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RD Exam - Domain II, MNT(question and
answers)graded A+ 2023 updated to
pass
How do H₂ Blockers (Cimetidine, Ranitidine) help w/ gastric ulcers? - correct answer Prevents binding of histamine to receptor; decreases acid secretion Diverticulosis - correct answer Presence of diverticula (mucosal sacs in intestinal wall) rx: High fiber diet Diverticulitis - correct answer When diverticula become inflamed rx: Clear liquids (Low residue diet or elemental), gradual return to high fiber Describe how to tell if someone has lactose intolerance using the lactose tolerance test - correct answer If lactose intolerant - blood glucose will not rise past 25 mg/dl above fasting (flat curve) If tolerant - glucose will rise above 25 mg/dL (normal curve) What should be avoided w/ lactose intolerance? What might be tolerated? - correct answer Avoid - animal milk/milk products May tolerate - yogurt & small amounts of aged cheese What should be restricted in children up to age 6 in order to prevent chronic, nonspecific infantile diarrhea - correct answer No more that 4 oz or apple/grape juice 2' high osmolar loads What type of small bowel resection is more dangerous? What are some consequences? - correct answer ileal resection - ileum normally absorbs B₁₂, Intrinsic factor, bile salts, and major portion of fluid -If bile salts are recycled, lipids can't be emulsified --> malabsoprtion of fat-soluble vitamins
Nutritional Care for ileal resection - correct answer limit fat - use MCT oil (because it doesn't need bile salts for digestion) Parental B₁₂ initially followed by monthly injections What are the 4 liver enzymes and what is indicated if they are elevated? - correct answer ALP - Alkaline phosphatase LDH - lactic acid dehydrogenase AST - aspartate aminotransferase ALT - alanine aminotransferase Elevated liver enzymes indicates tissue damage Nutrition care for hepititis - correct answer Small, frequent feedings 2' anorexia High protein can help prevent fatty liver Describe how ascites occurs w/ liver disease - correct answer Connective tissue overgrowth blocks blood flow out of liver in to vena cava Fluid/blood builds up in liver, eventually leaking into peritoneal cavity High osmolar load pulls more fluid, leading to sodium & water retention What causes esophageal varicies? - correct answer Portal htn Wernicke-Korsakoff syndrome - correct answer confusion/ams 2' thamine deficiency - typically seen in alcoholic cirrhosis Typical treatments for ESLD - correct answer supplementing BCAAs - may not have benefit Lactulose - removes N Neomycin - destroys bacteria that produce ammonia Diet rx for HTN - correct answer low sodium ( ≤ 2400 mg), DASH diet
What does a BUN:Creatinine ratio < 10:1 indicate? - correct answer Renal damage May need dialysis Renal solute load - correct answer Measures solutes excreted in 1 L urine -mainly measures Nitrogen and electrolytes (sodium) Rx for someone with kidney stones - correct answer High fluid (1.5-2 L daily) to dilute urine Nephrosis/nephrotic syndrome (symptoms, rx) - correct answer Albuminuria, HLD Modest protein restriction (.8-1 k/kg) Low fat (<30% of kcals) What does a GRF need to be before you decide to restrict protein? - correct answer in CKD I,2,3 - If GFR < 60, rx .8 g/kg in CKD 4,5 - If GFR < 25, rx .6 g/kg Protein and kcal needs for hemodialysis? peritoneal dialysis? - correct answer HD Protein: 1.2 g/kg Kcals: 30-35 kcal/kg PD Protein: 1.2-1. Kcals: < 60 years old, 35 kcal/kg (including dialysate) ≥ 60 years old, 30-35 kcal/kg Normal blood glucose ranges (fasting and 2 hr post-prandial) - correct answer Fasting - 70-100 mg/dl 2hPH - < 140 mg/dl
Glucose ranges indicating DM fasting glucose tolerance test casual glucose hga1c - correct answer fasting ≥126 mg/dl GTT ≥ 200 mg/dl casual glucose ≥ 200 mg/dl if showing s/s of DM HgA1c ≥ 6. Goal for a1c in DM - correct answer <7% Describe the curve on a glucose tolerance blood test in normal vs. DM patients - correct answer Normal - sloped curve Diabetic curve - rounded Glycosylated Hemogloin - correct answer measures % of hemoglobin that has glucose attached Goals for all diabetics - correct answer -Maintain normal blood glucose (70-130 fasting, peak postprandial not more than 180) -Optimal lipid levels (LDL < 100, TG < 150, HDL >40M, >50F) -BP control (<130/80) Risk factors for gestational DM - correct answer BMI > 30 history of GDM Exchanges for bread/starch - correct answer CHO: 15 g Pro: 0-3 g Fat: 1g or less
Exchanges for fat serving - correct answer CHO: 0 Pro: 0 Fat: 5 g Rapid-acting insulin - correct answer onset: 5-15 min duration: 4 hours ex: aspart (Novolog), lispro (Humalog) Short-acting insulin - correct answer onset: 30-45 min duration: 3-6 hours ex: Regular insulin Intermediate-acting insulin - correct answer onset: 2-4 hours duration: 10-18 hours ex: NPH Long-acting insulin - correct answer onset: 2-4 hours duration: 18-24 hours ex: glargine (lantus), determir (Levemir) dawn phenomenon - correct answer natural increase in early morning blood glucose 2' increased glucose production by liver during over-night fast Acute ketoacidosis def and rx - correct answer hyperglycemia 2' insulin deficiency or excess CHO intake s/s: dehydration 2' polyuria, increased pulse rx: insulin, rehydration Acute hypoglycemia (s/s, rx) - correct answer s/s - slow pulse, hungry rx: 15 g of CHO q 15 minutes until glucose returns to > 70
Goal and teatments for postprandial or reactive hypoglycemia - correct answer def: overproduction of insulin or increased insulin sensitivity goal: prevent marked rise in blood glucose that would stimulate more insulin rx: avoid simple sugars, 5-6 small meals/day, spread intake of CHO throughout day Hyperthyroidism - correct answer elevated T₃ & T₄ increased BMR leads to weight loss Hypothyroidism - correct answer Low T₄; low to normal T₃ Decreased BMR leads to weight gain Galactosemia - correct answer missing enzyme prevents conversion of galactose-PO₄ -> glucose-1-PO⁴ treated solely by diet - galactose & lactose free Urea cycle defects - correct answer unable to synthesize urea, resulting in ammonia accumulation rx: protein restriction based on tolerance to lower ammonia Phenylketonuria (PKU) - correct answer Need diet low in phenylalanine because missing enzyme that metabolizes it Low protein, high CHO - may lead to dental carries Glycogen storage disease - correct answer Deficiency of glucose-6-phosphatase Liver can't convert glycogen to glucose - leads to hypoglycemia Homocystinuria - correct answer Inherited disorder of AA metabolism causes low folate, pyridoxine (B₆), B₁₂ Rx: supplement the 3 vitamins Rx for arthritis - correct answer general, well-balanced diet
MCV - what is tells you, normal ranges - correct answer mean corpuscular volume - tells you cell size wnl: 80-95 fl MCH - what it tells you, normal ranges - correct answer Mean corpuscular hemoglobin - tells you amount of hgb/cell color wnl: 27- Common allergens - correct answer peanuts, tree nuts, milk, wheat, soy, eggs, shellfish How does fever affect BMR? - correct answer BMR increases 7% for each degree rise in F temp (normal body temp is 98.6 F) Goals for care in burn patients - correct answer 1st - replace fluids & electrolytes lost 2nd - increase kcals and protein (1.5-3 g/kg) Results of physiologic stress - correct answer Little or no ketosis hyperinsulinemia hyperglycemia ↑glucagon Rx for thrush from oral infections - correct answer avoid spicy, acidic, strongly flavored foods provide bland liquids, soft foods, chilled/frozen foods Iatrogenic malnutrition - correct answer protein-calorie malnutrition 2' treatment, hospital, medications What BMI indicates obesity? - correct answer ≥ Rx for overweight children - correct answer wt maintenence
Indicators for parental nutrition - correct answer altered GI tract (inability to absorb nutrients/malabsoprtion) diffuse peritonitis intestinal obstruction short bowel syndrome hypermetabolic states (Ca patient on therapy) GI disorders Fistulas Severely malnourished pre-op patients Acute pancreatitis Critical care if expected to be NPO > 4-5 days and no EN possible Major concern in PN - correct answer translocation of gut baceria - could lead to sepsis Maximum rate of dextrose infusion - correct answer 4-5 mg/kg/minute to prevent hyperglycemia How to transitional-feed off of PN - correct answer Introduce full-strength EN at 30-40 ml/hr to establish tolerance Once tolerating 75% of needs via EN, can d/c PN Signs of Re-feeding syndrome - correct answer ↓Phos ↓Mag ↓K EAR - correct answer Estimated average requirements -for 50% of population AI - correct answer Adequate intake- used when insufficient evidence exists for EAR, RDA
realistic budget staff commitment support of target population At what BMI might a person be eligible for bariatric surgery? - correct answer BMI ≥ 40 or ≥ 35 w/ comorbidities Prader Willi syndrome - correct answer Congenital disorder where you do not sense satiety. Can lead to obesity by age 2. Best treatment is to control access to food. What are the recommendations for flouride supplementation in infants (birth - 6 months) infants (6-12 months) toddlers (12-24 months) children (2-3 years) - correct answer Birth - 6 months: fluoridated water, NO supplements 6-12 months: supplements if water supply is <.3 ppm Toddler: water+ supplements if necessary, toothpaste once able to spit out Children: water + supplements as needed, pea size-amount of tooth paste What is the consequence of infant sleeping w/ a bottle? - correct answer Baby bottle tooth decay Early childhood caries Achalasia (def, rx) - correct answer Disorder of lower esophageal sphincter motility; does not relax or open when swallowing & causes dysphagia rx: dysphagia diet - start w/ pureed moist thick foods Should sodium restriction be used in pregnancy induced htn? - correct answer No - because increased sodium demand w/ fluid retention in pregnancy
Elemental/chemically defined formula: use and composition - correct answer Predigested formulas used w/ malabsoption AAs, glucose or sucrose, small fat, vitamins, minerals, electrolytes What is transpyloric feeding and when is it needed? - correct answer Feeds passed pyloric valve in stomach Used in comatose patients or patients w/ no gag reflex What are water needs in EN patients? - correct answer 1 cc water/kcal What is generally the water composition of standard polymeric (1 kcal/cc) formulas? - correct answer 80- 86% water More kcal concentrated formulas have less water How do you calculate the kcal contribution of IV dextrose? - correct answer IV dextrose = 3.4 kcal/g (ml)(%)(3.4) How many kcals/cc are provided by 10% IVFE? 20% IVFE? - correct answer 10% IVFE = 1 kcal/cc 20% IVFE = 2 kcal/cc When should discharge planning begin? - correct answer Day 1 of a hospital stay What is the main cause of gastric ulcers? rx? - correct answer Helicobacter pylori bacteria Diet as tolerated Rx for hiatal hernia - correct answer small feedings, avoid late night snacks What type of surgeries might cause dumping syndrome? - correct answer Billroth I Billroth II
What area of the gut does Ulcerative colitis effect? What is the result? - correct answer Colon Chronic bloody diarrhea, loss of electrolytes Dietary rx for ESLD - correct answer moderate to high protein (1-1.5 g/kg) 30-35 kcal/kg Low sodium if ascites is present BCAA supplements might help w/ encephalopathy Anatomical consequences of a cholescystectomy - correct answer bile is now secreted from liver directly into intestine What is a major cause of pancreatitis - correct answer Blockage in ducts causes premature activation of enzymes within the pancreas, leading to autodigestion Rx for acute vs. chronic pancreatitis - correct answer Acute - elemental EN into jejunum may be tolerated (otherwise- bowel rest) Chronic - oral pancreatic enzyme replacement therapy w/ meals and snacks to avoid fat malabsorption
