TEST BANK for Krause and Mahan's Food and the Nutrition Care Process 16th Edition.
Chapter 01: Intake: Gastrointestinal Digestion, Absorption, and Excretion of Nutrients MULTIPLE CHOICE
1. Pepsinogen is converted to pepsin when it comes in contact with a. enterokinase. b. trypsinogen. c. hydrochloric acid. d. peptidases. ANS: C
Pepsinogen is secreted in the stomach and converted to its active form by the acid environment of the stomach. Enterokinase is secreted by the brush border of the small intestine in response to the presence of chyme. Trypsinogen is secreted by the pancreas and activated by enterokinase. Various peptidases are secreted by the either brush border or the pancreas. 2. Which of the following is formed by bacterial synthesis in the colon? a. Vitamin K b. Vitamin D c. Vitamin B6 d. Niacin ANS: A
Colonic bacteria produce vitamin K, vitamin B12, thiamin, and riboflavin. Vitamin D may be metabolized by exposure of precursor vitamin D in the skin to ultraviolet light. The human body can synthesize niacin from the amino acid tryptophan. Vitamin B6 must be obtained from dietary sources such as meats, whole grains, vegetables, and nuts. 3. After surgical removal of a large portion of the small intestine, what functional
complication is most likely to develop? a. Changes in dietary habits b. Impaired digestion c. Loss of absorptive tissue d. Elimination of dietary residue ANS: C
The small intestine is the primary site of nutrient absorption because of its large absorption
surface area. Secretions from the liver, gallbladder, and pancreas can still contribute to digestion of intestinal contents. However, decreased absorption of nutrients and food components may result in more intestinal remains and residue. A patient may change dietary habits as a result of gastrointestinal discomfort experienced after intestinal resection, but this is not a functional complication. 4. The sight or smell of food produces vagal stimulation of the parietal cells of the gastric
mucosa, resulting in the increased production of what? a. Motilin b. Gastrin c. Cholecystokinin d. Secretin ANS: B
Parasympathetic innervation that causes secretion of gastrin and release of hydrochloric acid helps prepare the stomach for the potential of receiving food. After food chyme is passed into the small intestine from the stomach, secretin and cholecystokinin are secreted to stimulate pancreatic secretion of water and bicarbonate. They also signal gallbladder contractions and colonic motility, all resulting in reductions in stomach emptying and duodenal motility. Motilin is secreted from the duodenal mucosa during fasting to stimulate gastric emptying and intestinal motility. 5. If a patient experiences malabsorption of fat resulting from an impaired ability to produce
adequate bile salts for micelle formation, how may fat absorption be improved? a. By increasing short-chain fatty acids in the diet b. By increasing medium-chain fatty acids in the diet c. By increasing long-chain fatty acids in the diet d. By restricting dietary intake of cholesterol ANS: B
Medium-chain fatty acids of 8 to 12 carbons can be absorbed directly by mucosal cells without the presence of bile. The long-chain fatty acids require micelle formation for absorption. Short-chain fatty acids result from bacterial fermentation of malabsorbed carbohydrates and fibers. As bile is produced from cholesterol, dietary restriction of cholesterol is negligible in regard to improvements in fat absorption. 6. What is the function of secretin? a. Stimulation of gastric secretions and increased motility
b. Stimulation of gallbladder contraction and the release of bile c. Stimulation of the pancreas to secrete water and bicarbonate d. Stimulation of the parietal cells to secrete gastrin ANS: C
Secretin is the hormone that works in opposition to gastrin. Whereas gastrin stimulates stomach digestion activities, secretin decreases gastric output and promotes pancreatic secretions to neutralize the acidity of chyme. Cholecystokinin is also secreted when chyme enters the duodenum, and it is responsible for stimulating the gallbladder. 7. Which of the following is a list of enzymes released from the pancreas? a. Insulin, trypsin, and secretin b. Lactase, isomaltase, and dextrinase c. Protease, pepsin, and gastrin d. Trypsin, chymotrypsin, and carboxypeptidase ANS: D
Trypsin, chymotrypsin, and carboxypeptidase are three protein digestive enzymes secreted by the pancreas. Insulin is an endogenous hormone secreted by the pancreas. Secretin is a hormone secreted by the small intestine. Lactase and isomaltase (also known as dextrinase) are brush-border enzymes. Pepsin, which is a protease, and gastrin are hormones secreted by the stomach. 8. In what form is dietary fat absorbed from the lumen of the intestine? a. Chylomicron b. Micelle c. Triglyceride d. Lipoprotein ANS: B
Fats must be emulsified into micelles so that they may cross the unstirred water layer that borders the brush-border membranes. These micelles leave monoglycerides and fatty acids at the brush border, where they are reabsorbed and reassembled as triglycerides. The triglycerides are packaged with cholesterol, fat-soluble vitamins, and phospholipids into chylomicrons, which pass into the lymphatic circulation. When these reach the liver, the chylomicron components are repackaged into low-density lipoproteins. 9. Which of the following is true of probiotics? a. Probiotics are live microorganisms found in food.
b. Probiotics are nondigestible carbohydrates. c. Probiotics act primarily on bacteria in the proximal small intestine. d. Probiotics cannot be given as supplements because they readily die. ANS: A
Probiotics are live microorganisms, which when administered in adequate amounts confer a health benefit on the host. They are found in fermented foods like yogurt and sauerkraut or as a nutritional supplement. Bacterial action is most intense in the distal small intestine and large intestine. 10. By which transport mechanism are most vitamins absorbed from the small intestine into
the blood? a. Passive diffusion b. Active diffusion c. Facilitative diffusion d. Passive osmosis ANS: A
Passive diffusion is limited by the number of channels available for nutrients to randomly pass through. Facilitated diffusion requires the presence of carrier proteins, which may be limited by the health and nutritional status of the person. Active transport requires energy, which also may be limited by the person’s health and nutritional status. Osmosis occurs in regard to concentration gradient and only involves the movement of water, not vitamins. 11. What are primarily absorbed by the large intestine? a. Water and fats b. Carbohydrates c. Proteins d. Water and electrolytes ANS: D
Water and electrolytes are usually the only absorbable remnants of dietary intake that reach the large intestine. Fats, carbohydrates, and proteins from the diet are absorbed throughout the small intestine.
12. What happens to cellulose and lignin as they go through the GI tract? a. They are converted into glucose before absorption. b. They are converted into glucose and absorbed by active transport. c. They are excreted in the feces unchanged. d. They are excreted in the feces as glucose. ANS: C
In humans, the secreted amylases cannot split the 1-2 and 1-4 linkages between the saccharides within the cellulose molecule. As a result, no individual glucose molecules are broken off. 13. Which is the process by which minerals are absorbed when they are bound to an acid,
organic acid, or amino acid? a. Cotransportation b. Carrier protein c. Competitive inhibition d. Chelation ANS: D
Chelation refers to the binding of a cation mineral to a ligand, not a whole protein. Cotransporters carry two different minerals at a time, such as the case with sodium and phosphorus. An overlap of mineral transport mechanisms may lead to competitive absorption between minerals in the presence of other minerals, such as the case with iron or zinc supplementation, leading to a decrease in copper absorption. 14. How often do the cells lining the intestinal tract recycle? a. Every 2 to 3 days b. Every 3 to 5 days c. Every 5 to 7 days d. Every 10 to 14 days ANS: B
Intestinal mucosal cells have a life span of 3 to 5 days before they are sloughed off and recycled. They are fully functional only for the last 2 to 3 days as they migrate to the distal third of the villi. 15. What effect may be achieved by eating a diet high in prebiotic carbohydrates? a. Decreased SCFA production in the bowel b. Increased growth of Lactobacillus spp.
c. Decreased absorption of bile salts d. Increased absorption of cation minerals ANS: B
The use of prebiotic carbohydrates favors the growth of friendly bacteria such as lactobacilli and bifidobacteria. These bacteria ferment the prebiotic carbohydrates, promoting increased short-chain fatty acid production. These types of carbohydrates have not been demonstrated to have a bile-sequestering effect. Impairments in absorption of cation minerals tend to be in relation to phytates and oxalates that are present in plant foods. 16. How long does it take for small intestine contents to reach the ileocecal valve? a. 18 to 72 hours b. 3 to 8 hours c. 1 to 2 hours d. 2 to 3 hours ANS: B
Travel of contents through the small intestine takes 3 to 8 hours. A liquid meal empties from the stomach within 1 to 2 hours of eating. A solid meal takes 2 to 3 hours. Total transport from mouth to anus takes 18 to 72 hours on average.
Chapter 02: Intake: Energy Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. A particular food provides 100 kcal. How many kJ does this equal? a. 420 b. 480 c. 4200 d. 4800 ANS: A
One kilocalorie is equal to 4.184 kJ (100 kcal 4.2 kJ/kcal = 420 kJ). 2. Which of the following conditions is necessary to obtain an accurate measure of a patient’s
basal metabolic rate (BMR)? a. Test at the end of the day when the patient is ready to go to sleep. b. Test 2 to 3 hours after the last meal. c. Test in the morning after the patient has awakened. d. Test in environmental conditions equal to body temperature. ANS: C
For an accurate measurement of BMR, the test should be performed when the body is using its minimum amount of energy, usually in the morning after waking, and at least 10 to 12 hours after the last meal so as to not include the thermic effect of food. Climates above 86F increase metabolism because of sweat gland activity. 3. If a patient’s body temperature were 104.6°F, what would the BMR be compared with
normal? a. 58% of normal b. 135% of normal c. 142% of normal d. 178% of normal ANS: C
An increase in body temperature increases the BMR by 7% for every degree Fahrenheit above the normal 98.6°F (104.6 – 98.6 = 6°F; 6°F 7% ÷ 1°F = 42%).
4. How does an elevation in body temperature with fever affect the metabolic rate? a. It does not change the metabolic rate. b. It increases the metabolic rate by 7% per degree Fahrenheit above normal. c. It increases the metabolic rate by 14% per degree Fahrenheit above normal. d. It decreases the metabolic rate by 7% per degree Fahrenheit above normal. ANS: B
Fever causes an increase in body temperature. For every degree Fahrenheit above the normal 98.6°F, the BMR increases by 7%. 5. Which of the following does not increase the thermic effect of food (TEF)? a. Carbohydrates b. Fat c. Regular eating schedule d. Spicy foods ANS: B
Although dietary fat provides the highest concentration of energy, metabolism of fat is highly efficient, with only 4% of calories wasted. This partly explains the obesogenic aspect of dietary fat. The TEF after intake of carbohydrates and proteins tends to be higher than after fat intake. Following a regular eating schedule results in a higher TEF than irregular eating. The use of spice and mustard increases metabolism more than unspiced meals. 6. What is the clinical method for measuring human energy expenditure? a. Bomb calorimetry b. Indirect calorimetry c. Doubly labeled water d. Direct calorimetry ANS: B
Indirect calorimetry is commonly used in hospital settings. The piece of equipment is known as a metabolic cart or monitor. Other methods of measuring energy expenditure include doubly labeled water and direct calorimetry; however, these are not practical for clinical practice. Bomb calorimetry measures the energy available from food. 7. When is basal metabolism at its highest rate? a. During the digestion of a meal b. During periods of sleep
c. During periods of exercise d. During periods of rapid growth ANS: D
Because basal metabolism only accounts for the proportion of energy necessary for support of life functions, it does not include energy increase after eating (TEF) or during exercise (AT). During infancy, childhood, adolescence, and pregnancy, basal metabolism increases as FFM increases. 8. Which of the following best describes the contribution of physical activity to total energy
expenditure? a. It accounts for 10% of total energy expenditure. b. Its contribution to total energy expenditure increases with age. c. Its contribution to total energy expenditure is most consistent during childhood. d. It is the most variable component of total energy expenditure. ANS: D
Activity thermogenesis is highly variable and dependent on body size and the efficiency of individual habits of motion. Whereas the thermic effect of food tends to be about 10% of TEE, AT can range from 100 kcal/day in sedentary people to 3000 kcal/day in highly active people. AT tends to decrease with age, and it tends to be variable during childhood. 9. What does indirect calorimetry measure? a. The amount of heat produced by the body at rest b. The energy potential of foods consumed c. Oxygen consumption and carbon dioxide excretion d. The resting metabolic rate ANS: C
Indirect calorimetry measures gas exchange that results from metabolism. The oxygen consumption and carbon dioxide excretion can be used to estimate a resting metabolic rate. Direct calorimetry measures heat production, either from humans in a controlled environment, or from food, by incinerating the food and measuring the amount of heat released. 10. The respiratory quotient (RQ) is highest after consumption of a diet that is primarily
composed of what? a. Carbohydrate b. Protein
c. Fat d. Mixed macronutrients ANS: A
The RQ compares the carbon dioxide produced with the oxygen consumed when energy substrates are metabolized. The RQ for carbohydrate is 1. The RQs for protein, fat, and a mixed diet are, respectively, 0.82, 0.7, and 0.85. 11. Studies have shown that which factor(s) is(are) the primary determinant of an individual’s
resting energy expenditure (RMR)? a. The amount of lean body mass b. The amount of adipose tissue c. A person’s age, gender, and health status d. The individual’s body weight ANS: A
The lean body mass, or fat-free mass, accounts for about 80% of the variance in RMR. Although the body weight and composition are affected by a person’s age, gender, and health status, the amount of metabolically active tissue that exists within the overall lean body mass contributes to the overall metabolic rate. 12. Which of these best describes the change in the metabolic rate during pregnancy? a. It decreases as a result of a decrease in maternal physical activity. b. It increases as a result of fetal growth. c. It increases as a result of fetal growth and maternal cardiac output. d. It decreases as a result of an increase in maternal adipose tissue. ANS: C
Hormonal changes that occur during pregnancy support the changes in the maternal body to support the growth of the fetus. These changes include the growth of metabolically active tissue in the uterus, placenta, and fetus. Additionally, blood volume is increased, and cardiac workload increases. Because the metabolic rate is dependent on metabolically active tissues, as these increase and the heart’s work increases, the overall metabolic rate increases.
13. A dish has 60 g of carbohydrate, 35 g of protein, and 25 g of fat. How many total
kilocalories are in the dish? a. 480 kcal b. 555 kcal c. 605 kcal d. 655 kcal ANS: C
One gram of carbohydrate provides 4 kcal. One gram of protein provides 4 kcal. One gram of fat provides 9 kcal. Therefore, (60 4) + (35 4) + (25 9) = 240 kcal + 140 kcal + 225 kcal = 605 kcal. 14. How many kilocalories are in 4 oz of 40-proof schnapps? a. 28 kcal b. 64 kcal c. 128 kcal d. 240 kcal ANS: C
The kilocalorie equivalent of an alcoholic drink is equal to the volume of drink times the proof 0.8 kcal/proof/fl oz. 4 40 0.8 = 128 kcal. 15. How is the determination of the physical activity level (PAL) categories beyond sedentary
different from the sedentary category? a. They are based on metabolic equivalents. b. They are based on the pace of walking. c. They are based on the total time spent doing physical activity. d. They are based on types of physical activity. ANS: B
Beyond the sedentary category, the PAL category is determined according to the energy expended by a person walking a set pace of 3 to 4 mph. Low-active, active, and highly active PALs are equivalent to walking 2, 7, and 17 miles per day, respectively, at 3 to 4 mph. Metabolic equivalents (METs) are another means by which to determine energy expenditure during physical activity, but they are not used in the EER estimation. Determination of physical activity energy expenditure using METs does consider the type, or intensity, of physical activity and total time spent doing physical activity. 16. In research regarding the measurement of activity-related energy expenditure, what
method correlated with and validated triaxial monitors of human movement? a. Doubly labeled water b. Indirect calorimetry c. Heart rate monitor d. Physical activity questionnaire ANS: A
As doubly labeled water has become the research method of choice in regard to measurements of total energy expenditure as well as the individual components of energy expenditure, comparisons of other techniques are made to it. Indirect calorimetry can be used for activity energy expenditure but not in free-living situations. The heart rate monitor has not been found to be reliable in measurement of physical activity in individuals. Physical activity questionnaires would be used as a less expensive alternative to movement monitors and are not used for validation of other techniques. 17. A respiratory quotient of 0.64 would most likely occur in which of these patients? a. A pregnant woman b. A patient with diabetic ketoacidosis c. A trauma patient in the ICU d. Someone who had just eaten a high-fat meal ANS: B
The respiratory quotient provides information on the type of fuel the body is burning for energy. A mixed fuel meal yields a respiratory quotient of 0.82. Burning fat exclusively is 0.7. Burning ketones results in a respiratory quotient less than or equal to 0.65. 18. A cocktail containing 10 g of alcohol and 20 g of carbohydrate would provide how many
calories? a. 150 b. 170 c. 120 d. 220 ANS: A
Alcohol contains 7 kcal/g. 10 g 7 kcal/g = 70 kcal. Carbohydrates provide 4 kcal/g. 20 g 4 kcal/g = 80 kcal. 70 + 80 = 150 kcal.
Chapter 03: Clinical: Water, Electrolytes, and Acid–Base Balance Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. Eating which of the following would most likely 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. Which effect is of greatest concern in water intoxication? a. Increased fluid 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 fluid volume of brain cells results in swelling which contributes to 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 2700 ml/day for women and 3700 ml/day for men. The general recommendation for water intake is approximately 35 ml/kg of usual body weight in adults. 5. How does body water, as a percentage of body weight, change based on stage of the life
cycle and lifestyle? a. Decreases significantly with age and is higher in athletes than nonathletes. b. Decreases significantly with age and is lower in athletes than nonathletes. c. Increases significantly with age and is higher in athletes than nonathletes. d. Increases significantly with age and is lower in athletes than nonathletes. 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 space 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. Statement is true concerning thirst? a. It is regulated by the hypothalamus. b. It is related to a decrease in serum osmolality. c. The elderly have an increased sense of thirst. d. Thirst receptors are located in the thyroid gland. ANS: A
Thirst is regulated by the hypothalamus in response to increased serum osmolality. The elderly have a diminished sense of thirst. There are no thirst receptors in the thyroid gland. 8. The kidneys compensate for a loss of body water by excreting a. additional fluids 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 are equal to the amount of water lost through urine, feces, sweat, and respiration. Excessive water intake or losses result in water imbalance. 11. Refeeding syndrome can result in a. hypophosphatemia. b. hypomagnesemia. c. death. d. All of the above. ANS: D
Refeeding syndrome occurs when a starved patient is fed and there is rapid utilization of phosphorus for phosphorylation of glucose. ATP production also requires magnesium. As the body begins making ATP, serum magnesium and phosphorus drop. If not treated this can be a life-threatening condition. 12. Which of the following results from ingesting a large amount of sodium? a. Hypotension b. Muscular cramps c. Increased urinary calcium excretion d. Increased urinary potassium excretion 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 increased 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 for 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. Diabetic 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 buildup 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.
Chapter 04: Intake: Assessment of Food- and Nutrition-Related History Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. The purpose of nutritional screening is to a. identify patients at nutritional risk. b. determine a patient’s nutritional problem. c. categorize patients as high or moderate risk. d. assess the patient’s nutritional status. ANS: A
Nutrition screening is a quick means of identifying whether or not a person may be at risk for a nutritional problem. Usually, only a few well-selected parameters related to nutrition are evaluated to determine this risk. If screening does identify a potential risk, then a more complete nutrition assessment should be performed. The assessment will identify any specific nutrition problems the patient may have. Generally, screening is not used to classify degree of risk—either the patient is at nutritional risk or not. 2. A food diary or calorie count should be recorded for
hours.
a. 48 b. 72 c. 24 d. 36 ANS: B
With the availability of complete intake records, 72 hours is usually enough to reflect an individual’s average intake. With incomplete records, the data collection may need to be extended beyond 72 hours. In a hospital setting, between the patient’s health status and the foods and menus offered, intake will vary from meal to meal and from day to day. By tracking the intake across 3 days, the assessment can account for this variation. 3. What is a limitation of using the 24-hour recall and the food frequency? a. The patient’s level of literacy b. The time required to collect data c. The lack of tools for conducting these d. Reliance on the patient’s memory
ANS: D
Both the food frequency and the 24-hour food recall depend on the patient’s memory of past intake. This can be of particular difficulty when trying to evaluate the diet history of an elderly person or a child. To their benefit, both of these methods require little time or materials to administer, and they do not require the patient to write down and maintain his or her own record of intake. 4. Which of the following is not true of nutrition screening? a. Should be able to be done quickly b. Should include weight history c. Should be done by dietitians d. Should be setting specific ANS: C
Tools and parameters should be established by dietitians but screening may be performed by other health care professionals. The parameters should be easily accessible and the process should be quick. The screening tool used should be specific to the setting. 5. The Nutrition Care Process Food- and Nutrition-Related History includes a. dietary practices. b. medications. c. attitudes related to food. d. All of the above. ANS: D
All aspects of a patient’s life that affect intake of nutrients are included in the nutrition history, including dietary patterns, medication use, and attitudes and beliefs related to food and self-care. 6. In the patient’s
history, you would most likely find out about the patient’s cultural
views related to health care. a. medical b. social c. medication d. dietary ANS: B
Aspects of culture, which include religious and cultural beliefs and practices, are identified while obtaining a patient’s social history. Culture affects who a person turns to for health
care and how a person feels about different types of health care. Culture is also an included aspect of the diet history, but this would be focused on dietary habits and preferences dictated by culture as opposed to health care. 7. The MNA short form has been validated for use in what population? a. Critically ill elderly b. Surgical populations c. Subacute and ambulatory elderly d. Children ANS: C
The MNA short form is a rapid and reliable screening tool for ambulatory and subacute elderly populations. MUST is used for medical and surgical populations.
TRUE/FALSE
1. Smartphones are now a legitimate method to record food intake. ANS: T
Information about actual intake is collected through direct observation or an inventory of foods eaten based on observation of what remains on the individual’s tray or plate after a meal. In many cases photographs taken by smartphones are useful in documenting amount of food consumed.
Chapter 05: Clinical: Biochemical, Physical, and Functional Assessment Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. Laboratory tests for nutrients a. are not useful if you have only a single test result. b. are always best done on whole blood. c. may indicate deficiency before clinical or anthropometric data does. d. are currently not well controlled. ANS: C
Laboratory-based nutrition testing, used to estimate nutrient concentration in biologic fluids and tissues, is critical for assessment of both clinical and subclinical nutrient deficiencies. Most of these states can be assessed in the laboratory so that nutritional intervention can occur before a clinical or anthropometric change or a frank deficiency occurs. Single test results may be useful for screening or to confirm an assessment based on changing clinical, anthropometric, and dietary status. The best biologic medium to test depends on the specific nutrient. Laboratory assessment is stringently controlled. It involves comparing control samples with predetermined substance or chemical constituent concentrations with every patient specimen. 2. Which of the following is not associated with a decrease in prealbumin levels? a. Starvation b. Inflammation c. Protein-wasting disease of the gastrointestinal tract d. Zinc deficiency ANS: A
Prealbumin levels may appear normal when a patient has uncomplicated or severe malnutrition due to starvation without inflammation. Prealbumin levels decrease in response to inflammation, protein-wasting diseases of the intestines and kidney, and in malignancy. As zinc is necessary in the synthesis of prealbumin, zinc deficiency will result in decreased levels. 3. Which nutrient-related disorder is likely to result in a stool test being ordered? a. Diabetes
b. Anemia c. Night blindness d. Cheilosis ANS: B
The fecal occult blood test is routinely ordered for adults older than age 50 years and younger adults with unexplained anemia. The presence of blood may indicate bleeding in the gastrointestinal tract that is causing the anemia. 4. Which of the following occurs during acute illness or trauma? a. Negative acute-phase reactants increase. b. Positive acute-phase reactants decrease. c. Negative acute-phase reactants decrease. d. Both positive and negative acute-phase reactants increase. ANS: C
Negative acute-phase proteins are those that are negatively affected by trauma, meaning that their levels and production decrease in response to the trauma. These include albumin, transferrin, prealbumin, and retinol-binding protein. Positive acute-phase reactants are those that increase in levels and production in response to trauma. 5. Which of the following is a positive acute-phase reactant? a. Interleukin-1 b. Albumin c. Transthyretin d. C-reactive protein ANS: D
Positive acute-phase reactants include C-reactive protein, alpha-1-antichymotrypsin, alpha-1-antitrypsin, fibrinogen, ferritin, and complement components C3 and C4, just to name a few. Interleukin-1 is one of the cytokines triggered by trauma that reorients hepatic synthesis of plasma proteins. Albumin and transthyretin (prealbumin) are both negative acute-phase proteins. 6. During trauma, what happens to negative acute-phase reactant levels? a. Blood levels decrease because of decreased synthesis. b. Blood levels increase because of transport into the vascular space. c. Blood levels are not altered because of the catabolism of proteins.
d. Blood levels are similar to what they would be during simple starvation. ANS: A
During the acute phase of trauma, the negative acute-phase reactant levels decrease in the blood. Part of this is because of decreased synthesis resulting from a downregulation of gene expression and translation. In the case of albumin, other aspects of the reduction include increased catabolism and transport to extravascular spaces. This is different from what happens to albumin during starvation because in that case, plasma albumin levels are maintained by a shift from the extravascular space. 7. Which of the following is true about bioelectric impedance analysis? a. It measures lean body tissue. b. It is noninvasive and portable. c. It is not accurate in a dehydrated individual. d. All of the above. ANS: D
Bioelectrical impedance analysis (BIA) is a body composition analysis technique based on the principle that, relative to water, lean tissue has a higher electrical conductivity and lower impedance than fatty tissue because of its electrolyte content. BIA has been found to be a reliable measurement of body composition (fat-free mass and fat mass). The equipment needed is portable, and the method has been shown to be safe and noninvasive. For accurate results the patient should be well hydrated; have not exercised in the previous 4 to 6 hours; and have not consumed alcohol, caffeine, or diuretics in the previous 24 hours. If the person is dehydrated, a higher percentage of body fat than really exists is measured. 8. Which indicator of protein status has the longest half-life? a. Albumin b. Prealbumin c. Retinol-binding protein d. Transferrin ANS: A
Albumin has a half-life of about 3 weeks. Prealbumin has a half-life of 2 days. Retinol-binding protein has a half-life of about 12 hours. Transferrin has a half-life of 8 days. 9. Which of the following has been used as a measure of somatic protein status?
a. C-reactive protein b. Retinol-binding protein c. Urinary methylmalonic acid d. Urinary creatinine ANS: D
Urinary excretion of creatinine is related to the skeletal muscle or somatic protein; however, as the value can be affected by the intake of muscle meats, use of this measure is more limited to research. C-reactive protein is used as an indicator of inflammation. Retinol-binding protein may be used as an indicator of starvation-related malnutrition but it does decrease with inflammation. Urinary methylmalonic acid is a sensitive indicator of vitamin B12 deficiency. 10. Which of the following manifestations will occur in iron deficiency anemia? a. Microcytic anemia b. Macrocytic anemia c. High reticulocyte count d. High MCV ANS: A
Microcytic anemia is mostly associated with iron deficiency. Macrocytic anemia, which would be reflected by a high MCV value, is usually caused by either folate or vitamin B12 deficiency. Reticulocytes are large, nucleated, immature red blood cells that are released in small numbers with mature red blood cells. The presence of these may indicate erythropoiesis in response to blood loss, hemolysis, or iron, folate, or vitamin B12 therapies. 11. Which of the following is a measure of iron storage? a. TIBC b. Serum ferritin c. Transferrin d. Hemoglobin ANS: B
Ferritin is the storage protein that sequesters the iron gathered in the liver, spleen, and marrow. Total-iron binding capacity is a direct measure of all proteins available to bind iron dependent on the number of free iron-binding sites on transferrin. Transferrin is the primary blood transport protein of iron. Hemoglobin is the oxygen-carrying protein in red blood cells and uses iron as a functional component. 12. Which of the following deficiencies could cause macrocytic anemia? a. Vitamin B12 b. Vitamin B6 c. Homocysteine d. Iron ANS: A
Vitamin B12 and folate deficiencies both may promote the development of macrocytic anemia because they are involved in DNA synthesis, and loss of either results in the impaired production of red blood cells. Homocysteine is a product of methionine metabolism. Levels of homocysteine increase when vitamin B12 and folate are deficient because these are necessary for its conversion back to methionine. Vitamin B6 affects homocysteine by converting it to cysteine. However, neither of these promote anemia. Iron is associated with microcytic anemia. 13. Which of the following would be included in a complete blood count? a. Total cholesterol b. Mean cell volume c. Glucose d. Albumin ANS: B
A CBC panel focuses on the analysis and descriptions of the red blood cells, including hemoglobin, hematocrit, and mean cell volume (the size of the red blood cells). Glucose, total cholesterol, and albumin are values on a common serum chemistry or blood panel. 14. Which laboratory value would be added in a comprehensive metabolic pane, CMP
(compared with a Basic Metabolic Panel, BMP)? a. Albumin b. Glucose c. Blood urea nitrogen d. White blood cells
ANS: A
The Centers for Medicare and Medicaid Services established that for the BMP, the following tests are reimbursable: glucose, calcium, potassium, carbon dioxide, chloride, blood urea nitrogen, and creatinine. For the CMP, the following are added: albumin, total protein, alkaline phosphate, alanine aminotransferase, aspartate aminotransferase, and bilirubin. WBC would appear on a CBC, which may include a differential identifying the levels of the different types. 15. Which of the following is not a laboratory measure of hydration status? a. Serum sodium b. Blood urea nitrogen c. Serum glucose d. Urine specific gravity ANS: C
Although high serum glucose levels in people with diabetes mellitus have a dehydrating effect, by itself, it is not a measure of hydration. Glucose, sodium, and blood urea nitrogen (BUN) are all factors in the calculation of serum osmolality. Serum osmolality, serum sodium, BUN, and urine specific gravity are all laboratory values that may be used to assess hydration status. 16. Which of the following is a measure of glucose control? a. Highly sensitive C-reactive protein b. Hemoglobin A1C c. Homocysteine d. Apolipoprotein B ANS: B
The percentage of glycosylated hemoglobin (hemoglobin A1C) in the blood is directly related to the average blood glucose levels for the preceding 2 to 3 months. Homocysteine and hs-CRP are two inflammatory markers, higher levels of which are associated with increased risk of cardiovascular disease. Apolipoprotein B is the part of the protein present in low-density lipoprotein, and it is also associated with increased risk of atherogenesis, possibly through its susceptibility to oxidation by ROS and lipid peroxides. 17. In urinalysis tests, which of the following is expected to appear at some level in normal
people? a. Glucose
b. Ketones c. Blood d. Protein ANS: D
Small amounts of protein, from 2 to 8 mg/dL, are expected in normal urine. Larger amounts are associated with damage to the kidneys. Results for glucose, ketones, and blood in the urine are expected to be negative. 18. Which of the following is a criterion for diagnosing malnutrition in adults? a. Excess adiposity b. Intention weight loss c. Energy intake less than estimated needs d. Hypoalbuminemia ANS: C
Criteria to diagnose malnutrition in adults include unintentional weight loss, energy intake below estimated needs, functional capacity, muscle wasting, fat loss, and fluid accumulation. Two criteria must be met to diagnose malnutrition. Each criterion is quantified as either severe or nonsevere for acute, chronic, and environmental malnutrition. Presence of adiposity and intentional weight loss are not included. No laboratory data is required.
Chapter 06: Clinical: Nutritional Genomics Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. Approximately how many nucleotides make up human DNA? a. 1 million b. 2 billion c. 3 billion d. 8 billion ANS: C
When mapping of the human genome was completed in 2003, human DNA was determined to consist of 3 billion nucleotides. 2. What is the term that describes the natural variations in a gene that create no adverse
effects on the individual and appear frequently within the population? a. Autosomal dominant b. Homozygous c. Polymorphism d. Heterozygous ANS: C
Polymorphism refers to one of multiple variations of a gene’s sequences, which explains why human beings are distinctly different from one another. Autosomal dominant refers to genetic inheritance when an allele on an autosome presents a phenotype, whether a single copy of the allele (heterozygous) or two copies of the allele (homozygous) are present. 3. What is the effect of a silent mutation on DNA? a. It is harmful to the host. b. It accumulates additional mutations more quickly than unaffected DNA. c. It improves certain functions of the DNA. d. It has no effect on the DNA. ANS: D
A silent mutation is a gene variant that has no effect on DNA function. The term “mutation” tends to refer to a genetic difference that results in a harmful effect. “Gene variant” refers to a genetic difference that may result in a difference, but this difference is
not necessarily harmful. 4. What is the term that describes a gene that is present but is not readily measurable? a. Pedigree b. Reduced penetrance c. Dominance d. Linkage ANS: B
Reduced penetrance refers to when a person has the genotype that is not readily measurable. This concept is usually applied to the genetic inheritance of disease, such as when the pedigree of a disease is tracked through a family history. Dominance refers to the phenotypic expression of a single allele, whether it is associated with an autosome or a sex-linked chromosome. Linkage refers to how genes are sequenced with others in the DNA strand. 5. Which type of disorders is the most common of the Mendelian inherited disorders? a. Autosomal recessive diseases b. Autosomal dominant diseases c. X-linked dominant diseases d. X-linked recessive diseases ANS: A
Autosomal recessive diseases are the most common as two copies of an abnormal autosomal allele are necessary for the phenotype to be expressed. Both autosomal and X-linked dominant diseases only need one abnormal allele for expression to occur. An X-linked recessive condition could only occur in a woman if she inherits two copies of the recessive trait. Because males only have one X chromosome, if the recessive trait is present, it will be expressed. 6. Which of the following is a syndrome caused by extra chromosomes? a. William syndrome b. Down syndrome c. Angelman syndrome d. Prader-Willi syndrome ANS: B
Down syndrome is also known as trisomy 21 because an extra chromosome 21 is present. William syndrome is a condition resulting from a missing chromosome 7. Angelman and
Prader-Willi syndromes both involve missing chromosome 15. 7. What syndrome results from inheriting two copies of a deletion in chromosome 15 from
the father? a. William syndrome b. Down syndrome c. Angelman syndrome d. Klinefelter syndrome ANS: C
The difference between Angelman syndrome and Prader-Willi syndrome is the source of the inherited abnormal alleles. When both are inherited from the father, the result is Angelman syndrome. When both are inherited from the mother, then Prader-Willi syndrome is the result. William syndrome results from a deletion of chromosome 7. Down syndrome results from the presence of an extra chromosome 21. Klinefelter syndrome results from an extra X chromosome. 8. Phenylketonuria is what type of genetic disorder? a. Autosomal dominant b. Autosomal recessive c. X-linked dominant d. X-linked recessive ANS: B
PKU, tyrosinemia, maple syrup urine disease, and other metabolic disorders known as inborn errors of metabolism result from autosomal recessive disorders. Examples of nutrition-related conditions that are autosomal dominant disorders include Albright hereditary osteodystrophy and familial hypercholesterolemia. One nutrition-related X-linked dominant disorder is fragile X syndrome. Diabetes insipidus and adrenoleukodystrophy are examples of X-linked recessive disorders with nutritional implications. 9. The purpose of the Genetic Information Nondiscrimination Act (GINA) is to a. protect against discrimination. b. ban insurers from denying coverage based on genetic information. c. prevent employers from firing individuals based on genetic testing results. d. All of the above. ANS: D
Many legislators and legal experts believe the Americans with Disabilities Act sufficiently protects against discrimination, but as an added measure of protection, the GINA was passed by Congress and went into effect on November 21, 2009. GINA defines genetic testing and genetic information, bans discrimination based on genetic information, and penalizes those who violate the provisions of this law. Consumers and health care professionals can feel comfortable in adopting this new service. 10. In regard to nutritional assessment, which of the following will nutrition professionals
need to be able to read to identify a patient’s potential susceptibility to diseases? a. Phenotype b. Genotype c. Karyotype d. Genomic imprint ANS: B
Whereas the genotype refers to the patient’s unique genetic makeup, the phenotype is the measurable expression of a gene. The genotype can provide the information that the patient may be susceptible to a particular disease, depending on the influence of specific food components and other environmental factors. If the disease of concern became present, this would be the phenotype expressed. A karyotype is a visual display of chromosomes. Genomic imprinting refers to the process by which a phenotype is influenced by whether a gene variant was inherited from the mother or the father. 11. Within a strand of DNA, which of the following nucleotide base pairing is possible? a. Adenine-guanine b. Cytosine-thymine c. Adenine-uracil d. Cytosine-guanine ANS: D
In DNA, only two potential base pairings are possible: adenine with thymine and cytosine with guanine. In RNA, uracil may take the place of thymine to be paired with adenine.
12. In protein synthesis, what subcomponent of DNA directs the inclusion of a specific amino
acid within the protein? a. The gene b. The intron c. The codon d. The exon ANS: C
Whereas a gene is the sequence of nucleotides that codes for a whole particular protein, a codon within the gene is a three-nucleotide sequence that specifies the individual amino acid included with the protein. The exon is the sequence of nucleotides that corresponds to the sequence of amino acids within the protein. The exon is made up of codons. An intron is a sequence of nucleotides that does not code for amino acids, and these are interspersed between exons. 13. During protein synthesis, when are introns removed? a. Transcription b. Posttranscriptional processing c. Translation d. Posttranslational processing ANS: B
After transcription results in mRNA production, the mRNA must undergo preparation for translation processes within the endoplasmic reticulum. Among these posttranscriptional processes are the removal of introns, the capping of the 5-prime end, and the addition of a polyadenosine tail to the 3-prime end of the mRNA. After the protein is produced during translation, posttranslational processing involves the change in the protein to its active form. 14. In genomics, “SNP” refers to a. the sequencing of nucleotides to make proteins. b. a method of extracting a gene from a DNA strand. c. a variation in a DNA sequence caused by one nucleotide. d. sex-linked nucleotide penetrance. ANS: C
An SNP is a single nucleotide polymorphism, which results from the inclusion or deletion of a single nucleotide, thus affecting promoting a variation in DNA. An SNP can affect the
sequencing of proteins by transcribing for a different amino acid in the protein sequence. Sex-linked penetrance of a disease within a population is more associated with chromosomal differences as opposed to individual nucleotides. Restriction endonucleases are the enzymes used to cut DNA to extract a nucleotide sequence. 15. Which of the following may promote a change in a DNA molecule affecting gene
expression without changing the nucleotide sequence? a. Genomic imprinting b. Mutation c. SNP d. Gene variant ANS: A
Genomic imprinting refers to the process by which a change in the DNA results in a phenotype influenced by whether a gene variant was inherited from the mother or the father. Mutations or gene variants are changes in the nucleotide sequence. A single nucleotide polymorphism results in a change in the nucleotide sequence, but by only one nucleotide. 16. Which area of study focuses on the identification and understanding of the function of the
end products of the genes within the human genome? a. Nutrigenomics b. Proteomics c. Metabolomics d. Genomics ANS: B
Proteomics focuses on studying the proteins produced by genes. Metabolomics focuses on the study of cellular metabolites that may be useful in the monitoring of disease progression. Nutrigenomics studies the influence of nutrient and other food factors on the expression of genes. Genomics is the all-encompassing study of genes and proteins and their relation to disease, including the influences of environmental factors. 17. The 677CT variant of the MTHFR gene may increase the risk of a. copper toxicity. b. vitamin A toxicity. c. zinc deficiency. d. folic acid deficiency.
ANS: D
The 677CT variant of the MTHFR gene results in decreased conversion of dietary folate or folic acid to 5-methyl folate and can result in folic acid deficiency. 18. Nutritional components of food affect genetic expression by acting as ligands for
peroxisome proliferator-activated receptors (PPARG). Which disease may not be positively affected by this nutrigenomic relationship? a. Type 2 diabetes mellitus b. Cancer c. Obesity d. Atherosclerosis ANS: B
PPARG transcription factors function in lipid and lipoprotein metabolism, glucose homeostasis, adipocyte proliferation, and foam cell formation. Omega-3 and omega-6 fatty acids serve as ligands for PPARs, and as a result, potential beneficial effects could result in reduced expression of type 2 diabetes mellitus, atherosclerosis, and obesity. Research connecting nutrigenomics to cancer presently is investigating relationships to detoxification factors. 19. Among which types of inheritance have no nutrition-related disorders been identified? a. Autosomal recessive b. X-linked dominant c. Y-linked d. X-linked recessive ANS: C
Y-linked disorders are associated with males, but no specific nutrition-related disorders have been associated with Y-linked inheritance. Nutrition-related autosomal recessive disorders include inborn errors of metabolism. An X-linked dominant nutrition-related disorder is fragile X syndrome, a type of mental disorder susceptible to folic acid deficiency. X-linked recessive nutrition-related disorders include nephrogenic diabetes insipidus and adrenoleukodystrophy.
Chapter 07: Inflammation and the Pathophysiology of Chronic Disease Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. Allostasis is a. a test for inflammation. b. a root cause of obesity. c. lysosomal degradation. d. a condition of metabolic stability with adjustments for environmental influences. ANS: D
Allostasis is a condition of metabolic stability with adjustments for environmental influences and stresses. It will be established even under inflammatory conditions. This can lead to inflammation but allostasis is not a test for inflammation. 2. Nutrient Triage Theory refers to a. the nutrient partner principle. b. nutrients being preferentially used for functions important for survival during poor
dietary supply. c. nutrients being preferentially used to fuel inflammation. d. nutrients being preferentially used to resolve long-latency nutrient insufficiencies. ANS: B
The concept of Nutrient Triage Theory states that during poor dietary supply, nutrients are preferentially utilized for functions that are important for survival. The nutrient partner principle refers to the symbiosis between two nutrients such as calcium and vitamin D. Long-latency nutrient insufficiencies result from chronic poor intake and contribute over a period of time to the development of chronic disease. 3. Chronic inflammation is associated with
.
a. a progressive shift in the type of cells present at the site of inflammation b. production of cytokines c. loss of the body’s ability to recognize “self” d. All of the above ANS: D
Prolonged inflammation known as chronic inflammation leads to a progressive shift in the
type of cells present at the site of inflammation and is characterized by simultaneous destruction and healing of tissue. The immune system’s response to physiologic and metabolic stress is to produce proinflammatory molecules such as cytokines. The immune system’s function is to keep the body healthy by responding appropriately with an inflammatory response and then returning the body to an alert system of defense. But when the natural defense system is damaged in multiple areas, such as the gastrointestinal barrier, lining of the lungs, ears, nose, throat, and skin, there can be a loss of ability of the body to recognize “self” from “nonself.” 4. Increased intestinal permeability is associated with
.
a. blocking of large molecules to prevent passage into the internal microenvironment b. an allogenic state c. decreased antigenic load d. more severe food sensitivity or allergy ANS: D
The loss of the integrity of the gut barrier leads to intestinal permeability. It is sometimes known as “leaky gut.” This condition provides access of larger molecules into the internal microenvironment. A situation occurs where antigens, often from food, become more significant and allostasis is no longer present. 5. Essential fatty acids and polyunsaturated fatty acids are converted to what? a. Insulin b. Cytokines and adipokines c. Prostaglandins d. Interleukin-6 ANS: C
Essential fatty acids and polyunsaturated fatty acids are converted into prostaglandins as part of the eicosanoid cascade. Interleukin-6 is a marker of inflammation. Adipokines and cytokines are proinflammatory molecules. Insulin is a protein hormone produced by the pancreas. 6. Which of the following is not a biomarker of inflammation? a. Hemoglobin A1C b. Sedimentation rate c. High-sensitivity C-reactive protein d. TNF-alpha
ANS: A
Biomarkers of inflammation include high-sensitivity C-reactive protein, interleukin-6, TNF-alpha, and sedimentation rate. Hemoglobin A1C is used to determine average blood glucose over a 3-month period. 7. 70% of the immune system resides in
.
a. the thymus gland b. the GI tract c. white blood cells d. lean body tissue ANS: B
Because 70% of the immune system is contained in the GI tract it is important to assess its condition when evaluating inflammation. The thymus gland and white blood cells play important roles in the immune system. Lean body tissue does not, although increased amounts of adipose tissue can be proinflammatory. 8. Dietary factors that help to maintain healthy fluid viscosity and therefore a healthy
immune system include all except a. carbohydrate. b. hydration. c. plant-based diet. d. monounsaturated fat. ANS: A
Dietary factors that help to maintain healthy fluid viscosity are hydration, a plant-based diet, polyunsaturated fatty acids, and monounsaturated fatty acids. Carbohydrate is not known to have an effect. 9. Cytochrome P450 enzymes are essential for a. production of cholesterol. b. detoxification transport of toxins for elimination. c. production of prostacyclins. d. All of the above. ANS: D
Cytochrome P450 enzymes are essential for the production of cholesterol, steroids, prostacyclin, and thromboxane A2. They are involved in the hydroxylation of endogenous and exogenous toxic molecules in the detoxification transport of toxins.
10. Which of the following nutrients may contribute physiologically to all immune responses? a. Vitamin E b. Vitamin C c. Vitamin D d. Folate ANS: C
Vitamin D functions as a prohormone with multiple roles, including hormone and immune modulation, antiinflammatory, and antitumor effects and apoptosis support. This suggests that vitamin D is able to physiologically contribute to the regulation of all immune responses, by means of the vitamin D receptor. 11. Curcumin is a powerful flavonoid found in
.
a. turmeric b. apples and onions c. green vegetables d. fatty fish ANS: A
Curcumin is the most studied flavonoid compound researched to date and is found in the spice turmeric. Quercetin is another example of a flavonoid and it is found in apples and onions. 12. Medical nutrition therapy for maintaining a healthy gut microbiome includes a. fermented foods. b. avoiding processed foods. c. prebiotics. d. All of the above. ANS: D
Medical nutrition therapy recommendations for increasing fermented foods, lowering intake of processed foods, and avoiding gastrointestinal irritating foods and any known antigens for an individual are basic to improving the microbial ecology. Therapeutic use of functional foods, such as probiotics and prebiotics, can be indicated to restore gut health.
is a toxic substance within a biologic organism that is not normally present and
13.
does damage to the metabolism. a. Antioxidant b. Xenobiotic c. Glutathione d. GALT ANS: B
Xenobiotics are toxic substances not normally found in the organism that damage metabolism. Glutathione is a powerful antioxidant, and GALT refers to the immune tissue in the GI tract.
Chapter 08: Behavioral-Environmental: The Individual in the Community Raymond: Krause and Mahan’s Food and the Nutrition Care Process, 16th Edition
MULTIPLE CHOICE 1. Which of the following is the focus of the traditional public health approach to health
care? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Patient care ANS: A
The traditional public health approach to health care is through health promotion at the primary prevention level. Secondary prevention focuses on risk appraisal and reduction before development of disease. Tertiary prevention focuses on treatment and rehabilitation to prevent the progression of disease or to reduce the debilitating consequences of the disease. 2. Which of the following is not one of the core functions of public health? a. Community assessment b. Food security c. Policy development d. Public health assurance ANS: B
Although how they are performed varies depending on the community setting, the three core functions of public health are community assessment, policy development, and public health assurance. Food security may be one of the issues addressed in public health but is not a focus in all public health programs. 3. While performing a community assessment, you determine that you need information
about local cardiovascular morbidity and mortality. Which of the following would be an appropriate resource for this information? a. Census Bureau b. Centers for Disease Control and Prevention c. Department of Health and Human Services