NUTRILAB

SAS 17

Answer: c The definition of myocardial infarction is the medical term for heart attack.

Answer: d Risk factors are conditions or habits that make a person more likely to develop a disease. They
can also increase the chances that an existing disease will get worse. Important risk factors for heart
disease are: High blood pressure, High blood cholesterol, Diabetes, Smoking, Being overweight, Lack of
exercise, Having a family history of early heart disease, Age (55 or older for women)

Answer: d Foods that are lower in sodium includes fruits and vegetables like dried apricot.

Answer: c Patients with CHF should avoid excessive sodium. All of the options expect one contain at
least one sodium spice, therefore, Ginger & Bay Leaves are okay to use.

Answer: b Coumadin prevents clotting of the blood. Due to the high amount of vitamin k (vitamin k plays
a role in clotting) in green leafy vegetable, these foods should be limited.

SAS 18

Answer: d When a patient has a stroke they are at risk for aspiration due to the decrease ability to
swallow. Many times a stroke with affect speech as well the patient‘s ability to utilize the swallowing
muscles. Generally, when garbled speech is noted in a stroke victim this is a sign there is a problem with
the patient’s ability to use their swallowing muscles. A mechanically altered diet with nectar thick liquid
will usually be prescribed. However, a speech evaluation will determine what is needed.

Answer: a While both buoy your consumption of heart-healthy fats, half an avocado has fewer calories
and less total saturated and polyunsaturated fats than two tablespoons of peanut butter. And according
to the National Nutrient Database for Standard Reference, avocados also boast more fiber and
potassium than PB. When it comes to spreadable fat and the health of your heart, soft-tub margarine (as
long as it is free of hydrogenated vegetable oils, or trans fats) is still recommended over the use of
butter or margarine that contains trans fats.

3. Which is better for your heart health? a. Chicken b. Pork c. Fish d. Beef Answer: c Choosing white
meat over red meat is already a step in the right direction when it comes to your heart health. But
choosing fish twice a week will provide you with the long-chain omega-3 fatty acids — EPA
(eicosapentaenoic acid) and DHA (docosahexaenoic acid) — that have been associated with an increase
in HDL (good) cholesterol, a reduced risk of coronary atherosclerosis, and lower triglyceride levels, blood
pressure and heart rate.

4. Which is better for your heart health? a. Coffee b. Tea c. Cola d. All of the above Answer: b Both
coffee and tea have their advantages, and both are much better choices than sugar-sweetened drinks
like cola. A 2010 study in the medical journal Arteriosclerosis, Thrombosis, and Vascular Biology, a
journal of the American Heart Association, found that heavy black-tea drinkers (six or more cups a day)
experienced a 36 percent reduced risk of heart disease when compared with people who drank less than
a cup of tea per day. But if you’re a committed java junkie, there’s no reason to ditch your latte just yet.
Coffee drinkers who had two to four cups a day also saw a 20 percent decrease in heart disease.
5. Which is better for your heart health? a. Dark chocolate b. Either c. Milk chocolate d. Neither Answer:
a A 2017 study out of Denmark found that people who eat a small amount of chocolate each week were
at a reduced risk of developing atrial fibrillation (irregular heartbeat). While some dark chocolate is
lower in sugar and higher in heart-healthy flavonoids (look for packages labeled 70 percent cacao or
higher), the participants in the study who enjoyed milk chocolate experienced the same reduced risk of
A-fib

SAS 19

1. Medically speaking, which term refers to kidney function? a. Hepatic b. Dialysis c. Renal d. Urinary
Answer: c "Renal" is the medical term that refers to kidney function. "Renal function" refers to the state
of the kidneys, and how well they filter blood. Two healthy kidneys provide 100% of your renal function.

2. Common non-specific symptoms of chronic kidney disease include: a. Increased urination at night b.
Swelling of hands and feet c. Loss of appetite d. All of the above Answer: d Kidney disease can have
many different signs and symptoms that are non-specific, meaning, these same symptoms could also be
signs of dysfunction in another body organ. Some non-specific symptoms of renal disease include:
Fatigue, Weakness, Difficulty concentrating, Trouble sleeping, Dry, itchy skin, Frequent urge to urinate,
Blood in the urine, Urine is foamy, Puffiness around the eyes, Loss of appetite, Swelling in the ankles and
feet, Muscle cramps.

3. People on dialysis should maintain diets high in __________________. a. Protein b. Fats c. Fibe d.
Carbohydrates Answer: a People on dialysis should maintain diets high in protein. High-quality protein
produces less waste for removal during dialysis. Good sources for protein include meat, poultry, fish,
and eggs.

4. Patients with kidney diseases must manage fluid intake because fluid... a. Retention can cause
swelling and weight gain b. Overload can result in heart trouble c. Affects blood pressure d. All of the
above Answer: d Healthy kidneys work to remove excess fluid from your body and they do so regularly.
A person on dialysis can have fluid buildup between treatments. Excess fluid can cause swelling and
weight gain, elevated blood pressure, and a buildup of fluid in the lungs that makes it more difficult to
breathe. Excess fluid also means the heart has to work harder. Patients on dialysis must carefully control
fluid intake, and that includes fluid from foods such as fruits and vegetables. Salt should also be reduced
or avoided, as it can make you thirsty, causing a greater fluid intake.

5. You are seeing a patient on hemodialysis for a monthly lab review. During the review, you notice that
his albumin level is 2.6 g/dL. He says he eats one meal per day and would like advice on what meats and
meat alternatives to prepare. Which proteins are among those you would advise your patient to eat? a.
Chicken, fish, beef, eggs, soybeans, quinoa b. Legumes c. Potatoes, rice, breads, and pasta d. Sesame
seeds, pumpkin seeds, almonds, walnuts Answer: a Chicken, fish, beef, eggs, soybeans, quinoa are
known as high protein foods.
SAS 20

1. A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain
the patient should follow a: a. Low protein, low sodium, low potassium, low phosphate diet b. High
protein, low sodium, low potassium, high phosphate diet c. Low protein, high sodium, high potassium,
high phosphate diet d. Low protein, low sodium, low potassium, high phosphate diet Answer: a The
patient should follow this type of diet because protein breaks down into urea (remember patients will
have increased urea levels), low sodium to prevent fluid retention, low potassium to prevent
hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low
phosphate to prevent hyperphosphatemia.

2. Your kidneys are what part of which system in your body? a. Reproductive system b. Gastrointestinal
tract c. Respiratory system d. Urinary system Answer: d The urinary system is made up of two kidneys;
two ureters, which are thin tubes that carry urine from the kidneys to the bladder; the bladder, which
stores urine; two sphincter muscles that prevent urine from leaking; nerves in the bladder; and the
urethra, which is the tube that carries urine outside the body.

3. What is the most common cause of kidney disease? a. Drug abuse and smoking b. Uncontrolled
diabetes c. High blood pressure d. B and C Answer: d High blood pressure (hypertension) and
uncontrolled diabetes can damage the kidneys' small blood vessels so they are unable to filter blood.
This can eventually cause kidney failure. Uncontrolled diabetes means high blood sugar over longperiods
of time. Diabetes and high blood pressure are the leading causes of kidney disease. The most common
reason for a kidney transplant is the long-term effects of uncontrolled diabetes.

4. How do most kidney-damaging diseases affect the kidneys? a. They damage nephrons, the kidney's
filtering mechanisms b. They damage urethras c. They damage the bladder d. They damage all tissue
Answer: a Each kidney contains about a million tiny filtering units called nephrons. A nephron is made
up of small tubes and blood vessels. Diseases that affect the kidneys can damage the nephrons. As a
result, the kidneys have problems getting rid of waste products.

5. If you have decreased kidney function, you should monitor which of these in your diet? a. Protein b.
Food dyes c. Sodium d. a and c Answer: d According to the National Institute of Diabetes and Digestive
and Kidney Disease, people who have decreased function of their kidneys may need to monitor the
protein in their diet. Sodium, found in salt, may raise your blood pressure. High blood pressure can
damage the kidneys. Talk with your healthcare provider to be sure you’re getting the proper nutrition,
as well as making the appropriate changes in your diet to help your kidneys work well.

SAS 21

1. Nurses are in an ideal position to a. screen patients for risk of malnutrition b. conduct comprehensive
nutrition assessments c. order therapeutic diets d. calculate a patient's calorie and protein needs
Answer: a Nurses have been identified as being in an ideal position to carry out routine nutritional
screening to detect patients at risk of malnutrition and hence refer to the dietitian for detailed
nutritional assessment and provision of nutritional support.
2. Which of the following criteria would most likely be on a nutrition screen in the hospital? a.
prealbumin value c. weight change b. serum potassium value c. weight change d. cultural food
preferences Answer: c Nutrition is a basic requirement for life. Accordingly, nutrition plays an important
role in promoting health and preventing disease. Many factors can lead to weight change and
malnutrition. Malnutrition is a condition resulting from a combination of varying degrees of under- or
overnutrition and inflammatory activity, leading to an abnormal body composition and diminished
function

3. Patient Sinthia has a question about the cardiac diet the dietitian reviewed with her yesterday. What
is the nurse's best response? a. "ask your doctor when you go for your follow-up appointment" b. "What
is the question? If I can't answer it, I will get the dieting to come back to answer it" c. "Just do your best.
The handout she gave you is simply a list of guidelines, not rigid instructions" d. "If I see the dieting
around, I will tell her you need to see her." Answer: b Show interest in and empathy for clients’
problems and situations. Suggest actions that are possible for clients given their situations.

4. Characteristics of successful dieters include all of the following except: a. Maintaining a daily food
journal b. Adhering to a strict eating plan c. Counting calories d. Eliminating all carbohydrates from their
diets Answer: d Along with the above-mentioned characteristics, successful dieters monitor their
weight, practice portion control, increase physical activity, and aim for healthy realistic weight loss
ranging from 10% to 20% of initial bodyweight in a year. Successful dieters maintain their motivation by
celebrating the achievement of weight-loss milestones

5. Motivating clients to participate in health promotion activities requires a variety of appealing

strategies such as: a. Adapting the program educational materials to the demographic characteristics of
the target audience b. Considering education level of the participants c. Finding convenient class times
and locations d. Performing health-risk assessments e. All of the above Answer: e 6 principles of
effective nutrition education programs: Message: send a clear, simple, well-organized message to the
learner, Format: pick the most appropriate (lecture, small group, storytelling), Environment: create best
possible (room, furniture, visual aids, other materials, Experience: organize positive and meaningful
experience, Participation: engage learner (hands-on, etc.), Evaluation: give feedback, quizzes, etc.

SAS 22

1. Which of the following is a systematic problem-solving method that dietitians use critical-thinking
skills to make evidence-based decisions addressing the nutrition-related problems of their patients? a.
nutritional assessment c. nutritional screening b. the nutrition care process d. nutrition monitoring
Answer: b The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition
care.

2. What snack choice would be the best suggestion by the nurse for a patient on a renal diet? a. Peanut
butter b. Diet cola c. Bananas d. Carrot sticks Answer: d Carrots contain a moderate amount of
potassium and can healthfully be included in a kidney-friendly diet.

3. Assists people to learn about themselves, their environment, and the methods of handling their roles
and relationships. a. Interview b. Assessment c. counseling d. relationship Answer: c Professional
counselors help clients identify goals and potential solutions to problems which cause emotional
turmoil; seek to improve communication and coping skills; strengthen self-esteem; and promote
behavior change and optimal mental health.

4. Analysis of nutrition science, psychology and physiology, and eventual negotiated treatment plan
followed by an evaluation; requires assessment and diagnosis prior to intervention a. Nutrition
counseling b. Motivational Interview c. Nutrition education d. Assessment Answer: a A process by which
a health professional with special training in nutrition helps people make healthy food choices and form
healthy eating habits.

5. Directive, client-centered counseling style for eliciting behavior change by helping clients to explore
and resolve ambivalence to change a. Nutrition counseling c. Nutrition education b. Motivational
Interview c. Nutrition education d. Assessment Answer: b Motivational Interviewing (MI) attempts to
help clients find the motivation to make positive decisions.

B. Nutrition Care Plan (15 Points) Nutrition care plan Name: Nutrition diagnosis Date Goal Actions
Evaluation (tick) Goal Met Goal not

SAS 23

1. The minimum time food workers should wash their hands is: a. 5 seconds b. 30 seconds c. 20 seconds
d. 40 seconds Answer: c The minimum time food workers should wash their hands after contaminating
them is 20 seconds in order to remove non indigenous organisms from the skin’s surface.

2. Workers should not handle food or eating and drinking utensils when they have or recently had any of
the following symptoms: a. Vomiting, diarrhea, fever, sore throat with fever, jaundice, infected cuts b.
Runny nose, sneezing, cough, congestion, cold symptoms c. A and B d. None of the above Answer: a
Food workers that have or recently had symptoms including vomiting, diarrhea, fever, sore throat with
fever, jaundice or infected cuts must not handle food being served to the public or handle any eating or
drinking utensils. This restriction is because of the high risk such workers pose to transmit disease-
causing bacteria and viruses to others through food or utensils. Food workers that have other symptoms
such as runny nose, sneezing, cough or congestion are allowed to handle food and utensils provided
they wash hands when required and are careful to not contaminate food or utensils. As implied above,
bacteria and viruses are the primary organisms of concern with regards to preventing food-borne illness.
These organisms cause thousands of documented and undocumented cases of food-borne illness each
year around the world. The most prevalent virus causing food-borne illness is Norovirus, while
Salmonella is the most frequent bacteria implicated in outbreaks

3. Examples of cross-contamination are: a. Raw chicken is processed on cutting board then lettuce is
sliced on same surface b. Food worker handles raw meat then assembles sandwich without washing
hands c. Liquids from raw hamburger drip onto vegetables for salad d. All of the above Answer: d Cross-
contamination is one of the leading causes of food-borne illness outbreaks. It occurs when harmful
organisms are transferred from one item to another itr item without further washing, cooking or
reheating. The best ways to prevent cross contamination are to process raw animal foods on a separate
surface from other foods and store raw animal foods below and away from other foods.
4. Examples of how to rapidly cool food include: a. Portioning large quantities of foods into smaller units
by slicing and pouring b. Using metal rather than plastic containers c. Ensuring vigorous air circulation
around food d. All of the above Answer: d Potentially hazardous foods such as most soups, beef and
poultry must be rapidly cooled to minimize growth and reproduction of microorganisms. Rapid cooling
means food is chilled from 135O F (57OC) to 41O F (5OC) in six hours or less. However, if cooling food
cannot be chilled from 135O F (57OC) to 70O F (21OC) within the first two hours of the process, the food
should be reheated to 165O F (74OC) and the cooling process should be re-started.

5. Food workers should wash their hands after which of the following: a. Coughing, sneezing, scratching,
wiping nose, cleaning b. Touching exposed body parts, handling raw animal food, handlingmoney c.
Before putting on disposable gloves or after using the restroom d. All of the above Answer: d Food
workers must wash their hands after any activity that contaminates their hands. Such activities include,
but are not limited to: using the restroom, coughing, sneezing, scratching, wiping nose, cleaning,
touching exposed body parts, handling raw animal food, handling money and before putting on
disposable gloves

6. If you are a food handler and you have been vomiting and/or had diarrhoea when should you return
to work? a. When you feel better c. After 1 week b. When your doctor advises you can d. The next day
Answer: b Food handler who suffered from vomiting and/or diarrhea should present a medical
certificate indicating that he/she is already fit for work.

7. How does the marketplace affect food choice? a. expense c. convenience b. types of food d. a and c
Answer: d Generally, the smaller the selling venue is, the more expensive the food items are. Small
stores buy their food items from larger stores or wholesalers, and increase the selling price to cover
their costs.

8. Who is responsible for safe food handling in the food premises? a. Head Chef c. Owner b. Anyone
handling food d. All of the above Answer: d Everyone is responsible to handle food safely.

9. How can you tell if food has enough bacteria to cause food poisoning? a. It smells bad c. It tastes bad
b. It smells, tastes and looks bad d. All of the above e. None of the above Answer: e You can’t tell. It
smells, tastes and looks normal.

10. What are the basic steps of washing hands? a. Wash thoroughly and dry well b. Apply soap, wash
well, rinse and dry with disposable paper towel c. Apply soap, wash well, rinse and dry with tea towel d.
Rinse and dry with tea towel Answer: b STEP 1: Wet your hands using clean, running water when
available. STEP 2: Lather the front and back of hands, between fingers, and under fingernails with soap.
STEP 3: Scrub hands together for at least 20 seconds. STEP 4: Rinse hands under clean, running water.
STEP 5: Dry hands completely with a clean towel, or air dry.

NUTRI LECTURE

SAS 17

1. For a patient who is at high risk of aspiration and is not expected to be able to eat table foods for
several months, an appropriate placement of a feeding tube might be: a. nasogastric. b. nasoenteric. c.
gastrostomy. d. jejunostomy. Answer: D Rationale: If the nasoenteric route is inaccessible due to an
obstruction or other medical reasons, a direct route to the stomach or intestine may be created by
passing the tube through an enterostomy, an opening in the abdominal wall that leads to the stomach
(gastrostomy) or jejunum (jejunostomy). An enterostomy can be made by either surgical incision or
needle puncture. 2. In selecting an appropriate enteral formula for a patient, the primary consideration
is: a. formula osmolality. b. the patient’s nutrient needs. c. availability of infusion pumps. d. formula
cost. Answer: B Rationale: Most enteral formulas can supply all of an individual’s nutrient requirements
when consumed in sufficient volume, a necessity for the patient who is using a tube feeding for more
than a few days. Formula chosen should meet the patient’s medical and nutrient needs with the lowest
risk of complications and the lowest cost3. An important measure that may prevent bacterial
contamination in tube feeding formulas is: a. nonstop feeding of formula. b. using the same feeding bag
and tubing each day. c. discarding opened containers of formula not used within 24 hours. d. adding
formula to the feeding container before it empties completely. Answer: CRationale: Hang no more than
an 8-hour supply of formula (or a 4-hour supply for newborn infants) when using liquid formula from a
can. Formulas prepared from powders or modules should hang no longer than 4 hours. Discard any
formula that remains, rinse the feeding bag and tubing, and add fresh formula to the feeding bag. A new
feeding container and tubing (except for the feeding tube itself) is necessary every 24 hours. For closed
systems, the hang time should be no long 4. The nurse using a feeding tube to deliver medications
recognizes that: a. medications given by feeding tubes generally do not cause GI complaints. b.
medications can usually be added directly to the feeding container. c. enteral formulas do not interact
with medications in the same way that foods do. d. thick or sticky liquid medications and crushed tablets
can clog feeding tubes. Answer: Rationale: Thick or sticky liquid medications and crushed tablets can
clog feeding tubes and can be a cause of aspiration. 5. For a patient receiving central TPN who also
receives intravenous lipid emulsions two or three times a week, the lipid emulsions serve primarily as a
source of: a. essential fatty acids. b. cholesterol. c. fat-soluble vitamins. d. concentrated energy Answer:
C Rationale: Lipid emulsions are often provided daily and may supply 20 to 30 percent of total kcalories.
Including lipids as an energy source reduces the need for energy from dextrose and thereby lowers the
risk of hyperglycemia in glucose-intolerant patients

SAS 18

1. Foods permitted on the clear liquid diet include all of the following except: a. milk. b. fruit ices. c.
flavored gelatin. d. consommé. Answer: A Rationale: A diet that consists of foods that are liquid at room
temperature, require minimal digestion, and leave little residue (undigested material) in the colon. 2. If a
patient with dysphagia has difficulty swallowing solids but can easily swallow liquids: a. the problem is
most likely a motility disorder. b. the patient may have achalasia. c. the problem is probably an
esophageal obstruction. d. the patient most likely has oropharyngeal dysphagia. Answer: C Rationale: A
person with esophageal dysphagia has difficulty passing materials through the esophageal lumen and
into the stomach, usually due to an obstruction in the esophagus or a motility disorder. 3. Possible
consequences of GERD include all of the following except: a. reflux esophagitis. c. Barrett’s esophagus. b.
dysphagia. d. gastric ulcer Answer: D Rationale: Gastric ulcer is a common manifestation of peptic ulcer
disease. 4. Chronic gastritis may increase risk of: a. dumping syndrome. b. bone disease. c. iron and
vitamin B12 deficiencies. d. gallbladder disease. Answer: C Rationale: Chronic gastritis can lead to
Pernicious anemia, characterized by autoimmune destruction of the gastric cells that produce
hydrochloric acid and intrinsic factor, is a form of atrophic gastritis that is usually associated with the
macrocytic anemia of vitamin B12 deficiency 5. The main dietary recommendation for patients with
gastritis or peptic ulcers is to consume foods that: a. neutralizes stomach acidity. b. is well tolerated and
does not cause discomfort. c. coat the stomach lining. d. promotes healing of mucosal tissue. Answer: B
Rationale: Nutrition care for gastritis and peptic ulcer disease includes correcting any nutritional
deficiencies that develop and eliminating dietary substances that cause pain or discomfort. 6. The health
practitioner advising an elderly patient with constipation encourages the patient to: a. consumes a low-
fat diet low in sodium. b. consumes a high-protein diet rich in calcium. c. gradually adds high-fiber foods
to the diet. d. eliminates gas-forming foods from the diet. Answer: C Rationale: In individuals with a low
fiber intake, the primary treatment for constipation is a gradual increase in fiber intake to at least 25
grams per day. High-fiber diets increase stool weight and fecal water content and promote a more rapid
transit of materials through the colon. 7. Osmotic diarrhea often results from: a. excessive colonic
contractions. b. excessive fluid secretion by the intestines. c. nutrient malabsorption. d. viral, bacterial,
or protozoal infections’ Answer: C Rationale: Osmotic diarrhea, unabsorbed nutrients or other
substances attract water to the colon and increase fecal water content; common causes include high
intakes of poorly absorbed sugars (such as sorbitol, mannitol, or fructose) and lactase deficiency (which
causes lactose malabsorption) 8. Symptoms of irritable bowel syndrome most often include: a.
constipation and/or diarrhea and flatulence. b. weight loss and malnutrition. c. strong odors and
obstructions. d. nausea and vomiting. Answer: A Rationale: The symptoms usually include disturbed
defecation (diarrhea and/or constipation), flatulence, and abdominal discomfort or pain; the pain is
often aggravated by eating and relieved by defecation. 9. Ulcerative colitis may afflict which region of
the digestive tract? a. Ileum, rectum, and colon b. Rectum and colon c. Stomach and duodenum d. Most
regions of the GI tract can be affected Answer: B Rationale: Ulcerative colitis is confined to the rectum
and colon; always involves the rectum but often extends into the colon, 10. After an ileostomy, the most
serious concern is that: a. the diet is too restrictive to meet nutrient needs. b. waste disposal causes
frequent daily interruptions. c. incompletely digested foods may cause obstructions. d. fluid restrictions
prevent patients from drinking beverages freely Answer: C Rationale: Foods that are incompletely
digested can cause obstructions, a primary concern of ileostomy patients. Although these patients can
consume almost any food that is cut in small pieces and carefully chewed, the following foods may
cause difficulty: celery, coconut, coleslaw, mushrooms, peas, salad greens, dried fruit, unpeeled fresh
fruits, pineapple, nuts, seeds, popcorn, frankfurters, sausages, and tough, chewy meats.

SAS 19

1.Possible causes of malabsorption include all of the following except: a. inflammatory bowel disease. b.
pancreatic dysfunction. c. liver disease. d. flatulence Answer: D This document and the information
thereon is the property of PHINMA Education (Department of Nursing) 10 of 12 Rationale: Flatulence is
a buildup of gas in the GI system that can lead to abdominal discomfort which doesn’t contribute to
malabsorption. 2. Nutrition problems that may result from fat malabsorption include all of the following
except: a. weight loss. b. essential amino acid deficiencies. c. bone loss. d. oxalate kidney stones.
Answer: B Rationale: From the word “fat”, essential amino acid deficiencies are a consequence of
protein malabsorption. 3. Lactose intolerance is a direct consequence of: a. insufficient lactase. b. milk
allergy. c. fluid imbalance. d. pancreatic dysfunction. Answer: A Rationale: Lactose intolerance is caused
by the loss or reduction of lactase, the intestinal enzyme that digests the lactose in milk products. 4. The
majority of chronic pancreatitis cases can be attributed to: a. bacterial and viral infections. b. gallstones.
c. alcohol abuse. d. elevated triglyceride levels Answer: C Rationale: About 70 to 80 percent of cases are
caused by excessive alcohol consumption. 5. A person on a gluten-free diet must avoid products
containing: a. wheat, barley, and rye. b. lactose. c. excessive fat. d. corn, rice, and millet Answer: A
Rationale: The gluten-free diet eliminates foods that contain wheat, barley, and rye. 6. In cases of fatty
liver that are unrelated to excessive alcohol intakes, the primary risk factor is: a. following a high-protein
diet. b. use of illicit drugs. c. following a high-fat diet. d. insulin resistance. Answer: D Rationale: In cases
unrelated to alcohol, insulin resistance (reduced sensitivity to insulin in liver, muscle, and adipose cells)
is the primary risk factor; thus, fatty liver frequently accompanies diabetes mellitus, metabolic
syndrome, and obesity. Other causes of fatty liver include protein-energy malnutrition and long-term
total parenteral nutrition7. Which of the following statements about hepatitis is true? a. Chronic
hepatitis can progress to cirrhosis. b. Whatever the cause of hepatitis, symptoms are typically severe. c.
Vaccines are available to protect against hepatitis A, B, and C viruses. d. HCV infection can be spread
through contaminated foods and water. Answer: A Rationale: Long-term hepatitis can lead to cirrhosis
and liver cancer. 8. Esophageal varices are a dangerous complication of liver disease primarily because
they: a. interferes with food intake. b. can lead to massive bleeding. c. diverts blood flow from the GI
tract. d. contributes to hepatic encephalopathy. Answer: B Rationale: If ruptured, they can cause
massive bleeding that is sometimes fatal. The blood loss is exacerbated by the liver’s reduced
production of blood-clotting factors. 9. A complication of cirrhosis that contributes to the development
of ascites is: a. portal hypertension. b. elevated serum ammonia levels. c. bile obstruction. d. insulin
resistance. Answer: A Rationale: Ascites is primarily a consequence of portal hypertension, sodium and
water retention in the kidneys, and reduced albumin synthesis in the diseased liver. As a result of portal
hypertension, the distorted blood flow elsewhere in the body alters kidney function, leading to sodium
and water retention and an accumulation of body fluid. 10. Regarding the major risk factors for gallstone
disease: a. prevalence is much higher in men than in women. b. gallstone risk is increased during
pregnancy. c. rapid weight loss can temporarily shrink gallstones. d. risk is generally similar among
ethnic groups. Answer: B Rationale: Gallstone risk is increased in pregnancy due to hormonal changes:
the higher estrogen levels raise bile’s cholesterol concentration, and the increase in progesterone levels
reduces gallbladder motility. The risk of gallstones worsens as the pregnancy progresses and is especially
high during the third trimester.

SAS 20

1. Which of the following is characteristic of type 1 diabetes? a. Abdominal obesity increases risk. b. The
pancreas makes little or no insulin. c. It is the predominant form of diabetes. d. It often arises during
pregnancy. Answer: B Rationale: Type 1 DM is usually caused by autoimmune destruction of the
pancreatic beta cells, which produce and secrete insulin. By the time symptoms develop, the damage to
the beta cells has progressed so far that insulin must be provided, most often by injection 2. Which of
the following is true about type 2 diabetes? This document and the information thereon is the property
of PHINMA Education (Department of Nursing) 7 of 8 a. It is usually an autoimmune disease. b. The
pancreas makes little or no insulin. c. Diabetic ketoacidosis is a common complication. d. Chronic
complications may develop before it is diagnosed. Answer: D Rationale: Option A, B, and C describes
Type 1 DM. 3. Most chronic complications associated with diabetes result from: a. altered kidney
function. b. infections that deplete nutrient reserves. c. weight gain and hypertension. d. damage to
blood vessels and nerves. Answer: B Rationale: Prolonged hyperglycemia can damage cells and tissues.
Glucose non-enzymatically combines with proteins, producing molecules that eventually break down to
form reactive compounds known as advanced glycation end products (AGEs); in diabetes, these AGEs
accumulate to such high levels that they alter the structures of proteins and stimulate metabolic
pathways that are damaging to tissues. 4. The most effective meal-planning strategy for managing
diabetes is: a. carbohydrate counting. b. an eating plan based on food lists created for persons with
diabetes. c. following menus and recipes provided by a registered dietitian. d. the approach that best
helps the patient control blood glucose levels. Answer: D Rationale: There’s no best meal planning
strategy for managing diabetes it should be focus on the approaches that helpsthe patient control blood
glucose levels. 5. Which dietary adjustment may be helpful for women with gestational diabetes? a.
Consuming most of the day’s carbohydrate allotment in the morning b. Restricting carbohydrate to
about 30 grams at breakfast c. Avoiding food intake after dinner d. Reducing energy intake to about 50
percent of the calculated requirement Answer: D Rationale: Women with gestational diabetes may need
to restrict energy and/or carbohydrate intakes to maintain appropriate glucose levels

SAS 21

1. Ischemia in the coronary arteries is a frequent cause of: a. angina pectoris. b. hemorrhagic stroke. c.
aneurysm. d. hypertension Answer: A Rationale: Atherosclerosis can affect almost any organ or tissue in
the body and, accordingly, is a major cause of disability or death. Obstructed blood flow in the coronary
arteries can cause pain or discomfort in the chest and surrounding regions (angina pectoris) or lead to a
heart attack. 2. Dietary lipids with the strongest LDL cholesterol–raising effects are: a. monounsaturated
fats. b. polyunsaturated fats. c. saturated fats. d. plant sterols. Answer: C Rationale: Saturated fats which
are solid at room temperature, increases the level of low density lipoprotein. 3. Hemorrhagic stroke: a.
is the most common type of stroke. b. results from obstructed blood flow within brain tissue. c. comes
on suddenly and usually lasts for up to 30 minutes. d. results from bleeding within the brain, which
damages brain tissue. Answer: D Rationale: Hemorrhagic strokes occur in 13 percent of cases and result
from bleeding within the brain, which damages brain tissue 4. Hypertensive patients can benefit from all
of the following dietary and lifestyle modifications except: a. including fat-free or low-fat milk products
in the diet. b. reducing total fat intake. c. consuming generous amounts of fruit, vegetables, legumes,
and nuts. d. reducing sodium intake. Answer: B Rationale: Not all fats are dangerous, and lowering the
total fat intake can affect the absorption of the fat soluble vitamins. 5. Nutrition therapy for a patient
with heart failure usually includes: a. weight loss. b. reducing total fat intake. c. sodium restriction. d.
cholesterol restriction. Answer: C Rationale: The DASH Eating Plan is even more effective when
accompanied by a low sodium intake. In a research study that tested the blood pressure–lowering
effects of the DASH dietary pattern in combination with sodium restriction, the best results were
achieved when sodium was reduced to 1500 milligrams daily.

SAS 22

1. Which of the following is not a function of the kidneys? a. Activation of vitamin K b. Maintenance of
acid-base balance c. Elimination of metabolic waste products d. Maintenance of fluid and electrolyte
balances Answer: A Rationale: Vitamin K is synthesized in the liver. 2. The nephrotic syndrome
frequently results in: a. the uremic syndrome. b. oliguria. c. edema. d. renal colic. Answer: C Rationale:
The condition arises because damage to the glomeruli increases their permeability to plasma proteins,
allowing the proteins to escape into the urine. The loss of these proteins may cause serious
consequences, including edema, blood lipid abnormalities, blood coagulation disorders, and infections.
3. If a patient with acute kidney injury should require a high protein intake, which additional treatment
may be necessary? a. Frequent dialysis b. Use of diuretics c. Enteral nutrition support d. Fluid restrictions
Answer: A Rationale: Protein recommendations are influenced by kidney function, the degree of
catabolism, and the use of dialysis (dialysis removes nitrogenous wastes4. The most common cause of
chronic kidney disease is: a. diabetes mellitus. b. hypertension. c. autoimmune disease. d. exposure to
toxins. Answer: A Rationale: The most common causes of chronic kidney disease are diabetes mellitus
and hypertension, which are estimated to cause 45 and 27 percent of cases, respectively 5. A person
with chronic kidney disease who has been following a renal diet for several years begins hemodialysis
treatment. An appropriate dietary adjustment would be to: a. reduce protein intake. b. consume protein
more liberally. c. increase intakes of sodium and water. d. consume potassium and phosphorus more
liberally Answer: B Rationale: Nitrogenous wastes which is a product of protein catabolism can be now
excreted via dialysis

SAS 23

1. Which of the following metabolic changes accompanies acute stress? a. Hypoglycemia b. Reduced
heart and respiratory rates c. Elevated immune responses d. Muscle protein catabolism Answer: D
Rationale: Notable metabolic changes in patients undergoing metabolic stress include hypermetabolism,
negative nitrogen balance, insulin resistance, and hyperglycemia. Hypermetabolism and negative
nitrogen balance can lead to wasting, which may impair organ function and delay recovery. 2. Which of
the following statements concerning protein and energy recommendations during acute metabolic
stress is true? a. Protein and energy recommendations are similar to those for healthy people. b. Protein
and energy recommendations are reduced because a stressed individual cannot metabolize nutrients
normally. c. Acutely stressed individuals can benefit from as much protein and energy as can be
provided. d. Protein and energy recommendations are often increased to minimize muscle tissue losses.
Answer: D Rationale: To maintain lean tissue, the protein intakes recommended during acute stress are
higher than DRI values (the adult RDA is 0.8 grams per kilogram body weight) 3. A primary feature of
emphysema is: a. obstruction within the bronchi. b. obstruction within the bronchioles. c. destruction of
the walls separating the alveoli. d. excessive lung elasticity. Answer: C Rationale: Emphysema is
characterized by the breakdown of the lungs’ elastic structure and destruction of the walls of the
bronchioles and alveoli, changes that significantly reduce the surface area available for respiration. 4.
The weight loss and wasting that often occur in COPD can be caused by: a. reduced food intake. b.
increased metabolic rate. c. reduced exercise tolerance. d. all of the above. Answer: D Rationale: Weight
loss and wasting are common in the advanced stages of disease and may result from hypermetabolism,
poor food intake, and the actions of various inflammatory proteins. 5. Nutrition therapy for a person
with respiratory failure includes: a. careful attention to providing enough, but not too much, energy. b. a
generous fluid intake to facilitate mucus clearance. c. a high fat intake to prevent weight loss and
wasting. d. a high carbohydrate intake to increase carbon dioxide production. Answer: A Rationale:
Patients with lung injuries or ARDS are frequently hypermetabolic and/or catabolic and at high risk of
muscle wasting. The primary concerns are therefore to provide enough energy and protein to sustain
muscle mass and lung function without overtaxing the respiratory system 6.Which of these dietary
substances may help to protect against cancer? a. Alcoholic beverages b. Well-cooked meats, poultry,
and fish c. Animal fats d. Compounds in fruits and vegetables Answer: D Rationale: Fruits and vegetables
lowers the risk of cancer 7. An advantage of radiation therapy over chemotherapy is that: a. radiation is
not damaging to rapidly dividing cells. b. side effects of radiation therapy do not include malnutrition. c.
radiation can be directed toward the regions affected by cancer. d. the radiation used is too weak to
damage GI tissues Answer: C Rationale: Radiation therapy treats cancer by bombarding cancer cells with
X-rays, gamma rays, or various atomic particles. These treatments generate reactive forms of oxygen,
such as superoxide and hydroxyl radicals, which can damage cellular DNA and cause cell death. 8. Which
food below should be avoided by a patient consuming a low-microbial diet? a. Baked potato b.
Pasteurized yogurt c. Banana d. Leftover luncheon meat Answer: D Rationale: Leftover luncheon meat
may harbor harmful bacteria that may put the patient at risk for infection. 9. HIV can enter and destroy:
a. epithelial cells. b. helper T cells. c. liver cells. d. intestinal cells. Answer: B Rationale: HIV infection
destroys immune cells that have a protein called CD4 on their surfaces. The cells most affected are the
helper T cells, also called CD4+ T cells because the presence of CD4 is a primary characteristic. 10. In
people with HIV infection, mouth sores may be caused by all of the following except: a.
cryptosporidiosis. b. Kaposi’s sarcoma. c. herpes simplex virus. d. candidiasis. Answer: A Rationale:
Cryptosporidiosis is a foodborne illness caused by the parasite Cryptosporidium parvum.