NUTRITION AND DIETETICS

Medical Nutrition Therapy

Name: ___________________________________________ Date:_____________ Score:_________

TEST I. Multiple Choice. Write the CAPITAL letter of your answer BEFORE the number.
1. When should a tube feeding be recommended?
A. When a person has an inadequate oral nutrient intake for 2-4 days.
B. When a person has severe diarrhea.
C. When GI tract works, but patient cannot meet nutrient needs orally.
D. When a person has intractable vomiting.
2. How do enteral and parenteral nutrition differ?
A. Enteral is administered via a vein; parenteral via the ilium.
B. Enteral is administered via a blood vessel; parenteral via the mouth.
C. Parenteral is administered via GI tract; enteral via a site outside the GI tract.
D. Enteral is administered via the GI tract; parenteral via a site outside the GI tract.
3. When is a tube feeding contraindicated?
A. When aggressive nutritional therapy is not appropriate. C. When the person cannot meet nutritional needs
orally.
B. When the person has severe dysphagia. D. When the person is comatose and has a functioning GI
tract.
4. What is/are the location(s) for transnasal tube feedings?
A. Jejunum C. Duodenum
B. Stomach D. All of the above
5. A feeding ostomy should NOT be considered when:
A. A tube can’t be passed through the nose C. There is a blockage in the esophagus.
B. Long term tube feeding is required. D. Only short-term TF is required.
6. What diameter tube should be used for a tube feeding?
A. the smallest diameter through which the formula barely moves
B. the smallest diameter through which the enteral formula freely flows
C. a medium diameter
D. the largest diameter possible
7. A polymeric formula is used when the person cannot digest intact nutrients adequately or when a small absorptive area is
available.
A. True
B. False
8. A modular formula is used when the person has specific nutrient needs that need to be individualized.
A. True
B. False
9. What are the benefits of enteral formulas with fiber?
A. Fiber provides fuel to the cells of the colon lining C. Fiber helps maintain normal bowel function.
B. Fiber prevents clogging of a feeding tube. D. Only A and C
10. What volume of a standard enteral formula would a patient requiring 2800 kcal need?
A. 1000 ml C. 2800 ml
B. 5600 ml D. 5300 ml
11. These are the method/s of tube feeding administration except:
A. Bolus C. Continuous drip
B. Intermittent drip D. Permanent drip
12. Is it necessary to dilute a formula when it is first introduced?
A. Yes
B. No
13. Blenderized formulas and opened canned formulas should be used within _____ hours of preparation or opening.
A. 6 hours C. 12 hours
B. 24 hours D. 4 hours
14. An advantage of the continuous method of enteral nutrition administration compared to the bolus method is that it:
A. Requires less equipment C. Is more physiologic
B. Is better tolerated when feeding into the jejunum D. Is less expensive
15. What are concerns of drug administration via feeding tubes?
A. Feeding tube getting clogged with the drug D. Drug-nutrient interactions
B. Feeding tube hindering drug absorption E. All choices are correct
C. Increasing the blood concentration of the drug F. Only A and D
16. How are adequacy of energy and protein monitored in a patient on tube feeding?
A. Daily body weight, body mass index for protein C. BUN for energy, electrolyte for protein
B. Serum albumin for energy; hematocrit for protein D. Daily BW for energy; prealbumin/albumin for CHON
17. Which of the following strategies has been recommended to minimize the risk of aspiration in patients receiving enteral
nutrition?
A. Keeping the head of the bed flat C. Adding blue food dye to the enteral feeding formulation
B. Changing from continuous to bolus administration D. Holding the feeding if gastric residual volume is elevated
18. When selecting an enteral feeding formulation for a patient, which of the following characteristics is least important?
A. The amount of protein per liter C. The amount of calories per liter
B. Vitamin content D. Osmolality
19. When the need for enteral nutrition is anticipated for less than 3 weeks in a patient with normal functioning motility and no
history of aspiration, the best access choice is:
A. Nasogastric C. Nasojejunal
B. Gastrostomy D. Jejunostomy
20. Enteral feeding is:
A. The delivery of liquid nutrients via tube or mouth into the GI tract
B. Preferred over parenteral feeding for patients with abnormally functioning GI tracts
C. Preferred for feeding patients with normal functioning GI tracts.
D. A and C
21. Enteral feeding may be indicated for patients who:
A. Will not, should not, or cannot eat C. Are/will become malnourished
B. Unable to maintain optimal nutrition via oral feedings D. All are correct.
22. Nasoenteric tubes are typically:
A. Used for long term nutritional support, easiest to place, least expensive
B. Used for short term nutritional support, easiest to place, least expensive
C. Used for short term nutritional support, most expensive
D. Used for short term nutritional support, most difficult to place, least expensive
23. In order to help learners adopt a total dietary approach that is sustainable and fits individual preferences, evidence supports
what kind of dietary planning?
A. Identifying the waste after production of the food
B. Implementing behavior-oriented food and nutrition programs
C. Incorporating different cultural foods weekly
D. None are appropriate.
24. Providing simple one-size-fits-all decision rules can be a convenient approach in educating patients, but how can this method
mislead a consumer?
A. Consumers may conduct pantry evaluation in their homes and discard important foods.
B. Consumers may think that a given type of food is always positive or negative.
C. Consumers may eat everything when on a modified diet
D. There are no negative effects of such an approach.
25. The minimum amount of a specific nutrient needed by the body to attain a specified state of health.
A. Dietary Allowance C. Dietary Pattern
B. Dietary Requirement D. Optimum Requirement
26. Is for hospitalized patients whose condition does not require a modified diet.
A. Regular Diet C. DAT
B. Full Diet D. All of the Above
27. Is a physician’s written statement in the medical record of what a client should receive.
A. Diet Prescription C. Diet Order
B. Diet Specification D. All of the Above
28. Maintains close communication with hospital administrator.
A. Clinical Dietitian C. Hospital Dietitian
B. Administrative Dietitian D. Nurse
29. It is a systematic method to collect and evaluate information from a variety of sources that allows the RD to make a
determination regarding nutrition status.
A. Nutrition Assessment C. Nutrition Screening
B. Nutrition Diagnosis D. Nutrition Evaluation
30. Nutrition History looks into:
A. Food Intake C. Physical Activity
B. Nutrition Awareness D. All of the Above
31. Which category of the Nutrition Problem does energy balance, fluid intake, and nutrient intake fall under?
A. Intake C. Clinical
B. Behavioral-Environmental D. None of the Above
32. Impaired nutrient utilization is an example of:
A. Intake C. Clinical
B. Behavioral-Environmental D. None of the Above
33. Purposely-planned actions designed with the intent of changing a nutrition-related behavior, risk factor, environmental
condition, or aspect of health status for an individual, a target group, or population at large.
A. Problem-solving C. NCP
B. Intervention D. Monitoring
34. Determines whether participant is meeting nutrition intervention goals or desired outcomes.
A. Problem-solving C. NCP
B. Intervention D. Monitoring
35. Which of the following represents the second step in the Nutrition Care Process?
A. Formulate a PES statement C. Gain information on patient health history
B. Counsel patient according to diagnosis D. Follow-up regarding lifestyle behavior changes
36. Which of the following best represents the first step in the Nutrition Care Process?
A. Obtain anthropometric data C. Write a PES statement
B. Counsel patient using open-ended questions D. Provide evidence-based recommendations
37. The “problem” in the nutrition diagnosis describes:  
A. Possible risk C. A past nutrition problem
B. The potential nutrition problem  D. A current nutrition problem 
38. The connectors used in a PES statement are:
A. Related to, as evidenced by   C. Due to, as evidence by
B. Related to, signs and symptoms  D. Due to, signs and symptoms 
39. Lab values or weight status may be used in which part of the PES statement?
A. Problem  C. Etiology
B. Signs and symptoms D. Any of the above
40. During a reassessment of a patient, the RD usually refers to which portion of the PES Statement to determine whether the patie
nt has improved? 
A. Problem C. Etiology 
B. Signs/symptoms D. Monitoring
41. What is the first step in planning the Nutrition Intervention?
A. Prioritize nutrition diagnoses C. Consult evidence based guides 
B. Jointly determine patient focused  outcomes  D. Develop nutrition prescription 
42. Which of the following is not a nutrition intervention domain?   
A. Nutrition counseling  C. Food and/or nutrient delivery
B. Identification of possible nutrient-drug interactions D. Coordination of nutrition care
43. When determining the intervention it should ideally focus on the 
A. Problem in the PES statement C. Etiology in the PES statement
B. Signs and Symptoms in the PES statement  D. None of the above
44. All of the following are activities which pertain to monitoring and evaluation except: 
A. Measuring C. Reviewing overall effectiveness of nutrition care
B. Determining objectives  D. Reviewing data at scheduled intervals
45. All the following are true about the Nutrition Diagnosis except:
A. It is the “naming” of the nutritional problem(s) being addressed by the RND
B. Uses standardized language developed by the ADA
C. Is recorded as a PES statement
D. Identifies the intervention necessary to treat the problem
46. The terms “nutrition education” and “nutrition counseling” are purposefully separated. What is the MAIN difference in meaning
behind these two intervention categories?
A. The use of “skill development” in nutrition education, but not in nutrition counseling
B. There is no difference between the two, since most dietitians used them intertwined
C. Nutrition education is more theoretical whereas nutrition education is more practical
D. Nutrition education works to fill a knowledge deficit, whereas nutrition counseling works to facilitate the client identifying
what changes to make and how
47. Mr. West is on a low-residue diet and asks the dietician if he can eat an apple. The dietician would:
A. Allow Mr. West to eat the apple. C. Call the doctor and ask if Mr. West can eat the apple.
B. Explain that raw fruit is not allowed on his diet. D. Tell Mr. West that apples will cause his gums to bleed.
48. Mrs. Krasinski is on a clear liquid diet, and asks for something to drink. She is permitted to have:
A. 7-up C. Fresh Tomato juice
B. Hot chocolate D. Orange juice with pulp
49. Danita had an hysterectomy (removal of the uterus). The day after surgery, what diet will her surgeon most likely order?
A. Regular C. Soft
B. Full liquid D. Clear liquid
50. Mr. John is a healthy, elderly patient with a good set of dentures. What type of diet would be most suitable for Mr. Johns?
A. Fat-restricted C. Liquid
B. Soft diet D. Regular diet
51. Someone who eats a fat-free diet could become deficient in:
A. Minerals C. Complete proteins
B. Fat-soluble vitamins D. Fat proteins
52. A pregnant woman who is retaining fluid (edema) will be placed on a:
A. Full liquid diet C. Bland diet
B. Low-sodium diet D. Low-cholesterol diet
53. A bland diet would most likely be prescribed for a patient with:
A. Hyperthyroidism C. Obesity
B. Heart disease D. Ulcer
54. A restricted residue diet is for treatment of:
A. Inflammation of the colon (colitis) C. Dehydration
B. Diabetes D. Both A and C
55. A patient with gallbladder disease would be on a _________ diet.
A. Clear liquid C. Soft
B. Low fat D. Low carbohydrate
56. Which item is NOT considered a fluid?
A. Ice cream C. Popsicle
B. Mashed potatoes D. Cream soup
57. Fluid thickness from least to most is:
A. Thin, nectar, honey, pudding C. Nectar, thin, honey, pudding
B. Thin, honey, nectar, pudding D. Honey, thin, nectar, pudding
58. How many kcals/ml do most intact enteral formulas contain?
A. 7 kcal/ml C. 5 kcal/ml
B. 2 kcal/ml D. 1 kcal/ml
59. What is the volume per feeding of a patient with a tube feeding prescription of 2100 kcal divided into 6 equal feeding 1.5:1
dilution?
A. 233 ml C. 350 ml
B. 150 ml D. 300 ml
60. A formula that approximates the osmolality of blood serum is referred to as:
A. Isotonic C. Hypertonic
B. Isocaloric D. Concentrated
61. Which of these food is not recommended to be used in a blenderized formula?
A. Malunggay leaves C. Chayote
B. Lugao D. White bread
62. A patient receive 500 ml of a 5% dextrose solution. How much calories did he receive?
A. 54 calories C. 85 calories
B. 100 calories D. 60 calories
63. Which of the following could be a possible cause of loose stools in a patient on tube feeding?
A. Feeding was administered at too rapid a rate C. The osmolality of the feeding formula was too low
B. Use of high fiber formula D. The patient is constipated
64. These are enteral formulas composed of single specific nutrients designed to be added to other formulas to alter nutrient
composition.
A. Elemental C. Polymeric
B. Modular D. Disease specific
65. One gram of dextrose is equivalent to how many calories?
A. 4 kcal C. 3.4 kcal
B. 7 kcal D. 8.3 kcal
66. The volume of formula that remains in the stomach from a previous feeding:
A. Bolus feeding C. Gastric residual
B. Aspiration D. Drip feeding
67. Loss of teeth and periodontal disease in the elderly can be managed by giving a:
A. Regular diet C. Mechanical soft diet
B. Liquid diet D. Tube feeding
68. The person who is a good candidate for central TPN rather than PPN:
A. Needs long-term parenteral nutrition support C. Is well nourished
B. Has strong peripheral veins and moderate nutrient needs D. Does not have high nutrient requirements
69. A patient has been NPO for 4 days. For the initial feeding you suggest a formula that is:
A. Low osmolality and lactose free C. High residue, low kcalories
B. Modular D. Milk-based
70. A new patient just admitted to the cardiac unit. On reviewing his chart, you notice the doctor has written an order for a low-
sodium diet. You attempt to contact the physician to clarify the level of sodium restriction, but are unable to reach him. You
should:
 A. Remove the salt packets from his tray before he can eat any food
B. Wait until you can contact the doctor before serving him his food
C. Contact the dietary department and arrange for a 2000 mg sodium diet until you can contact the doctor
D. Assume the dietary clerk will know which sodium level the physician means

TEST II. Identification. Choose your answers from the list of words provided. Write your choice on the space before the numbers.
NO ERASURES.
Set A.
Osmolality Diet RND Technician Bolus
Full Diet Adequate Health Rapid Feeding 45
Enteral Parenteral Creaming 100
Nutriture Dietary Requirement Therapeutic Diet Nutrition Therapy 3.4
Viscosity Renal Solute Load Caloric Density Cracking
Aggregation
1. It is the measure of the ability of a solution to lose or draw water though a semi-permeable membrane.
2. Refers to the resistance of a fluid to flow.
3. Considers the energy value of the food in relation to the volume.
4. Elevate the client’s upper body to at least ____ degrees to minimize risk of aspiration.
5. Is the intermittent, rapid administration of large volumes of formula (240-480 ml) over a very short period of time
usually by syringe in 10-15 minutes.
6. It is the provision of nutrients into the bloodstream intravenously to those who are unable to assimilate nutrients
provided via the GIT.
7. The accumulation of triglycerides at the top of emulsion.
8. Dextrose gives ____ kcal/g.
9. Refers to the amount of urea, sodium, potassium, and chloride in the urine.
10. Food and drink consumed regularly by an individual.
11. Is an individual who has completed a degree in nutrition-dietetics but did not take the board examination.
12. A state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.
13. For hospitalized patients whose condition does not require a modified diet.
14. The minimum amount of a specific nutrient needed by the body to attain a specified state of health.
15. A diet modified or adopted from the normal diet to suit specific disease conditions.

Set B.

Drug Pill Bioavailability Adverse Effect

Pharmacy Pharmacodynamics Pharmacogenetics GI disturbances
Liver Kidney Pancreas Warfarin
Vitamin B6 Corticosteroids Vitamin K Absorption rate
Polypharmacy Weight loss Weight gain Alcohol

1. Degree to which a drug or other substance reaches the circulation and becomes available to the target organ or tissue
2. Undesirable effect of a drug
3. Any chemical used to prevent or treat disease
4. Study of the physiologic and biochemical effects of a drug or combination of drugs
5. Major organ of metabolism of drugs
6. Major route of elimination for drugs and drug metabolites
7. Involves genetically determined variations that are revealed solely by the effects of drugs in the body
8. The use of multiple drugs to treat one or more health conditions
9. Most commonly reported side effects of drug therapy
10. What nutrient should NOT be taken when a patient is using warfarin?
11. What is the effect of metformin on nutritional status?
12. What class of drugs is most associated with weight gain?
13. Isoniazid causes what vitamin deficiency?
14. This should not be taken in with any drug, even over-the-counter drugs.
15. The percentage of a drug that is free to function at a given time

TEST III. Matching Type. Match Column A with Column B. Write the CAPITAL letter of your choice before the number in Column A.

Column A Column B
 1. strained fruit juices, fat-free clear broth, gelatin, tea, softdrinks E. Soft Diet
2. pureed meat in soup, liver spread, potted meat, soft-cooked F. Low Residue Diet
egg, milk, pureed strained lugao, pureed vegetables G. Hypoallergenic Diet
3. foods that are easily chewed and digested, mildly flavored, not H. Full Diet
fried I. Clear Liquid Diet
4. for ambulatory patients whose conditions do not require any J. Full Liquid Diet
dietary modification for therapeutic purposes K. Dysphagia Diet
5. pre-cut meats, foods in strips, wedges, or bite-sized cubes; use L. Ketogenic Diet
of adaptive equipment M. Finger-Food Modification
6. similar to low fiber diet, but includes restrictions on foods that Diet
increase bowel activity N. Gluten-Free Diet
7. high fat, low carbohydrate diet that helps to control seizures O. Purine-Restricted Diet
8. eliminates or restricts food or an ingredient found in food that
is suspected to cause an adverse reaction or hypersensitivity
response
9. eliminates barley, graham flour, wheat, oats, rye, flour starch
10. for those with difficulty in swallowing

TEST IV. Computations.

1. 1900 kcal. 2:1 kcal to ml ratio. 4/F. Use Glucerna SR.
a. Scoops per day?
b. Kcal per feeding?
c. Ml per feeding?
d. Scoops per feeding?
e. Protein per day?
2. 2000 kcal. 1:1 kcal to ml ratio. 6/F. Use Ensure Gold.
a. Scoops per day?
b. Kcal per feeding?
c. Ml per feeding?
d. Scoops per feeding?
e. Protein per day?