Deck 35: Medical Nutrition Therapy for Renal Disorders

Question 1

Which of the following increases the excretion of urinary calcium and uric acid?

A) Animal protein
B) Carbohydrate
C) Fat
D) Increased water intake

Answer 1

A
Explanation: High animal protein intake promotes the excretion of urinary calcium and uric acid, increasing the risk of development of calcium oxalate or uric acid stones. Carbohydrates contribute phytates to the diet, which have been observed to be associated with decreased kidney stone formation. Omega-3 fatty acids in fish oil supplements lower urinary calcium excretion, partly because of less arachidonic acid production, which can increase hypercalciuria. Increased fluid intake decreases the risk of stone formation.

Question 2

At least how much protein should be provided by the diet of a patient who receives hemodialysis three times per week?

A) 0.6 g/kg of body weight
B) 1 g/kg of body weight
C) 1.2 g/kg of body weight
D) 1.5 g/kg of body weight

Answer 2

C
Explanation: Dialysis processes promote protein loss, and therefore, daily protein intake needs to be increased to compensate for this. For patients on hemodialysis, the recommendation is to consume 1.2 g protein per kg of body weight. Patients using peritoneal dialysis should consume 1.2 to 1.5 g protein per kg of body weight.

Question 3

In children with CKD, the primary goal of MNT is

A) to control hypertension.
B) fluid balance.
C) normal growth and development.
D) adherence to protein restriction.

Answer 3

C
Explanation: Cyclosporine is an immunosuppressive medication that promotes hyperkalemia, hypertension, and hyperlipidemia. Because of the potential for excessive potassium levels, planning of diets should account for potassium intake. Sodium intake need not be restricted below levels recommended by the Dietary Guidelines. To obtain protein, lean sources should be used in the diet. Adequate intake of calcium by transplant patients is necessary because of the risk of osteopenia promoted by other immunosuppressive medications.

Question 4

The primary cause of anemia that presents in chronic renal failure is

A) lack of heme and nonheme iron intake.
B) loss of iron through the diseased kidney.
C) deficiency of the hormone erythropoietin.
D) loss of blood through dialysis.

Question 5

A complication of intradialytic parenteral nutrition that is NOT commonly associated with usual PN is

A) vitamin deficiency.
B) hypophosphatemia.
C) infection.
D) hypoglycemia.

Question 6

Which of the following can minimize the resorption effects of increased parathormone on bone calcium that occurs in renal disease?

A) eliminating carbonated beverages to decrease phosphates
B) using thiazide diuretics to eliminate calcium
C) supplementing calcium early in the disease
D) decreasing protein products high in phosphate

Question 7

Which of the following guidelines should be followed by a patient who has a history of kidney stones?

A) Decrease fluid intake to keep urine output to less than 1 L/day.
B) Decrease intake of magnesium-containing antacids.
C) Increase fluid intake to maintain urinary output at or above 2 L/day.
D) Use sodium bicarbonate to alkalize urine.

Question 8

Which of the following diseases is NOT among the top three considered to cause nephrotic syndrome?

A) Kidney cancer
B) Diabetes
C) Lupus
D) Amyloidosis

Question 9

Renal adaptations that permit "normal" function eventually fail, causing a progression toward ESRD because of

A) loss of nephrons.
B) uremia.
C) increases in blood pressure.
D) imbalances between glomerular and tubular functions.

Question 10

Which of the following foods does NOT potentially increase the acidity of urine?

A) Lemons
B) Cranberries
C) Chicken
D) Spaghetti noodles

Question 11

The type of renal therapy that requires the patient to restrict fluid intake is

A) impaired renal function.
B) hemodialysis.
C) CAPD.
D) CCPD.

Question 12

The most common renal stones contain calcium precipitates of

A) oxalate.
B) phosphate.
C) phytate.
D) struvite.

Question 13

Which kidney condition is associated with hematuria?

A) Nephritic syndrome
B) Nephrotic syndrome
C) Pyelonephritis
D) Renal tubular acidosis

Question 14

The rennin-angiotensin mechanism

A) regulates calcium and phosphorus balance.
B) regulates blood pressure.
C) is the first function of the kidney to deteriorate in AFI.
D) is responsible for the production of EPO.

Question 15

During which stage of chronic kidney disease does the National Kidney Foundation (NKF) recommend that a protein intake of 0.6 g/kg/day be initiated?

A) for acute kidney injury
B) when HD is started
C) when the GFR falls below 25 ml/min
D) protein should never be as low as 0.6 g/kg/day

Question 16

Which of the following blood parameters is associated with uremia?

A) Sodium greater than 145 mEq/L
B) Blood urea nitrogen greater than 100 mg/dl
C) Creatinine level between 0.6 and 1.5 mg/dl
D) eKt/V greater than 1.2

Question 17

A reduction in which of the following parameters is the first alteration that leads to the development of chronic renal failure or end-stage renal disease?

A) Blood pressure
B) Left ventricular ejection
C) Blood volume
D) Glomerular filtration rate

Question 18

Which type of dialysis treatment is usually done at night?

A) Continuous ambulatory peritoneal dialysis
B) Continuous cyclic peritoneal dialysis
C) Hemodialysis
D) Intermittent dialysis

Question 19

Intake of which of the following nutrients is generally NOT decreased in the nutrition therapy of patients with ESRD?

A) Sodium
B) Phosphorus
C) Calcium
D) Potassium

Question 20

When acute kidney injury (AKI) is caused by hypertrophy of the prostate, the ARF is classified as _____ AKI.

A) secondary
B) prerenal
C) intrinsic
D) postrenal