purine diet are sardines, broth, and organ meats. These foods are high in purine and are eliminated in the treatment of gout, caused by high levels of uric acid in the blood.

Question 7

A medication which needs to be discontinued in a uremic patient is:

Accepted Answer

A medication which may need to be discontinued in uremia is Triamterene, a potassium-sparing diuretic. Because serum potassium levels are high in uremia, use of potassium-sparing diuretics such as Triamterene is contraindicated. Epogen stimulates red blood cell production, Kayexelate is a potassium-binder, and Humulin is synthetic insulin, all of which may be indicated for use in uremia.

Question 8

Stomatitis is treated with which of the following dietary interventions?

Accepted Answer

Stomatitis is an inflammation of the mucous membranes of the mouth. It may be caused by iron deficiency, in which case it is treated with iron supplementation. The usual dietary regimen is avoidance of acidic and spicy foods.

Question 9

Antidiuretic hormone (ADH) is released in response to:

Accepted Answer

Antidiuretic hormone (ADH) is released in response to increased serum osmolality. ADH promotes retention of water by the kidneys, in response to increased osmolality, which causes increases the solute content of the blood.

Question 10

The usual dietary treatment for cholecystitis is:

Accepted Answer

The usual treatment for cholecystitis is a 25% fat diet with fat-soluble vitamin supplementation. Cholecystitis is inflammation of the gall bladder, usually caused by the accumulation of bile due to blockage of the bile duct or gallstone formation. Lower fat restriction is not used because some fat is needed to stimulate gallbladder constriction and drainage of bile.

Question 11

Which of the following is not included in extracellular water (ECF)?

Accepted Answer

Metabolic water, the water produced by the digestion and absorption of food, is not included in extracellular water, which is composed of plasma, lymph, and spinal fluid, as well as water from secretions.

Question 12

Which of the following measures are used to calculate serum osmolality?

Accepted Answer

Sodium, glucose, and BUN are used to calculate serum osmolality, which is a measure of osmotically active particles in the blood. Normal serum osmolality is about 300 mEq/liter.

Question 13

Low-salt syndrome may be caused by:

Accepted Answer

Low-salt syndrome is occasionally seen in individuals with congestive heart failure who are being treated with severe sodium restriction. It may also be caused by decreased glomerular filtration rate in renal disease, and by adrenal gland insufficiency, both of which affect the body's ability to retain sodium.

Question 14

The herbal remedy St John's Wort may interact with which of the following medications?

Accepted Answer

The herbal remedy St John's Wort, used to treat mild to moderate depression, may have adverse reactions with statin drugs, digoxin, and coumadin. It may decrease the effectiveness of all of these medications by interfering with the biochemical pathways by which they are metabolized.

Question 15

The kidney is active in all of the following bodily functions except:

Accepted Answer

The kidney is active in all of the listed bodily activities except oxidation. Renal functions include filtration of solutes (via the distal tubules), secretion (production of hormones that control blood pressure), and absorption (retention of glucose, water, and sodium).

Question 16

Dietary zinc may promote wound healing by which of the following mechanisms?

Accepted Answer

Dietary zinc may promote wound healing by increasing collagen synthesis at the site of the wound. Collagen synthesis is essential for tissue repair.

Question 17

Which microorganism is involved in the etiology of peptic ulcer:

Accepted Answer

The microorganism which causes peptic ulcer is Heliobacter pylori, commonly known as H. pylori. H. pylori causes peptic ulcer by eroding the mucosal lining of the stomach.

Question 18

Food intolerance is distinguished from food allergy in what way:

Accepted Answer

Food intolerance is distinguished from food allergy by the lack of immunologic reaction, which involves release of an antibody in response to an antigen (allergen). Food allergy, not food intolerance, involves the reaction of the body's cellular immune system, and is often caused by the passage of intact proteins across the GI tract.

Question 19

A food frequency questionnaire differs from a 24-hour recall in what way:

Accepted Answer

A food frequency questionnaire differs from a 24-hour recall because it does not ask about typical meal patterns. A food frequency questionnaire asks about intakes of different types of foods and usual portion sizes over time, and does not allow open-ended responses. The types of foods asked about on a food frequency questionnaire may be changed to reflect the population of interest.

Question 20

The dietary treatment which may be most effective for symptoms of polycystic ovary syndrome (PCOS) is:

Accepted Answer

The dietary treatment which may be most effective for reducing the symptoms of polycystic ovary syndrome is a low glycemic index diet with omega-3 fatty acid supplementation. PCOS is a common endocrine disorder in teenage girls that is characterized by weight gain and abnormal blood sugar levels. Eating a diet based on low glycemic index foods helps to stabilize blood sugar, and omega-3 fatty acids can help regulate hormone levels.

Quiz 1: Nutrition Support Clinician