1.

Height assessment on children younger than 2 to 3 years of age should be

performed

a. with the child recumbent.

b. using the arm span.
c. using a stationary meter.
d. using the sitting height.

ANS: A

2. For infants and children under 3 years of age, recumbent length should be
determined by using a length board to measure the child from the crown
of the head to the heels of the feet. Arm span is an indirect measure of
height that may be used in adults who cannot stand or lie flat. For older
children and adults capable of standing, a stationary meter or statiometer
should be used. Sitting height may be used for children who are not
capable of standing.

Mid-upper arm circumference (MAC) combined with triceps skinfold

thickness (TSF) measurements provide information about

a. risk of obesity-related diseases.

b. measure of adiposity.
c. BMI.
d. arm muscle and arm fat area.

ANS: D

Although not commonly used in the acute care setting, measures of the MAC and
TSF in long-term care can provide information about a person’s arm muscle area
and arm fat area. These can be compared with percentile charts to determine the
person’s relative risk for undernutrition or can be tracked over time for changes in
the person’s nutritional status. One-time measures of these are not appropriate for
identifying body composition related to overall adiposity. Body mass index by
itself identifies the relative risk of obesity-related diseases.

3. During the assessment of nutritional status, which of the following is the

most objective measure?
 a. Obtaining a dietary history
b. Evaluating biochemical tests
c. Observing meal consumption
d. Evaluating height and weight based on reference standards

ANS: B

Biochemical tests are considered to be the most objective and sensitive measures
of nutritional status. Subjective information is based on an individual’s responses,
observations, or interpretations. An iron deficiency may be suspected by reviewing
a patient’s diet history that seems to show little intake of iron-rich foods or
observing the eating of a foods that do not contain iron, but measurement of iron-
related blood parameters provides clear evidence that is not subject to debate.
Reference standards for height and weight are established based on cultural
interpretations of what levels are appropriate.

4. The skinfold sites most useful for measurement of body fat are

a. at the biceps and triceps.

b. below the scapula and above the biceps.
c. at the triceps and below the scapula.
d. at the iliac crest and the upper thigh.

ANS: C

Measurements of the triceps and subscapular skinfolds are the most useful for
evaluating body fatness because the most complete standards and methods of
evaluation are available for these two sites. Skinfolds at the biceps, iliac crest, and
upper thigh have also been used but have not been as thoroughly investigated as
the triceps and scapula.

5. Arm muscle area is determined by using

a. weight and height measurements.

b. triceps skinfold and weight measurements.
triceps skinfold and mid-upper arm circumference
c.
measurements.
d. mid-upper arm circumference and weight measurements.
ANS: C

Arm muscle area is determined based on the assumption that a cross-section of the
upper arm reflects two circles with the same center point, one within the other. The
outer circle is considered to be a layer of subcutaneous fat, and the inner circle is
considered to be the muscle. With knowledge of the overall MAC, the inner circle,
the AMA, can be estimated by subtracting the area between the two circles. This
area is related to the triceps skinfold.

6. Measurement of head circumference is useful as an indicator of

a. malnutrition in children younger than 3 years of age.

non-nutritional abnormalities in children younger than 3
b.
years of age.
c. nutritional deficiencies in children older than 3 years of age.
d. non-nutritional abnormalities in adults.

ANS: B

Up to the age of 3 years, head circumference is a measure of child growth and

brain growth. Any abnormalities or changes in the growth of head circumference
can be monitored. However, these abnormalities are not necessarily specific to
nutritional status. Undernutrition must be very severe to affect this growth.

7. ________ reorient(s) hepatic synthesis of plasma proteins and increase the

breakdown of muscle

a. Hormones
b. Prealbumin
c. Cytokines
d. Oxidants

ANS: C
Cytokines (interleukin-1, interleukin-6, tumor necrosis factor, and eicosanoids)
influence whole-body metabolism, body composition, and nutritional status.
Cytokines reorient hepatic synthesis of plasma proteins and increase the
breakdown of muscle protein to meet the demand for protein and energy during the
inflammatory response.

8. The Functional Nutritional Assessment includes assessment of tissue

reserves of key nutrients.

a. True
b. False

ANS: A

The functional nutritional assessment focuses on early diagnosis and treatment of

nutritional problems associated with chronic disease including long-latency
nutritional insufficiencies. Assessment of nutrient tissue reserves is advocated with
this approach.

9. Which of the following can be used for assessing bone mineral density as
well as measuring fat and boneless lean tissue?

a. Bioelectrical impedance analysis

b. Magnetic resonance imaging
c. Computed tomography
d. Dual-energy x-ray absorptiometry

ANS: D

Dual-energy x-ray absorptiometry relies on passing an energy beam through

various tissue types, and based on the amount of energy lost, the amount or density
of the tissue can be measured. Bioelectrical impedance analysis conducts an
electrical charge through the body to measure the water content and thus lean
tissue of the body. Magnetic resonance imaging can be used to image the size of
body organs, the skeleton, and the amount and distribution of body fat. Computed
tomography images cross sections of the body, and from these, subcutaneous and
intraabdominal fat can be identified.
 10.What physical examination technique is being used when a doctor listens for
bowel sounds?

a. Auscultation
b. Inspection
c. Palpation
d. Percussion

ANS: A

Auscultation involves the listening for various body sounds. Inspection refers to an
observation of a patient by using vision, smell, and hearing. Palpation involves
feeling the patient, such as when a pulse is determined. Percussion is the use of
sound to determine body organ borders, shape, or position. For example, to
determine the size of the liver, the physician will palpate around the right abdomen
to estimate the borders.

11. A patient who currently weighs 145 pounds weighed 180 pounds 3 months
ago. How would his current weight be assessed?

a. The patient is underweight.

b. The patient has significant weight loss.
c. The patient has severe malnutrition.
d. The patient has severe weight loss.

ANS: D

This patient has lost 35 pounds (180 – 145), which is about 19% of his original
weight in 3 months. Because this is greater than 7.5% weight loss, this is
interpreted as severe weight loss. Significant weight loss would be reflected by
losing exactly 7.5% of body weight in this same period of time. No information is
given in regard to the patient’s height or whether 180 pounds is his usual weight.
Therefore, determination of underweight cannot be made. If 180 pounds had been
his usual weight, 145/180 ´ 100% = 80% of UBW, which would be assessed as
moderate malnutrition.

12.An adult weighs 90 kg and is 1.83 m tall. This person’s BMI would be
classified as
 a. underweight.
b. healthy weight.
c. overweight.
d. obese.

ANS: C

This person’s BMI would be calculated as 90/1.832 = 26.9 kg/m2. This value falls
into the overweight category, 25 to 29.9.

13._______ is used to assess body composition using by measuring body

density.

a. Total body potassium measurement

b. Air displacement plethysmogram
c. Bioelectrical impedance analysis
d. Neutron activation analysis

ANS: B

Air displacement plethysmography relies on measurement of body density to

estimate body fat and fat-free mass. A “bod-pod” is a piece of equipment used for
this measurement.

14.In patients with fluid retention, what happens to biochemical indicators of

nutritional status, such as serum proteins and electrolytes?

a. They are increased because of increased urinary output.

b. They are decreased because of poor nutritional status.
c. They are increased because of hemoconcentration.
d. They are decreased because of hemodilution.

ANS: D

When a patient experiences fluid excess, such as may be associated with renal
failure or congestive heart failure, the excess fluid in the body will affect blood
measures by causing them to be lower. This is simply a reflection of the
concentration of the specific blood parameters in relation to the increased water in
the body. If a patient were dehydrated, the effect would be the reverse—the blood
values would increase because of relative concentration in less water in the body.

15.Which of the following is NOT a physical sign of overhydration?

a. Weight gain over 2 to 3 days

b. Peripheral edema
c. Decreased skin turgor
d. Ascites

ANS: C

Short-term weight gain, peripheral edema, and ascites are all signs of
overhydration. Decreased skin turgor is associated with dehydration.

16.It can be argued that a functional nutrition assessment will better identify
why a patient is losing weight because:

a. it uses more advanced body composition techniques.

b. it includes assessment of gastrointestinal function.
c. tumor necrosis factor is used as a marker of weight loss.
d. it uses prealbumin rather than albumin for analysis.

ANS: B

Assessment of the capacity for digestion, absorption, and transport as well as

hormonal status provides critical background information as to why a patient may
be malnourished. Malabsorption syndrome, in which several nutrients are
abnormally absorbed, is the most dramatic. Constipation, diarrhea, excessive
vomiting, and flatulence also warrant further analysis. Mucosal changes in the
gastrointestinal (GI) tract are indicated by problems such as diarrhea and anorexia.
Tests may be done on a stool sample and can reveal excessive amounts of fat, an
indication of malabsorption, the status of the GI flora, and the amounts and types
of bacteria present in the gut.

17.A general estimate of desirable body weight for a woman who is 5’5” tall is.
 a. 140 pounds
b. 125 pounds
c. 110 pounds
d. 115 pounds

ANS: B

Desirable body weight can be calculated using the Hamwi method of 100 pounds
for the first 5 feet of height and 5 pounds for each inch above 5 feet for women.
For men the calculation is 106 pounds for the first 5 feet of height and 6 pounds for
every inch above 5 feet.

18.A 19-year-old man weighs 75 kg and is 1.78 m tall. His BMI would be
interpreted as

a. underweight.
b. normal, healthy weight.
c. overweight.
one that needs to be plotted on a growth chart for
d.
interpretation.

ANS: D

The BMI calculation would be 75/1.782 = 23.7 kg/m2. However, because the man
is 19 years old, this BMI should be plotted on the growth chart comparing BMI
with age for males, 2 to 20 years of age. After being plotted, this man’s BMI would
be evaluated as being between the 50th and 75th percentiles of BMI for age.

19.Measurement of waist:hip ratio

has been implicated in the risk of developing cardiovascular

a.
disease.
b. is particularly useful in a hospital setting.
c. can be directly correlated with serum albumin.
has been implicated in the risk of developing Crohn’s
d.
disease.

ANS: A
Because fat distribution is an indicator of risk, circumferential or girth
measurements may be used. The presence of excess body fat around the abdomen
out of proportion to total body fat is a risk factor for ailments associated with
obesity and the metabolic syndrome.

Mahan: Krause’s Food and the Nutrition Care Process, 13th Edition

Chapter 7: Water, Electrolytes, and Acid-Base Balance

1. Eating which of the following would most increase dietary potassium

intake?

a. Fruits and vegetables

b. Saltwater fish
c. Grains
d. Cereals

ANS: A

Fruits and vegetables tend to be the richest sources of dietary potassium, with a
number of them providing more than 300 mg per serving. Seafood, grains, and
cereals do not contribute nearly the same amount of potassium available in fruits
and vegetables.

2. When vasopressin is excessively secreted in the blood, which of the

following effects occurs?

a. Low serum potassium because water is retained

b. Low serum sodium because water is retained
c. High serum potassium because water is excreted
d. High serum sodium because water is excreted

ANS: B

Vasopressin, also known as antidiuretic hormone, stimulates renal reabsorption of

water. In syndrome of inappropriate diuretic hormone, excessive secretion of
vasopressin retains water and results in hyponatremia and low urine output.
Aldosterone is the hormone that stimulates renal sodium retention, and when
present, the kidneys excrete potassium in exchange for the sodium, which then
attracts the retention of water

3. What effect is of greatest concern in water intoxication?

a. Increased volume of the brain cells

b. Hypertension
c. Decreased circulating blood volume
d. Increased urinary output

ANS: A

When water intake exceeds the body’s ability to excrete it, such as with
impairment in kidney function, intracellular fluid volume increases. The increase
in the volume of brain cells results in headaches, nausea, blindness, vomiting, and
convulsions. Hypertension, decreased circulating blood volume, and changes in
urinary output tend to be associated with or the cause of hypovolemia.

4. For the average woman, _____ mL/day would meet fluid needs.

a. 1500
b. 1700
c. 2700
d. 3500

ANS: C

A daily allowance of water from all sources, including beverages and foods, is
about 2,700 mL per day for women and 3,700 mL per day for men. The general
recommendation for water intake is 1 mL/kcal eaten of 35 mL/kg body weight for
adults.

5. How does body water, as a percentage of body weight, change based on

stage of the life cycle and lifestyle?

Decreases significantly with age and is higher in athletes than

a.
non-athletes
 Decreases significantly with age and is lower in athletes than
b.
non-athletes
Increases significantly with age and is higher in athletes than
c.
non-athletes
Increases significantly with age and is lower in athletes than
d.
non-athletes

ANS: A

At birth, an infant’s body weight is about 75% to 85% water compared with a lean
adult, who is 60% to 70% by body weight. As muscle mass decreases with age,
total body water also decreases. Also, compared with the lean adult, an obese adult
may be 45% to 55% water by body weight. This is because the weight is displaced
by adipose tissue, which contains very little water.

6. Where in the body is interstitial fluid located?

a. Within body cells and the lymphatic system

b. Within body cells
c. Between and around body cells
d. In the blood and the lymphatic system

ANS: C

The interstitial space is the spaces between and around the body cells, and it
contains the interstitial fluid. Fluid within body cells is known as intracellular
fluid. Fluid within the blood and lymphatic system is considered to be extracellular
fluid.

7. By what mechanism is thirst stimulated in the hypothalamus?

a. Increase in serum osmolality

b. Decrease in serum osmolality
Increase in both serum osmolality and in extracellular
c.
volume
Decrease in serum osmolality and an increase in extracellular
d.
volume
ANS: A

A decrease in extracellular fluid volume results in a hemoconcentration of the

blood, resulting in an increase in serum osmolality. The renin–angiotensin system
is triggered by the decreased extracellular volume, and as a consequence,
angiotensin II stimulates the thirst centers.

8. The kidneys compensate for a loss of body water by excreting

a. additional fluid and electrolytes.

b. additional electrolytes.
c. more concentrated urine.
d. more dilute urine.

ANS: C

When water loss occurs, antidiuretic hormone secretion promotes renal

reabsorption of water as a means of conserving water in the body. As a result, the
urine that is excreted will be more concentrated with metabolites and electrolytes.
This can be evidenced by a darker urine that has a higher than normal specific
gravity.

9. The recommended fluid intake based on caloric intake is

a. 2 mL/kcal for adults and 3 mL/kcal for infants.

b. 0.5 mL/kcal for adults and infants.
c. 2 mL/kcal for adults and 1 mL/kcal for infants.
d. 1 mL/kcal for adults and 1.5 mL/kcal for infants.

ANS: D

Fluid intake of 1 mL/kcal for adults and 1.5 mL/kcal for infants provides about 35
mL/kg in adults and 150 mL/kg in infants. These levels help to maintain fluid
balance within humans.

10.For a normal healthy adult, fluid balance is achieved when the amount of
water taken in is

a. half the amount that is lost.

 b. about equal to the amount lost.
c. twice the amount lost.
d. unrelated to the amount of water lost.

ANS: B

Water balance is achieved when the water taken into the body through food and
beverage sources and water produced through metabolic processes is equal to the
amount of water lost through urine, feces, sweat, and respiration. Excessive water
intake or losses results in water imbalance.

11.How does dehydration affect the specific gravity of urine?

a. Specific gravity of urine increases above normal.

b. Specific gravity of urine does not change during dehydration.
c. Specific gravity of urine decreases below normal.
d. Specific gravity of urine undergoes a threefold increase.

ANS: A

Dehydration stimulates antidiuretic hormone activity, which promotes reabsorption

of water from the kidneys while still allowing for the excretion of electrolytes and
metabolites. This results in more highly concentrated urine. Because specific
gravity is a measure of the concentration of the urine, the specific gravity will
increase above normal.

12.Which of the following results from ingesting a large amount of sodium in a

short time?

a. Hypotension
b. Muscular cramps
c. Increased urinary calcium excretion
d. Increased urinary output of potassium

ANS: C

Persistent excessive sodium intake has been associated with the development of
hypertension and increased calcium excretion. Hypotension does not occur as
result of decreased sodium intake. Muscle cramping is more associated with
imbalances in calcium and magnesium intake. Increased urinary output of
potassium is a common side effect of the use of loop diuretics used in the control
of hypertension and fluid volume.

13.Which organ(s) maintain acid–base balance by the regulation of hydrogen

ions?

a. Lungs
b. Liver
c. Kidneys
d. Adrenal glands

ANS: C

Hydrogen ion excretion and retention is controlled through the kidneys. The
kidneys also contribute to acid–base regulation through the excretion and retention
of bicarbonate. The lungs are the other organs involved in acid–base regulation,
and they do so by controlling the expiration of carbon dioxide. The liver and
adrenal glands do not function in acid–base regulation, although their metabolic
activities may contribute to acid or base production.

14.What is the primary means by which hydrogen ions are generated in the
body?

a. Normal tissue metabolism

b. Ingestion of highly acidic foods
c. Oxidation-reduction reactions
d. Reabsorption of bicarbonate

ANS: A

Hydrogen ion and acid formation results from normal metabolism. All foods, not
just acidic ones, may result in the production of organic acids. Carbon dioxide is a
common volatile acid that results from oxidation of carbohydrates, fats, and
proteins. Bicarbonate is considered to be a base, and control of its concentration,
along with carbon dioxide concentrations, is a primary focus of acid–base
regulation.
 15.Which of the following is a characteristic of metabolic acidosis?

a. Accumulation of bicarbonate
b. Decreased ventilation and retention of carbon dioxide
c. Accumulation of acids from abnormal metabolism
d. Excessive loss of carbon dioxide from the lungs

ANS: C

Metabolic acidosis is simply named for the production of acids through metabolic
processes. Diabetes ketoacidosis and lactic acidosis are two conditions that lead to
metabolic acidosis. Metabolic alkalosis results from an accumulation of
bicarbonate. Respiratory acidosis results from retention of carbon dioxide, but
respiratory alkalosis is associated with excessive carbon dioxide respiration.

16.Sodium is increased the most by the intake of

a. fresh vegetables.
b. frozen vegetables.
c. fresh meats.
d. luncheon meats.

ANS: D

One ounce of luncheon meat could provide 400 mg of sodium. Fresh meat
provides 30 mg of sodium per ounce if no salt, flavored salt, or flavor enhancers
are used. Fresh vegetables provide very little sodium, and processing 1 cup of
frozen vegetables without salt will provide about 10 mg of sodium.

17.In the extracellular space, what is the primary buffer system?

a. Phosphate
b. Bicarbonate and carbonic acid
c. Hydrogen
d. Protein

ANS: B
Bicarbonate and carbonic acid buffer the production of hydrogen ions and carbon
dioxide that results from cellular metabolism, and this occurs primarily in the
extracellular space. The phosphate buffering system and protein buffering are
activities that more commonly occur in the intracellular space.

18.Which acid–base imbalance can result from diuretics use, vomiting, and loss
of chloride?

a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Metabolic acidosis

ANS: C

Metabolic alkalosis results from a loss of acid, such as HCl through gastric
suctioning, and loss of extracellular fluid, such as would occur in diuretic use or
vomiting. Respiratory alkalosis occurs when excessive respiration occurs, such as
heavy breathing after exercise or in anxiety. Respiratory acidosis happens when
there is damage to the lungs or respiration that does not allow for the exchange of
carbon dioxide with oxygen. Metabolic acidosis results from medical conditions
that lead to a build-up of metabolic acids in the body.

19.What is the primary disturbance when respiratory alkalosis occurs?

a. Increased bicarbonate
b. Increased partial pressure of carbon dioxide
c. Decreased bicarbonate
d. Decreased partial pressure of carbon dioxide

ANS: D

Because respiratory alkalosis is associated with the excessive elimination of carbon

dioxide, the primary disturbance is a decrease in the partial pressure of carbon
dioxide in the blood. Respiratory acidosis would result in an increased partial
pressure of carbon dioxide. Metabolic alkalosis would be reflected by an increase
in bicarbonate, and metabolic acidosis would be evident with a decrease in
bicarbonate
 20.How would the body compensate for metabolic acidosis?

a. Increased kidney excretion of bicarbonate

b. Increased ventilation of carbon dioxide
c. Decreased kidney excretion of bicarbonate
d. Decreased ventilation of carbon dioxide

ANS: B

When excessive metabolic production of acids occurs, the body compensates by

stimulating increased expiration of carbon dioxide to reduce acid concentrations in
the body. Whereas increased kidney excretion of bicarbonate would be the
compensation mechanism for dealing with respiratory alkalosis, decreased
excretion of bicarbonate would compensate for respiratory acidosis. In metabolic
alkalosis, the lungs would compensate by reducing expiration of carbon dioxide.