Sample Chapter



Nutrition And Diet Therapy 8th Edition By Linda Kelly DeBruyne – 
Test Bank


Chapter 1 – Overview of Nutrition and Health


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. Minerals and water are organic and yield energy in the human body.


  1. An excess intake of any energy nutrient can lead to becoming overweight.


  1. The Dietary Reference Intakes are a set of standards that define the amount of energy, nutrients, other dietary components, and physical activity that best support health.


  1. To ensure that the vitamin and mineral recommendations meet the needs of as many people as possible, the recommendations are set near the top end of the range of the population’s estimated average requirements.


  1. Dietary Reference Intakes are values that are appropriate to use for planning and assessing diets for individuals and groups.
  2. Consuming nutrient-dense foods can help control your kcalorie intake.


  1. The ingredients list on a food label must list the ingredients in descending order of predominance by weight.


  1. A package of prunes states that the product is a good fiber source and the Nutrition Facts panel indicates the product contains 12% of the Daily Value for dietary fiber. This product can legally make this claim.
  2. A carton of yogurt claims that it is fat free and the Nutrition Facts panel indicates the product contains 5 grams of fat per serving. This product can legally make this claim.


  1. A package of cookies claims that the cookies are low kcalorie, and the Nutrition Facts panel indicates that each cookie contains 70 kcalories. This product can legally make this claim.


Nutrition in Practice – Finding the Truth about Nutrition


  1. There is no nationally accepted definition for the term nutritionist.


Multiple Choice


  1. The reason that most of us enjoy turkey and pumpkin pie at Thanksgiving is due to:
  2. habit.
  3. associations.
  4. values.
  5. emotional state.


  1. Personal preference plays a significant part in the food choices of an individual. Widely shared preferences include:
  2. a desire for sour tastes.
  3. significant nutritional value.
  4. tastes for salt and sugar.
  5. a craving for protein.


  1. You are at a friend’s house for dinner and high-fat foods are being served. You go ahead and consume these foods primarily because of:
  2. emotional state.
  3. associations.
  4. social interaction.
  5. ethnic heritage.


  1. Which of the following foods best exemplify the Asian culture?
  2. soybeans, squid, rice, peanuts
  3. tomatoes, olives, fish, mozzarella cheese
  4. tortillas, corn, avocado, refried beans
  5. black-eyed peas, biscuits, peaches, beef


  1. Which of the following characterizes the diet of most ethnic groups?
  2. excludes milk
  3. excludes green leafy vegetables
  4. excludes grains and grain products
  5. excludes meat and meat products


  1. Orange juice fortified with calcium to help build strong bones is an example of a(n):
  2. phytochemical.
  3. functional food.
  4. organic food.
  5. convenience food.


  1. All of the following nutrients are organic except:
  2. carbohydrate.
  3. fat.
  4. protein.
  5. minerals.


  1. The kcalorie content of a food depends on how much it contains of each of the following except:
  2. carbohydrate.
  3. fat.
  4. water.
  5. protein.


  1. Which of the following statements about vitamins is true?
  2. They are inorganic.
  3. They facilitate the release of energy from the energy-yielding nutrients.
  4. They are the medium in which all of the body’s processes take place.
  5. They provide energy to the body.


  1. The essential nutrients are those:
  2. the body can make for itself.
  3. that are predominant in most foods.
  4. that must be obtained from foods.
  5. included in the main DRI table.


  1. Which of the following becomes a major fuel for the body only when the other fuels are unavailable?
  2. carbohydrate
  3. fat
  4. protein
  5. water
  6. All of the following are energy-yielding nutrients except:
  7. carbohydrate.
  8. protein.
  9. fat.
  10. vitamins.


  1. Vitamins provide ___ kcalories per gram.
  2. 0
  3. 4
  4. 7
  5. 9


  1. How many kcalories are provided by a food that contains 25 g carbohydrate, 6 g protein, and 5 g fat?
  2. 172
  3. 169
  4. 142
  5. 102


  1. Which nutrient has the greatest energy density?
  2. carbohydrate
  3. protein
  4. fat
  5. vitamins


  1. How many fat kcalories are in a food that contains 15 grams of fat?
  2. 60
  3. 105
  4. 135
  5. 215


  1. Your friend always refers to meat as “protein.” You try to correct her by stating that:
  2. practically all foods contain mixtures of the energy-yielding nutrients.
  3. protein is not the predominant nutrient in meat.
  4. protein-rich foods are always high in fat.
  5. meat contains more carbohydrate than protein.


  1. Alcohol:
  2. is a nutrient.
  3. promotes maintenance and repair in the body.
  4. is not metabolized into energy.
  5. contributes to body fat.


  1. All of the following contain mixtures of the energy nutrients except:
  2. beef.
  3. potato.
  4. oil.
  5. legumes.


  1. Dietary Reference Intakes are designed to:
  2. recommend numbers of servings of food to eat per day.
  3. help food manufacturers decide on product contents and processing methods.
  4. meet minimum nutrient needs to prevent malnutrition in people.
  5. specify nutrient needs that best support the health of people in the United States and Canada.


  1. The Recommended Dietary Allowances:
  2. are designed primarily to prevent toxicities.
  3. are set when there is a lack of scientific data to generate an Adequate Intake.
  4. focus on all dietary components.
  5. are the foundation of the Dietary Reference Intakes.


  1. Which of the following Dietary Reference Intake categories is most appropriately used to develop and evaluate nutrition programs for groups?
  2. Estimated Average Requirement
  3. Tolerable Upper Intake Level
  4. Adequate Intake
  5. Recommended Dietary Allowance


  1. Consumers who take vitamin/mineral supplements should be aware that excessive intakes can pose hazards, and refer to the _____ values of the Dietary Reference Intakes.
  2. Adequate Intake (AI)
  3. Estimated Average Requirement (EAR)
  4. Recommended Dietary Allowance (RDA)
  5. Tolerable Upper Intake Level (UL)


  1. Which of the following statements is not true regarding the Dietary Reference Intakes?
  2. The DRI are designed to prevent nutrient deficiency diseases.
  3. The DRI focus on disease prevention.
  4. The DRI focus on adequacy of nutrients.
  5. The DRI apply to the diets of individuals.


  1. Dietary Reference Intakes may be used to:
  2. treat persons with diet-related illnesses.
  3. assess dietary nutrient adequacy.
  4. specify the minimum daily intake of all nutrients.
  5. estimate energy needs.


  1. A good indicator that an individual’s energy intake is appropriate is a healthy:
  2. height.
  3. weight.
  4. elbow breadth.
  5. body composition.


  1. An individual’s Estimated Energy Requirement (EER) is deemed adequate in the absence of:
  2. bone loss.
  3. weight gain or loss.
  4. obvious signs of malnutrition.
  5. body fat.


  1. According to the DRI committee, protein should provide ______ of daily kcalories.
  2. 45-65%
  3. 20-35%
  4. 10-35%
  5. 8-21%


  1. The data collected in nutrition surveys is used by the government to:
  2. establish public policy on nutrition education.
  3. regulate nutrition labeling on food products.
  4. decide what nutrition issues will be granted funds for research.
  5. assess the effectiveness of government publications about nutrition.
  6. One of the first nutritional surveys, taken before World War II, suggested:
  7. at least 90% of the population had adequate nutritional intakes.
  8. 75% of the population needed to change their eating habits.
  9. less than 5% of the population were eating appropriately.
  10. up to one-third of the population might be eating poorly.


  1. Major reports regarding the contribution of diet and nutrition status to the health of the people of the United States depend on information collected by the:
  2. Continuing Survey of Food Intakes by Individuals.
  3. National Health and Nutrition Examination Survey.
  4. National Nutrition Monitoring Program.
  5. Nationwide Food Consumption Survey.


  1. Healthy People is a program that sets goals every ____ years for improving the nation’s health.
  2. 5
  3. 7
  4. 10
  5. 20


  1. Nutrient density refers to foods that:
  2. are iron-rich.
  3. contain a mixture of carbohydrate, fat, and protein.
  4. carry nutrient labeling information.
  5. deliver the most nutrients for the least amount of kcalories.


  1. Research confirms that a common contributor to three of the leading causes of death is:
  2. undernutrition.
  3. overnutrition.
  4. lack of exercise.
  5. genetics.


  1. The six diet planning principles include:
  2. adequacy, B vitamins, carbohydrates, meat, variety, and portion control.
  3. abundance, balance, carbohydrates, moderation, vegetables, and variety.
  4. adequacy, balance, kcalorie control, moderation, variety, and nutrient density.
  5. abundance, B vitamins, kcalorie control, milk, vegetables, and nutrient density.


  1. Which of the following have the highest nutrient density?
  2. lamb, ice cream, and pre-sweetened cereal
  3. whole-grain bread, poultry, and skim milk
  4. cottage cheese, sweet potatoes, and ham
  5. dried apples, legumes, and pancakes


  1. Which of the following foods would provide the highest nutrient density for calcium?
  2. cheddar cheese
  3. fat-free milk
  4. ice cream
  5. frozen yogurt


  1. Foods such as potato chips, candy, and colas are called empty-kcalorie foods because they:
  2. are inexpensive.
  3. are lacking in calories.
  4. are low in nutrient density.
  5. should be eaten in moderation.
  6. You are advising a client on components of the Dietary Guidelines for Americans. Which of the following would you include in your advice?
  7. Increase vegetable and fruit intake
  8. Decrease intake of milk and milk products to two servings per day.
  9. Decrease intake of whole grains and other complex carbohydrates.
  10. Increase intake of trans fats and saturated fats.


  1. The 2010 Dietary Guidelines for Americans recommend that people over the age of 51 reduce their intake of sodium to:
  2. 1500 mg per day.
  3. 2300 mg per day.
  4. 3000 mg per day.
  5. 3200 mg per day.


  1. The 2010 Dietary Guidelines for Americans recommend keeping the consumption of trans fatty acids as low as possible. To do this, you would:
  2. avoid consuming tropical oils.
  3. avoid eating dairy products.
  4. avoid consuming partially hydrogenated oils.
  5. avoid eating avocadoes, olives, and nuts.


  1. The 2010 Dietary Guidelines specifically recommend replacing some of the meat and poultry you eat with:
  2. seafood.
  3. green leafy vegetables.
  4. dark green, red, and orange vegetables.
  5. milk and milk products.


  1. The group that is not a basic member of the USDA Food Guide is the:
  2. milk group.
  3. vegetables group.
  4. fruits group.
  5. grains group.
  6. fats and sugars group.


  1. A client consumes the following foods from the grain group of the USDA Food Guide: ½ cup oatmeal, 2 slices of bread, 3 cups popped popcorn, and 1 cup pasta. How many ounce equivalents did the client consume?
  2. 2
  3. 4
  4. 6
  5. 8


  1. According to the USDA Food Guide, someone who needs 2000 kcal/day should consume _____ cup(s) of milk or the equivalent in milk products each day.
  2. one
  3. two
  4. three
  5. four
  6. five


  1. The USDA Food Guide:
  2. emphasizes nutrient-dense foods within each food group.
  3. is a very rigid guide for providing a balanced diet.
  4. fails to encourage the consumption of whole grains.
  5. does not specify portion sizes.
  6. The difference between the kcalories needed to supply nutrients and those needed for energy is referred to as:
  7. nutrient density.
  8. the discretionary kcalorie allowance.
  9. the recommended kcalorie allowance.
  10. excess kilocalories.


  1. For comparison purposes, 3 ounces of meat can be visualized as being about the size of:
  2. a 9-volt battery.
  3. a CD case.
  4. a deck of cards.
  5. a paperback book.


  1. You are assessing your own diet. Which of the following would be the most practical tool to use?
  2. MyPyramid
  3. EARs
  4. DVs
  5. Dietary Guidelines for Americans


  1. Which of the following statements is true regarding nutrition information on foods?
  2. Nutrition information is required for the 20 most frequently eaten fresh fruits and vegetables.
  3. Food manufacturers held to strict standards, called standards of identity, are not required to list ingredients on their labels.
  4. Raw fish must provide nutrition information on labels.
  5. Plain coffee, tea, spices and other foods containing few nutrients are exempt from nutrition labeling requirements.


  1. A set of nutrient standards designed strictly for use on food labels is called the:
  2. Recommended Dietary Allowances.
  3. Dietary Reference Intakes.
  4. Daily Values.
  5. FAO recommendations.


  1. The Nutrition Facts label must contain information about which minerals, according to labeling standards?
  2. calcium and iron
  3. calcium and magnesium
  4. iron and potassium
  5. iron and zinc


  1. To be labeled as “healthy,” a food must be low in fat, saturated fat, cholesterol, and sodium, and contain at least _____% of the DV for vitamin A, vitamin C, iron, calcium, protein, or fiber.
  2. 5
  3. 10
  4. 15
  5. 20


  1. Which of the following health claims linking nutrients and food constituents to disease states is not on the FDA’s list of reliable health claims?
  2. calcium and osteoporosis
  3. zinc and immune system response
  4. folate and neural tube defects
  5. dietary fat and cancer
  6. According to the Dietary Guidelines for Americans, nutrients of concern that Americans need to consume more of include
  7. sodium, fiber, magnesium, and vitamin A.
  8. potassium, fiber, calcium, and vitamin D.
  9. vitamin D, fluoride, protein, and niacin.
  10. calcium, iron, omega-3 fatty acids, and sodium.


  1. Statements on the label of a food or dietary supplement about the substance’s effect on a structure or function of the body are called:
  2. “B” list claims.
  3. structure-function claims.
  4. scientific evidence.
  5. unsupported claims.


  1. In order to comply with recommendation of the 2010 Dietary Guidelines for Americans regarding vegetable intake, you should eat more:
  2. spinach.
  3. summer squash.
  4. green beans.
  5. potatoes.


  1. Which of the following foods is not considered a protein food?
  2. green beans
  3. almonds
  4. pinto beans
  5. shrimp


Nutrition in Practice – Finding the Truth about Nutrition


  1. Which of the following is not a red flag of junk science?
  2. a product that promises a quick and easy fix
  3. a claim made to help sell a product
  4. a simple conclusion drawn from a complex study
  5. an abstract published on the NLM’s PubMed website


  1. When searching the Internet for a credible source of nutrition information, one should go to the website of a:
  2. government health agency.
  3. national health food store chain.
  4. multi-level marketing company that sells supplements.
  5. popular fitness magazine.


  1. The FDA advises consumers that:
  2. a product that is labeled as “natural” and “non toxic” is always safe to use.
  3. products based on “ancient remedies” are preferable to those based on modern “scientific breakthroughs.”
  4. they should be suspicious of product claims that use impressive-sounding medical terms.
  5. an offer of a “money-back” guarantee from the manufacturer means the product is more likely to be effective.


  1. The primary nutrition expert on the health care team is the:
  2. dietetic technician.
  3. registered dietitian.
  4. nutritionist.
  5. nutrition consultant.



  1. Identify and give an example of each of the thirteen factors which influence food choices.


  1. Provide a rationale for the following statement: “Too much meat is just as fattening as too many potatoes.”


  1. List and briefly describe the major categories of Dietary Reference Intakes and their uses.


  1. List the six principles of diet planning and briefly describe each one.


  1. Explain the difference between a health claim and a structure-function claim on a food label.


  1. Identify characteristics of the Daily Values used on food labels, and explain their appropriate uses.




a.     a set of values for the dietary nutrient intakes of healthy people in the United States and Canada.

b.     a set of values reflecting the average daily amounts of nutrients considered adequate to meet the known nutrient needs of practically all healthy people in a particular life stage and gender group; a goal for dietary intake by individuals.

c.     a set of values that are used as guides for nutrient intakes when scientific evidence is insufficient to determine RDA.

d.     the lowest continuing intake of a nutrient that will maintain a specified criterion of adequacy.

e.     in regard to nutrient intake, the amount below which almost all healthy people can be expected, over time, to experience deficiency symptoms.

f.     the average daily nutrient intake levels estimated to meet the requirements of half of the healthy individuals in a given age and gender group.

g.     A set of values reflecting the highest average daily nutrient intake levels that are likely to pose no risk of toxicity to almost all healthy individuals in a particular life stage and gender group.

h.     the dietary energy intake level that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, and physical activity level consistent with good health.

i.      ranges of intakes for the energy-yielding nutrients that provide adequate energy and nutrients and reduce the risk of chronic disease.





Chapter 2 – Carbohydrates


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. Whenever carbohydrate is available to the body, the human brain depends exclusively on it as an energy source.


  1. Most food fiber is kcalorie-free.


  1. A client consumes 2600 kcalories per day and 50 grams of carbohydrate from concentrated sweets. According to the USDA Food Guide recommendations, the client’s sugar intake is within the guidelines.


  1. Experts agree that moderate amounts of sugar in the diet may pose a number of major health risks.


  1. A client consumes 2000 kcalories per day and 200 grams of carbohydrate. This person meets the current dietary recommendations for carbohydrate intake.


  1. Cindy consumed 2 servings of vegetables, 2 servings of fruit, 5 servings of whole grains, and 2 servings of legumes during the day. Cindy meets the DV recommendation for fiber for the day.


Multiple Choice


  1. The main function of carbohydrates in the body is to:
  2. furnish the body with energy.
  3. provide material for synthesizing cell walls.
  4. synthesize fat.
  5. insulate the body to prevent heat loss.


  1. Which of the following is a simple carbohydrate?
  2. starch
  3. glycogen
  4. sucrose
  5. some fibers


  1. The _____ are the basic units of all carbohydrates.
  2. monosaccharides
  3. disaccharides
  4. polysaccharides
  5. sucrose molecules


  1. Three monosaccharides important in nutrition are:
  2. glucose, lactose, and fructose.
  3. fructose, glucose, and sucrose.
  4. maltose, fructose, and lactose.
  5. galactose, sucrose, and lactose.
  6. fructose, glucose, and galactose.


  1. The primary source of energy for the brain and nervous system under normal conditions is:
  2. sucrose.
  3. amino acids.
  4. fructose.
  5. glucose.
  6. fatty acids.


  1. The hormone that moves glucose from the blood into the cells is:
  2. glucagon.
  3. insulin.
  4. testosterone.
  5. sucrose.


  1. Which of the following does not come exclusively from plants?
  2. glucose
  3. maltose
  4. fructose
  5. galactose


  1. Fructose is:
  2. the sweetest of the sugars.
  3. known as milk sugar.
  4. abundant in whole grains.
  5. also known as dextrose.


  1. Fructose occurs naturally in:
  2. bread.
  3. milk.
  4. meats.
  5. fruits.


  1. Which monosaccharide is found most often in nature as a part of a disaccharide?
  2. glucose
  3. fructose
  4. maltase
  5. galactose


  1. Which of the following compounds is a disaccharide?
  2. glucose
  3. fructose
  4. lactose
  5. galactose


  1. All of the following terms are used to describe sucrose except:
  2. white sugar.
  3. milk sugar.
  4. table sugar.
  5. cane sugar.


  1. The most familiar source of sucrose is:
  2. bread.
  3. table sugar.
  4. milk.
  5. meat.
  6. fruit.
  7. The principle carbohydrate in cakes and cookies is:
  8. fructose.
  9. galactose.
  10. maltose.
  11. sucrose.


  1. One molecule of sucrose contains _____ molecule(s) of glucose.
  2. one
  3. two
  4. three
  5. four


  1. Which of the following is the principal carbohydrate in milk?
  2. galactose
  3. fructose
  4. sucrose
  5. lactose


  1. Chemically, lactose is a:
  2. monosaccharide.
  3. disaccharide.
  4. dextrose.
  5. polysaccharide.


  1. An example of a polysaccharide is:
  2. starch.
  3. meat.
  4. fruit.
  5. protein.


  1. Which of the following carbohydrates is a polysaccharide?
  2. fructose
  3. starch
  4. maltose
  5. lactose


  1. The stored form of glucose in the body is called:
  2. glycogen.
  3. insulin.
  4. fat.
  5. muscle.


  1. Polysaccharides are composed of:
  2. one glucose unit.
  3. two glucose units.
  4. three glucose units.
  5. many glucose units.


  1. Excess glucose in the blood is converted into glycogen and stored primarily in the:
  2. brain and liver.
  3. liver and muscles.
  4. blood cells and brain.
  5. pancreas and brain.


  1. The richest sources of starch are:
  2. fruits.
  3. grains.
  4. vegetables.
  5. soybeans.


  1. Whole grains, vegetables, legumes, and fruits are rich sources of:
  2. sucrose.
  3. dietary fiber.
  4. fat.
  5. glycogen.


  1. Cellulose, pectin, hemicellulose, and gums are:
  2. artificial sweeteners.
  3. sugar alcohols.
  4. fibers.
  5. simple carbohydrates.


  1. _____ is a fiber found in all vegetables, fruits, and legumes.
  2. Hemicelluose
  3. Pectin
  4. Mucilage
  5. Cellulose


  1. Which of the following fibers is a nonpolysaccharide?
  2. cellulose
  3. lignin
  4. pectin
  5. gum


  1. All of the following fibers are used by the food industry as additives or stabilizers except:
  2. pectins.
  3. gums.
  4. lignins.
  5. mucilages.


  1. _____ escape digestion and absorption in the small intestine.
  2. Resistant starches
  3. Polysaccharides
  4. Bacteria
  5. Disaccharides


  1. Fibers are categorized by:
  2. the type of chemical bonds that hold them together.
  3. their chemical and physical properties.
  4. the number of hydrogen molecules they contain.
  5. their ability to be digested by human enzymes.


  1. The sugars in fruits, vegetables, grains, and milk are:
  2. usually added to these foods.
  3. considered discretionary kcalories.
  4. naturally occurring.
  5. resistant to digestion.


  1. The steady upward trend in sugar consumption among Americans can be attributed to:
  2. consumer demand.
  3. food manufacturers.
  4. better food preservation techniques.
  5. improved food safety practices.


  1. The leading source of added sugar in the American diet is:
  2. baked goods such as cookies and cakes.
  3. fruit packed in heavy syrup.
  4. soft drinks and other sugar-sweetened beverages.
  5. chocolate bars and other candy treats.


  1. According to the World Health Organization’s recommendations, no more than _____% of daily kcalories should come from added sugars.
  2. 5
  3. 10
  4. 15
  5. 20


  1. Which of the following statements best describes the role of sugar in the development of obesity?
  2. Sugar consumption is a direct cause of weight gain leading to obesity.
  3. The increased use of added sugars by food manufacturers is the cause of obesity.
  4. Sugar contributes to obesity when it is part of excessive energy intakes.
  5. There is a direct correlation between the consumption of added sugars and the rise in obesity.


  1. Which of the following statements about excessive sugar consumption is true?
  2. It causes cancer.
  3. It causes heart disease.
  4. It causes dental caries.
  5. It causes hyperactive behavior in children.


  1. Which of the following ingredients represents a sugar alcohol?
  2. polydextrose
  3. maltitol
  4. cellulose
  5. aspartame


  1. How many kcalories are provided by 100 grams of carbohydrate?
  2. 100
  3. 200
  4. 300
  5. 400


  1. Sweeteners that yield energy are called:
  2. nutritive sweeteners.
  3. artificial sweeteners.
  4. resistant sweeteners.
  5. glycemic sweeteners.


Ice Cream

A carton of ice cream contains the following list of ingredients: milkfat and nonfat milk, sorbitol, pecans, cellulose, butter, caramel color, citric acid, aspartame, carrageenan.


  1. Refer to Ice Cream. How many alternative sweeteners are contained in this product?
  2. one
  3. two
  4. three
  5. four


  1. Refer to Ice Cream. How many artificial sweeteners are contained in the product?
  2. one
  3. two
  4. three
  5. four


  1. The artificial sweetener sucralose is made from:
  2. sucrose.
  3. an amino acid.
  4. aspartame.
  5. maltose.


  1. The artificial sweetener that is similar in structure to fructose is:
  2. tagatose.
  3. neotame.
  4. sucralose.
  5. stevia.


  1. Which of the following foods would you recommend to someone interested in lowering his or her blood cholesterol level?
  2. wheat bread
  3. oatmeal
  4. strawberries
  5. pork


  1. Soluble fiber can help reduce blood cholesterol levels by:
  2. converting cholesterol into vitamin D.
  3. binding cholesterol and carrying it out of the body with the feces.
  4. blocking the absorption of bile.
  5. preventing the production of bile.


  1. Which of the following statements is not true regarding the health benefits of fiber?
  2. Fiber aids in weight management.
  3. Fiber aids in reducing the risk of type 2 of diabetes.
  4. Fiber aids in overall health of the gastrointestinal tract.
  5. Fiber aids in the prevention of osteoporosis.


  1. The _____ describes the effect a food has on blood glucose levels.
  2. glycemic index
  3. insulin index
  4. solubility factor
  5. viscosity index


  1. Soluble fibers are found in:
  2. celery, wheat bran, and corn.
  3. kidney beans, apples, and oatmeal.
  4. corn, apples, and sunflower seeds.
  5. celery, soybeans, and bran flakes.


  1. Which of the following is the most effective at alleviating constipation?
  2. cellulose
  3. pectin
  4. gums
  5. psyllium


  1. Carbohydrate should contribute approximately _____% of the total daily energy intake.
  2. 35-40
  3. 45-55
  4. 45-65
  5. 55-60


  1. A 2000-kcalorie diet that provides 175 grams of carbohydrate provides:
  2. inadequate carbohydrate.
  3. excessive carbohydrate.
  4. an appropriate amount of carbohydrate.
  5. inadequate fiber.


  1. The Dietary Reference Intake for dietary fiber is approximately _____ grams per day.
  2. 10-15
  3. 15-25
  4. 25-35
  5. 35-50


  1. Grains, legumes, and root vegetables contain predominantly:
  2. simple sugars and fiber.
  3. starches and fiber.
  4. fat and fiber.
  5. simple sugars and fat.


  1. Foods richest in carbohydrates are:
  2. eggs, cheese, and milk.
  3. rice, broccoli, and apples.
  4. milk, nuts, and oils.
  5. mayonnaise, butter, and salad dressing.


  1. Which of the following groups contains the least carbohydrate?
  2. grains and starchy vegetables
  3. nuts and dried fruits
  4. milk and cheese
  5. fruits and vegetables


  1. Jeff consumed the following foods for a meal: small baked potato, ½ cup of carrots, 1 cup skim milk, and 1 small banana. Approximately how many grams of carbohydrate did Jeff consume?
  2. 47
  3. 57
  4. 66
  5. 69


  1. A valid concern about excessive sugar consumption is:
  2. an increased risk for developing cancer.
  3. its contribution to behavioral problems in children.
  4. the potential for malnutrition.
  5. an increased risk for developing hypertension.


  1. High-fructose corn syrup is composed of:
  2. fructose and glucose.
  3. glucose and galactose.
  4. sucrose and maltitol.
  5. fructose and galactose.


  1. Which of the following is the equivalent of 1 teaspoon of white sugar?
  2. 1 tablespoon of catsup
  3. 1 tablespoon of jelly
  4. 2 oz. of a carbonated soft drink
  5. 3 teaspoons of honey


  1. Aspartame is made from:
  2. sucrose.
  3. fructose.
  4. two amino acids.
  5. two monosaccharides.


  1. The World Health Organization set an upper limit for fiber intake at _____ grams per day.
  2. 30
  3. 40
  4. 50
  5. 60


Nutrition in Practice – The Glycemic Index in Nutrition Practice


  1. The glycemic index ranks carbohydrate foods based on their effect on:
  2. blood glucose and insulin levels.
  3. blood pressure.
  4. weight.
  5. blood cholesterol and triglyceride levels.


  1. The glycemic index of a food can be measured by comparing the increase in one’s blood glucose levels after consuming a carbohydrate to that caused by a reference food such as:
  2. white bread.
  3. a banana.
  4. ice cream.
  5. oatmeal.


  1. Which of the following breakfast foods has the lowest glycemic index?
  2. cornflakes
  3. instant oatmeal
  4. white bagel
  5. cooked oatmeal


  1. Factors that influence the GI value of a food include all of the following except the
  2. structure of the starch.
  3. fiber content in the food.
  4. manner in which the food was processed.
  5. time of day the food is consumed.


  1. People with _____ may benefit from limiting their intake of high-GI foods.
  2. heart disease
  3. arthritis
  4. diabetes
  5. migraine headaches


  1. Which of the following statements most accurately reflects current recommendations about the glycemic index?
  2. People with type 2 diabetes may benefit from limiting high-GI foods.
  3. High-GI foods such as potatoes and bread should be avoided.
  4. There is ample evidence that low-GI diets should be recommended for the general population.
  5. All foods with a GI greater than 70 should be avoided until further research is done.





a.     a hormone secreted by the pancreas in response to high blood glucose; promotes cellular glucose uptake.

b.     a hormone that is secreted by special cells in the pancreas in response to low blood glucose concentration; elicits release of glucose from storage.

c.     a measure of the extent to which a food raises the blood glucose concentration and elicits an insulin response, as compared with pure glucose.

d.     the more common type of diabetes in which the fat cells resist insulin.

e.     indigestible food components that readily dissolve in water and often impart gummy or gel-like characteristics to foods.

f.     having a gel-like consistency.

g.     the tough, fibrous structures of fruits, vegetables, and grains; indigestible food components that do not dissolve in water.

h.     the amount of an artificial sweetener that individuals can safely consume each day over the course of a lifetime without adverse effect.





  1. Of all the possible alternatives, why is carbohydrate the preferred energy source?


  1. How would you respond to the statement that honey is more nutritious than white sugar?


  1. Compare and contrast the 6 FDA-approved artificial sweeteners.


  1. Describe how fiber-rich foods help with weight control.


  1. Discuss the harmful effects of excessive fiber intake.


  1. Given the nutrient information on food labels, how could you determine the number of grams of starch in a food product?


  1. Differentiate between added sugars and naturally occurring sugars.


  1. Does high-fructose corn syrup contribute to obesity more than other types of sugar? Explain your answer.





Chapter 3 – Lipids


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. A triglyceride must contain specific combinations of fatty acids.


  1. High intakes of saturated and trans fat increase the risk of heart disease by lowering LDL and raising HDL cholesterol.


  1. Not all fatty acids have the same cholesterol-raising effect.


  1. Foods that are thought of as protein-rich foods may actually contain more fat energy than protein energy.


  1. It is possible to consume too little fat.


  1. Research has shown that fat substitutes are always effective at promoting weight loss.


Multiple Choice


  1. Fat functions in the body to:
  2. provide energy.
  3. regulate body processes.
  4. build muscle tissue.
  5. synthesize enzymes.


  1. The body fuel that can be stored in unlimited amounts is:
  2. glycogen.
  3. fat.
  4. protein.
  5. glucose.


  1. Which of the following does not describe a function of fat?
  2. It provides insulation to the body.
  3. It is an essential constituent of cell membranes.
  4. It is the best source of energy for the brain.
  5. It is a storage form of energy.


  1. Which of the following fats predominates in the diet and in the body?
  2. triglycerides
  3. cholesterol
  4. phospholipids
  5. lecithins


  1. The compound that forms the backbone of triglycerides is called:
  2. glycerol.
  3. fatty acid.
  4. acetic acid.
  5. glycogen.


  1. Fatty acids are packaged with _____ to make a triglyceride.
  2. glycerol
  3. glycogen
  4. glucose
  5. sucrose


  1. The term “unsaturated fat” means that:
  2. its carbon chains contain fewer than ten carbons.
  3. the fat lacks glycerol.
  4. hydrogens are missing in the fatty acid chains.
  5. the fat is solid at room temperature.


  1. A fatty acid with two or more double bonds is described as:
  2. monounsaturated.
  3. polyunsaturated.
  4. emulsified.
  5. homogenized.


  1. Which of the following contains the softest fat?
  2. pork fat
  3. chicken fat
  4. beef tallow
  5. lard


  1. When exposed to oxygen, fats can become _____.
  2. saturated
  3. hydrogenated
  4. rancid
  5. trans fats


  1. Food producers hydrogenate unsaturated fatty acids in order to:
  2. make them softer.
  3. give foods a longer shelf life.
  4. make them more healthy.
  5. reduce the kcalories in a food.


  1. Trans-fatty acids are:
  2. naturally found in some foods.
  3. beneficial to health.
  4. created by an oxidation reaction.
  5. essential.


  1. Trans fatty acids are found in the greatest amounts in:
  2. animal foods.
  3. plant foods.
  4. foods made with partially hydrogenated oils.
  5. the essential fatty acids.


  1. Which of the following compounds cannot be synthesized in the body in amounts sufficient to meet physiological needs?
  2. lecithin
  3. cholesterol
  4. linoleic acid
  5. glycogen


  1. An essential fatty acid is one which:
  2. is necessary and made by the body in large quantities.
  3. comes only from plant foods.
  4. is necessary and must be supplied by food.
  5. comes only from animal sources.


  1. Linolenic acid is classified as an essential fatty acid because it:
  2. neutralizes cholesterol.
  3. cannot be made from other substances in the body.
  4. is a monounsaturated fatty acid.
  5. is found in both animal and plant foods.


  1. Linoleic and linolenic fatty acids are both:
  2. phospholipids.
  3. trans fats.
  4. monounsaturated fatty acids.
  5. essential fatty acids.


  1. Linoleic acid is found primarily in:
  2. plant oils.
  3. fish oils.
  4. fast foods.
  5. refined grains.


  1. All of the following are examples of omega-3 fatty acids except:
  2. EPA.
  3. linolenic.
  4. DHA.
  5. linoleic.


  1. EPA and DHA are:
  2. omega-6 fatty acids.
  3. omega-3 fatty acids.
  4. found primarily in plant oils and seeds.
  5. made from linoleic acid.


  1. _____ fatty acids are essential for normal growth and development and appear to play an important role in the prevention and treatment of many chronic diseases.
  2. Monounsaturated
  3. Saturated
  4. Omega-3
  5. Omega-6


  1. The phosphate group on a phospholipid:
  2. enables phospholipids to dissolve in water.
  3. makes the phospholipid saturated.
  4. prevents the digestion of lecithin supplements.
  5. competes with fatty acids.


  1. The lecithin needed for building cell membranes and other functions:
  2. should be consumed as a supplement.
  3. must be furnished in the diet.
  4. is made from scratch by the liver.
  5. is an essential nutrient.


  1. Which of the following is not a sterol?
  2. cholesterol
  3. lecithin
  4. vitamin D
  5. sex hormones


  1. Which of the following foods does not contain cholesterol?
  2. eggs
  3. cheese
  4. milk
  5. peanut butter


  1. Which of the following is not true regarding plant sterols?
  2. They are structurally similar to cholesterol.
  3. They interfere with cholesterol absorption.
  4. They raise blood cholesterol levels.
  5. They help to reduce blood cholesterol levels.


  1. The liver can make cholesterol from:
  2. carbohydrate or fat.
  3. carbohydrate or protein.
  4. phospholipids or bile.
  5. phospholipids or protein.


  1. The main route for excretion of cholesterol from the body is:
  2. via the lungs.
  3. in the urine.
  4. in the feces.
  5. through the skin.


  1. Excessive consumption of saturated fat or trans fat may result in:
  2. weight loss due to extra digestive involvement.
  3. reduced serum cholesterol levels.
  4. storage of the essential fatty acid, linoleic acid.
  5. an increased risk of developing cardiovascular disease.


  1. Which of the following statements about cholesterol is not true?
  2. Cholesterol in food is not the main factor in raising blood cholesterol.
  3. High blood levels of HDL cholesterol raise the risk of heart disease.
  4. Cholesterol is found only in animal foods.
  5. Some vegetable fats can contribute to high blood levels of cholesterol.


  1. Which of the following statements is true?
  2. Saturated fatty acids elevate LDL blood cholesterol.
  3. Polyunsaturated fatty acids elevate LDL blood cholesterol.
  4. Monounsaturated fatty acids elevate LDL blood cholesterol.
  5. Trans fatty acids lower LDL blood cholesterol.


  1. Trans-fatty acids contribute to heart disease by:
  2. producing inflammation in the arteries.
  3. contributing to high blood pressure.
  4. causing blood clots.
  5. causing irregular heartbeats.


  1. Jack is confused about whether to use margarine or butter. Which of the following is the best advice for him?
  2. Use margarine instead of butter because it contains no cholesterol and protects against heart disease.
  3. Use butter instead of margarine since margarine contains trans-fatty acids, which are harmful.
  4. Choose soft or liquid margarine that contains 0 grams of trans fat instead of hard margarine or butter.
  5. Eliminate both butter and margarine from your diet.


  1. Since 2006, food manufacturers have been required to list the amount of _____ fatty acids on the food label.
  2. trans
  3. polyunsaturated
  4. monounsaturated
  5. essential


  1. Which of the following fats is mostly monounsaturated?
  2. canola oil
  3. corn oil
  4. soybean oil
  5. margarine


  1. Which of the following is a rich source of monounsaturated fat?
  2. olive oil
  3. coconut oil
  4. sunflower oil
  5. corn oil


  1. People who live in the Mediterranean area have lower rates of heart disease. This is often attributed to:
  2. the fact that food manufacturers are not allowed to use trans fats.
  3. the liberal use of olive oil.
  4. decreased sodium intake.
  5. the liberal use of safflower oil.


  1. Vegetable oils contain large amounts of:
  2. short-chain fatty acids.
  3. saturated fatty acids.
  4. polyunsaturated fatty acids.
  5. medium-chain fatty acids.


  1. Rich sources of polyunsaturated fatty acids are found in:
  2. lamb.
  3. egg yolk.
  4. milk.
  5. sunflower oil.


  1. Polyunsaturated fats:
  2. are more abundant in plant foods than in animal products.
  3. are more solid than saturated fats.
  4. don’t spoil as easily as saturated fats.
  5. do not have any health benefits.


  1. Due to the increased production and use of vegetable cooking oils by food manufacturers, Americans need to consume more:
  2. omega-3 fatty acids.
  3. omega-6 fatty acids.
  4. monounsaturated fatty acids.
  5. essential fatty acids.


  1. Which of the following would be the best way to increase your intake of omega-3 fatty acids?
  2. Eat more fish.
  3. Eat more seed oils.
  4. Take supplements.
  5. Eat more plants.


  1. The American Heart Association recommends that individuals consume at least _____ serving(s) of fatty fish each week.
  2. 1
  3. 2
  4. 3
  5. 4


  1. Which fish would be most likely to contain high levels of mercury?
  2. salmon
  3. catfish
  4. pollock
  5. shark


  1. Connie wants to increase her intake of omega-3 fatty acids in an effort to prevent heart disease, hypertension, and cancer. Which of the following would you recommend to Connie?
  2. increase consumption of vegetable oils
  3. take omega-3 supplements
  4. eat a variety of different types of fatty fish
  5. increase consumption of nuts


  1. A 2000-kcalorie diet that provides 25% of kcalories from fat would contain _____ grams of fat.
  2. 500
  3. 550
  4. 55
  5. 15


  1. Current dietary guidelines regarding fat include all of the following except:
  2. total fat intake should not exceed 35% of kcalories.
  3. saturated fats should contribute less than 10% of kcalories.
  4. an upper limit of 300 milligrams cholesterol daily.
  5. polyunsaturated fats should provide at least 10% of kcalories.


  1. Compared to carbohydrate, fat is:
  2. not useful for providing energy.
  3. a more concentrated form of energy.
  4. a faster source of energy.
  5. a less concentrated form of energy.


  1. Approximately how many grams of fat do three tablespoons of salad dressing add to a salad?
  2. 12
  3. 15
  4. 27
  5. 30


  1. Invisible fats include the fats in:
  2. margarine.
  3. fried foods.
  4. shortening.
  5. sour cream.


  1. A change from whole milk to skim milk would:
  2. decrease the amount of saturated fat.
  3. increase the number of kcalories.
  4. decrease the amount of calcium.
  5. increase vitamin consumption.


  1. Five grams of fat provide _____ kcalories.
  2. 5
  3. 20
  4. 45
  5. 65


  1. Which of the following food groups always contains fat?
  2. fruits
  3. grains
  4. meats
  5. vegetables


  1. Which of the following spreads would add the least amount of fat to a bagel?
  2. jelly
  3. margarine
  4. butter
  5. reduced-fat cream cheese


  1. Sally eats meat but wants to reduce her saturated fat and cholesterol intake. Which of the following should Sally do?
  2. eliminate dairy foods from her diet
  3. eat less meat and include more fruits, vegetables, and grains in her diet
  4. eat more eggs and less meat
  5. eliminate beef and pork from her diet


  1. If Ann is watching her weight, which of the following suggestions would be most beneficial to her?
  2. Use margarine instead of butter.
  3. Switch from whole milk to fat-free milk.
  4. Eliminate fat from your diet.
  5. Choose processed meats instead of fresh meats.


  1. Food manufacturers use all of the following techniques to reduce the fat and kcalories in food except:
  2. adding water to the food.
  3. whipping air into the food.
  4. rearranging the molecules in the fat.
  5. baking foods instead of frying them.


  1. Characteristics of olestra include all of the following except:
  2. it is made with sucrose.
  3. it passes through the body unabsorbed.
  4. it is used in some snack foods.
  5. it can be toxic.


  1. Which statement is true?
  2. The use of sugars and proteins as fat replacers results in higher-kcal products.
  3. Unlike a triglyceride, an olestra molecule does not contain fatty acids.
  4. Fat replacers made from oats can be beneficial additions to the diet.
  5. Since it is not absorbed, olestra does not affect the absorption of nutrients.


  1. Consumers should keep the following in mind about foods made with fat substitutes:
  2. They are a weight loss wonder.
  3. They still provide kcalories.
  4. They aid in the absorption of certain vitamins.
  5. They adversely affect the taste and texture of foods.


Nutrition in Practice – Figuring Out Fats


  1. Recommendations for fat intake have changed over the years due to:
  2. poor interpretation of the results of scientific research.
  3. increased scientific understanding about types of fat and how they affect health.
  4. misinterpretation of recommendations by the media.
  5. disagreement between the medical community and government agencies.


  1. Researchers are steering away from population-wide recommendations for low-fat diets because:
  2. most people don’t follow them anyway.
  3. there have been reports of nutrient deficiencies associated with low-fat diets.
  4. some sources of fat are valuable to health and should not be avoided.
  5. low-fat diets really aren’t beneficial after all.


  1. Today’s recommendations for fat intake emphasize:
  2. lowering the intake of all types of fat.
  3. low-fat diets only for those at risk for heart disease.
  4. replacing saturated and trans fats with unsaturated fats.
  5. consuming no more than 20 grams of fat per day.


  1. Which nutrition guidelines emphasize that the human body has no need for saturated fat or trans fat?
  2. MyPyramid
  3. RDA
  4. DRI
  5. Dietary Guidelines for Americans


  1. Which type of nut seems to exert the most favorable effect on blood lipid levels?
  2. peanuts
  3. pecans
  4. walnuts
  5. macadamia


  1. Which snack food (in a reasonable portion size) would be the best choice for a person wanting to decrease his or her risk of heart disease?
  2. almonds
  3. unsalted crackers
  4. baked chips
  5. popcorn


  1. Which of the following high-fat foods would be the least desirable to consume if one is concerned about reducing one’s risk of heart disease?
  2. avocados
  3. walnuts
  4. potato chips
  5. canned tuna


  1. Olive oil helps to protect against heart disease because it:
  2. lowers HDL levels.
  3. enhances the inflammatory response.
  4. lowers total and LDL cholesterol.
  5. increases blood clotting factors.


  1. Nuts may protect against heart disease in all of the following ways except:
  2. they are low in saturated fat.
  3. they are high in vegetable protein, fiber, and vitamin E.
  4. they contain phytochemicals.
  5. they are low in monounsaturated fats.




a.     the term used to describe fats when they have deteriorated, usually by oxidation.

b.     the process of a substance combining with oxygen.

c.     as a food additive, preservatives that delay or prevent rancidity of foods and other damage to food caused by oxygen.

d.     a chemical process by which hydrogens are added to monounsaturated or polyunsaturated fats to reduce the number of double bonds.

e.     a type of artery disease characterized by accumulations of lipid-containing material on the inner walls of the arteries.

f.     a general term for all diseases of the heart and blood vessels.

g.     compounds that interfere with cholesterol absorption.

h.     the body’s fat, which consists of masses of fat-storing cells called adipose cells.






  1. Describe the various functions of fat in the human body.


  1. What is meant by saturation of a fatty acid?


  1. What are trans-fatty acids, and how do they influence health?


  1. Describe the health effects of omega-3 fatty acids, and recommendations regarding their intake.


  1. Discuss the potential benefits and risks of taking fish oil supplements.


  1. Discuss the concept of “good fats” and “bad fats.”


  1. Make a list of high-fat foods that are beneficial to health and explain why each of these foods is on your list.





Chapter 4 – Protein


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. The DRI committee that reviewed the safety of amino acid supplements was unable to set Tolerable Upper Intake Levels for safe supplement use.


  1. Vegans must carefully combine their plant protein foods in order to obtain the full array of essential amino acids.


Nutrition in Practice – Vegetarian Diets


  1. Research supports the idea that vegetarians may actually be healthier than meat eaters.


Multiple Choice


  1. Proteins differ from the other energy nutrients because they contain:
  2. glycerol.
  3. carbon.
  4. fatty acids.
  5. nitrogen.


  1. Protein is:
  2. unique in that it is the only dietary component that contains oxygen.
  3. important primarily because it builds strong bones and teeth.
  4. made up of 20 different amino acids.
  5. made up of branches of amino acids combined with branches of glucose.


  1. Proteins are comprised of chains of:
  2. monosaccharides.
  3. fatty acids.
  4. ketones.
  5. amino acids.


  1. The component that distinguishes one amino acid from another is its:
  2. side group.
  3. backbone.
  4. size.
  5. shape.


  1. If the shape of a protein is changed, the _____ of the protein is changed.
  2. function
  3. size
  4. electrical charge
  5. nutritional value


  1. An essential amino acid:
  2. is not necessary to the diet.
  3. must be supplied by the diet.
  4. can be made from glucose in the body.
  5. can be made from fat in the body.


  1. The term “non-essential,” as it applies to amino acids, means that:
  2. the body does not require them.
  3. they differ in their capacity to support growth.
  4. the liver can produce those the body lacks.
  5. they are not used to synthesize tissue.


  1. Not all amino acids have to be supplied by food. This is true because:
  2. not all necessary amino acids are found in food.
  3. hormones furnish the missing amino acids.
  4. the liver is able to manufacture some amino acids from others.
  5. the liver is able to manufacture some amino acids from fatty acids.


  1. How many essential amino acids are required by the adult?
  2. 9
  3. 16
  4. 10
  5. 22


  1. Essential amino acids:
  2. are found mostly in plant foods.
  3. cannot be synthesized by the body.
  4. cannot be supplied by the diet.
  5. are the best source of energy for the body.


  1. An example of a conditionally essential amino acid is:
  2. valine.
  3. leucine.
  4. lysine.
  5. tyrosine.


  1. Which of the following is not one of the nine essential amino acids?
  2. carnitine
  3. phenylalanine
  4. tryptophan
  5. histidine


  1. The process of protein breakdown and synthesis is called:
  2. protein recovery.
  3. the protein cycle.
  4. protein turnover.
  5. protein rotation.


  1. When a normal, healthy adult consumes twice as much protein as he requires, his nitrogen output will:
  2. equal his nitrogen intake.
  3. exceed his nitrogen intake.
  4. depend on his individual pattern.
  5. be less than his nitrogen intake.


  1. A person is in positive nitrogen balance during:
  2. growth.
  3. old age.
  4. exercise.
  5. adulthood.


  1. Individuals likely to be in negative nitrogen balance include all of the following except:
  2. people who have burns.
  3. individuals who are starving.
  4. individuals who are pregnant.
  5. people with serious injuries.


  1. Enzymes:
  2. are made up of carbohydrate.
  3. are essential to all life processes.
  4. are altered by the chemical reactions they facilitate.
  5. are essential nutrients.


  1. Which of the following statements is not true of enzymes?
  2. They are essential to all life processes.
  3. They are all proteins.
  4. They are involved in synthesis reactions only.
  5. They are all catalysts.


  1. One reason why proteins in fluids can help determine the fluids’ distribution in living systems is that proteins are:
  2. large.
  3. resistant to heat.
  4. attracted to water.
  5. small.


  1. An important buffer in the maintenance of the acid-base balance of the blood is:
  2. fatty acids.
  3. lactic acid.
  4. protein.
  5. carbohydrate.


  1. One of the reasons why acid-base balance is so important in the body is that:
  2. highly acidic conditions cause vital proteins to denature.
  3. highly acidic conditions cause the destruction of certain fatty acids.
  4. acid-base imbalances contribute to the destruction of hormones.
  5. acid-base imbalances compromise growth in children.


  1. Resistance to disease is dependent largely on the body’s:
  2. carbohydrates.
  3. lipids.
  4. proteins.
  5. vitamins.


  1. Which of the following proteins helps the body maintain its resistance to disease?
  2. antibodies
  3. collagen
  4. hormones
  5. hemoglobin


  1. An antibody is a type of protein that:
  2. regulates pH balance in the body.
  3. transports lipids throughout the body.
  4. protects the body from viruses, bacteria, and other disease agents.
  5. regulates fluid balance in the body.


  1. Amino acids are a secondary source of energy. Their primary function is to:
  2. build proteins needed by the body.
  3. provide essential water-soluble vitamins.
  4. produce thyroxin and insulin.
  5. supply most of the kcalories in the average U.S. diet.


  1. When glucose is unavailable, the functioning of which two parts of the body becomes compromised?
  2. lungs and circulatory system
  3. kidneys and liver
  4. brain and nervous system
  5. bones and muscles


  1. The body uses amino acids extensively for energy when:
  2. protein stores run low.
  3. there is inadequate glucose or fatty acids.
  4. an athlete performs strength training exercises.
  5. the body becomes dehydrated.


  1. Marasmus may best be described as a nutritional deficiency disease caused by:
  2. a chronic, severe deprivation of food.
  3. deficiency of energy.
  4. a chronic, severe deprivation of protein.
  5. deficiency of protein and vitamins.


  1. The severe malnutrition of marasmus:
  2. results in low resistance to disease.
  3. causes increased body temperature.
  4. is found only in children.
  5. affects physical development but leaves the brain unaffected.


  1. The child with marasmus differs from the child with kwashiorkor in that the:
  2. marasmic child has a skin rash.
  3. marasmic child experiences edema.
  4. marasmic child is young enough to suffer brain impairment.
  5. marasmic child develops a fatty liver.


  1. Kwashiorkor most frequently develops among:
  2. older adults.
  3. newborns.
  4. newly weaned children.
  5. adolescents.


  1. What is the primary cause of the edema that accompanies kwashiorkor?
  2. Proteins and hormones diminish and fluid leaks into interstitial spaces.
  3. Lipoprotein synthesis is diminished, causing fat to accumulate.
  4. Protein is lost from the heart muscle, resulting in a weak heartbeat.
  5. Synthesis of enzymes is reduced.


  1. Fat accumulation in the liver is a symptom of:
  2. kwashiorkor.
  3. marasmus.
  4. eosinophilia myalgia syndrome.
  5. dystentery.


  1. Risks associated with the overconsumption of protein include all of the following except:
  2. an increased risk of heart disease.
  3. the worsening of existing kidney disease.
  4. inadequate intake of fruits, vegetables, and whole grains.
  5. an increased risk of developing liver disease.


  1. stomach.
  2. liver.
  3. kidneys.
  4. gallbladder.


  1. The protein RDA for adults is _____ grams per kilogram of body weight.
  2. 0.4
  3. 0.5
  4. 0.8
  5. 1.0


  1. In order to estimate a person’s protein requirements, you must know her or his:
  2. age.
  3. height.
  4. weight.
  5. gender.


  1. A 25-year-old man weighs 154 pounds and consumes 2,700 kcalories with 45 grams of protein a day. If two-thirds of the protein comes from animal sources, it may be concluded that he:
  2. ingested his recommended allowance of protein.
  3. needs 8 grams more protein to meet the recommended allowance.
  4. needs 11 grams more protein to meet the recommended allowance.
  5. has exceeded his recommended allowance of protein.


  1. The RDA for protein for a 121-pound woman is _____ grams per day.
  2. 44
  3. 60
  4. 75
  5. 100


  1. The protein requirement of a child as compared to an adult is:
  2. approximately the same.
  3. higher.
  4. much lower.
  5. dependent on the activity level of the child.


  1. In setting the RDA for protein, the committee assumed that:
  2. protein will be of low quality.
  3. protein will be consumed together with adequate energy and other nutrients.
  4. other nutrients in the diet will be inadequate.
  5. the RDA will be applied to individuals with unusual metabolic needs.


  1. The recommended intake of protein is _____ of daily energy intake.
  2. 15-20%
  3. 10-20%
  4. 15-35%
  5. 10-35%


  1. Mary consumes approximately 1800 kcalories per day. If she wants to consume 15% of her kcalories from protein, how many grams of protein would she need each day?
  2. 28
  3. 48
  4. 58
  5. 68


  1. A measure of the amount of amino acids absorbed from a given protein intake is called:
  2. protein quality.
  3. net protein utilization.
  4. protein digestibility.
  5. protein efficiency ratio.


  1. The plant food with the highest protein digestibility is:
  2. corn.
  3. sweet potato.
  4. asparagus.
  5. soybeans.


  1. An essential amino acid found in the shortest supply relative to the amounts needed for protein synthesis in the body is termed a(n) _____ amino acid.
  2. indigestible
  3. non-essential
  4. reduced
  5. limiting


  1. What happens when the diet is lacking an essential amino acid?
  2. Proteins will be made but they will be limited in that particular amino acid.
  3. The body will synthesize it.
  4. A person’s health will not be affected as long as carbohydrate and fat intakes are adequate.
  5. Protein synthesis will be limited.


  1. Which of the following provides the highest quality protein?
  2. citrus fruits
  3. cereal
  4. legumes
  5. bread


  1. The best choice for a dessert that will provide high-quality protein is:
  2. milk pudding.
  3. fruit gelatin.
  4. sherbet.
  5. egg custard.


  1. All of the following are considered to be high-quality proteins except:
  2. fish.
  3. eggs.
  4. milk.
  5. gelatin.


  1. Which of the following foods contains low-quality protein?
  2. corn
  3. soy
  4. legumes
  5. beef
  6. Which of the following food groups in the USDA Food Guide contains only tiny amounts of protein?
  7. fruit
  8. vegetables
  9. grains
  10. milk


  1. How many grams of protein are in a 6-ounce serving of rib eye steak?
  2. 18
  3. 24
  4. 42
  5. 48


  1. Which of the following provides the largest amount of protein?
  2. ½ cup cooked broccoli
  3. 2 tablespoons peanut butter
  4. 1 cup milk
  5. 1 cup tofu


  1. Each of the following provides about seven grams of protein except:
  2. ½ cup of legumes.
  3. 1 ounce chicken.
  4. 1 egg.
  5. 1 slice of bread.


  1. What is the best strategy for consuming adequate amino acids?
  2. Eat high-quality proteins or foods containing complementary proteins.
  3. Avoid protein supplements in favor of single amino acid supplements.
  4. Take the Tolerable Upper Intake Level for supplemental amino acids.
  5. Consume the perfect ratio of carbohydrate to protein.


  1. Complementary proteins:
  2. enhance the taste of food.
  3. increase the quality of the protein.
  4. combine proteins from different foods to provide all essential amino acids.
  5. decrease the loss of nitrogen from the body.


  1. Dietary protein will not be used efficiently and will not support growth if _____ are lacking in the diet.
  2. vegetables
  3. essential fatty acids
  4. kcalories
  5. dairy foods


  1. All of the following non-meat mixtures provide high-quality protein except:
  2. black beans and rice.
  3. pasta with broccoli, peppers, and sesame seeds.
  4. peanut butter and whole-wheat bread sandwich.
  5. stir-fried cabbage, squash, and green peppers.


  1. A major reason why people must have sufficient carbohydrate and fat in the diet is to:
  2. stimulate the breakdown of body protein for energy.
  3. prevent the loss of essential fatty acids.
  4. prevent the breakdown of body protein for energy.
  5. stimulate the synthesis of essential amino acids.


  1. Structural proteins are found in all of the following except:
  2. muscles.
  3. blood.
  4. hormones.
  5. bones.


Nutrition in Practice – Vegetarian Diets


  1. Someone who excludes meat from their diet but occasionally consumes poultry, fish, and shellfish is called a:
  2. lacto-ovo vegetarian.
  3. partial vegetarian.
  4. ovo-vegetarian.
  5. temporary vegetarian.


  1. The task of acquiring enough vitamin B12 may pose a problem to vegans because:
  2. fibers in vegetables inhibit its absorption.
  3. they lack the intrinsic factor.
  4. it is found only in animal-derived products.
  5. deficiency may occur from excess intake of soy products.


  1. A vegetarian must be careful about intakes of:
  2. vitamin C and vitamin A; they may be too high.
  3. iron and zinc; they may be too low.
  4. iron and zinc; they may be too high.
  5. vitamin C and vitamin A; they may be too low.


  1. Vegetarians should eat iron-rich foods with foods rich in _____ to increase iron absorption.
  2. vitamin C
  3. calcium
  4. phytic acid
  5. fiber


  1. Which minerals are most likely to be lacking in the diet of vegetarians?
  2. sodium, potassium, and chloride
  3. zinc, magnesium, and fluoride
  4. iron, manganese, and calcium
  5. iron, zinc, and calcium


  1. All of the following foods will contribute to the calcium intake of a vegan except:
  2. dark, green, leafy vegetables.
  3. fortified soy milk.
  4. legumes.
  5. deep orange and yellow fruits and vegetables.


  1. All of the following foods will provide essential fatty acids to a vegan except:
  2. kidney beans.
  3. flaxseed.
  4. soybeans.
  5. walnuts.





a.     maintenance of the necessary amounts and types of fluid and minerals in each compartment of the body fluids.

b.     the swelling of body tissue caused by leakage of fluid from the blood vessels and accumulation of the fluid in the interstitial spaces.

c.     compounds that release hydrogen ions in a solution.

d.     compounds that accept hydrogen ions in a solution.

e.     the balance maintained between acid and base concentrations in the blood and body fluids.

f.     the concentration of hydrogen ions.

g.     too much acid in the blood and body fluids.

h.     too much base in the blood and body fluids.

i.      compounds that can reversibly combine with hydrogen ions to help keep a solution’s acidity or alkalinity constant.

j.      large proteins of the blood and body fluids, produced in response to invasion of the body by unfamiliar molecules called antigens.

k.     chemical messengers.




88, 89             1.     Explain the difference between an essential and a nonessential amino acid.


91-92             2.     Describe the role of protein in maintaining the body’s acid-base balance.


93-94             3.     Differentiate between the symptoms of kwashiorkor and marasmus.


95-96             4.     What are the possible risks associated with overconsumption of protein?


96-97             5.     Discuss potential problems with the use of amino acid supplements.


97-98             6.     Discuss the factors that determine protein quality. What makes a protein “high quality”?


99                   7.     Under what conditions will dietary protein not be used efficiently by the body, regardless of the quality? Why does this occur?




Chapter 5 – Digestion and Absorption


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. A nutrient or other substance must pass through the cells of the digestive tract wall before it actually enters the body.


  1. Digestion is completed in the large intestine.


  1. Segmentation propels or pushes food through the GI tract while peristalsis mixes the food, with a more gradual pushing motion.


  1. The mouth initiates the liquefying process to reduce the food to a coarse mash suitable for swallowing.


  1. Of all the organs in the GI tract, the small intestine has the thickest walls and strongest muscles.


  1. Saliva protects tooth surfaces and the linings of the mouth, esophagus, and stomach from attack by molecules that might be harmful.


  1. Pepsin cannot function in the strong acid of the stomach.


  1. Drinking plenty of water in conjunction with eating foods high in fiber supplies fluid for the fiber to take up, thus relieving constipation.


  1. Some partially digested nutrients can be caught in the microvilli, but they cannot be further digested.


  1. People should not eat certain food combinations at the same meal because the digestive system cannot handle more than one task at a time.


Multiple Choice


  1. Another name for the digestive tract is the:
  2. urinary tract.
  3. exocrine system.
  4. gastrointestinal system.
  5. muscular system.


  1. The digestive tract begins at the ____ and ends at the ____.
  2. stomach; large intestine
  3. pharynx; rectum
  4. lower esophageal sphincter; rectum
  5. mouth; anus


  1. sphincter muscle separating the stomach from the small intestine.
  2. portion of food swallowed at one time.
  3. enzyme that hydrolyzes starch.
  4. portion of partially digested food expelled by the stomach into the duodenum.


  1. The _____ is formed in the mouth.
  2. bile
  3. bolus
  4. chyme
  5. villus


  1. The _____ prevents food from entering the lungs.
  2. lower esophageal sphincter
  3. pharynx
  4. ileocecal valve
  5. epiglottis


  1. The stomach empties into the:
  2. ileum.
  3. cecum.
  4. jejunum.
  5. duodenum.


  1. Chyme is:
  2. a semiliquid mass of partially digested food.
  3. a portion of food swallowed at one time.
  4. an enzyme in the stomach needed for the digestion of protein.
  5. an esophageal secretion.


  1. Two organs that secrete digestive juices into the small intestine are the _____ and _____.
  2. gallbladder; pancreas
  3. pancreas; liver
  4. gallbladder; liver
  5. duodenum; pancreas


  1. The movement of chyme from the stomach into the small intestine is regulated by the:
  2. pancreas.
  3. pyloric sphincter.
  4. ileocecal valve.
  5. duodenum.


  1. Immediately before passing into the large intestine, the food mass must pass though the:
  2. pyloric sphincter.
  3. lower esophageal sphincter.
  4. ileocecal valve.
  5. bolus.


  1. “Peristalsis” is a term that refers to the:
  2. circulation of blood in the blood vessels.
  3. absorption of food in the intestines.
  4. mixing and moving of food through the lymphatic system.
  5. action of the involuntary muscles of the digestive tract.


  1. Involuntary muscle contractions move food through the intestinal tract. The movement that forces the contents back a few inches before pushing it forward again is called:
  2. segmentation.
  3. rotation.
  4. peristalsis.
  5. liquefaction.


  1. Enzymes:
  2. facilitate chemical reactions.
  3. draw water into the small intestine.
  4. are present in all parts of the GI tract.
  5. encourage bacterial growth.


  1. Which specific enzyme breaks down starch in the mouth?
  2. carbohydrase
  3. lipase
  4. salivary amylase
  5. gastric protease


  1. Saliva contains an enzyme that digests:
  2. proteins.
  3. minerals.
  4. starches.
  5. vitamins.


  1. Which of the following is not a component of gastric juice?
  2. water
  3. enzymes
  4. chylomicrons
  5. hydrochloric acid


  1. The normal pH of the stomach is:
  2. very acidic.
  3. slightly acidic.
  4. neutral.
  5. slightly alkaline.
  6. strongly alkaline.


  1. Which of the following organs does not contribute juices during digestion?
  2. salivary glands
  3. small intestine
  4. pancreas
  5. esophagus


  1. The function of mucus in the stomach is to:
  2. neutralize stomach acid.
  3. activate pepsinogen to pepsin.
  4. protect stomach cells from gastric juices.
  5. emulsify fats.


  1. The major digestive work in the stomach is the initial breakdown of:
  2. starch.
  3. proteins.
  4. fat.
  5. vitamins.


  1. In addition to hydrochloric acid, the stomach cells also secrete:
  2. mucus.
  3. bile.
  4. amylase.
  5. lipoproteins.


  1. The major digestive enzyme secreted by the stomach is:
  2. amylase.
  3. lipase.
  4. pepsin.
  5. disaccharidase.


  1. The nutrients that are digested in the small intestine are:
  2. carbohydrate, fat, and protein.
  3. fat, water, and fiber.
  4. protein, vitamins, and fiber.
  5. water, fiber, and minerals.


  1. The digestion of proteins begins in the _____ and ends in the _____.
  2. stomach; pancreas
  3. pancreas; small intestine
  4. stomach; small intestine
  5. small intestine; liver


  1. Which of the following organs is the primary source of digestive enzymes?
  2. pancreas
  3. gallbladder
  4. small intestine
  5. liver


  1. After the pancreatic juices have mixed with chyme in the intestine, the resulting mixture is:
  2. very acidic.
  3. slightly acidic.
  4. strongly alkaline.
  5. slightly alkaline.
  6. The liver:
  7. reabsorbs water and salts.
  8. secretes bile.
  9. churns food to chyme.
  10. performs enzymatic digestion.


  1. The main function of bile is to:
  2. emulsify fats.
  3. stimulate the activity of protein digestive enzymes.
  4. neutralize the intestinal contents.
  5. decrease the acidity of the contents of the stomach.


  1. If the gallbladder becomes diseased, the digestion of _____ can become compromised.
  2. fat
  3. protein
  4. carbohydrate
  5. fiber


  1. The gallbladder:
  2. reabsorbs water and salts.
  3. churns food to chyme.
  4. performs enzymatic digestion.
  5. stores bile.


  1. The emulsification of fat requires:
  2. bile.
  3. enzymes.
  4. prostaglandins.
  5. intestinal flora.


  1. Which of the following contains no digestive enzymes?
  2. saliva
  3. gastric juice
  4. intestinal juice
  5. bile


  1. Of the following, which nutrient takes longest to digest?
  2. fat
  3. sugar
  4. vitamin C
  5. iron


  1. Fats present in the GI tract:
  2. slow down the process of digestion and absorption.
  3. cause difficulty in digestion.
  4. stimulate and hasten digestion and absorption.
  5. are carriers of thiamin, riboflavin, and niacin.


  1. Which of the following foods would result in the slowest rate of digestion?
  2. a piece of toast with strawberry jam
  3. a grilled steak
  4. a green salad with low-fat salad dressing
  5. a cup of green beans


  1. Which of these foods would be digested most quickly?
  2. sugar cookies
  3. peanut butter sandwich and milk
  4. stew and cornbread
  5. hamburger, french fries, and milkshake


  1. Which of the following foods would result in the most rapid rate of digestion?
  2. a scoop of lemon sherbet
  3. an apple
  4. a baked potato with sour cream
  5. a piece of cheese on a cracker


  1. Which nutrients must be broken down in order to be absorbed?
  2. vitamins, minerals, water
  3. carbohydrate, vitamins, minerals
  4. fat, protein, minerals
  5. carbohydrate, protein, fat


  1. Bacteria in the GI tract perform all of the following functions except:
  2. producing biotin.
  3. protecting people from infection.
  4. producing vitamin K.
  5. producing bile.


  1. Fiber functions to:
  2. aid in the absorption of vitamins.
  3. produce GI bacteria.
  4. stimulate the GI tract muscles.
  5. stimulate the absorption of nutrients.


  1. A benefit of fiber is that it:
  2. promotes mineral absorption.
  3. aids in keeping stools soft.
  4. prevents diarrhea.
  5. keeps individual foods from getting mixed together.


  1. Once the digestive process is complete, the colon retrieves materials that the body must recycle. These materials are:
  2. water and dissolved salts.
  3. iron and water.
  4. protein and sodium.
  5. water and fiber.


  1. The primary site of nutrient absorption is the:
  2. stomach.
  3. pancreas.
  4. small intestine.
  5. large intestine.


  1. Villi are part of the structure of the:
  2. esophagus.
  3. stomach.
  4. small intestine.
  5. large intestine.


  1. The microscopic hairs that cover the surface of each cell lining the small intestine are called:
  2. intestinal folds.
  3. villi.
  4. microvilli.
  5. lymphatics.


  1. Which of the following nutrients is/are absorbed into the lymphatic system?
  2. fat-soluble vitamins
  3. water
  4. amino acids
  5. glucose


  1. After absorption, the water-soluble nutrients are released directly into the:
  2. bloodstream.
  3. kidneys.
  4. liver.
  5. lymph.


  1. After absorption, the larger fats and fat-soluble vitamins are first released into the _____ transport system.
  2. excretory
  3. mesentery
  4. vascular
  5. lymphatic
  6. After digestion, lipids are packaged for transport as lipoproteins known as:
  7. HDL.
  8. VLDL.
  9. LDL.
  10. chylomicrons.


  1. Which of the following is not part of the structure of a chylomicron?
  2. phospholipid
  3. protein
  4. triglyceride
  5. water-soluble vitamins


  1. The lymphatic system:
  2. contains fluid with the same composition as blood.
  3. eventually drains into the blood circulatory system.
  4. carries chylomicrons to the intestines.
  5. is where metabolism of nutrients takes place.


  1. When nutrients enter the blood vessels from the small intestine, they are first transported to the:
  2. kidney.
  3. liver.
  4. cells throughout the body.
  5. thoracic duct.


  1. Which of the following is the body’s major metabolic organ?
  2. pancreas
  3. small intestine
  4. gallbladder
  5. liver


  1. Elevated LDL concentrations are associated with a high risk of heart disease because they:
  2. transport cholesterol and triglycerides from the liver to the tissues.
  3. carry excessive amounts of fat that is deposited around the heart.
  4. encourage high levels of iron in the blood.
  5. take excess cholesterol back to the liver, which increases the production of cholesterol.


  1. Elevated HDL concentrations are associated with a low risk of heart disease because they:
  2. transport newly absorbed lipids from intestinal cells to the rest of the body.
  3. carry cholesterol and triglycerides from the liver to the rest of the body.
  4. carry lipids around in the blood more than LDL.
  5. take excess cholesterol and phospholipids from the tissues and return them to the liver.


  1. The lipoprotein that contains the greatest proportion of triglyceride is the:
  2. HDL.
  3. LDL.
  4. VLDL.
  5. chylomicron.


  1. Which of the following factors is not instrumental to the optimal health and performance of the digestive system?
  2. adequate sleep
  3. enzyme supplements
  4. mental state
  5. nutrition


Nutrition in Practice – Food Safety


  1. Which of the following will cause a foodborne infection?
  2. Foods containing toxin-producing microbes
  3. Clostridium botulinum
  4. Campylobacter jejuni
  5. Staphylococcus aureus


  1. To prevent bacterial growth when holding cooked foods, they should be kept at _____° F or higher until served.
  2. 40
  3. 140
  4. 165
  5. 200


  1. Which of the following statements is true regarding the prevention of foodborne illnesses?
  2. Fresh produce should be washed before it is eaten.
  3. Only new sponges and towels should be used in the kitchen.
  4. Leftovers can safely be covered and left at room temperature until the next meal.
  5. Meats should be marinated at room temperature.


  1. Cold food should be stored at _____ or less.
  2. 40° F
  3. 55° F
  4. 80° F
  5. 140° F


  1. Leftovers should be used within _____ days.
  2. 5-7
  3. 3-4
  4. 2-3
  5. 1-2





a.     the oral cavity containing the tongue and teeth.

b.     the passageway leading from the nose and mouth to the larynx and esophagus, respectively.

c.     a cartilage structure in the throat that prevents fluid or food from entering the trachea when a person swallows.

d.     the passageway from the mouth and nose to the lungs.

e.     the conduit from the mouth to the stomach.

f.     the sphincter muscle at the junction between the esophagus and the stomach.

g.     the sphincter muscle separating the stomach from the small intestine.

h.     the organ that stores and concentrates bile.

i.      a gland that secretes enzymes and digestive juices into the duodenum.

j.      a 10-foot length of small-diameter (1-inch) intestine that is the major site of digestion of food and absorption of nutrients.

k.     the top portion of the small intestine.

l.      the first two-fifths of the small intestine beyond the duodenum.

m.   the last segment of the small intestine.

n.     the sphincter muscle separating the small and large intestines.

o.     the last portion of the intestine, which absorbs water.

p.     a narrow blind sac extending from the beginning of the large intestine; stores lymphocytes.

q.     the muscular terminal part of the GI tract extending from the sigmoid colon to the anus.

r.      the terminal sphincter muscle of the GI tract.


a.     class of lipids composed of glycerol with three fatty acids attached.

b.     the lipoproteins that transport lipids from the intestinal cells into the body.

c.     a cluster of lipids associated with proteins that serves as a transport vehicle for lipids in the lymph and blood.

d.     the type of lipoproteins made primarily by liver cells to transport lipids to various tissues in the body; composed primarily of triglycerides.

e.     the type of lipoproteins derived from VLDL as cells remove triglycerides from them; composed primarily of cholesterol.

f.     the type of lipoproteins that transport cholesterol back to the liver from peripheral cells; composed primarily of protein.





107-110         1.     Outline and trace the path food follows through the digestive tract from one end to the other.


107,113-14   2.     Describe the role of the stomach in the process of digestion.


113-114         3.     Should antacids be taken to decrease the strong acidity of the stomach? Explain your answer.


115                 4.     Explain what determines the rate of digestion of the energy nutrients.


115                 5.     Explain the benefits of intestinal flora to health.


118-120         6.     Describe the difference between low-density lipoproteins (LDL) and high-density lipoproteins (HDL). What is the relationship between blood levels of these lipoproteins and risk of heart disease?



Chapter 6 – Metabolism, Energy Balance, and Body Composition


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. Fat can be made from an excess of any energy-yielding nutrient.


  1. In the body, no metabolic difference exists between fasting and starving.


  1. Ketones can meet some of the nervous system’s energy needs.


  1. Normally, the nervous system consumes more than 50% of the total glucose used each day.


  1. The body’s adaptations to fasting are sufficient to maintain life for a long period.


  1. Basal metabolic needs are large compared to energy needs for activities.


  1. Voluntary activities normally require less energy in a day than basal metabolism does.


  1. People can change their voluntary actions to spend more or less energy in a day, but they cannot change their basal metabolic rate.


  1. A smoker may weigh less than a non-smoker, but will likely have a greater waist circumference.


  1. Skinfold measurements provide an inaccurate estimate of total body fat.


Nutrition in Practice – Eating Disorders


  1. Central to the diagnosis of anorexia nervosa is a distorted body image that overestimates body fatness.


  1. More men suffer from bulimia nervosa than from anorexia.


Multiple Choice


  1. Which of the following systems possesses the most rapidly multiplying cells?
  2. digestive
  3. excretory
  4. cardiovascular
  5. nervous


  1. Which of the following is not a function of the liver?
  2. metabolizing nutrients
  3. manufacturing immune factors and transport proteins
  4. secreting insulin and glucagon
  5. participating in iron recycling


  1. A healthy pancreas secretes _____ into the blood between meals and _____ right after a meal.
  2. glucagon; insulin
  3. insulin; glucagon
  4. digestive juices; glucagon
  5. glycogen; digestive juices


  1. Perry’s body is not able to efficiently remove metabolic waste products from his blood, so he must receive dialysis treatments. Which organ(s) in his body is/are diseased?
  2. pancreas
  3. heart and blood vessels
  4. liver
  5. kidneys


  1. The metabolic breakdown of glucose to pyruvate is called:
  2. metabolism.
  3. glycolysis.
  4. lipolysis.
  5. gluconeogenesis.


  1. The production of glucose from protein or fat is called:
  2. glyconeogenesis.
  3. gluconeogenesis.
  4. glycolysis.
  5. glycogenolysis.


  1. The part of the triglyceride that can be made into glucose is:
  2. short-chain fatty acids.
  3. medium-chain fatty acids.
  4. all fatty acids.
  5. glycerol.


  1. What percentage of fat cannot be converted to glucose at all?
  2. 50
  3. 75
  4. 95
  5. 100


  1. Glycogen is stored in the liver and muscles when:
  2. excessive fat is present in the blood.
  3. vigorous muscular activity has just ended.
  4. excessive glucose is present in the blood.
  5. excessive cholesterol is present in the blood.


  1. Surplus dietary carbohydrate is first stored as:
  2. glycogen.
  3. protein.
  4. fat.
  5. triglycerides.


  1. When carbohydrate consumption is in excess of body needs, the excess glucose is:
  2. not absorbed from the small intestine.
  3. excreted in the feces.
  4. stored as glycogen and fat.
  5. stored as glycogen only.


  1. Alcohol contributes to obesity because it:
  2. diminishes the body’s use of fat for fuel.
  3. has as many kcalories as fat.
  4. increases appetite.
  5. encourages storage of body protein.


  1. Which of the following statements is true regarding the effect of alcohol on body weight?
  2. Alcohol yields no energy so it does not affect body weight.
  3. Alcohol is low in kcalories and has very little effect on body weight.
  4. Alcohol slows down the body’s use of fat, causing more fat to be stored.
  5. Alcohol speeds up the body’s metabolism and discourages the storage of body fat.


  1. Of all the nutrients, which is the easiest for the body to store as fat?
  2. protein
  3. carbohydrates
  4. fat
  5. vitamins


  1. When protein consumption is in excess of body needs and energy needs are met, the excess amino acids are metabolized and:
  2. stored as fat.
  3. excreted in the feces.
  4. stored as amino acids.
  5. stored as glycogen and fat.


  1. Energy is stored in the body for future use as:
  2. triglycerides.
  3. glycerol.
  4. fatty acids.
  5. lecithin.


  1. Within a day of beginning a fast, most of the body’s stores of _____ are depleted.
  2. glycogen
  3. amino acids
  4. fatty acids
  5. glycerol


  1. The part of a triglyceride that can be made into glucose is:
  2. the saturated fatty acids.
  3. the glycerol backbone..
  4. the unsaturated fatty acids.
  5. the long-chain fatty acids.


  1. In the first few days of fasting, body protein is used primarily to:
  2. rebuild tissue.
  3. replace worn out cells.
  4. provide glucose.
  5. stabilize fluid balance.


  1. Which of the following is/are an acidic, fat-related compound(s) formed from the incomplete breakdown of fat when carbohydrate is not available?
  2. amino acids
  3. pyruvate
  4. carbon dioxide
  5. ketone bodies
  6. ammonia and urea
  7. As the body shifts to partial dependence on ketones for energy during prolonged fasting:
  8. the body increases its energy output.
  9. the body conserves its lean tissue.
  10. the body increases its metabolism.
  11. the body’s loss of lean tissue increases.


  1. Changes that take place in the body during fasting include all of the following except:
  2. wasting of lean tissue.
  3. disturbances of fluid and electrolyte balance.
  4. impairment of disease resistance.
  5. increased body temperature.


  1. Fasting results in:
  2. degradation of lean body tissue.
  3. safe, quick, and easy loss of fat tissue.
  4. immediate loss of energy and mental alertness.
  5. cleansing of toxins from the body.


  1. For every _____ kcalories a person eats in excess of kcalorie expenditures, a pound of body fat is stored.
  2. 100
  3. 350
  4. 1000
  5. 3500


  1. BMR is lowest during:
  2. pregnancy.
  3. physical activity.
  4. sleep.
  5. sedentary activity.


  1. The energy needed to maintain life when a person is at complete digestive, physical, and emotional rest is termed:
  2. basal metabolism.
  3. the kcalorie.
  4. physiological fuel value.
  5. heat of combustion.


  1. Basal metabolic rate is lowered by:
  2. loss of lean body mass.
  3. stress or fever.
  4. high thyroid gland activity.
  5. increase in lean body mass.


  1. Which of the following individuals would have the lowest basal metabolic rate?
  2. a pregnant woman
  3. a tall, thin person
  4. a person with malnutrition
  5. a person with a fever


  1. Which of the following individuals would have the slowest basal metabolic rate?
  2. a 51-year-old male
  3. a 20-year-old inactive woman
  4. a 25-year-old pregnant woman
  5. a 3-year-old child


  1. An individual can most easily alter his/her energy output by altering:
  2. the time of day he/she exercises.
  3. the intensity, duration, and frequency of exercise.
  4. his/her eating patterns.
  5. the combination of foods eaten at a meal.


  1. The thermic effect of food represents about _____% of the total food energy taken in.
  2. 4
  3. 10
  4. 16
  5. 25


  1. Men generally have a higher BMR than women do because:
  2. women have less lean body mass.
  3. women tend to eat less.
  4. men tend to eat more.
  5. men have less lean body mass.


  1. Men have a higher BMR than females because they:
  2. are more active.
  3. eat more.
  4. have more lean tissue.
  5. have more fat tissue.


  1. The basal metabolic rate slows with increasing age because:
  2. the elderly are malnourished.
  3. fat mass in the body decreases.
  4. digestive efficiency declines.
  5. lean body mass diminishes.


  1. Which of the following is not a factor in the variability of energy needs between individuals?
  2. gender
  3. age
  4. physical activity
  5. food preferences


  1. What body component has the greatest variability in quantity and quality?
  2. bone mass
  3. muscle mass
  4. fluid
  5. fat mass


  1. Which of the following individuals would be classified as being very active?
  2. a carpenter
  3. a teacher
  4. a football player
  5. a gardener


  1. Given that EER for women = [354 – (6.91 ´ age)] + PA ´ [(9.36 ´ wt) + (726 ´ ht)], estimate the energy requirements for Anne, an active 27 year old who is 5 feet 4 inches tall and weighs 130 pounds. Choose the kcal range closest to your estimate.
  2. 1700-1800
  3. 2300-2400
  4. 2600-2700
  5. 3200-3300
  6. In order to calculate a person’s EER, which of the following is not required?
  7. height
  8. percent body fat
  9. weight
  10. gender


  1. Calculate the BMI of a male who is 5’11” tall and weighs 210 pounds.
  2. 23
  3. 27
  4. 29
  5. 33


  1. According to BMI criteria, a person with a BMI of 24 would be considered:
  2. underweight.
  3. overweight.
  4. obese.
  5. normal weight.


  1. A weakness in using BMI to assess body weight is:
  2. it doesn’t distinguish between male and female.
  3. it doesn’t distinguish between young and old.
  4. it doesn’t indicate where excess fat is located on the body.
  5. it doesn’t indicate the ideal weight for a given height.


  1. Which type of fat poses the greatest risk to health?
  2. visceral fat
  3. dietary fat
  4. subcutaneous fat
  5. lower body fat


  1. The health risk associated with central obesity has to do with:
  2. an imbalance in adipokines.
  3. the proximity of the excess fat to the gallbladder.
  4. an imbalance in cytokines.
  5. the proximity of excess fat to the small intestine.


  1. A good indicator of fat distribution on an individual is:
  2. BMI.
  3. body weight.
  4. hip circumference.
  5. waist circumference.


  1. Which of the following people would be at lowest risk for the accumulation of abdominal fat?
  2. a smoker
  3. a postmenopausal woman
  4. a middle-aged man
  5. a premenopausal woman


  1. The recommended range of body fat for a woman is:
  2. 13 to 21%.
  3. 15 to 23%.
  4. 23 to 31%.
  5. 27 to 35%.


  1. A lack of body fat can result in:
  2. infertility in women.
  3. depression.
  4. abnormal hunger regulation.
  5. insomnia.


  1. About _____% of U.S. adults are overweight or obese.
  2. 33
  3. 42
  4. 57
  5. 68


  1. Obesity is officially defined as a BMI of ____ or higher.
  2. 25
  3. 30
  4. 35
  5. 40


  1. All of the following are health risks associated with obesity except:
  2. hypertension.
  3. type 2 diabetes.
  4. sleep apnea.
  5. tuberculosis.


  1. Which person is at the greatest health risk?
  2. a 27-year-old woman with a waist circumference of 40 inches
  3. a 25-year-old athlete with a BMI of 33
  4. a 50-year-old male with a BMI of 29 who works out every day
  5. a 42-year-old woman with a waist circumference of 34 inches


  1. Which of the following is not one of the three indicators established by obesity experts for evaluating health risks from overweight and obesity?
  2. a person’s disease risk profile
  3. BMI
  4. waist circumference
  5. family history


Nutrition in Practice – Eating Disorders


  1. A primary factor involved in the development of eating disorders is:
  2. the use of antidepressant drugs.
  3. dissatisfaction with one’s body.
  4. aversions to certain foods.
  5. an absent parent.


  1. Characteristics of individuals with anorexia nervosa include:
  2. they come from families of lower economic means.
  3. polite, controlled, rigid, unspontaneous behavior.
  4. they come from families that value an inner sense of worth.
  5. rebellious, uncontrollable behavior.


  1. Which of the following is not a criteria for a diagnosis of anorexia nervosa?
  2. Refusal to maintain body weight at or above a minimal normal weight for age and height
  3. Intense fear of gaining weight or becoming fat, even though underweight
  4. Undue influence of body weight or shape on self-evaluation
  5. Recurrent inappropriate compensatory behavior in order to prevent weight gain


  1. Lindsay is 23 years old and graduated from college with honors. She is emotionally insecure and experiences considerable social anxiety. She has no close friends, is sometimes depressed, and often exhibits impulsive behavior. Lindsay has a preoccupation with food and her weight even though she is close to her ideal body weight. Lindsay most nearly fits the profile of a person with:
  2. anorexia nervosa.
  3. binge eating disorder.
  4. bulimia.
  5. body dysmorphic disorder.


  1. The consequences of purging may include any of the following except:
  2. erosion of the teeth.
  3. a ruptured esophagus.
  4. dangerously low potassium concentrations.
  5. a ruptured appendix.


  1. One of the goals of the dietary plan to treat bulimia is to help clients:
  2. decrease control.
  3. restrict kcalorie intake.
  4. restore nutritional health.
  5. develop a set pattern of menus.


  1. Which eating disorder responds most readily to treatment?
  2. anorexia nervosa
  3. bulimia
  4. binge eating disorder
  5. body dysmorphic disorder





Match each range to the appropriate health indicator.


a.             normal BMI
b.             obese BMI
c.             overweight BMI
d.             underweight BMI
e.             waist size (in inches) indicating risk in men
f.             waist size (in inches) indicating risk in women





133                 1.     Explain how the body maintains its constant normal temperature of 98.6° F.


138                 2.     Describe how fat can be made from an excess of each of the energy nutrients—carbohydrate, protein, or fat.


139-140         3.     Explain why less fat may be lost during fasting than is lost when at least some food is supplied.


143                 4.     Define the thermic effect of food and explain its effect on energy expenditure.


143-144         5.     Identify and briefly describe five factors that affect a person’s basal metabolic rate.


146-147         6.     Explain why excessive abdominal fat appears to increase the risk of chronic disease.


150                 7.     Discuss three indicators used to identify and evaluate the health risks from overweight and obesity.


153-154         8.     What are the three characteristics of the female athlete triad?



Chapter 7 – Weight Management: Overweight and Underweight


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. Genetics influences the way the body consumes, stores, and spends energy.


  1. Genetics alone determines a person’s susceptibility to obesity.


  1. Some research indicates that obese people have much more lipoprotein lipase activity in their fat cells than lean people do.


  1. In lean people adipose tissue tends to secrete higher amounts of adiponectin than it does in obese people.


  1. Most obese people have leptin deficiency.


  1. Ghrelin is a hormone produced in the stomach that acts much like leptin.


  1. On a sensible weight-control program, meals and snacks should include whole-grain foods and fiber-rich vegetables.


  1. Television and sedentary video and computer entertainment contribute to obesity because they have mostly replaced outdoor activity for many people.


  1. Health-promoting built environments may result in a healthier and leaner population.


  1. There is no such thing as cellulite.


Multiple Choice


  1. _____ is a hormone produced by the stomach cells that promotes positive energy balance by stimulating appetite and promoting efficient energy storage.
  2. Insulin
  3. Leptin
  4. Ghrelin
  5. Yohimbe


  1. The development of excess fat cells is most likely to occur:
  2. when you eat a large breakfast.
  3. during late childhood and early puberty.
  4. if you are inactive.
  5. around the age of 40.


  1. The theory that the body tends to maintain a certain weight by means of its own internal controls is referred to as the _____ theory.
  2. environmental stimuli
  3. genetics
  4. learned behavior
  5. set-point


  1. Which of the following is not an environmental stimulus that contributes to obesity?
  2. the abundance of food available
  3. an increase in portion sizes
  4. energy-dense fast food
  5. the year-round availability of fresh fruits and vegetables


  1. Fast food contributes to obesity because it generally provides:
  2. nutrient-dense foods.
  3. smaller portions.
  4. plenty of low-kcalorie choices.
  5. large portions and energy-dense foods.


  1. The psychological desire to eat is referred to as:
  2. satiety.
  3. appetite.
  4. hunger.
  5. obesity.


  1. Which of the following is the best example of the link between food behavior and emotions?
  2. someone who eats fast food for lunch every day
  3. someone who would rather sit home and eat than ask a friend to go to a movie and risk rejection
  4. someone who always eats popcorn while watching a movie
  5. a pregnant women who craves pickles


  1. Susie has been overweight for many years. She tends to eat when she is not really hungry and eats more food when she is angry or depressed. Which of the following theories could explain Susie’s problem of overweight?
  2. lipoprotein lipase
  3. set-point theory
  4. learned behavior
  5. genetics


  1. The question of whether a person should lose weight depends on all of the following except:
  2. the extent of overweight.
  3. age.
  4. health.
  5. basal metabolic rate.


  1. _____ is an amphetamine-like substance once available over the counter for weight loss that was banned by the FDA due to many ill effects reported by consumers.
  2. Ephedrine
  3. Pyruvate
  4. Chitosan
  5. Yohimbe


  1. Which of the following statements is true regarding weight loss?
  2. Laxatives promote weight loss.
  3. Hot baths speed up metabolism.
  4. Grapefruit juice melts body fat.
  5. Unwise weight-loss techniques can be dangerous.


  1. _____ is a prescription drug that works on the brain’s neurotransmitters to suppress appetite.
  2. Orlistat
  3. Sibutramine
  4. Olestra
  5. Xenical


  1. _____ is a prescription drug used to treat obesity that reduces the absorption of fat.
  2. Orlistat
  3. Sibutramine
  4. Olestra
  5. Meridia


  1. The surgical approach to weight loss can often be justified in cases of:
  2. BMI 25-30.
  3. uncontrolled diabetes.
  4. clinically severe obesity.
  5. peptic ulcer disease.


  1. Weight-loss surgeries:
  2. reduce the capacity of the stomach.
  3. are dangerous and should be avoided.
  4. have no complications.
  5. worsen existing health conditions associated with obesity.


  1. Complications from weight-loss surgery include all of the following except:
  2. infections.
  3. nutritional deficiencies.
  4. the development of diabetes.
  5. psychological problems.


  1. The long-term safety and effectiveness of gastric surgery depend largely on:
  2. compliance with dietary instructions.
  3. avoidance of all fats.
  4. following recommended food combining patterns.
  5. regular monitoring of blood glucose levels.


  1. The secret to safe and permanent weight loss is a sensible approach involving:
  2. physical activity and a healthy, low-kcalorie diet.
  3. hormones and diet pills.
  4. a very-low-kcalorie diet combined with excessive exercise.
  5. herbal supplements and a low-kcalorie diet.


  1. Severe kcalorie restriction and rapid weight loss can result in all of the following except:
  2. excessive loss of lean tissue.
  3. a lower basal metabolism.
  4. rapid regain of weight.
  5. excessive loss of fat tissue.


  1. In order to lose one pound per week, you would need to reduce your food intake by _____ kcalories per day.
  2. 100
  3. 250
  4. 500
  5. 1000


  1. Women following a weight-loss diet may need supplements of _____.
  2. amino acids and/or essential fatty acids
  3. iron and/or calcium
  4. sodium and/or potassium
  5. vitamin C and/or calcium


  1. Donna currently weighs 160 pounds. How many kcalories should Donna consume daily in order to lose weight while also meeting her nutritional needs?
  2. 1200
  3. 1600
  4. 1800
  5. 2000


  1. Jill currently weighs 180 pounds and has asked to be placed on a weight-loss diet to allow her to lose two pounds a week. You tell Jill that she must cut _____ kcalories/day in order to achieve this goal.
  2. 500
  3. 700
  4. 1000
  5. 1200


  1. Nutritional adequacy is difficult to achieve on fewer than _____ kcalories a day.
  2. 1000
  3. 1200
  4. 1500
  5. 1700


  1. Sarah is trying to lose 10 pounds. Which of the following would you suggest?
  2. Reduce your kcalorie intake by 100-200 kcalories a day and engage in 15 minutes of exercise per day.
  3. Ask your physician for a prescription for orlistat.
  4. Replace two meals a day with a bowl of cereal.
  5. Reduce your kcalorie intake by 300-500 kcalories a day and engage in at least 250 minutes of physical activity per week.


  1. On a sensible weight-loss plan, the nutrient from which most kcalories should be consumed is:
  2. carbohydrate.
  3. fat.
  4. protein.
  5. vitamins.


  1. Compared to refined foods, high-fiber, unprocessed, or lightly processed foods aid in weight loss because they provide:
  2. less absorption, resulting in fewer kcalories.
  3. a faster transit time through the intestinal tract.
  4. the same number of kcalories in a larger amount of food.
  5. bulk and satiety for fewer kcalories.


  1. An appropriate food to consume before a meal to increase one’s feeling of fullness is:
  2. a cup of cream of chicken soup.
  3. an unbuttered roll.
  4. a cup of vegetable soup.
  5. a breadstick dipped in olive oil.


  1. Which food has the lowest energy density?
  2. 15 fresh grapes
  3. ½ cup rice
  4. ½ cup ice cream
  5. 16 baked chips


  1. The average U.S. diet delivers an estimated _____ kcalories a day from sweetened beverages.
  2. 50-75
  3. 75-150
  4. 160-185
  5. 190-225


  1. The benefits of physical activity include all of the following except:
  2. it speeds up basal metabolism.
  3. it reduces abdominal obesity.
  4. it lowers basal metabolism.
  5. it may help to counteract the negative effects of excess body weight on health.


  1. The benefits of regular physical activity in weight loss include all of the following except:
  2. appetite control.
  3. a long-term increase in basal metabolism.
  4. stress reduction.
  5. loss of lean body mass.


  1. Benefits of physical activity in a weight-control program include:
  2. it helps a person to not think about food.
  3. it decreases energy expenditure.
  4. it speeds up basal metabolism.
  5. it helps one “spot reduce.”


  1. The American College of Sports Medicine recommends _____ minutes of moderate-intensity exercise per week for weight gain prevention.
  2. 60
  3. 90
  4. 120
  5. 150


  1. Basal metabolism remains elevated for _____ after intense and prolonged activity.
  2. 30 minutes
  3. 1 hour
  4. several hours
  5. 72 hours


  1. A good way to begin a safe and effective weight-loss program is to:
  2. keep a food and activity diary.
  3. reduce energy intake to 800 kcalories per day.
  4. start on a Monday.
  5. recognize that the feelings of starvation are inevitable.


  1. The best form of physical activity for a person who is trying to lose weight is:
  2. running 5 miles at least 3 times a week.
  3. walking 2 miles in 30 minutes.
  4. a daily workout at the gym.
  5. something he or she enjoys and will do regularly.
  6. Lucie is practicing good cognitive skills for weight loss when she tells herself:
  7. “I shouldn’t have eaten that ice cream yesterday… no wonder I’m fat.”
  8. “I was able to walk on the treadmill 15 minutes longer today than I could 2 weeks ago… my fitness level is improving.”
  9. “I really, really want to lose weight; I just can’t seem to succeed no matter how hard I try.”
  10. “I need to remember to stop by the grocery store and pick up some more fresh vegetables for salads, and some light vinaigrette.”


  1. A key to preventing weight regain is to:
  2. only check weight once a month.
  3. avoid thinking thoughts that promote self-efficacy.
  4. view weight maintenance as a lifestyle, not a goal.
  5. skip breakfast every day.


  1. A person trying to gain weight should:
  2. avoid any form of exercise.
  3. eat energy-dense foods.
  4. eat faster.
  5. consume fewer beverages.


  1. James is trying to gain weight. Which of the following would you suggest to help James with his goal?
  2. Choose milkshakes instead of milk.
  3. Drink black coffee.
  4. Skip beverages.
  5. Skip dessert.


  1. David has a difficult time gaining weight. Your recommendations to him include:
  2. “Eat all you want and avoid physical activity.”
  3. “Limit low-kcalorie foods like fruits and vegetables.”
  4. “Ask your doctor for a prescription for orlistat.”
  5. “Consume energy-dense foods and engage in weight training.”


  1. Zachary is trying to gain weight. He complains that he has a hard time eating a lot of food at one meal. You advise him to:
  2. eat energy-dense snacks between meals.
  3. eat more slowly.
  4. drink less water.
  5. eat a salad before his meal.


  1. For someone who is trying to gain weight, an easy way to add kcalories is to:
  2. drink a lot of water.
  3. increase consumption of caloric beverages.
  4. use fat-free salad dressings freely.
  5. add more salt to food.


Nutrition in Practice – Fad Diets


  1. Which of the following statements is true regarding fad diets?
  2. They are based on credible scientific research.
  3. The FDA requires proof that they work and are safe.
  4. They usually offer distorted bits of legitimate research, which makes them sound feasible.
  5. Scientists have overlooked the obvious facts and a lay person has figured out the key to successful weight loss.
  6. Quite simply, the key to weight loss is:
  7. combining foods correctly at meals.
  8. not eating desserts.
  9. eating less carbohydrate.
  10. consuming fewer kcalories.


  1. Despite claims that each new fad diet is different and offers a new approach to weight loss, most fad diets
  2. cut kcalories.
  3. eliminate animal foods.
  4. encourage skipping meals.
  5. are individualized.


  1. Of the fat diets compared in the textbook, which one comes closest to meeting dietary standards for health?
  2. Ornish Diet
  3. Atkins Diet
  4. Sonoma Diet
  5. Cheater’s Diet


  1. The major drawback of most fad diets is:
  2. They promote false information about weight loss.
  3. They do not create lifestyle changes to support long-term weight control.
  4. They create false hopes among those who try them.
  5. They usually require the purchase of dietary supplements.


  1. The minimum number of kcalories provided by a weight-loss diet should be:
  2. 800.
  3. 1200.
  4. 1400.
  5. 1600.


  1. Warning signs of an unsound weight-loss program include:
  2. a diet that provides at least 1200 kcalories.
  3. recommendations to consume ordinary foods.
  4. requirements to purchase their brand of foods/supplements.
  5. encouragement to pursue physical activity.





a.     an enzyme mounted on the surface of fat cells that hydrolyzes triglycerides in the blood into fatty acids and glycerol for absorption into the cells.

b.     the buildings, roads, utilities, homes, fixtures, parks, and all other man-made entities that form the physical characteristics of a community.

c.     a hormone produced by fat cells that decreases appetite and increases energy expenditure.

d.     a hormone produced primarily by the stomach cells that signals the hypothalamus of the brain to stimulate appetite and food intake.

e.     supposedly, a lumpy form of fat; actually, a fraud.

f.     the physiological need to eat, experienced as a drive to obtain food.

g.     the psychological desire to eat.

h.     the theory that proposes that the body tends to maintain a certain weight by means of its own internal controls.

i.      a protein produced by the fat cells that inhibits inflammation.





162-163         1.     Briefly describe the following theories for the cause of obesity:

  1. set-point theory.
  2. fat cell development.


163-165         2.     Discuss the role of environmental stimuli in the development of obesity.


168-169         3.     Discuss the pros and cons of gastric bypass and gastric banding surgeries for weight loss.


172-174         4.     Describe why physical activity is very important in a weight-loss program.


178-179         5.     Describe strategies for successful weight gain.




Chapter 8 – The Vitamins


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




  1. The only disease a vitamin can cure is the disease caused by a deficiency of that vitamin.


  1. The cooking method used to prepare a food can affect the bioavailability of vitamins.


  1. Because of their inorganic nature, vitamins can be destroyed during storage and in cooking and must be handled with care.


  1. Children are most vulnerable to vitamin A toxicity because they need less of the vitamin.


  1. The body makes one unit of retinol from approximately 12 units of beta-carotene.


  1. In adults, vitamin E deficiency is usually associated with diseases that cause malabsorption of carbohydrates.


  1. The eight B vitamins must be present in every cell at all times to function as they should.


  1. Sixty milligrams of niacin can be made from one milligram of tryptophan.


  1. In vegans, the deficiency of vitamin B12 may be masked by the high intake of folate.


  1. Potatoes provide about half of the vitamin C consumed by Americans.



Multiple Choice


  1. The amount of a vitamin absorbed and used by the body is called:
  2. vitamin efficiency.
  3. bioavailability.
  4. fortification.
  5. vitamin equivalency.


  1. Which of the following is not a fat-soluble vitamin?
  2. vitamin A
  3. vitamin C
  4. vitamin D
  5. vitamin E
  6. vitamin K


  1. It is not absolutely necessary to consume the fat-soluble vitamins every day because they:
  2. would just be excreted from the body.
  3. are only absorbed in limited amounts.
  4. can be stored in the body for future use.
  5. would reach toxic amounts in the body.


  1. Overconsumption of the fat-soluble vitamins results in:
  2. accumulation, which aids in the prevention of colds and infections.
  3. a nonobservable condition, because they are excreted.
  4. possible toxicity, due to an accumulation in the body.
  5. weight gain due to increased fat intake.
  6. The fat-soluble vitamins:
  7. are less stable than the water-soluble vitamins.
  8. require bile for absorption.
  9. are usually constituents of coenzymes.
  10. are not essential.


  1. Which of the following is not a true statement about fat-soluble vitamins?
  2. They are readily excreted from the body when consumed in excess.
  3. They must be bound to proteins to travel in the blood.
  4. They may be consumed less frequently than the water-soluble vitamins.
  5. They may accumulate to toxic levels in the body.


  1. Generally, fat-soluble vitamins will be found in foods such as:
  2. oranges and strawberries.
  3. whole milk and eggs.
  4. potatoes and carrots.
  5. lettuce and spinach.


  1. The active form of vitamin A for vision is:
  2. opsin.
  3. collagen.
  4. retinal.
  5. keratin.


  1. Which form of vitamin A is involved in gene expression?
  2. retinoic acid
  3. retinol
  4. retinal
  5. retinol-binding protein


  1. A dietary deficiency of vitamin A can produce:
  2. rickets.
  3. night blindness.
  4. a prolonged blood-clotting time.
  5. sensitivity to light.


  1. Vitamin A plays a role in cell differentiation. What does this mean?
  2. It helps cells differentiate between the vitamins.
  3. It allows cells to mature so they can perform their intended functions.
  4. It promotes the storage of fat-soluble vitamins.
  5. It aids in differentiating between fat- and water-soluble vitamins.


  1. Vitamin A is involved in all of the following except:
  2. maintaining healthy epithelial tissues.
  3. maintaining healthy eye tissues.
  4. fighting infection.
  5. releasing energy from the energy-yielding nutrients.


  1. Beta-carotene prevents _____ from damaging cells.
  2. free radicals
  3. antioxidants
  4. blood clots
  5. vitamin E


  1. Which of the following is the major cause of preventable childhood blindness in the world?
  2. vitamin C deficiency
  3. riboflavin deficiency
  4. pantothenic acid deficiency
  5. vitamin A deficiency


  1. Many of the symptoms of vitamin A deficiency, such as blindness and an increase in respiratory infections, are related to the role of vitamin A in:
  2. blood clotting.
  3. synthesis of visual pigment.
  4. maintaining the epithelial cells.
  5. synthesis of some hormones.


  1. Children with measles or measles-related infections may benefit from supplementation with:
  2. vitamin C.
  3. vitamin A.
  4. iron.
  5. folate.


  1. Excessive vitamin A during pregnancy poses a teratogenic risk. This means that:
  2. it can increase the risk of birth defects.

b              it can build up in the blood and cause calcification of soft tissues.

  1. it can result in a low-birth weight infant.
  2. it can increase the risk of infectious disease.


  1. Vitamin A toxicity is likely to occur from:
  2. consuming too many dark green and deep orange vegetables.
  3. overconsumption of whole grains.
  4. consuming large amounts of fortified foods or vitamin A supplements.
  5. drinking too much orange juice.


  1. If your eyes have difficulty adjusting to dim light, which of the following foods might improve your vision?
  2. candied carrots
  3. a peanut butter sandwich
  4. brewer’s yeast
  5. pork chops


  1. Identify the food group that is the best source of beta-carotene.
  2. meat group
  3. milk group
  4. vegetable group
  5. grain group


  1. Among fruits and vegetables, the best sources of beta-carotene are:
  2. green or yellow, like lettuce and corn.
  3. dark green or deep orange, like broccoli and sweet potatoes.
  4. green, like lettuce, peas, and snap beans.
  5. brightly colored, like tomatoes and lemons.


  1. Vitamin D can be made in the body with the help of:
  2. bacteria.
  3. tryptophan.
  4. vitamin A.
  5. sunlight.


  1. The main function of vitamin D in bone growth is to:
  2. synthesize 7-dehydrocholesterol.
  3. assist in the absorption of calcium and phosphorus.
  4. mobilize calcium from the bone.
  5. secrete calcitonin.


  1. The effects of a deficiency of vitamin D are most readily observed in the:
  2. nervous system.
  3. skeletal system.
  4. muscular system.
  5. epithelial tissue.


  1. A deficiency of vitamin _____ can cause rickets.
  2. A
  3. B12
  4. C
  5. D


  1. The vitamin D-deficiency disease of children is:
  2. xerophthalmia.
  3. osteomalacia.
  4. osteoporosis.
  5. rickets.


  1. Osteomalacia is mainly due to a deficiency of:
  2. vitamin A.
  3. vitamin D.
  4. parathormone.
  5. calcitonin.


  1. An excess of vitamin _____ can cause excess calcium withdrawal from the bones.
  2. A
  3. B6
  4. D
  5. C


  1. Excessive intakes of vitamin D by adults may result in:
  2. greater bone density.
  3. mineral deposits in soft tissues such as the kidney.
  4. deformity of the leg bones, ribs, and skull.
  5. increased bone calcification.


  1. After 30 minutes of sun exposure, which of the following people would have synthesized more vitamin D?
  2. a light-skinned person
  3. a dark-skinned person
  4. neither, because skin pigmentation is not related to vitamin D synthesis
  5. they would both synthesize the same amount


  1. Vitamin D deficiency is most likely among:
  2. dark-skinned people who live in the south.
  3. fair-skinned people who live in the south.
  4. dark-skinned people with limited exposure to sunlight.
  5. fair-skinned people with limited exposure to sunlight.


  1. Factors that may limit sun exposure and, therefore, vitamin D synthesis include all of the following except:
  2. geographic location.
  3. season of the year.
  4. sunscreens.
  5. use of tanning beds.


  1. From the list below, choose the most reliable food source of vitamin D for children.
  2. whole grains
  3. fortified milk
  4. yogurt
  5. orange juice


  1. The chemical name for vitamin E is:
  2. beta-carotene.
  3. cholecalciferol.
  4. ascorbic acid.
  5. tocopherol.


  1. The major role of vitamin E in the body seems to be to:
  2. aid in normal blood clotting.
  3. act as an antioxidant.
  4. aid in formation of normal epithelial tissue.
  5. act as a coenzyme in protein metabolism.


  1. Vitamin E:
  2. functions as an effective antisterility agent in human beings.
  3. protects vitamin A and polyunsaturated fatty acids from oxidation.
  4. is needed by human beings as a dietary supplement because of the variety of functions it has in the body.
  5. slows down the aging process.


  1. Regarding vitamin E supplementation, scientists have concluded that:
  2. there is not enough evidence to recommend taking supplements to prevent heart disease.
  3. sufficient evidence exists to recommend that everyone over 40 should take a supplement.
  4. large doses are more beneficial than low doses.
  5. all people who have had a heart attack should take a supplement.


  1. Vitamin E deficiency causes:
  2. xerophthalmia.
  3. rickets.
  4. erythrocyte hemolysis.
  5. osteomalacia.


  1. Vitamin E is widespread in all of the following foods except:
  2. margarine.
  3. salad dressing.
  4. wheat germ oil.
  5. butter.


  1. Vitamin E deficiencies are rarely observed in human beings because:
  2. the vitamin is so widespread in foods.
  3. it can be synthesized by the body.
  4. most people take vitamin E supplements.
  5. it is not essential.


  1. Vitamin K has long been known for:
  2. being responsible for energy metabolism.
  3. promoting healthy epithelial tissue.
  4. being involved with blood clotting.
  5. enhancing calcium utilization.


  1. Which vitamin is synthesized in the intestine by bacteria?
  2. vitamin A
  3. vitamin C
  4. vitamin K
  5. vitamin E


  1. Overconsumption of the water-soluble vitamins will likely result in:
  2. a reserve supply, which will aid in the prevention of colds and infections.
  3. no apparent change, because they are stored in the adipose tissues.
  4. no apparent change, because they are excreted.
  5. toxic accumulation in the liver.


  1. Thiamin is involved in:
  2. formation of red blood cells.
  3. blood coagulation.
  4. collagen formation.
  5. energy metabolism.


  1. Abuse of alcohol may lead to a severe form of thiamin deficiency called:
  2. beriberi.
  3. Wernicke-Korsakoff syndrome.
  4. pellagra.
  5. rickets.


  1. Riboflavin is used by the body to:
  2. facilitate energy metabolism.
  3. prevent the disease pellagra.
  4. provide building material for red blood cells.
  5. maintain epithelial tissue.


  1. Which of the following foods would make the greatest contribution to a person’s intake of riboflavin?
  2. oatmeal
  3. milk
  4. oranges
  5. yellow squash


  1. Which of the following statements is true of niacin?
  2. It can be synthesized in the body from the amino acid tryptophan.
  3. It can be used successfully to cure schizophrenia.
  4. It is water soluble and therefore safe to administer in large doses.
  5. It is an antioxidant.


  1. Which vitamin can be used as a pharmacological agent for the treatment of high cholesterol?
  2. thiamin
  3. vitamin E
  4. niacin
  5. vitamin C


  1. The most well-known role of vitamin B6 is in relation to:
  2. carbohydrate and lactose metabolism.
  3. fat metabolism.
  4. protein and amino acid metabolism.
  5. mineral metabolism.


  1. Vitamin B6 differs from the other water-soluble vitamins because:
  2. it does not play a role in the metabolism of energy-yielding nutrients.
  3. it can be stored in the body.
  4. it is absorbed like the fat-soluble vitamins.
  5. it is only found in animal foods.


  1. Which vitamin is most vulnerable to interactions with alcohol and other drugs?
  2. vitamin C
  3. vitamin E
  4. folate
  5. biotin


  1. The replacement of red blood cells and digestive tract cells depends most heavily on:
  2. thiamin.
  3. riboflavin.
  4. niacin.
  5. folate.


  1. The most important role of vitamin B12 is to assist folate in:
  2. cell division.
  3. conversion of tryptophan to niacin.
  4. release of energy from food.
  5. regulation of the body’s use of calcium and phosphorus.


  1. Absorption of _____ requires the presence of intrinsic factor.
  2. vitamin B6
  3. vitamin D
  4. vitamin B12
  5. vitamin A


  1. Which of the following groups of people is most at risk for a primary deficiency of vitamin B12?
  2. the elderly
  3. infants
  4. athletes
  5. vegans


  1. Ascorbic acid is another name for:
  2. niacin.
  3. thiamin.
  4. vitamin C.
  5. vitamin B6.


  1. The formation of collagen requires an adequate intake of:
  2. vitamin K.
  3. vitamin E.
  4. vitamin C.
  5. folate.


  1. Many of the symptoms of vitamin C deficiency, such as dry scaly skin and failure of wounds to heal, are related to the role of vitamin C in the synthesis of:
  2. calcium and iron.
  3. thyroxin.
  4. collagen.
  5. adrenal hormones.


  1. The first signs of vitamin C deficiency appear in the:
  2. blood vessels.
  3. bones.
  4. hair.
  5. fingernails.


  1. _____ may occur from taking megadoses of vitamin C.
  2. Iron overload
  3. Scurvy
  4. Gout
  5. Gallstones


  1. Among the following, the best food sources for the water-soluble vitamins are:
  2. butter and vegetable oils.
  3. oranges and cereals.
  4. sugar and cornstarch.
  5. egg yolks and apples.


  1. Which of the following groups needs an intake of vitamin C in excess of the RDA?
  2. smokers
  3. professional athletes
  4. the elderly
  5. growing children


  1. Which of these meals is lacking in vitamin C?
  2. hotdog, cabbage, french fries, and milk
  3. roast beef, cheese sauce, noodles, and tea
  4. roast beef, broccoli, noodles, and coffee
  5. spaghetti with tomato sauce, meatballs, garlic bread, and cantaloupe


  1. The absorption of iron from iron-containing foods can double or triple when eaten at the same meal with foods containing:
  2. folate.
  3. protein.
  4. vitamin C.
  5. calcium.


Nutrition in Practice – Phytochemicals and Functional Foods


  1. Which of the following statements is not true regarding functional foods?
  2. Functional foods provide health benefits beyond basic nutrition by altering one or more body processes.
  3. Vegetables, fruits, and other whole foods are examples of functional foods.
  4. Calcium-fortified orange juice is a functional food.
  5. The health benefits of functional foods are listed on the food label.


  1. Phytochemicals:
  2. are essential nutrients.
  3. are bioactive compounds found in foods.
  4. have no biological activity in the body.
  5. are nonessential nutrients.


  1. Studies suggest that a diet rich in carotenoids is associated with a lower risk of:
  2. diabetes.
  3. arthritis.
  4. heart disease.
  5. osteoporosis.


  1. The best way to reap the benefits of phytochemicals is by:
  2. eating a variety of plant foods.
  3. taking a variety of supplements.
  4. increasing your consumption of animal foods.
  5. frequently consuming manufactured functional foods.


  1. Research concerning the safety and effectiveness of manufactured functional foods:
  2. is inconclusive at this time.
  3. shows definite benefits to consuming such foods.
  4. suggests that they may be substituted for prescription drugs.
  5. is supported by the FDA.





196                 1.     Identify three ways vitamin D helps to maintain blood concentrations of calcium and phosphorus.


197                 2.     Describe the factors that may interfere with vitamin D synthesis.


199                 3.     Identify groups of people who are at risk for vitamin E deficiency, in addition to those with diseases.


202,203-5     4.     Define the term coenzyme. Name and describe the role of the B vitamins that function as part of the structure of coenzymes.


203-211         5.     For each of the following vitamins, identify its chief functions in the body, the symptoms characteristic of a deficiency, and significant food sources.

  1. thiamin
  2. riboflavin
  3. niacin
  4. vitamin B6
  5. folate
  6. vitamin B12
  7. pathothenic acid
  8. biotin
  9. vitamin C


204                 6.     Why is milk usually sold in cardboard or opaque plastic containers?


209                 7.     Discuss the potential problems with vegetarianism and vitamin B12 deficiency.


192,198,209 8.     Name the antioxidant vitamins and describe how they function in the body.





a.     the vitamin D–deficiency disease in children.

b.     a bone disease characterized by softening of the bones.

c.     literally, porous bones; reduced density of the bones.

d.     a vitamin B12-deficiency disease caused by lack of intrinsic factor and characterized by large, immature red blood cells and damage to the nervous system.

e.     rupture of the red blood cells, caused by vitamin E deficiency.

f.     the vitamin K–deficiency disease in which blood fails to clot.

g.     the thiamin-deficiency disease.

h.     the niacin-deficiency disease.

i.      malformations of the brain, spinal cord, or both during embryonic development.

j.      a metabolic disease in which crystals of uric acid precipitate in the joints.

k.     the vitamin C–deficiency disease.

l.      a compound that protects other compounds from oxygen by itself reacting with oxygen.

m.   highly reactive chemical forms that can cause destructive changes in nearby compounds, sometimes setting up a chain reaction.

n.     the amount of niacin present in food, including the niacin that can theoretically be made from tryptophan, its precursor, present in the food.



a.     a fat-soluble vitamin with the three chemical forms retinol, retinal, and retinoic acid.

b.     a vitamin A precursor made by plants and stored in human fat tissue.

c.     the specific protein responsible for transporting retinol.

d.     the hard, transparent membrane covering the outside of the eye.

e.     the layer of light-sensitive nerve cells lining the back of the inside of the eye.

f.     the slow recovery of vision after exposure to flashes of bright light at night.

g.     the development of specific functions different from those of the original.

h.     cells on the surface of the skin and mucous membranes.

i.      tissue composing the layers of the body that serve as selective barriers between the body’s interior and the environment.

j.      membrane composed of mucus-secreting cells that lines the surfaces of body tissues.

k.     a water-insoluble protein; the normal protein of hair and nails.

l.      a group of cells in the skin from which a hair grows.

m.   vitamin A in its active form.

n.     causing abnormal fetal development and birth defects.

o.     a measure of vitamin A activity; the amount of retinol that the body will derive from a food containing preformed retinol or its precursor beta-carotene.

p.     the addition to a food of nutrients to meet a specified standard.

q.     the addition to a food of nutrients that were either not originally present or present in insignificant amounts.





Chapter 9 – Water and the Minerals


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




225 1.                     Thirst and satiety are the two factors that govern water intake in healthy people.   


227 2.                     Pale, yellow urine is representative of dehydration.


227 3.                     Water constitutes up to 95 percent of the volume of most fruits and vegetables.


229 4.                     People who eat mostly processed and fast foods have the highest sodium intakes.


231 5.                     Potassium deficiency is characterized by a decrease in blood pressure, salt sensitivity, kidney stones, and bone turnover.


232 6.                     Adequate calcium intake is important between the ages of 12 and 30 because this is the time when bones grow thicker and denser.


236 7.                     Mustard greens, kale, parsley, watercress, and broccoli are good sources of available calcium.


239 8.                     Absorption of iron increases as intake increases.


240 9.                     Parasitic infections of the GI tract can lead to iron-deficiency anemia due to bleeding.


245 10.                  Children with a mild iodine deficiency typically perform poorly in school.


Multiple Choice


  1. What percentage of an adult’s body is water?
  2. 30%
  3. 40%
  4. 60%
  5. 90%


  1. Water is involved in all of the following except:
  2. regulating body temperature.
  3. converting lipids to amino acids.
  4. serving as a solvent for minerals and vitamins.
  5. acting as a lubricant around joints.


  1. The hormone that stimulates the kidneys to reabsorb water rather than excrete it is
  2. thyroxine.
  3. ADH.
  4. cortisone.
  5. epinephrine.


  1. What is the minimum amount of urine the body must excrete each day to remove waste products?
  2. 500 mL
  3. 700 mL
  4. 2300 mL
  5. 3000 mL
  6. A person must have water in his or her diet:
  7. because the kidneys exert no control over the amount of water excreted in the urine.
  8. to prevent vitamin imbalances in the body.
  9. because the kidneys must excrete a minimum amount of water as urine to rid the body of wastes.
  10. in order to prevent water intoxication.


  1. According to the DRI Committee, the adequate intake for total water for a female is:
  2. 2 cups per day.
  3. 2.7 L per day.
  4. 3.7 L per day.
  5. 24 ounces per day.


  1. In regard to caffeine, the DRI Committee determined that:
  2. beverages that contain caffeine do not count toward meetings one’s fluid needs.
  3. a person should not consume more than three cups of caffeine-containing beverages a day.
  4. caffeinated beverages contribute to daily total water intake similar to that contributed by non-caffeinated beverages.
  5. caffeine causes a net deficit of fluid in the body; therefore, caffeine-containing beverages should be avoided by athletes particularly.


  1. Electrolytes in the body function to:
  2. maintain fluid balance.
  3. stimulate enzyme action.
  4. synthesize protein.
  5. maintain the health of cell membranes.


  1. Body sodium levels are largely regulated through:
  2. changes in intestinal absorption, depending on need.
  3. changes in fecal excretion.
  4. storage of excess sodium in the liver.
  5. excretion of excess sodium by the kidneys.


  1. Which of the following organ systems plays the primary role in maintaining acid-base balance?
  2. lungs
  3. skin
  4. GI tract
  5. kidneys


  1. Which of the following is a trace mineral?
  2. iron
  3. sulfur
  4. calcium
  5. potassium


  1. The primary regulator of extracellular fluid volume is:
  2. chlorine.
  3. sodium.
  4. magnesium.
  5. potassium.


  1. The UL for sodium intake for adults is set at:
  2. 1200 mg.
  3. 1500 mg.
  4. 2300 mg.
  5. 3000 mg.


  1. The largest percentage of sodium in people’s diets comes from:
  2. salt added during cooking.
  3. salt added to foods by manufacturers.
  4. salt added at the table.
  5. the natural salt content of foods.


  1. Which of the following groups of people would have the lowest sodium intakes?
  2. those who avoid adding salt to their food
  3. those who exercise strenuously on a regular basis
  4. those who eat mostly processed foods
  5. those who eat mostly whole, unprocessed foods


  1. Which of the following foods is low in sodium?
  2. pickles
  3. fresh carrots
  4. processed cheese
  5. bologna


  1. The major negative ion of the extracellular fluid is:
  2. sodium.
  3. potassium.
  4. chloride.
  5. calcium.


  1. An important function of chloride in the body is to:
  2. maintain fluid balance.
  3. regulate metabolism.
  4. develop bone cells.
  5. control blood glucose levels.


  1. The most reliable food source(s) of chloride is (are):
  2. meats and whole-grain cereals.
  3. salt.
  4. dark green vegetables.
  5. drinking water.


  1. Potassium:
  2. is directly necessary for protein synthesis in cells.
  3. protects bone structure against degeneration.
  4. is the body’s principal electrolyte inside the cells.
  5. is necessary for wound healing.


  1. An irregular heartbeat related to potassium loss may occur:
  2. with diets low in fresh fruits and vegetables.
  3. as a result of severe diarrhea.
  4. in persons with diabetes.
  5. due to an excessive intake of protein.


  1. People who regularly take prescription drugs such as steroids and diuretics are at risk for a deficiency of:
  2. potassium.
  3. chloride.
  4. iodine.
  5. selenium.


  1. From the list below, choose the richest source of potassium.
  2. fresh fruits and vegetables
  3. milk and dairy products
  4. meats and meat substitutes
  5. bread and cereals


  1. Which of the following is not a good source of potassium?
  2. orange juice
  3. bananas
  4. cheese
  5. broccoli


  1. The typical U. S. diet provides about _____ the recommended intake of potassium.
  2. ¼
  3. 1/3
  4. ½
  5. ¾


  1. Almost all (99%) of the calcium in the body is used to:
  2. provide energy for cells.
  3. provide rigidity for the bones.
  4. regulate the transmission of nerve impulses.
  5. regulate muscle contraction.


  1. Ninety-nine percent of the body’s calcium is stored in the:
  2. bones.
  3. liver.
  4. kidneys.
  5. blood.


  1. Bones continuously gain and lose minerals. This ongoing process is called:
  2. reorganization.
  3. remodeling.
  4. reorienting.
  5. redesigning.


  1. Which of the following body processes is not dependent upon the presence of calcium in the body fluids?
  2. blood clotting
  3. muscle contractions
  4. transmission of nerve impulses
  5. transportation of oxygen in the bloodstream


  1. When blood calcium falls too low, a regulatory system acts in three locations to raise it. Which of the following is not one of those locations?
  2. stomach
  3. small intestine
  4. bones
  5. kidneys
  6. Blood calcium levels can be increased by all of the following except:
  7. increased absorption of calcium in the intestines.
  8. retention of calcium by the kidneys.
  9. release of calcium from the bones.
  10. manufacture of calcium from albumin.


  1. Osteoporosis is found in:
  2. young women; they have porous and thin bones.
  3. older women; they have large bones.
  4. older women; they have porous, thin, and fragile bones.
  5. young children; they have bowed legs.
  6. men; they have thick bones.


  1. Osteoporosis is more prevalent in women due to all of the following reasons except:
  2. women consume less calcium.
  3. women have lower bone mass.
  4. women have smaller bodies.
  5. bone loss begins later in women.


  1. All of the following foods are good sources of bioavailable calcium except:
  2. milk.
  3. sardines.
  4. cheddar cheese.
  5. spinach.


  1. Calcium is found in the most abundance in:
  2. dark green vegetables.
  3. milk.
  4. meats.
  5. cereal grains.


  1. Which of the following enhances calcium absorption from the GI tract?
  2. vitamin D
  3. vitamin C
  4. protein
  5. linoleic acid


  1. All of the following are true of phosphorus except that it:
  2. participates in the transfer of energy during cellular metabolism.
  3. is necessary for growth.
  4. is found with calcium in bones and teeth.
  5. aids in blood glucose regulation.


  1. Which mineral is a principal component of cell membranes?
  2. iron
  3. phosphorous
  4. potassium
  5. iodine


  1. Of the foods listed, the best source of phosphorus is:
  2. tofu.
  3. chicken.
  4. noodles.
  5. cheese.


  1. The mineral that is least likely to be deficient in anyone’s diet is:
  2. calcium.
  3. phosphorus.
  4. iron.
  5. iodine.


  1. Magnesium’s major functions in the body include all of the following except:
  2. it is critical to the operation of hundreds of enzymes.
  3. synthesis of protein in the soft tissues.
  4. it allows muscles to relax after contraction.
  5. regulation of body temperature.


  1. The hallucinations commonly experienced during withdrawal from alcohol intoxication are believed to be due to a deficiency of:
  2. magnesium.
  3. phosphorus.
  4. iron.
  5. calcium.


  1. Magnesium deficiency may occur as a result of all of the following except:
  2. vomiting.
  3. diarrhea.
  4. constipation.
  5. alcohol abuse.


  1. The best food sources of magnesium include:
  2. legumes, whole grains, and chocolate.
  3. milk, rice, and apples.
  4. oranges, beef, and cheese.
  5. oils, bananas, and pork.


  1. Amino acids containing the mineral _____ help to form the shape of proteins.
  2. sulfur
  3. sodium
  4. phosphorous
  5. selenium


  1. A person who is severely lacking in _____ may experience a sulfur deficiency.
  2. carbohydrate
  3. fatty acids
  4. protein
  5. vitamins


  1. Iron is important in the body because it is:
  2. needed for blood clotting.
  3. an integral part of bones and teeth.
  4. an antioxidant.
  5. an integral constituent of hemoglobin.


  1. Iron is a component of the protein _____, which transports oxygen in the bloodstream.
  2. myoglobin
  3. transferrin
  4. hemosiderin
  5. hemoglobin


  1. The percentage of dietary iron normally absorbed is about:
  2. 10-15%.
  3. 25-50%.
  4. 35-65%.
  5. 70-80%.


  1. Which of the following is not a form of iron?
  2. transferrin
  3. ferritin
  4. hemosiderin
  5. hepcidin


  1. Worldwide, the most common nutrient deficiency is:
  2. zinc deficiency.
  3. selenium deficiency.
  4. iron deficiency.
  5. iodine deficiency.


  1. In the U.S., low iron intake is often associated with:
  2. high sugar and fat intakes.
  3. high protein intake.
  4. low carbohydrate intake.
  5. low intake of fruits and vegetables.


  1. Pica is a behavior seen in some people who are deficient in:
  2. sodium.
  3. potassium.
  4. chromium.
  5. iron.


  1. Supplements containing _____ should be kept out of children’s reach to prevent accidental poisonings, which can potentially be fatal.
  2. iron
  3. vitamin D
  4. zinc
  5. niacin


  1. Which of the following is a poor food source of iron?
  2. dried fruits
  3. enriched cereals
  4. legumes
  5. cheese


  1. In order to increase the amount of iron absorbed from a meal, you would:
  2. consume tea as a beverage with the meal.
  3. eat a calcium-rich food with the meal.
  4. consume orange juice as a beverage with a meal.
  5. avoid eating foods rich in vitamin C with the meal.


  1. Which of the following food components or nutrients does not contribute to iron deficiency?
  2. tannins
  3. calcium
  4. phytates
  5. vitamin C


  1. Which mineral is essential for wound healing?
  2. potassium
  3. sulfate
  4. zinc
  5. iodine


  1. Zinc is highest in foods with high _____ content.
  2. alcohol
  3. protein
  4. carbohydrate
  5. fat


  1. Keshan disease is related to a deficiency of:
  2. fluoride.
  3. iodine.
  4. selenium.
  5. iron.


  1. Iodine deficiency is associated with all of the following except:
  2. weight gain.
  3. cretinism.
  4. weight loss.
  5. goiter.


  1. A good food source of iodine is:
  2. bananas.
  3. seafood.
  4. broccoli.
  5. pork.
  6. High intakes of _____ interfere with copper absorption and can lead to a deficiency.
  7. zinc
  8. iron
  9. chromium
  10. manganese


  1. Fluoride seems to be helpful in preventing:
  2. cancer.
  3. diabetes.
  4. dental decay.
  5. heart disease.
  6. goiter.


  1. A diabetes-like condition may develop when _____ is lacking in the diet.
  2. iron
  3. zinc
  4. chromium
  5. molybdenum


  1. The best way to ensure an adequate intake of trace minerals is to:
  2. eat foods containing the major minerals.
  3. make sure your diet is sufficient in vitamins.
  4. consume a variety of foods.
  5. practice dietary adequacy.


Nutrition in Practice – Vitamin and Mineral Supplements


  1. Nutrient supplements in amounts consistent with the RDA should be taken in all of the following circumstances except:
  2. when your energy intake is low.
  3. when you are a vegan.
  4. when you have an illness that takes away your appetite.
  5. when you depend primarily on grocery-store foods.


  1. Supplement users are more likely to have excessive intakes of:
  2. the B vitamins.
  3. iron, zinc, vitamin A, and niacin.
  4. vitamins A, D, E, and K
  5. calcium, iron, vitamin C, and thiamin


  1. When selecting a vitamin-mineral supplement, choose one in which the nutrient levels are:
  2. at or very close to the RDA.
  3. all the same.
  4. at least 200 percent of the RDA.
  5. at least 300 percent of the RDA.


  1. All of the following supplement preparations should be avoided except those:
  2. containing carnitine or inositol.
  3. claiming to be “high-potency” or a “therapeutic dose.”
  4. containing a balance of vitamins and minerals.
  5. claiming to be “organic” or “natural” preparations with added substances.


  1. The best advice to give someone who is considering a supplement to improve their health is:
  2. Choose a supplement that has been approved by the FDA.
  3. Spend your money on fruits, vegetables, whole grains, lean meats, and milk products instead.
  4. Buy supplements that have the USP symbol on the label for assurance of safety and effectiveness.
  5. Choose a supplement that contains the Tolerable Upper Intake Level for maximum effectiveness.





a.     the balance between water intake and water excretion that keeps the body’s water content constant.

b.     the loss of water from the body that occurs when water output exceeds water input.

c.     the rare condition in which body water contents are too high.

d.     a part of the brain that helps regulate many body balances, including fluid balance.

e.     in the brain, the “king gland” that regulates the operation of many other glands.

f.     a hormone released by the pituitary gland in response to high salt concentrations in the blood; the kidneys respond by reabsorbing water.

g.     a hormone secreted by the adrenal glands that stimulates the reabsorption of sodium by the kidneys; also regulates chloride and potassium concentrations.

h.     fluid residing outside the cells; includes the fluid between the cells (interstitial fluid), plasma, and the water of structures such as the skin and bones.

i.      high blood pressure.

j.      a precursor to hemoglobin.

k.     a craving for nonfood substances.





225-226         1.     Describe the body’s mechanism for regulating water excretion.


233, 236        2.     Describe how the body regulates the absorption of calcium.


239-240         3.     Describe the major causes of iron deficiency in the U.S.


243-244         4.     Identify four groups of individuals in the U. S. who are at risk for developing zinc deficiency and briefly describe the rationale for including each group.


246                 5.     Discuss the functions of copper in the body.


246-247         6.     What is the mechanism by which fluoride exerts a caries-reducing effect?




Chapter 10 – Fitness and Nutrition


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




258-259                 1.     The types and amounts of physical activity needed to promote fitness may differ from those needed to obtain health benefits.


263 2.                     The amount of glycogen a body stores depends partially on the amount of carbohydrate in the diet.


267 3.                     Areas of the body that have the most fat to spare donate the greatest amounts of fatty acids to the blood during exercise.


271 4.                     Sports anemia clears up without treatment.


273 5.                     People normally need to make special efforts to replenish electrolytes lost during exercise.


                                        Nutrition in Practice: Supplements and Ergogenic Aids Athletes Use


283 6.                     No research supports the idea that caffeine enhances endurance.


Multiple Choice


  1. As many as _____ percent of adults in the U.S. are completely inactive.
  2. 20
  3. 50
  4. 60
  5. 75


  1. Benefits of fitness include all of the following except:
  2. it shifts body composition toward more lean tissue .
  3. it enables the body to resist colds.
  4. improved self-discipline.
  5. improved bone density.


  1. All of the following are benefits of physical activity except:
  2. lower blood pressure.
  3. slower resting pulse.
  4. increased HDL cholesterol.
  5. increased LDL cholesterol.


  1. The Physical Activity Guidelines for Americans specify that people need to spend at least _____ performing moderate-intensity aerobic activity on five to seven days per week.
  2. 20 minutes
  3. 30 minutes
  4. 45 minutes
  5. 60 minutes


  1. Running at a pace of 6.5 miles/hour is an example of a(n):
  2. vigorous-intensity physical activity.
  3. moderate-intensity physical activity.
  4. muscle-strengthening physical activity.
  5. anaerobic physical activity.


  1. The ability to bend and recover without injury is called:
  2. muscular endurance.
  3. flexibility.
  4. strength.
  5. cardiorespiratory endurance.


  1. A fitness program should help you maintain all of the following health-related components except:
  2. speed.
  3. flexibility.
  4. muscle endurance.
  5. muscle strength.


  1. An increase in the size and strength of muscle tissues is called:
  2. hypertrophy.
  3. overload.
  4. hyponatremia.
  5. atrophy.


  1. Which of the following is not a benefit of weight training?
  2. improved posture
  3. enhanced psychological well-being
  4. improved muscle endurance
  5. enhanced appetite


  1. VO2max refers to:
  2. maximal oxygen uptake.
  3. maximal pulse rate.
  4. maximal repetitions.
  5. maximal resistance.


  1. Aerobic exercise results in all of the following except:
  2. a stronger heart muscle.
  3. an increase in blood pressure.
  4. increased stroke volume..
  5. more efficient breathing.


  1. The average resting pulse rate for adults is around _____ beats per minute.
  2. 50
  3. 60
  4. 70
  5. 80


  1. Glycogen stores can be quickly depleted when an exerciser is on a diet that is:
  2. low in carbohydrates.
  3. high in protein.
  4. low in fat.
  5. high in carbohydrates.


  1. During rest, the body derives a little more than half of its energy from:
  2. glucose.
  3. fatty acids.
  4. amino acids.
  5. glycogen.


  1. A high-carbohydrate diet enhances an athlete’s endurance by:
  2. providing plenty of fiber.
  3. ensuring ample glycogen stores.
  4. improving oxygen uptake.
  5. ensuring ample stores of fatty acids.


  1. The rate at which a person uses glycogen during physical activity depends on all of the following except:
  2. duration of the activity.
  3. intensity of the activity.
  4. how well-trained the person is.
  5. body weight.


  1. Which of the following would benefit from consuming a drink that provides glucose during exercise?
  2. someone who swims for more than an hour and a half a day
  3. someone who plays tennis three times a week for an hour
  4. someone who jogs two to three times a week for half an hour
  5. someone who rides a bike every other day for 30 minutes


  1. Following exercise, approximately _____ grams of carbohydrate should be consumed in order to maximize an athlete’s glucose supply.
  2. 20
  3. 40
  4. 60
  5. 80


  1. After _____ minutes of exercise, the body begins to use more fat for fuel.
  2. 10
  3. 20
  4. 30
  5. 60


  1. Athletic performance may be inhibited by:
  2. very-low-fat diets.
  3. high-carbohydrate diets.
  4. low-protein diets.
  5. high-sodium diets.


  1. Diets lacking in carbohydrate:
  2. necessitate the conversion of amino acids to glucose.
  3. cause amino acids to be converted to fatty acids.
  4. require more fluid intake.
  5. necessitate the conversion of glucose to amino acids.


  1. Which of the following groups has the lowest protein needs?
  2. body builders
  3. endurance athletes
  4. sedentary people
  5. all need the same amount of protein
  6. Estimate the recommended protein intake for a 150-pound male endurance athlete.
  7. 55-68 grams per day
  8. 82-95 grams per day
  9. 90-112 grams per day
  10. 109-116 grams per day


  1. Iron-deficiency anemia hinders exercise performance by limiting the amount of _____ available to muscles.
  2. oxygen
  3. hydrogen
  4. glycogen
  5. hemoglobin


  1. Iron deficiency is especially likely to develop in:
  2. children.
  3. physically active young women.
  4. physically active men.
  5. older active adults.


  1. Iron supplements are needed when athletes:
  2. feel tired after exercise.
  3. have sports anemia.
  4. have iron-deficiency anemia.
  5. become dehydrated.


  1. The most critical nutrient needed for the exerciser is:
  2. iron.
  3. water.
  4. calcium.
  5. protein.


  1. Drinking extra fluid in the days leading up to an athletic event:
  2. increases fluid stores in the body.
  3. increases glycogen stores.
  4. ensures maximum tissue hydration to start the event.
  5. assists the body in better utilizing protein for energy.


  1. Severe headache, vomiting, bloating, confusion, and seizure are all symptoms of:
  2. “hitting the wall.”
  3. hyponatremia.
  4. hypothermia.
  5. sports anemia.


  1. Based on an appropriate schedule of hydration for physical activity, after exercise at least _____ cups of fluid for each pound of weight lost should be consumed.
  2. 1
  3. 2
  4. 3
  5. 4


  1. The best fluid to support physical activity for endurance athletes is:
  2. plain, cool water.
  3. saltwater mixtures.
  4. sports drinks.
  5. lukewarm water.


  1. Characteristics of the best diet for fitness include all of the following except:
  2. high in carbohydrates.
  3. based on nutrient-dense foods.
  4. adequate in protein.
  5. high in fat.


  1. The optimum diet for an athlete provides about _____ percent of kcalories from carbohydrates.
  2. 30-40
  3. 40-50
  4. 50-60
  5. 60-70


  1. If an athlete consumes 3000 kcalories, at a minimum how many grams of carbohydrate should he consume?
  2. 200
  3. 325
  4. 450
  5. 500


  1. Desirable characteristics of foods included in a pregame meal include:
  2. high in fat.
  3. high in fiber.
  4. low in carbohydrate.
  5. low in protein.


  1. Which of the following foods would be the best choice for a pregame meal?
  2. black beans and rice
  3. pasta in marinara sauce
  4. peanut butter and jelly sandwich
  5. cheese and crackers


  1. Which of the following foods should be avoided prior to competition?
  2. ice cream
  3. grape juice
  4. banana
  5. graham crackers


Nutrition in Practice: Supplements and Ergogenic Aids Athletes Use


  1. Supplements of carnitine are not necessary because it is naturally found in:
  2. fruits and vegetables.
  3. whole grains.
  4. nutrient-dense foods.
  5. milk and meat products.


  1. Which of the following ergogenic aids has been shown to boost performance?
  2. carnitine
  3. ribose
  4. royal jelly
  5. none of the above


  1. If taken correctly, in which of the following sports might creatine enhance performance?
  2. weight lifting
  3. tennis
  4. swimming
  5. baseball


  1. Adverse effects associated with steroid use include all of the following except:
  2. cancerous liver tumors.
  3. decreased blood pressure.
  4. sterility.
  5. testicular shrinkage in men.


  1. The way to make muscle cells grow is to:
  2. make them work.
  3. take protein supplements.
  4. consume more dietary protein.
  5. a and b





a.     physically inactive (literally “sitting down a lot”).

b.     an increase in the frequency, duration, or intensity of an activity.

c.     an increase in size in response to use.

d.     a decrease in size because of disuse.

e.     requiring oxygen.

f.     the maximum rate of oxygen consumption by an individual.

g.     the volume of blood discharged by the heart each minute.

h.     the amount of oxygenated blood ejected from the heart toward body tissues at each beat.

i.      the major hormone that elicits the stress response.

j.      not requiring oxygen.

k.     a compound produced during the breakdown of glucose in anaerobic metabolism.

l.      an above-normal body temperature.

m.   an acute and life-threatening reaction to heat buildup in the body.

n.     a below-normal body temperature.

o.     a decreased concentration of sodium in the blood.

p.     compounds that supply glucose, not as single molecules, but linked in chains somewhat like starch.

q.     water that is fortified with ingredients such as vitamins, minerals, protein, oxygen, or herbs.





262-263         1.     Describe some of the conditioning effects of cardiorespiratory training.


259                 2.     Explain what a person has to do in terms of type, frequency, intensity, and duration of activity to meet the ACSM’s guidelines for physical activity.


273                 3.     Why is plain, cool water the best fluid for noncompetitive, everyday active people?


275-278         4.     Describe characteristics of a diet best suited for a person who engages in physical activity.


276-277         5.     Describe the desirable composition of a pregame meal and explain why certain categories of foods should be avoided.





Chapter 11 – Nutrition Through the Life Span: Pregnancy and Lactation


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




288 1.                     A low-birthweight baby has a statistically greater chance of contracting diseases and dying early in life.


297 2.                     Because of the dangers of obesity, an overweight woman should try to gain little or no weight during pregnancy.


306 3.                     Increasing maternal fluid intake does not increase breast milk volume.


308 4.                     A lactating mother should avoid all types of oral contraceptives.


Nutrition in Practice – Encouraging Successful Breastfeeding


315 5.                     Improper breastfeeding position is a frequent cause of sore nipples.


Multiple Choice


  1. The most potent single predictor of an infant’s future health status is:
  2. rapidity of the mother’s recovery.
  3. the infant’s birthweight.
  4. the age at which the infant first learns to walk.
  5. the ease and rapidity of delivery.


  1. Research suggests that low-birthweight babies may experience any of the following long-term health effects except:
  2. a lower adult IQ.
  3. greater risk of heart disease and hypertension.
  4. short stature.
  5. greater risk of psychological problems.


  1. All of the following are likely complications that obese pregnant women may face except:
  2. premature delivery.
  3. a larger-than-normal baby.
  4. complications during delivery.
  5. a low-birthweight baby.


  1. Nutrients and oxygen travel to the developing fetus via:
  2. the placenta.
  3. the amniotic sac.
  4. its lungs.
  5. its intestines.


  1. The effects of malnutrition during critical periods in pregnancy:
  2. can be offset by vitamin and mineral supplementation.
  3. are irreversible.
  4. can be remedied later in pregnancy with a nutritious diet.
  5. are not significant.


  1. A pregnant woman’s daily energy needs increase by _____ kcalories in the first trimester, ____ kcalories in the second trimester, and _____ kcalories in the third trimester.
  2. 0, 340, 450
  3. 100, 300, 500
  4. 50, 140, 250
  5. 0, 300, 600


  1. During pregnancy, food energy needs increase less than nutrient needs. To achieve this balance, food selection should include all but which of the following?
  2. foods of high nutrient density
  3. decreased portions of calcium-rich foods
  4. use of nonfat milk and lean meats
  5. increased portions of vitamin C-rich foods


  1. Ample carbohydrate is needed by the pregnant woman in order to:
  2. raise blood glucose levels.
  3. fuel the fetal brain and spare protein needed for fetal growth.
  4. provide adequate protein.
  5. increase glycogen stores in the fetus.


  1. Low-carbohydrate diets during pregnancy:
  2. help to prevent excess weight gain for the mother.
  3. may impair brain development in the fetus.
  4. may lead to pre-term labor.
  5. aid in preventing gestational diabetes.


  1. The RDA for protein during pregnancy is an additional _____ grams per day.
  2. 10
  3. 15
  4. 20
  5. 25


  1. To ensure sound nutrition, the mother’s diet during pregnancy should include:
  2. twice as many kcalories to spare protein for tissue synthesis.
  3. an additional 25 grams of protein each day.
  4. enough salt to promote edema.
  5. vitamin and mineral supplements, instead of food, to prevent weight gain.


  1. Pregnant women who are vegans should get their protein from:
  2. protein supplements.
  3. high-protein smoothies.
  4. legumes, whole grains, nuts, seeds, and tofu.
  5. milk, yogurt, and cheese.


  1. The developing brain of a fetus contains substantial amounts of lipid material and depends on _____ for proper development and function.
  2. long-chain omega-3 and omega-6 fatty acids
  3. monounsaturated fatty acids
  4. cholesterol
  5. medium-chain fatty acids


  1. An increased requirement for _____ during pregnancy is related to their roles in the synthesis of red blood cells.
  2. calcium and vitamin K
  3. vitamin E and vitamin C
  4. folate and vitamin B12
  5. protein and calcium


  1. The requirement for folate during pregnancy increases from 400 micrograms per day to _____ micrograms per day.
  2. 450
  3. 500
  4. 600
  5. 800


  1. A low intake of _____ increases the likelihood that an infant will be born with a neural tube defect.
  2. iron
  3. vitamin C
  4. protein
  5. folate


  1. Jane does not eat many fruits and vegetables and she dislikes dairy products. To increase her folate and calcium intake, you would recommend that she consume plenty of:
  2. yogurt.
  3. calcium-fortified orange juice.
  4. calcium-fortified cheese.
  5. enriched grains.


  1. Examine the following menu for a pregnant woman:



2 scrambled eggs

1 whole-wheat English muffin

1 cup orange juice



2 pieces (4 oz.) fried chicken

2 wheat rolls w/butter

½ cup mashed potatoes and gravy

Iced tea


3 oz. pork chop

1 ear corn on the cob

Lettuce and tomato salad
w/2 tbsp. dressing

2 cups low-fat milk


According to the recommended food intake for pregnancy, this menu has three problems:

  1. it should offer more meat
  2. it lacks a vitamin A-rich vegetable or fruit
  3. it should offer more milk
  4. it should offer more fruit or vegetables
  5. it should offer less starch
  6. 1, 3, 5
  7. 2, 3, 4
  8. 1, 3, 4
  9. 2, 4, 5
  10. 3, 4, 5


  1. In early pregnancy, intestinal absorption of _____ doubles and the mother’s bones store the nutrient.
  2. phosphorus
  3. vitamin C
  4. vitamin D
  5. calcium


  1. Most pregnant women need iron supplements because:
  2. their RDA for iron is twice that of non-pregnant women.
  3. the body does not conserve iron well during pregnancy.
  4. iron supplements are better absorbed than iron from food.
  5. their iron reserves are generally not high.


  1. Women who enter pregnancy with iron-deficiency anemia have a greater risk of:
  2. preterm delivery.
  3. excessive weight gain.
  4. inadequate weight gain.
  5. gestational diabetes.


  1. Which of the following foods is not provided by the WIC program?
  2. milk
  3. iron-fortified cereal
  4. granola bars
  5. eggs


  1. What nutrients are typically found in greater quantities in prenatal supplements compared to regular vitamin/mineral supplements?
  2. sodium, potassium, chloride
  3. thiamin, niacin, riboflavin
  4. folate, iron, calcium
  5. folate, vitamin B12, vitamin A


  1. For a healthy pregnant woman, physicians often recommend:
  2. multivitamin and mineral supplements and weight gain of about 25-35 pounds.
  3. no vitamin or mineral supplements and weight gain of at least 30 pounds.
  4. vitamin C supplements and weight gain of about 20 pounds.
  5. multivitamin and mineral supplements and weight gain of no more than 20 pounds.


  1. An obese women should gain _____ pounds during pregnancy.
  2. 5-7
  3. 11-20
  4. 17-24
  5. 25-35


  1. If a woman gains 30 pounds during pregnancy, the net amount of body fat she gains is about _____.
  2. 1 pound
  3. 7 pounds
  4. 10 pounds
  5. 15 pounds


  1. The benefits of physical activity during pregnancy include all of the following except:
  2. It improves the overall fitness of the mother.
  3. It helps to prevent or manage gestational diabetes.
  4. It may result in fewer discomforts during pregnancy.
  5. It promotes an earlier delivery.
  6. Nora, who is pregnant, awakens at 2:00 a.m. craving pickles and chocolate sauce. The craving probably indicates that she:
  7. drank too much coffee last night.
  8. drank too much alcohol last night.
  9. needs some nutrients that are found in pickles and chocolate sauce.
  10. is experiencing hormone-induced changes in taste.


  1. If you counsel Mrs. Chamberlin regarding the “morning sickness” she is experiencing, you will suggest she:
  2. limit the amount of fat in her diet.
  3. take iron supplements on an empty stomach.
  4. limit meals to three a day.
  5. eat the foods she wants when she feels like eating.


  1. Women who develop gestational diabetes have a greater risk of developing _____ later in life.
  2. heart disease
  3. type 2 diabetes
  4. gastrointestinal problems
  5. osteoporosis


  1. The warning signs of preeclampsia include:
  2. hypertension 5.             ketonuria
  3. low blood iron 6.             proteinuria (protein in the urine)
  4. edema 7.             glucosuria
  5. diabetes 8.             hyperactivity
  6. 2, 4, 5
  7. 4, 7, 8
  8. 1, 3, 6
  9. 4, 5, 7


  1. The most common cause of maternal mortality in developed countries is:
  2. hypertension.
  3. eclampsia.
  4. gestational diabetes.
  5. preeclampsia.


  1. The adverse effects of cigarette smoking by pregnant women include all of the following except:
  2. future intellectual problems in the baby.
  3. developmental defects in the fetus.
  4. slowed growth in the fetus.
  5. excessive weight gain for the mother.


  1. Herbal supplements during pregnancy:
  2. are generally considered safe.
  3. do not need to be discussed with the physician since they can be purchased over the counter.
  4. are not recommended due to lack of evidence about their safety and effectiveness.
  5. are recommended for relieving nausea.


  1. Because of concern about mercury contamination, pregnant women are advised to avoid:
  2. king mackerel.
  3. shrimp.
  4. catfish.
  5. flounder.


  1. Practices that should be avoided during pregnancy include:
  2. smoking cigarettes 4.             exercise
  3. consumption of alcohol 5.             consumption of fat
  4. consumption of caffeine
  5. 1 and 2
  6. 1, 2, 3
  7. 2 only
  8. 1, 2, 4, 5


  1. The American Academy of Pediatrics and the American Dietetic Association support exclusive breastfeeding until an infant is _____ months old.
  2. 3
  3. 6
  4. 9
  5. 12


  1. The American Academy of Pediatrics recommends that infants receive breast milk for the first _____ months of life.
  2. 3
  3. 4
  4. 6
  5. 12


  1. To meet her increased energy needs, a breastfeeding woman is advised to consume an extra _____ calories per day until her infant is 6 months old.
  2. 230
  3. 330
  4. 430
  5. 530


  1. If a lactating woman’s diet is poor, her milk:
  2. volume will be normal but the nutrient quality will be poor.
  3. will be thin and watery.
  4. quality will be maintained at the expense of maternal stores.
  5. will contain toxic products.


  1. Which of the following is not an adverse effect of smoking during lactation?
  2. lower milk production
  3. lower fat content in breast milk
  4. low weight gain in the baby
  5. higher fat content in breast milk


  1. Which of the following situations indicates that the mother should not breastfeed?
  2. use of birth control pills
  3. an ordinary cold
  4. drug addiction
  5. moderate coffee consumption


Nutrition in Practice – Encouraging Successful Breastfeeding


  1. In the United States, about _____ of infants are still breastfeeding at one year of age.
  2. 10%
  3. 20%
  4. 35%
  5. 60%


  1. A major deterrent to breastfeeding is:
  2. fear and social anxiety.
  3. the medical community’s failure to encourage breastfeeding.
  4. the difficulty in breastfeeding for working mothers.
  5. post-partum depression.


  1. To encourage breastfeeding, maternity facilities would be wise to adopt all of the following policies except:
  2. Give no artificial nipples or pacifiers to breastfeeding infants.
  3. Help mothers initiate breastfeeding within half an hour of birth.
  4. Keep babies in the nursery until feeding time to allow new mothers to rest.
  5. Train all health care staff in the skills necessary to implement the breastfeeding policy.


  1. The ideal time for the first breastfeeding is:
  2. immediately after delivery.
  3. one hour after delivery.
  4. four hours after delivery.
  5. the next day after delivery.


  1. To successfully breastfeed her infant, the mother should do all of the following except:
  2. push the infant’s face toward her nipple.
  3. learn how to relax and position herself comfortably.
  4. touch the infant’s cheek to her nipple.
  5. slip a finger between the infant’s mouth and her breast to break suction.


  1. Milk is forced to the front of the breast when an infant begins to nurse. This is called the:
  2. rooting reflex.
  3. initial force.
  4. infant grasp.
  5. letdown reflex.


  1. For what length of time should the infant be encouraged to suck on each breast?
  2. two to four minutes
  3. four to eight minutes
  4. five to ten minutes
  5. ten to fifteen minutes





a.     an organ in the uterus through which the fetus receives nutrients and oxygen

b.     a serious central nervous system birth defect that often results in lifelong disability or death.

c.     in pregnant women, high blood pressure that is present and documented before pregnancy.

d.     one of the most common types of neural tube defects; characterized by the incomplete closure of the spinal cord and its bony encasement.

e.     the presence of abnormal glucose tolerance during pregnancy.

f.     a condition characterized by hypertension, fluid retention, and protein in the urine.

g.     a severe complication during pregnancy in which convulsions occur.

h.     the combination of exhaled smoke (mainstream smoke) and smoke from lighted cigarettes, pipes, or cigars (sidestream smoke) that enters the air and may be inhaled by other people.

i.      a serious foodborne infection that can cause severe brain infection or death in a fetus or newborn.

j.      a spectrum of physical, behavioral, and cognitive disabilities caused by prenatal alcohol exposure.

k.     the cluster of symptoms seen in an infant or child whose mother consumed excessive alcohol during her pregnancy.

l.      the developmental stage of the zygote when it is about five days old and ready for implantation.

m.   an uncommon and always fatal type of neural tube defect; characterized by the absence of a brain.

n.     the stage of development in which the blastocyst embeds itself into the wall of the uterus and begins to develop.

o.     high blood pressure that develops in the second half of pregnancy and usually resolves after childbirth.





287-288         1.     Discuss the potential health problems of a low-birthweight infant.


289-290         2.     What is meant by a “critical period” during pregnancy? What is the importance of nutrition during a critical period?


291-292         3.     Describe the energy, carbohydrate, and protein needs of a pregnant woman.


302,304         4.     Describe the effects of smoking, alcohol consumption, and excessive caffeine consumption on the growth and development of the fetus.


306-307         5.     Describe the nutrient needs of a breastfeeding woman.


313                 6.     What can maternity facilities do to encourage women to breastfeed their infants?



Chapter 12 – Nutrition Through the Life Span:
Infancy, Childhood, and Adolescence


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




318 1.                     Breast milk or infant formula normally provides enough water to replace fluid losses in healthy infants.


320 2.                     There are factors in breast milk that protect the infant against infection.


326 3.                     A child’s appetite begins to diminish around the first birthday.


331 4.                     A child’s brain is not affected by iron deficiency until a blood deficit of this mineral develops.


330 5.                     Children who eat nutritious breakfasts function better in school than their peers who do not.


333 6.                     Allergic reactions to multiple foods are common, while reactions to single foods are the exception.


334 7.                     Children’s food aversions may be the result of nature’s efforts to protect them from allergic or other adverse reactions.


336 8.                     Children who spend more than one to two hours daily watching television or other media can become obese even while consuming fewer kcalories than more active children.


339 9.                     Children forced to try new foods are less likely to try those foods again than are children who are left to decide for themselves.


339 10.                  The more often a food is presented to a young child, the less likely the child will like that food.


342 11.                  The problem of obesity is most evident in African American females and in Hispanic children.


342 12.                  Teenage boys experience a more intense growth spurt and develop more lean body mass than girls do.


Nutrition in Practice – Childhood Obesity and the Early Development of Chronic Diseases


351 13.                  Restricting dietary sodium causes an immediate drop in most children’s and adolescents’ blood pressure.


352 14.                  Recommendations limiting fat and cholesterol are not intended for infants or children under two years of age.


353 15.                  Adult heart disease is a major pediatric problem.


Multiple Choice


  1. An infant weighing 7 pounds at birth would normally weigh about _____ pounds at five months of age.
  2. 8
  3. 14
  4. 21
  5. 28


  1. During what period are kcalorie needs per unit of body weight the highest?
  2. infancy
  3. toddler years
  4. childhood
  5. adolescence


  1. An infant who weighs 8 pounds will require about _____ kcalories per day.
  2. 290
  3. 360
  4. 420
  5. 800


  1. Most standard infant formulas are fortified with:
  2. DHA and arachidonic acid.
  3. DHA and linoleic acid.
  4. linolenic and linoleic acid.
  5. DHA and EPA.


  1. With the possible exception of _____, the vitamin content of the breast milk of a well-nourished mother is ample.
  2. vitamin C
  3. vitamin D
  4. thiamin
  5. zinc


  1. The American Academy of Pediatrics recommends a supplement of _____ for all infants who are exclusively breastfed in the first six months of life.
  2. iron
  3. vitamin C
  4. folic acid
  5. vitamin D


  1. Characteristics of breast milk include all of the following except:
  2. ample vitamin content.
  3. high in sodium.
  4. adequate in zinc.
  5. iron which is highly absorbable.


  1. Infants are given a single dose of vitamin _____ at birth.
  2. A
  3. D
  4. C
  5. K


  1. Advantages to breastfeeding include all of the following except:
  2. it provides protection against the development of allergies.
  3. it provides possible protection against excessive weight gain later in life.
  4. it protects against intestinal infections.
  5. it is the only way to develop a true loving relationship with the baby.


  1. The only acceptable alternative to breast milk is:
  2. goat’s milk.
  3. cow’s milk.
  4. iron-fortified infant formula.
  5. low-iron infant formula.


  1. Which of the following should be used to feed an infant under one year of age who is being weaned from breast milk?
  2. whole milk
  3. low-iron infant formula
  4. evaporated milk
  5. iron-fortified infant formula


322 12.  Which of the following is considered a risk of formula feeding an infant?

  1. The infant may not receive all of the nutrients he/she needs.
  2. Formula may be incorrectly prepared and cause malnutrition and growth failure.
  3. Parents may not be aware that some formulas do not meet FDA requirements.
  4. Many infants are allergic to formula.


322 13.                  Children one to two years of age should drink _____ milk.

  1. reduced-fat
  2. low-fat
  3. fat-free
  4. whole


323 14.                  A good age to introduce solid foods to infants is:

  1. one to two weeks.
  2. two to three months.
  3. four to six months.
  4. one year.
  5. two years.


323 15.                  All of the following are considerations in deciding when to add solid foods to the diet of an infant except:

  1. the infant’s nutrient needs.
  2. the infant’s physical readiness to handle different forms of food.
  3. the need to detect and control allergic reactions.
  4. the type of milk the infant is consuming.


323 16.  The two nutrients needed early by infants and provided by the introduction of solid foods are:

  1. protein and calcium.
  2. iron and vitamin C.
  3. sodium and fat.
  4. vitamin D and fluoride.


324 17.                  Excessive consumption of fruit juice in infants and young children can lead to all of the following except:

  1. diarrhea.
  2. excessive kcal intake.
  3. poor intake of food.
  4. toxicity of the water-soluble vitamins.


324 18.                  Which of the following cereals causes allergy least often?

  1. wheat
  2. barley
  3. oats
  4. rice


324-325 19.                  All of the following foods should be omitted from a baby’s diet except:

  1. canned vegetables.
  2. canned fruits.
  3. honey.
  4. corn syrup.


325 20.  _____ develops when excessive milk intake displaces iron-rich foods in the diet of a young child.

  1. Scurvy
  2. Milk anemia
  3. Growth failure
  4. Weight loss


325 21.                  An important aspect of infant feeding is the prevention of future health problems. An appropriate measure is:

  1. encouragement of eating habits that will support normal weight.
  2. encouraging the infant to eat only those foods she likes.
  3. introduction of solid foods as early as possible.
  4. forcing the infant to finish her bottle.


326 22.                  Nancy consumes fewer kcalories at 14 months than she did at 11 months. This change in appetite probably indicates that she is:

  1. ill and needs medical attention.
  2. not as physically active now as when she was 11 months old.
  3. in a less rapid stage of growth now.
  4. becoming malnourished.


327 23.                  Research studies conducted on preschool children’s food intakes have shown that:

  1. food energy intake varied very little from meal to meal.
  2. the total daily energy intake was highly inconsistent.
  3. if they ate more at one meal, they ate less at the next.
  4. energy intake decreases as children get older.


327 24.                  Which of the following statements accurately describes the energy needs of a child?

  1. Total energy needs increase with age, but energy needs per kilogram of weight decline with age.
  2. Energy needs fluctuate as children get older.
  3. Total energy needs decrease with age, but energy needs per kilogram of weight increase with age.
  4. Energy needs remain the same until puberty.


327 25.                  Vegan diets must be planned carefully for children, because otherwise they may not provide enough:

  1. protein.
  2. fiber.
  3. kcalories.
  4. sodium.


327 26.                  A one-year-old child needs about _____ kcalories a day.

  1. 800
  2. 1000
  3. 1200
  4. 1400


325, 328                27.  A child who drinks a lot of milk and won’t consume much else is likely to show signs of:

  1. anemia.
  2. ariboflavinosis.
  3. hypercalcemia.
  4. rickets.


328 28.                  To prevent iron deficiency, a child needs _____ mg of iron per day.

  1. 2–3
  2. 3-5
  3. 7-10
  4. 9-12


328 29.                  Among the following, the foods that help most to meet children’s iron requirements are:

  1. milk, cheese, or yogurt.
  2. dark green, deep orange, or yellow vegetables.
  3. prunes , grapes, or raisins.
  4. whole-wheat, enriched, or fortified breads.


328 30.                  Which of the following foods would provide a child with a rich source of iron?

  1. ice cream
  2. applesauce
  3. bean dip
  4. cheese


328, 329                        31.  According to MyPyramid for Preschoolers and Kids, how many cups of milk or milk products are needed daily for a 2-5 year old child?

  1. 1
  2. 2
  3. 3
  4. 4


330 32.                  Which of the following is likely to occur if candy, cola, and other concentrated sweets are permitted in large quantities during the growing years?

  1. obesity
  2. hypertension
  3. nutrient toxicities
  4. developmental delays


330 33.                  Which of the following statements is not true?

  1. Normal-weight children naturally regulate their energy intake.
  2. The preference for sweet tastes is innate.
  3. Children can be trusted to naturally choose healthful foods.
  4. Underweight children can be allowed to eat higher-kcal but nutritious snacks.

330, 339                34.  The easiest and most practical way to control the amount of candy and carbonated drinks a child consumes is to:

  1. prevent the child from knowing of their existence.
  2. never let the child visit his grandparents.
  3. limit the availability of these items.
  4. teach the child that such foods are highly noxious.


330 35.                  How many ounces from the meat and beans group are needed daily to meet nutrient needs for a child who needs 1000 kcal/day?

  1. 2
  2. 3
  3. 4
  4. 5


330 36.                  One of the most significant effects of long-term hunger on children is:

  1. behavioral problems.
  2. poor performance in school.
  3. apathetic attitude.
  4. impaired growth.


331 37.  Nutrient deficiencies during childhood:

  1. have no effect on future health.
  2. can affect a child’s mood and behavior.
  3. are directly associated with dysfunctional families.
  4. are rare.


330-331                 38.  Children who skip breakfast exhibit all of the following characteristics except:

  1. lower energy intakes.
  2. poor concentration.
  3. lower test scores.
  4. higher energy intakes.


331 39.                  The best known and most widespread effects of iron-deficiency anemia are its impacts on:

  1. memory and sleep patterns.
  2. growth and athletic performance.
  3. behavior and intellectual performance.
  4. the immune system and reading level.


331 40.                  A child with any of several nutrient deficiencies may be described in all of these ways except:

  1. depressed.
  2. unlikable.
  3. hyperactive.
  4. unclean.


332 41.                  To prevent a child’s exposure to lead, you would do all of the following except:

  1. prevent the child from putting old painted objects in the mouth.
  2. allow the child to play with crayons made in other countries.
  3. make sure the child consumes nutritious meals consistently.
  4. make infant formula with lead-free water.


332 42.                  When a food protein enters the body and causes an immunologic response, this causes:

  1. a food allergy.
  2. an food intolerance.
  3. hyperactivity.
  4. anemia.


333 43.                  Which of the following foods is most likely to cause anaphylactic shock?

  1. peanuts
  2. rice
  3. oatmeal
  4. bananas


333 44.  All of these foods are likely to cause allergic reactions except:

  1. milk.
  2. coconut.
  3. soybeans.
  4. wheat.


334 45.                  Which of the following statements is true regarding hyperactivity?

  1. It can be cured with dietary changes.
  2. It is caused by consuming sugary foods.
  3. It can be cured by eliminating all food additives.
  4. It is not caused by poor nutrition.


335 46.  Based on data from the BMI-for-age growth charts, children and adolescents are categorized as overweight when their weight is above the _____ percentile.

  1. 75th
  2. 85th
  3. 95th
  4. 99th


335 47.  Logan is 14 years old and has a BMI in the 85th percentile. His mother’s BMI is 23 and his father’s BMI is 32. Logan’s chance of becoming an obese adult is:

  1. 50%.
  2. 60%.
  3. 70%.
  4. 80%.


335 48.  Which of the following statements regarding children’s food intake and health status is true?

  1. Children are lighter today than they were 20 years ago.
  2. The prevalence of overweight in children 6 to 11 years of age and adolescents has tripled over the last three decades.
  3. Changes in children’s weight status can be largely explained by genetics.
  4. The increase in children’s weight status can be blamed entirely on poor parenting skills.


336 49.                  As a strategy to help prevent childhood obesity, the American Academy of Pediatrics recommends that children be limited to _____ of television and video time per day.

  1. 30 minutes
  2. 1 hour
  3. 2 hours
  4. 3 hours


336 50.                  Which of the following statements about children and television viewing is not true?

  1. Children who have a TV in their room are more likely to be overweight.
  2. Children who watch excessive amounts of TV are least likely to eat fruits and vegetables.
  3. Children who watch excessive amounts of TV often snack on high-fat foods.
  4. Children who watch excessive amounts of TV are more likely to eat fruits and vegetables.


336 51.  A leading cause of pediatric hypertension is:

  1. a low intake of whole-grain foods.
  2. obesity.
  3. excessive sodium intake from soft drink consumption.
  4. type 1 diabetes.


337 52.  The Expert Committee of the American Medical Association recommends healthy habits for children and adolescents to prevent obesity. Which of the following is not one of those recommendations?

  1. Eat together as a family as often as possible.
  2. Engage in at least 20 minutes of moderate to vigorous physical activity every day.
  3. Learn to eat age-appropriate portions of foods.
  4. Limit the frequency of restaurant meals.


336-337                 53.  Which of the following is not a recommended approach for the treatment of childhood obesity?

  1. psychological support
  2. behavior modification
  3. family involvement
  4. diet restriction


338 54.                  Which obese teenager would be considered a candidate for bariatric surgery?

  1. Preston, who has a BMI of 52 and has an average IQ
  2. Jacob, who has a BMI of 38 and has reached physical maturity
  3. Darla, who has type 2 diabetes and hasn’t yet begun to menstruate
  4. Cynthia, who has just enrolled in a weight-loss program for the first time due to her BMI of 50


339 55.                  Children are more likely to eat vegetables when they are:

  1. not seasoned.
  2. cut in small pieces.
  3. raw or slightly undercooked.
  4. overcooked and very soft.


339 56.                  Power struggles over food arise when:

  1. parents try to control every aspect of a child’s eating.
  2. children are allowed to regulate their own food intake.
  3. parents don’t demonstrate healthy eating habits.
  4. children are presented with too many food choices.


338 57.                  Because the interactions between parents and children can set the stage for lifelong attitudes and habits, wise parents:

  1. do not attempt change.
  2. treat their child’s food preferences with respect.
  3. exert continuous pressure to initiate good food habits.
  4. impose their own eating habits on their children.
  5. wait until their children start school to initiate changes.


339 58.                  Positive eating habits for a young child can be promoted by:

  1. presenting a new food at the beginning of the meal.
  2. allowing him to stand and play at the table.
  3. making sure he eats all the food he is given at each meal.
  4. rewarding him with dessert when he has cleaned his plate.
  5. offering him a choice of two new foods at a time.


339 59.                  Children should not be allowed to eat while running because:

  1. this increases the child’s risk of choking.
  2. they should not be allowed to play until after meals.
  3. physical activity in children should be discouraged.
  4. this increases the child’s risk of food allergies.


340 60.                  The majority of children who eat school breakfast are:

  1. boys.
  2. girls.
  3. from low-income families.
  4. from high-income families.


341 61.  All of the following factors undermine the efforts of the National School Lunch Program to serve nutritious foods at school except:

  1. short lunch periods and long lines.
  2. the availability of salad bars.
  3. access to vending machines.
  4. the presence of fast-food restaurants.


342 62.                  The adolescent growth spurt:

  1. begins earlier in girls than in boys.
  2. affects every organ except the brain.
  3. decreases total nutrient needs.
  4. causes a greater weight gain in girls.


342-343                 63.  Nutrients often found lacking in teenage groups include:

  1. iron, calcium, and vitamin D.
  2. vitamin C, sodium, and protein.
  3. fat, iron, and fiber.
  4. calcium, zinc, and vitamin B12.


343 64.                  Iron intake often does not meet the iron needs of adolescent females because they tend to:

  1. eat less iron-rich foods and fewer kcalories.
  2. consume more foods that interfere with iron absorption.
  3. have a longer growth spurt.
  4. develop greater lean body mass.


343 65.                  Adolescents who eat at home with family members:

  1. tend to gain more weight.
  2. are less influenced by their peers.
  3. consume a more nutritious diet.
  4. watch more television.


343 66.                  A good way for an adolescent to build and protect her bones is to:

  1. snack on dairy products.
  2. eat tuna fish sandwiches for lunch.
  3. consume more fiber.
  4. choose low-fat snacks.


344 67.                  Which of the following statements is not true regarding teenagers and beverages?

  1. Juice is usually only consumed at breakfast.
  2. Soft drinks may affect bone density because they displace milk from the diet.
  3. Girls are more likely to drink enough milk to meet their calcium needs.
  4. Regular soft drink consumption can contribute to weight gain.


344 68.  Snacks provide about _____ of the average teenager’s total daily food energy intake.

  1. 1/3
  2. ¼
  3. 2/3
  4. ¾


343-344                 69.  At home, where teenagers are frequently snacking, the best strategy for parents is to stock the pantry with:

  1. plenty of diet drinks and low-fat snacks.
  2. easy-to-grab foods that are nutritious.
  3. enough food for only one snack a day.
  4. 100-kcalorie snack packs.


344 70.  Adolescents eat about _____ of their meals away from home, which can enhance or hinder their nutritional well being.

  1. ¼
  2. 1/3
  3. ½
  4. 2/3


341 71.                  Schools that participate in the USDA’s National School Lunch Program must develop and implement a wellness policy. By law, wellness policies must accomplish all of the following except:

  1. set goals for nutrition education and physical activity.
  2. establish nutrition guidelines for all foods available on school campuses.
  3. develop a plan to measure implementation of the policy.
  4. ensure that all curricula include nutrition education.


Nutrition in Practice – Childhood Obesity and the Early Development of Chronic Diseases


350 72.  Which of the following statements is true regarding the role of genetics in obesity?

  1. One is destined at birth to become obese.
  2. One inherits the potential to become obese.
  3. Obesity genes come from the mother’s side of the family.
  4. Obesity genes come from the father’s side of the family.


350-351                 73.  The most important risk factor for type 2 diabetes in children is:

  1. food intolerances.
  2. high cholesterol.
  3. obesity.
  4. food allergies.


351 74.                  Fatty streaks can appear in the arteries as early as:

  1. childhood.
  2. adolescence.
  3. the thirties.
  4. the fifties.


351 75.                  An acceptable cholesterol level for a child or adolescent is:

  1. < 170 mg/dL.
  2. 170-199 mg/dL.
  3. 200-239 mg/dL.
  4. > 240 mg/dL.


352-353 76.                  Persistent high blood cholesterol levels may need to be treated with drugs in children once they are _____ years old.

  1. 6
  2. 8
  3. 10
  4. 16




a.     the chief protein in human breast milk.

b.     a milklike secretion from the breasts that is rich in protective factors.

c.     a protein in breast milk that binds iron and keeps it from supporting the growth of the infant’s intestinal bacteria.

d.     factors in colostrum and breast milk that favor the growth of the “friendly” bacterium Lactobacillus bifidus in the infant’s intestinal tract.

e.     a protein in breast milk that attacks diarrhea-causing viruses.

f.     to gradually replace breast milk with infant formulas or other foods appropriate to an infant’s diet.

g.     extensive tooth decay due to prolonged tooth contact with a carbohydrate-rich liquid offered to an infant in a bottle.



a.     an adverse reaction to food that involves an immune response.

b.     an adverse response to a food or food additive that does not involve the immune system.

c.     a life-threatening whole-body allergic reaction to an offending substance.

d.     one of the stress hormones secreted whenever emergency action is needed; prescribed therapeutically to relax the bronchioles during allergy or asthma attacks.

e.     inattentive and impulsive behavior that is more frequent and severe than is typical of others of a similar age.

f.     the period of growth from the beginning of puberty until full maturity.

g.     the period in life in which a person becomes physically capable of reproduction.

h.     with respect to nutrition, a key person who controls other people’s access to foods and thereby exerts a profound impact on their nutrition.

i.      the maximum amount of residue permitted in a food when a pesticide is used according to the label directions.




319-321         1.     Describe the nutrient attributes of breast milk and how it is tailor-made to meet the nutrient needs of the human infant.


330-331         2.     Describe the relationship between hunger and school performance.


336                 3.     Identify ways in which watching television adversely affects children’s nutritional health.


336-338         4.     Describe an ideal treatment program for childhood obesity.


338-339         5.     Describe characteristics of vegetables preferred by children.


340-341         6.     Discuss the problems associated with providing nutritious lunches to students at school.


342-343         7.     Identify the nutrients most often found lacking in the diets of teenagers.


343-344         8.     What is the role of the “gatekeeper” as applied to nutrition?



Chapter 13 – Nutrition Through the Life Span: Later Adulthood


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




360 1.                     Studies suggest that a diet providing ample carotenoids, vitamin C, and vitamin E may help to prevent the early onset of cataracts.


362 2.                     Increasing evidence suggests that overweight and obesity in middle age are associated with Alzheimer’s disease.


362 3.                     Research supports the notion that an overload of minerals in the body causes Alzheimer’s disease.


364 4.                     The protein needs of older adults appear to be about the same as those of younger people.


366 5.                     Iron-deficiency anemia is more common in older adults than in young people.


366 6.                     Zinc intake is commonly low in older adults.


366 7.                     The elderly are more likely to have medical conditions or to take medications that may compromise folate status.


366 8.                     As people grow older, the use of medicines becomes commonplace, thus increasing the potential for diet-medication interactions.


368 9.                     Older adults spend more money per person on foods to eat at home than other age groups.


357 10.                  People can add years to their lives or enhance the quality of their lives through healthy behaviors.


Multiple Choice


356 1.                     The fastest growing age group in the U.S. population is people over:

  1. 50.
  2. 65.
  3. 75.
  4. 85.


356 2.                     Life expectancy in the U.S. is _____ years.

  1. 68
  2. 72
  3. 75
  4. 78


356 3.                     All of the following statements about aging are true except:

  1. aging is an inevitable, natural process.
  2. aging is programmed into the genes at conception.
  3. aging can be slowed by a healthy lifestyle.
  4. aging can be slowed with the use of appropriate supplements.


357 4.                     Which of the following health behaviors is the strongest predictor of continued mobility in the later years?

  1. not smoking
  2. low to moderate alcohol consumption
  3. maintenance of moderate body weight
  4. frequent physical activity


357 5.                     The benefits of physical activity in older adults include all of the following except:

  1. increased blood flow to the brain.
  2. decreased risk of falling.
  3. improved balance.
  4. decreased muscle mass.


359 6.                     Moderate energy restriction results in all of the following health benefits except:

  1. reduced body weight.
  2. reduced body fat.
  3. increased HDL cholesterol levels.
  4. increased LDL cholesterol levels.


360 7.                     A known connection exists between osteoarthritis and nutrition, as related to:

  1. milk.
  2. fish oil.
  3. overweight.
  4. sugar.


360 8.                     Vision problems in older adults may be due to dietary factors such as:

  1. underweight.
  2. low intake of vitamins D and E.
  3. overweight.
  4. low intake of vitamins C and E.


361 9.                     Rheumatoid arthritis may respond to a dietary intervention involving a diet:

  1. low in saturated fat and high in omega-3 fatty acids.
  2. high in vitamins A, C, and E.
  3. restricted in kcalories.
  4. low in carbohydrates.


361 10.                  Which of the following vitamins is not involved with cognition in older adults?

  1. folate
  2. vitamin B12
  3. vitamin A
  4. vitamin B6


362 11.                  All of the following seem to be related to the development of Alzheimer’s disease except:

  1. genetic factors.
  2. low levels of homocysteine.
  3. free-radical damage.


361 12.                  Your grandfather is having trouble with his short-term memory. You suggest that he may be experiencing symptoms of a deficiency of:

  1. essential fatty acids.
  2. thiamin, niacin, and/or folate.
  3. vitamin B12, vitamin C, and/or vitamin E.
  4. protein.


362 13.                  The most important nutrition concern for the person with Alzheimer’s disease is:

  1. allowing the person to choose their own foods.
  2. a strict eating schedule.
  3. maintaining appropriate body weight.
  4. a regimen of dietary supplements.


364 14.                  Sarcopenia refers to:

  1. loss of muscle mass.
  2. vitamin deficiency.
  3. bone loss.
  4. malnutrition associated with aging.


363-364 15.                  Energy needs decline with advancing age due to all of the following reasons except:

  1. sarcopenia can be significant in later years.
  2. basal metabolic rate declines as people age.
  3. older people usually reduce their physical activity.
  4. older people are better able to absorb energy from foods.


363 16.                  Physical changes of aging that affect nutrition include all of the following except:

  1. swallowing disorders.
  2. sluggish intestinal motility.
  3. diminished vision.
  4. increased sense of smell.


364 17.                  The estimated energy requirements for adults decrease steadily after age:

  1. 19.
  2. 30.
  3. 40.
  4. 51.


364 18.                  Which of the following sources of protein are most appropriate for older adults?

  1. milk and cheese
  2. legumes and fish
  3. whole grains and legumes
  4. nonfat milk and peanut butter


364 19.                  The best choice for older adults with small energy allowances is to:

  1. take vitamin-mineral supplements.
  2. select nutrient-dense foods.
  3. consume less food.
  4. moderate alcohol consumption.


364 20.                  Protein is especially important for older adults to:

  1. increase muscle mass.
  2. rebuild aging bones.
  3. support a healthy immune system.
  4. prevent macular degeneration.


365 21.                  The older adult’s intake of fruits and vegetables may be limited due to all of the following except:

  1. chewing problems.
  2. transportation problems.
  3. limited cooking facilities.
  4. decreased sense of smell.


365 22.                  Severe fat restriction among older adults may lead to:

  1. nutrient deficiencies.
  2. weight gain.
  3. greater risk of cancer.
  4. dehydration.


365 23.  Dehydrated older adults are more susceptible to all of the following except:

  1. disorientation.
  2. emphysema.
  3. urinary tract infections.
  4. pressure ulcers.


365 24.                  Fat intakes should be moderate in the diets of most older adults because:

  1. cutting fat helps alleviate constipation.
  2. cutting fat helps retard the development of atherosclerosis.
  3. cutting fat helps reduce the risk of osteoporosis.
  4. cutting fat helps increase lean body mass.


365 25.                  Older adults are predisposed to fluid imbalances due to all of the following reasons except:

  1. they do not pay attention to their thirst.
  2. they may find it difficult to obtain fluids.
  3. they may have reduced thirst.
  4. they may have an increase in total body water as they age.


365 26.                  Older adults face a greater risk of vitamin D deficiency than young people due to:

  1. low consumption of meat.
  2. low intake of vegetables.
  3. limited exposure to sunlight.
  4. low intake of fiber.


365-366 27.                  The DRI Committee found that _____% of adults 51 years and older lose the ability to absorb vitamin B12.

  1. 5 to 10
  2. 10 to 30
  3. 15 to 35
  4. 20 to 35


365 28.                  One nutrient that is underconsumed by many elderly people is:

  1. vitamin A.
  2. protein.
  3. vitamin D.
  4. vitamin C.


365-366                 29.  Many older people take in less than the recommended amount of all these nutrients except:

  1. vitamin A.
  2. vitamin D.
  3. folate.
  4. zinc.


366 30.                  All of the following factors in older people’s lives increase the likelihood of iron deficiency except:

  1. antacid use.
  2. reduced stomach acid secretion.
  3. limited intake of milk.
  4. chronic blood loss due to disease or medicines.


366 31.  An adequate calcium intake throughout life helps protect against:

  1. cancer.
  2. osteoporosis.
  3. diabetes.
  4. cardiovascular disease.


366 32.                  Few older adults consume the recommend amount of _____ due to complaints about stomach discomfort.

  1. meat
  2. fruit
  3. milk
  4. bread


366 33.                  The Recommended Dietary Allowance (RDA) for calcium for adults over 70 is:

  1. 600 mg/day.
  2. 800 mg/day.
  3. 1200 mg/day.
  4. 1500 mg/day.


367 34.                  The most common drug that can affect nutrition in older people is:

  1. alcohol.
  2. laxatives.
  3. antacids.
  4. aspirin.


367 35.                  Iron status in women generally improves:

  1. after menopause.
  2. with daily exercise.
  3. as muscle mass decreases.
  4. during perimenopause.


369 36.  Which of the following is not a risk factor for malnutrition in older adults?

  1. disease
  2. eating disorders
  3. economic hardship
  4. reduced social contact


369 37.  Which food assistance program would most likely improve the intake of fruits and vegetables among low-income older adults?

  1. OAA Nutrition Program
  2. Supplemental Nutrition Assistance Program
  3. Meals on Wheals
  4. Senior Farmers Market Nutrition Program


370 38.                  An older adult complains about the expense of cooking for one. You suggest:

  1. purchasing large bags of frozen vegetables.
  2. purchasing large bags of shredded cheese.
  3. purchasing eggs in large quantities.
  4. stocking up on fresh produce when in season.

Nutrition in Practice: Hunger and Community Nutrition


376 39.                  The primary cause of hunger in developed countries is:

  1. food poverty.
  2. war.
  3. mental illness.
  4. politics.


377 40.                  Major factors that contribute to food poverty include all of the following except:

  1. alcohol abuse.
  2. lack of knowledge about food assistance programs.
  3. pride.
  4. lack of insurance.


378 41.  The largest federal food assistance program is:

  1. WIC.
  2. SNAP.
  3. WHO.
  4. USDA.


377,379 42.                  A food recovery program might involve all of the following except:

  1. taking leftover food from a fundraiser to a local shelter.
  2. picking berries in an already harvested field.
  3. the delivery of day-old bread to a soup kitchen.
  4. collecting unused WIC vouchers.






a.     a person’s age as estimated from her or his body’s health and probable life expectancy.

b.     thickenings of the eye lenses that impair vision and can lead to blindness.

c.     deterioration of the macular area of the eye that can lead to loss of central vision and eventual blindness.

d.     inflammation of a joint, usually accompanied by pain, swelling, and structural changes.

e.     a painful, chronic disease of the joints that occurs when the cushioning cartilage in a joint breaks down.

f.     a disease of the immune system involving painful inflammation of the joints and related structures.

g.     nerve cells; the structural and functional units of the nervous system.

h.     the loss of brain function beyond the normal loss of physical adeptness and memory that occurs with aging.

i.      a progressive, degenerative disease that attacks the brain and impairs thinking, behavior, and memory.

j.      loss of skeletal muscle mass, strength, and quality.

k.     a condition characterized by chronic inflammation of the stomach accompanied by a diminished size and functioning of the mucosa and glands.

l.      the maximum number of years of life attainable by a member of a species.

m.   the average number of years lived by people in a given society.

n.     long duration of life.





360                 1.     Describe possible relationships between cataracts and nutrition.


362                 2.     Discuss the possible roles of nutrition in the prevention of Alzheimer’s disease.


363-364         3.     Describe why energy needs decline with advancing age.


365                 4.     Why is dehydration a risk for older adults?


365                 5.     Why are some elderly people at risk of developing vitamin D deficiency?


366, 367        6.     Describe factors in many older people’s lives that increase the likelihood of iron deficiency.


370-371         7.     List ten ways that older adults can stretch their food dollars.



Chapter 14 – Illness and Nutrition Care


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




401 1.                     Nutrition care is described in the medical record in various ways, but one of the most popular is the SOAP note.


402 2.                     If either the appetite or the sense of taste is affected by illness, the health practitioner should work with the patient to identify foods that are the most enjoyable.


400 3.                     A nutrition intervention should take into account the patient’s food habits, lifestyle, and other personal factors.


387 4.                     The 24-hour recall provides accurate and useful data for assessing the adequacy of an individual’s diet.


388, 389                5.     A written account of foods and beverages consumed by a patient over several days is called a nutrition diagnosis.


394 6.                     Serum protein values can be affected by fluid imbalances, pregnancy, infections, and some medications.


T     A     385                 7.     For patients on medication, nutrition intervention includes advice on managing nutrient-related medication problems.


385 8.                     Once nutrition problems have been diagnosed, the nurse or dietetic technician identifies expected outcomes to correct the problems.


399 9.                     Standard hospital diets provide all the nutrients in amounts appropriate for healthy people but exclude many foods.


399 10.                  A mechanically-altered diet is useful for patients with chewing or swallowing problems.


398 11.                  A patient with many medical problems may require a number of nutritional modifications.


392 12.                  Growth charts with BMI-for-age percentiles can be used to assess risk of underweight and overweight in children over six months of age.


Multiple Choice


382 1.                     Malnutrition has been reported in _____ of patients hospitalized with acute illness.

  1. 12-26%
  2. 27-37%
  3. 38-62%
  4. 65-72%


383 2.                     The registered dietitian performs all of the following services except:

  1. conducting nutrition assessments.
  2. planning and approving menus.
  3. diagnosing nutrition problems.
  4. changing a patient’s diet order.


383 3.     A patient’s nutrition prescription is prescribed by the:

  1. registered dietitian.
  2. physician.
  3. registered nurse.
  4. dietetic technician, registered.


383 4.                     Which of the following is not one of the nurse’s roles in nutrition care of a patient?

  1. nutrition screening
  2. encouraging patients to eat
  3. answering questions about special diets
  4. developing, implementing, and evaluating nutrition care plans


383 5.                     A coordinated program of treatment that merges the care plans of different health practitioners is a:

  1. critical pathway.
  2. care map.
  3. clinical pathway.
  4. care plan.


383-384                 6.     Which of the following health professionals does not assume a primary role in developing and implementing nutrition care plans?

  1. dietetic technician
  2. dietitian
  3. nurse
  4. pharmacist


383-384                 7.     Which of the following is not a characteristic of nutrition screening?

  1. accurate enough to identify nutrition risk
  2. combines different types of health-related information
  3. may lead to a referral for nutrition care
  4. the first step in the nutrition care process


384 8.                     Which of the following is not a criterion for identifying malnutrition risk?

  1. depression
  2. recent changes in appetite
  3. medical diagnosis
  4. gender


384 9.                     Which of the following evaluates a person’s risk of malnutrition by ranking key variables from the medical history and physical examination?

  1. subjective global assessment
  2. integrated assessment
  3. functional assessment
  4. nutrition care plan


386 10.                  The medical history provides information about:

  1. genetic susceptibility for diseases.
  2. living situation.
  3. recent food intake.
  4. financial concerns that may restrict access to food.


387 11.  Obtaining an accurate account of a person’s usual food intake is dependent upon all of the following but:

  1. the person’s memory.
  2. the person’s honesty.
  3. the interviewer’s skill.
  4. the interviewer’s personality.


387 12.                  “What is the first thing you ate or drank yesterday morning?” is the first question asked in a:

  1. food frequency questionnaire.
  2. kcalorie count.
  3. food diary.
  4. 24-hour recall.


387 13.  Limitations of a 24-hour recall include all of the following except:

  1. the previous day’s intake may not be typical.
  2. they are difficult to obtain.
  3. the person may not be able to accurately report portion sizes.
  4. they provide data for one day only.


387 14.                  Which of the following medical problems is not generally associated with malnutrition?

  1. celiac disease
  2. alcoholism
  3. pressure sores
  4. incontinence


387-389                 15.  Tools for obtaining food intake data include all of the following except:

  1. 24-hour recall.
  2. food frequency questionnaires.
  3. food records.
  4. food weighing.


388 16.  A disadvantage to using a food frequency questionnaire is:

  1. it does not take into account fluctuations in food intake.
  2. it cannot identify recent changes in food intake.
  3. the results are not affected by seasonal changes in diet.
  4. it may not be reflective of a typical day’s intake.


388,389                 17.  A disadvantage of using a food record is:

  1. the time involved in keeping one.
  2. it increases awareness of one’s food choices.
  3. the process does not rely on a person’s memory.
  4. it may provide more information than is needed.


388,389                 18.  Which of the following methods of collecting a dietary history is the most time-consuming and requires a high degree of motivation to complete?

  1. 24-hour recall
  2. food frequency questionnaire
  3. food record
  4. direct observation


389 19.                  Which of the following is most often used to monitor a patient’s response to and compliance with medical nutrition therapy?

  1. food record
  2. food frequency checklist
  3. 24-hour recall
  4. usual intake record


389 20.                  When direct observations are used to generate an estimate of a patient’s current food intake, the procedure is called a:

  1. kcalorie count.
  2. food diary.
  3. 24-hour recall.
  4. food record.


390 21.                  A child’s height is measured in the standing position once she or he reaches the age of:

  1. 12 months.
  2. 18 months.
  3. 2 years.
  4. 3 years.


390-391 22.                  Which of the following is not an anthropometric measurement commonly used to evaluate overnutrition and undernutrition?

  1. height
  2. arm length
  3. waist circumference
  4. head circumference


390 23.                  For an adult’s height to be accurately measured, the person should:

  1. stand erect without shoes.
  2. stand erect with shoes.
  3. stand with feet slightly apart.
  4. stand 2” away from the wall.


390 24.  The height of a person who is unable to stand is estimated from equations that use:

  1. elbow breadth or wrist circumference.
  2. knee height or full arm span.
  3. head circumference or wrist circumference.
  4. knee height or elbow breadth.


391 25.  All of the following standardized conditions should be used when making repeated weight measures on adults except:

  1. weight should be taken at the same time of day.
  2. weight must be estimated for bedridden patients.
  3. the same scale should be used.
  4. weight should be taken after the person has voided.


391 26.                  Which of the following is used in infancy to assess brain development?

  1. measure of abdominal girth
  2. fatfold measurement
  3. head circumference
  4. height and weight


392 27.                  In people who are ill, significant weight loss may be masked by:

  1. fluid retention.
  2. dehydration.
  3. a large tumor.
  4. drug therapy.


392 28.                  Which of the following is most valuable for evaluating the degree of nutrition risk associated with acute illness?

  1. ideal body weight
  2. height-weight tables
  3. percent ideal body weight
  4. percent usual body weight


391,392                 29.  What is the ideal body weight of a 42-year-old female who is 5’5” tall?

Optional hint[1]: IBW = (height in inches)2 × 0.0313

  1. 108 pounds
  2. 113 pounds
  3. 132 pounds
  4. 138 pounds


391,392                 30.  Jim is 5’10” tall and weighs 135 pounds. What is his malnutrition risk based on %IBW?

Optional hint: IBW = (height in inches)2 × 0.0313

  1. no risk of malnutrition
  2. risk of mild malnutrition
  3. risk of moderate malnutrition
  4. risk of severe malnutrition


392 31.                  What is the % IBW of a 35-year-old female whose IBW is 120 pounds and whose actual weight is 108 pounds?

  1. 90
  2. 110
  3. 120
  4. 132


392 32.                  Joe, a 69-year-old widower, has lost 27 pounds since his wife’s death a year ago. He is 5’11” and his usual body weight is 173 pounds. What is his %UBW?

  1. 15%
  2. 69%
  3. 84%
  4. 101%


393 33.                  Which of the following laboratory tests aids in the diagnosis of anemia?

  1. red blood cell count
  2. total protein
  3. C-reactive protein
  4. blood urea nitrogen


394 34.                  Which of the following statements is not true regarding albumin?

  1. It is the most abundant plasma protein.
  2. It is slow to reflect changes in nutrition status.
  3. It degrades slowly in the body.
  4. It is a sensitive indicator of effective nutritional intervention.


395 35.                  Signs of malnutrition tend to appear most often in parts of the body where cell replacement occurs at a rapid rate, including all of the following except the:

  1. hair.
  2. skin.
  3. respiratory tract.
  4. digestive tract.


394 36.                  Albumin has a half-life of:

  1. 14-20 days.
  2. 14-20 weeks.
  3. 3-6 days.
  4. 3-6 weeks.


395 37.                  Transthyretin is also known as:

  1. prealbumin.
  2. retinol-binding protein.
  3. transferrin.
  4. albumin.


394 38.                  What lab value responds to both PEM and iron status?

  1. albumin
  2. prealbumin
  3. retinol-binding protein
  4. transferrin


396 39.                  Edema means:

  1. fluid retention.
  2. dehydration.
  3. PEM.
  4. wasting.


396 40.                  Signs of fluid retention include all of the following except:

  1. tight-fitting shoes.
  2. puffy face.
  3. abdominal distension.
  4. reduced skin tension.


395 41.                  Which of the following is an indicator of good nutritional status?

  1. shiny hair
  2. smooth tongue
  3. lack of fat under the skin
  4. rough skin


383,400                 42.  Nutrition education or counseling is typically provided by the:

  1. registered nurse.
  2. nursing assistant.
  3. registered dietitian.
  4. dietetic technician.


400 43.  The dietitian adjusts the nutrition education plan after learning that the patient is a Native American. She is considering the patient’s:

  1. learning style.
  2. level of literacy.
  3. readiness to change.
  4. cultural background.


398 44.                  One of the characteristics of modified diets is:

  1. they are not included in a diet manual.
  2. they are always the same regardless of patient preferences.
  3. they are altered in consistency or nutrient content.
  4. they include all foods.


398 45.                  Which of the following is not a characteristic of a modified diet?

  1. emphasizes a narrow range of foods
  2. may be adjusted in consistency
  3. may be adjusted in nutrient content
  4. can be altered as a patient’s condition changes


396 46.                  Using the Harris-Benedict equation for women (below), estimate the resting metabolic rate of Mrs. Clements, who is 72 years old, is 157 cm tall, and weighs 53 kg.

RMR = 655.1 + [9.563 ´ weight (kg)] + [1.85 ´ height (cm)] – [4.676 ´ age (years)]

  1. 662 kcal
  2. 1115 kcal
  3. 1436 kcal
  4. 1789 kcal


396-397                 47.  Using the Mifflin-St. Jeor equation for men (below) and a stress factor of 1.3, estimate the energy needs of Mr. Briggs, who is 33 years old, is 173 cm tall, and weighs 67 kg.

RMR = [9.99 ´ weight (kg)] + [6.25 ´ height (cm)] – [4.92 ´ age (years)] + 5

  1. 1593 kcal
  2. 1918 kcal
  3. 2071 kcal
  4. 2493 kcal


398 48.                  Which of the following does not indicate the need to adjust a modified diet?

  1. a patient is not satisfied with the diet
  2. a patient is not tolerating the diet
  3. a patient complains of poor appetite
  4. a patient’s condition changes


398 49.  It is most helpful to think about modified diets in terms of:

  1. the diseases they are used to treat.
  2. the organ systems they relate to.
  3. the conditions they are used to treat.
  4. the symptoms they relieve.


399 50.                  Impaired swallowing indicates the need for a:

  1. mechanically altered diet.
  2. sodium-controlled diet.
  3. fat-controlled diet.
  4. fiber-restricted diet.


399 51.                  The most appropriate diet for a patient whose jaw was broken in a motor vehicle accident is a:

  1. fat-controlled diet.
  2. blenderized liquid diet.
  3. clear liquid diet.
  4. fiber-restricted diet.


399 52.                  Patients with certain malabsorptive disorders may benefit from a:

  1. sodium-controlled diet.
  2. high-kcalorie, high-protein diet.
  3. fat-controlled diet.
  4. blenderized liquid diet.


399 53.  The one criteria that does not determine whether a food is allowed on a clear liquid diet is whether it:

  1. requires minimal digestion.
  2. leaves little residue in the intestine.
  3. is liquid at room temperature.
  4. is high in nutrient density.


399 54.                  Which of the following foods would be allowed on a clear liquid diet?

  1. chicken broth
  2. cocoa
  3. cream of wheat
  4. ice cream


399 55.                  In order to minimize fecal volume, a patient may be placed on a _____ diet prior to surgery.

  1. fiber-restricted
  2. fat-controlled
  3. sodium-controlled
  4. high-kcalorie, high-protein


399 56.                  Which of the following foods is recommended for a high-kcalorie, high-protein diet?

  1. cheese
  2. raw vegetables
  3. fresh fruit
  4. plain pasta


398 57.                  Diet progression is appropriate for patients:

  1. following surgery.
  2. diagnosed with malnutrition.
  3. when a reduction in fecal volume is desired.
  4. prior to surgery.


398 58.  Following surgery, a patient may be given clear liquids initially, then gradually provided with other beverages or foods that are unlikely to cause discomfort. This is referred to as:

  1. a flexible diet order.
  2. diet progression.
  3. a food intolerance test.
  4. a mechanically altered diet.


399 59.                  Assuming the GI tract is functioning normally, what is the most appropriate method for feeding patients who are unable to meet their nutritional needs orally?

  1. intravenous feeding
  2. high-kcalorie, high-protein diet
  3. commercial supplement
  4. tube feeding


402 60.                  Patients often experience a poor appetite when hospitalized. All of the following are likely explanations for this except:

  1. emotional distress.
  2. medications that alter taste.
  3. meals are often served when the patient is not hungry.
  4. the presence of family members.


402 61.                  To increase a patient’s enjoyment of meals, the nurse can:

  1. make sure the patient’s favorite television program is on.
  2. make rounds during the meal to ensure the patient is eating well.
  3. see that the meal tray is attractive.
  4. encourage visitors during meal times.


398 62.  Diet manuals include all of the following except:

  1. foods allowed and not allowed on each diet.
  2. principles of nutrition education.
  3. information on rationale and indications for use.
  4. sample menus for each diet.


398-399                 63.  In some facilities, the diet manual is compiled by:

  1. the hospital administrator.
  2. several physicians.
  3. the nursing staff.
  4. the staff of dietitians.


396 64.                  Functional assessment of a patient includes all of the following except:

  1. testing the skin’s response to antigens.
  2. measuring hand grip strength.
  3. testing for iron status.
  4. measuring exercise tolerance.


399 65.                  A diet order that states “NPO” means that the patient should receive:

  1. nothing by mouth.
  2. medications only by mouth.
  3. liquids only.
  4. tube feedings.


400 66.                  Long-term dietary intervention is most successful when:

  1. patients are informed of the consequences of not following dietary recommendations.
  2. it is guided by an ambitious plan of care with many recommendations.
  3. patients are given a list of foods to eat and those not to eat.
  4. the plan does not deviate too much from the patient’s normal eating habits.


401 67.                  Which method of documenting nutrition care most closely reflects the steps of the nutrition care process?

  1. ADIME
  2. SOAP
  3. NCP
  4. PES


Case Study Questions


Use the following case study to answer questions 68-72.

John Wilson is a 74-year-old retired schoolteacher. He is 5’8” tall and weighs 136 pounds. His wife died nine months ago. During a routine visit to the doctor, it was noted that his weight had decreased 21 pounds since his visit a year ago. Mr. Wilson does not have any medical problems, though he does report feeling depressed and lonely. The physician ordered a panel of lab tests including albumin and transferrin. His albumin level was low, and his transferrin level was elevated.


392 68.                  What is Mr. Wilson’s percent usual body weight?

  1. 86.6%
  2. 88.3%
  3. 113.2%
  4. 115.4%


392 69.                  Based on Mr. Wilson’s %UBW, what is his nutrition risk?

  1. no risk of malnutrition
  2. risk of mild malnutrition
  3. risk of moderate malnutrition
  4. risk of severe malnutrition


382,384                 70.  The most likely cause of Mr. Wilson’s weight loss is:

  1. depression due to loss of his spouse.
  2. inadequate income to purchase food.
  3. lack of knowledge about nutrition.
  4. a high level of physical activity.


393,394-95           71.  Mr. Wilson’s elevated transferrin may be indicative of a deficiency of dietary:

  1. potassium.
  2. calcium.
  3. sodium.
  4. iron.


393,394 72.                  Mr. Wilson’s low albumin level may indicate a depletion of:

  1. body fat.
  2. body proteins.
  3. vitamin D.
  4. iron.


Nutrition in Practice – Nutritional Genomics


406,407 73.                  The study of the effects of diet on gene expression is called:

  1. gene expression.
  2. nutritional genomics.
  3. nutritional science.
  4. gene therapy.


406 74.                  The human body contains _____ chromosomes.

  1. 23
  2. 37
  3. 46
  4. 52


406 75.                  Segments of a DNA strand that can be translated into proteins are called:

  1. chromosomes.
  2. noncoding sequences.
  3. genomics.
  4. genes.


408 76.  Genomics research may be helpful in all of these areas except:

  1. fine-tuning nutrient recommendations for individuals.
  2. establishing indicators of nutrient status for some minerals.
  3. understanding how nutrient deficiencies may alter gene expression.
  4. determining environmental factors that may influence disease risk.


408 77.                  A drawback to obtaining detailed genetic information about one’s disease risk is:

  1. the potential for revealing private information.
  2. people may take better care of themselves and seek medical care less often.
  3. less effective treatments for some diseases.
  4. physicians may quit ordering less expensive lab tests.


Nursing Exam Review Questions


382 78.                  The nurse realizes that malnutrition is a common problem among people who are hospitalized and that it is associated with:

  1. a weakened immune system.
  2. lower mortality rates.
  3. reduced health care costs.
  4. fewer complications.


382 79.  The nurse recognizes that an illness that interferes with the digestion or absorption of nutrients may ultimately lead to:

  1. difficulty swallowing.
  2. inappropriate food intake.
  3. a shorter hospital stay.
  4. suboptimal healing.


400 80.  When a patient is diagnosed with a chronic illness that requires long-term dietary modifications, the most appropriate role for the nurse is to:

  1. write the correct diet order.
  2. help patients accept and understand the dietary changes.
  3. plan and approve the patient’s menus while she/he is in the hospital.
  4. evaluate the accuracy of the meal trays.


384 81.  The nurse understands that though a dietitian or dietetic technician may perform the nutrition screening, the Joint Commission recommends that patients be screened within _____ hours of admission.

  1. 12
  2. 24
  3. 36
  4. 48


384 82.                  An elderly male is admitted to the hospital with a diagnosis of malnutrition three months after his wife died. The nurse recognizes that this is most likely due to which criteria for identifying malnutrition risk?

  1. depression or social isolation
  2. recent unintentional weight change
  3. history of chronic illness
  4. age

386,387                 83.  The nurse recognizes that diseases involving the esophagus may have nutritional implications due to difficulty swallowing, and it will be necessary to:

  1. have a family member feed the patient.
  2. monitor the patient’s food intake.
  3. be in the room and encourage the patient to eat.
  4. provide the patient with assisted feeding devices.


385 84.  The nurse recognizes that the dietitian has appropriately documented a nutrition diagnosis for a patient who recently lost a significant amount of weight as:

  1. recent weight loss of 10 pounds.
  2. unintentional weight loss related to poor kcalorie intake as evidenced by 10% weight loss in the past 2 months.
  3. unintentional weight loss as evidenced by 10% weight loss.
  4. recent weight loss of 10% of usual body weight.


385 85. The nurse reviews the dietitian’s note that includes a specific nutrition problem, its etiology, and evidence of the problem. The nurse recognizes this as the:

  1. nursing diagnosis.
  2. physician’s diet order.
  3. nutrition prescription.
  4. nutrition diagnosis.


389 86.                  The dietitian asks the nurse to observe a patient’s food intake and record the kinds and quantities of foods the patient receives and leaves on his plate. The nurse realizes that the dietitian is interested in keeping a _____ for this patient.

  1. food record
  2. 24-hour recall
  3. kcalorie count
  4. usual intake record


390 87.                  The nurse understands the importance of evaluating the progress of growth in pregnant women, infants, children, and adolescents, detecting under- and over-nutrition in all age groups, and measuring changes in body composition over time. The nurse should recognize that all of these purposes can be served through:

  1. anthropometric measurements.
  2. functional tests of nutrition status.
  3. biochemical tests of protein status.
  4. physical examination for signs of malnutrition.


390 88.  The nurse is measuring the length of an infant and understands that in order to perform this measurement correctly:

  1. the infant must be completely undressed.
  2. a measuring board should be used.
  3. a flexible tape measure should be used.
  4. the measurement should be recorded to the nearest ¼”.


391 89.                  If the nurse is unable to obtain a patient’s weight and the patient states her weight, the nurse understands that:

  1. five pounds should be added to the self-reported weight.
  2. self-reported weights are valid.
  3. the weight should be documented as self-reported.
  4. it is impolite to ask a patient’s weight.


396 90.                  The nurse recognizes that weight gain due to fluid retention in a patient with liver cirrhosis can mask symptoms of:

  1. liver failure.
  2. PEM.
  3. obesity.
  4. gallbladder disease.


394 91.                  Interpreting laboratory tests can be challenging because many factors influence test results. The nurse understands that:

  1. no one lab value is an indicator of nutritional deficiencies.
  2. serum albumin is the only reliable lab value to determine protein status.
  3. fluid imbalances have no effect on lab values.
  4. serum values of vitamins and minerals are good indicators of nutrient deficiencies.


396 92.                  The nurse recognizes that a patient experiencing a high fever and vomiting is at risk for:

  1. malnutrition.
  2. wasting.
  3. dehydration.
  4. fluid retention.


383 93.  In terms of implementation of care plans, the nurse recognizes that her major role is to:

  1. deliver appropriate foods to the patient.
  2. offer support in the educational aspect of patient care.
  3. plan the diet for the patient.
  4. ensure that the appropriate foods are prepared for the patient.


383,400                 94.  A patient is discouraged by the dietary restrictions on her sodium-controlled diet. The most appropriate response from the nurse is to:

  1. emphasize foods the patient can eat.
  2. agree that the diet is unpalatable.
  3. allow the family to bring food to the patient.
  4. explain why the diet is necessary.


399 95.                  The nurse notices that an elderly patient is experiencing difficulty chewing. Which of the following diets would be most appropriate?

  1. clear liquid
  2. mechanical soft
  3. sodium-controlled
  4. blenderized liquid


399 96.                  Which of the following menu selections would be appropriate for a patient placed on a clear liquid diet?

  1. chicken broth, apple juice, popsicle
  2. yogurt, cranberry juice, beef broth
  3. scrambled egg, coffee, orange juice
  4. Jell-O, ice cream, coffee


399 97.  The hospitalized patient’s diet prescription was for a clear liquid diet. The nurse knew this patient’s diet was not correctly delivered when she saw these items on the patient’s tray:

  1. cherry gelatin, ginger ale, and coffee.
  2. cranberry juice, strawberry fruit ice, and soft drink.
  3. bouillon, apple juice, tea, and sugar.
  4. strained orange juice, popsicle, and tomato juice.


399 98.  A patient is scheduled for bowel surgery tomorrow. The appropriate diet order today is:

  1. blenderized liquid.
  2. fat controlled.
  3. low protein.
  4. clear liquid.


398 99.                  The hospitalized patient is on a progressive diet following surgery. One day the patient experiences nausea and vomiting after consuming lunch. The nurse recognizes that it is his responsibility to:

  1. track the patient’s tolerance and readiness to advance the diet.
  2. withhold all foods from the patient until the patient’s physician has been contacted.
  3. contact the kitchen immediately to report a case of foodborne illness.
  4. contact the dietitian and request that the diet order be changed.


398 100.              Which of the following factors would cause the nurse to reconsider allowing progression of the diet following surgery?

  1. fever
  2. patient feeling hungry
  3. vomiting
  4. abdominal distention


399 101.              Which of the following nutritional interventions is most appropriate for a patient in a coma?

  1. NPO
  2. tube feeding
  3. intravenous feeding
  4. clear liquid diet


403 102.              The nurse removes a patient’s meal try from the food cart and discovers that the food is not appropriate to the diet order. The nurse should:

  1. substitute another patient’s meal tray that contains the appropriate foods.
  2. ask a family member to go to the kitchen and request another meal tray.
  3. order a new food tray from the kitchen.
  4. call the dietitian to come address the problem.


398 103.              The nurse removes a patient’s meal tray from the meal cart and is not certain that it contains the correct foods for the diet order. The nurse should:

  1. call the kitchen.
  2. ask the patient.
  3. check the diet manual.
  4. check the care plan.





a.     liquid formulas delivered through a tube placed in the stomach or intestine.

b.     a diet that includes all foods and meets the nutrient needs of healthy people.

c.     a change in diet as a patient’s tolerances permit.

d.     related to physical measurements of the human body, such as height, weight, body circumferences, and percentage of body fat.

e.     a diet that is adjusted in consistency, in energy or nutrient content, or by the inclusion or elimination of certain foods

f.     the gradual atrophy (loss) of body tissues; associated with protein-energy malnutrition or chronic illness.

g.     a resource that specifies the foods allowed and restricted on modified diets and provides sample menus.

h.     loss of appetite.

i.      coordinated programs of treatment that merge the care plans of different health practitioners.

j.      the provision of nutrients through a vein, bypassing the intestine.



a.     segments of DNA that contain the information needed to make proteins.

b.     regions of DNA that do not code for proteins.

c.     the study of genomes.

d.     the study of dietary effects on genetic expression.

e.     a region of DNA involved with gene activation.

f.     structures within the nucleus of a cell that contain the cell’s DNA and associated proteins.

g.     the study of heritable changes in DNA structure that do not change the DNA nucleotide sequence.

h.     differences in the DNA sequences among individuals.

i.      research technology that monitors the expression of thousands of genes simultaneously.

j.      the full complement of genetic material in the chromosomes of a cell.

k.     proteins that bind DNA at specific sequences to regulate gene expression.

l.      the process by which a cell converts the genetic code into RNA and protein.

m.   medical conditions resulting from genetic defects.

n.     the subunits of DNA and RNA molecules.





382                 1.     Describe how prolonged bed rest may compromise nutrition status.


383-384         2.     Describe the types of information collected in a nutrition screening.


385-386         3.     List and describe the steps in the nutrition care process.


387-389         4.     List three different methods for obtaining food intake data and describe the major uses, advantages, and limitations of each.


393-395         5.     Describe the major biochemical tests of protein status and briefly discuss their major advantages and disadvantages.


398,399         6.     Differentiate between regular and modified diets.


399                 7.     Describe a mechanically altered diet and explain when it is useful.


398                 8.     Explain the concept of diet progression.


398-399         9.     Describe what is included in a diet manual.



Chapter 15 – Medications, Diet-Drug Interactions, and Herbal Supplements


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




413 1.                     A high-fiber diet and regular exercise may prevent the need for laxatives.


414 2.                     Although many medications can cause nausea, it usually subsides after the first few doses.


421 3.                     The National Center for Complementary and Alternative Medicine is one of the many institutes that make up the National Institutes of Health.


421 4.                     The adverse effects of herbs are required to be listed on supplement labels.


421 5.                     There are no known interactions between herbal supplements and medications.


422 6.                     Health practitioners do not need to be aware of patients’ use of complementary and alternative therapies.


Nutrition in Practice – Complementary and Alternative Therapies


427 7.                     An example of guided imagery is when person tries to reverse the disease process by using mental pictures.


426 8.                     Naturopathic medicine is based on the theory that “like cures like.”


425 9.                     CAM is used as a marketing ploy and is utilized by unscrupulous sellers of worthless treatments.


425 10.                  Physicians who practice integrative medicine may refer patients for complementary therapies while continuing to provide standard treatments.



Multiple Choice


411 1.                     Aspirin is an example of:

  1. an OTC drug.
  2. a generic drug.
  3. an herbal product.
  4. a prescription drug.


411 2.     Which of the following is a true statement about OTC drugs?

  1. They have no side effects.
  2. Some were once prescription drugs.
  3. They do not interact with other medications.
  4. They are the same as generic drugs.


412 3.                     Problems with medications can be reported to the FDA via:

  1. the MedWatch website.
  2. the DSHEA website.
  3. the NCCAM website.
  4. the USDA website.


412 4.                     Which population group is most prone to drug-drug interactions?

  1. infants
  2. children
  3. the elderly
  4. the disabled


412 5.                     Medication errors may be the result of any of the following except:

  1. improper dosages.
  2. misinterpretation of the physician’s order.
  3. confusion of drugs with similar names.
  4. bar code scanning systems.


412 6.                     Populations with increased vulnerability to the adverse effects of drugs include all of the following except:

  1. elderly people.
  2. pregnant women.
  3. middle-aged women.
  4. children.


413 7.                     Which of the following is a medical abbreviation that is prohibited on clinical documentation?

  1. q.i.d.
  2. mcg
  3. IU
  4. mg


421 8.                     Which of the following is true about dietary supplements?

  1. They can be marketed without studies to document their effectiveness and safety.
  2. They are always hazardous.
  3. The amount actually present in the product always equals the amount stated on the label.
  4. They are approved by the FDA.


413 9.                     Which of the following practices can help to reduce the likelihood of the adverse effects of drugs?

  1. Request a complete list of all medications and dietary supplements that a patient is taking.
  2. Ensure that more than one doctor is overseeing each patient’s medication use.
  3. Encourage patients to use multiple pharmacies so that more than one pharmacist can monitor their prescriptions.
  4. Tell patients that most side effects are temporary and to wait a few days before calling the doctor.


421 10.                  According to the DSHEA:

  1. herbal supplements must be approved by the FDA.
  2. manufacturers of herbal supplements must provide evidence of a product’s safety.
  3. the FDA must show that a supplement is unsafe before it can stop the sale of an herbal supplement.
  4. manufacturers of herbal supplements may make claims about the prevention or treatment of specific diseases.


421 11.                  Consistency in herbal supplements is not guaranteed because:

  1. no manufacturers have attempted to standardize them.
  2. they are natural substances, so there can be no consistency.
  3. growing conditions can affect the plants’ chemical composition.
  4. the active ingredient in an herb must be isolated to be effective.

421 12.  Yohimbe has been linked to:

  1. liver damage.
  2. heart arrhythmias.
  3. sexual dysfunction.
  4. hypertension.


421 13.                  The most common adverse effects of herbs include:

  1. breathing difficulties.
  2. renal failure, seizures, and heart palpitations.
  3. nausea, vomiting, and diarrhea.
  4. heart attack or stroke.


422 14.                  Which herb has been found to inhibit the action of oral contraceptives?

  1. St. John’s wort
  2. garlic
  3. ginseng
  4. kava


421 15.                  Concerns about the use of herbal supplements include all of the following except:

  1. contamination with toxic metals.
  2. adulteration with synthetic drugs.
  3. lack of consistency in ingredients.
  4. cost compared to benefit.


421-422                 16.  Which herb can raise the likelihood of bleeding when used in conjunction with anticoagulant drugs?

  1. ginseng
  2. ephedra
  3. kava
  4. valerian


420 17.  Which herb is often used for the prevention and treatment of nausea and motion sickness?

  1. ginseng
  2. ginger
  3. kava
  4. valerian


420, 421                18.  Which herb has been linked to liver damage?

  1. ginseng
  2. gingko
  3. kava
  4. garlic


421-422                 19.  Which herb can intensify the action of warfarin (Coumadin)?

  1. kava
  2. saw palmetto
  3. garlic
  4. echinacea


414 20.                  Unintentional weight gain can result from the use of:

  1. antidepressant medications.
  2. antihypertensive medications.
  3. sedatives.
  4. antinausea medications.


414 21.                  Megestrol acetate is a/an:

  1. appetite enhancer.
  2. weight-loss drug.
  3. antidepressant.
  4. pain reliever.


414 22.                  Which of the following types of drugs may cause unintentional weight gain?

  1. antipsychotics
  2. antiretrovirals
  3. antinauseants
  4. antibiotics


414 23.                  All of the following types of drugs can cause nutrient malabsorption except:

  1. antineoplastic drugs.
  2. antiretroviral drugs.
  3. NSAIDs.
  4. antiemetics.


415 24.  Medications that reduce stomach acid may impair the absorption of:

  1. vitamin C.
  2. vitamin B12.
  3. glucose.
  4. all nutrients.


414-415                 25.  Why is it recommended that tetracycline be taken on an empty stomach at least two hours before or after consuming dairy products?

  1. Tetracycline and calcium will bind to each other, reducing the absorption of both.
  2. Too much tetracycline will be absorbed and blood levels will be too high.
  3. The combination of tetracycline and calcium will cause tooth enamel to discolor.
  4. Too much calcium will be absorbed and blood levels will be too high.


414 26.                  The medications most likely to cause nutrient malabsorption are those that:

  1. lower blood glucose.
  2. control high blood pressure.
  3. damage the intestinal mucosa.
  4. slow gastric emptying.


416 27.  Which of the following can bind with medications and reduce their absorption?

  1. lactose
  2. phytates
  3. protein
  4. garlic


417 28.  Which of the following foods has been shown to raise blood levels of a variety of medications?

  1. bananas
  2. grapefruit juice
  3. tomato juice
  4. oranges


416 29.                  Anticonvulsant medications may increase levels of enzymes that metabolize all of these vitamins except:

  1. vitamin A.
  2. folate.
  3. vitamin D.
  4. vitamin K.

416 30.                  Methotrexate interferes with the metabolism of:

  1. folate.
  2. iron.
  3. vitamin B12.
  4. calcium.


418 31.  Supplements of _____ are usually given to patients receiving the antituberculosis drug isoniazid.

  1. iron
  2. vitamin B6
  3. vitamin B12
  4. folate


417 32.                  Grapefruit juice affects drug absorption by:

  1. increasing blood concentration of some drugs.
  2. decreasing blood concentration of some drugs.
  3. inactivating certain drugs.
  4. altering the action of certain drugs.


417 33.  The drug warfarin is structurally similar to:

  1. vitamin C.
  2. vitamin K.
  3. vitamin D.
  4. vitamin E.


417 34.                  Which of the following side effects might be expected from long-term use of corticosteroids?

  1. weight gain, muscle wasting, bone loss, hyperglycemia
  2. weight loss, hypertension, bone loss, hypoglycemia
  3. weight gain, high cholesterol, bone loss, hypoglycemia
  4. weight loss, muscle wasting, kidney failure, hyperglycemia


417 35.                  Individuals using warfarin are advised to:

  1. avoid all foods containing vitamin K.
  2. take a vitamin K supplement.
  3. consume consistent amounts of vitamin K daily.
  4. avoid green, leafy vegetables.


418 36.  An individual taking INH should also take supplements of:

  1. folate.
  2. vitamin B6.
  3. vitamin B12.
  4. iron.


418 37.                  People taking MAO inhibitors should restrict their intake of:

  1. tomato sauce.
  2. cheddar cheese.
  3. cottage cheese.
  4. white wine.


418 38.  Which food should not be eaten in a tyramine-controlled diet?

  1. tomatoes
  2. liver
  3. cucumbers
  4. pork sausage


418 39.                  People taking MAO inhibitors should avoid foods containing:

  1. tyramine.
  2. phenylalanine.
  3. tryptophan.
  4. starch.


418 40.                  People taking lithium are advised to maintain a consistent intake of _____ from day to day in order to maintain a stable blood level of lithium.

  1. calcium
  2. zinc
  3. sodium
  4. alcohol


421 41.  One of the problems with determining the effectiveness of an herbal remedy is:

  1. the lack of a consistent supply of herbs.
  2. the fact that different samples of an herb can have different chemical compositions.
  3. inconsistent labeling of supplements.
  4. differing opinions about the best method for testing herbs.


Case Study Questions


Use the following case study to answer questions 42-47.

Jose Salazar has been hospitalized following a motor vehicle accident. He has several broken bones, including his left jaw, two ribs on the left side, and a compound fracture of his left leg. According to his medical record, he is 47 years old, his height is 5’9”, and his weight is 171 pounds. During the course of his hospital stay, he was diagnosed with a heart arrhythmia. His current medications include lovastatin to lower his cholesterol, an MAO inhibitor to treat depression, and an analgesic to treat his pain. Mr. Salazar’s wife also reports that he takes several herbal products including, yohimbe, kava kava, valerian, and St. John’s wort.


417-418                 42.  Before leaving the hospital, Mr. Salazar will need nutrition education on:

  1. how to use a blender.
  2. food-medication interactions.
  3. food safety.
  4. weight loss.


418 43.                  In order to avoid a food-medication interaction with his MAO inhibitor, Mr. Salazar will need to avoid drinking:

  1. beer.
  2. cola beverages.
  3. tea.
  4. grapefruit juice.


417 44.                  Because Mr. Salazar is taking lovastatin, he should be counseled to avoid:

  1. apple juice.
  2. grapefruit juice.
  3. green leafy vegetables.
  4. milk.


422 45.  Mr. Salazar will be discharged with analgesic medications to control his pain. Which herbal products should he be advised to quit taking because of the potential for interaction?

  1. yohimbe and valerian
  2. kava kava and valerian
  3. St. John’s wort and yohimbe
  4. valerian and St. John’s wort

421 46.                  Which herbal product taken by Mr. Salazar may be causing his heart arrhythmia?

  1. yohimbe
  2. kava kava
  3. St. John’s wort
  4. valerian


413 47.                  What advice should be given to Mr. Salazar regarding his use of herbal products?

  1. Each time he visits his physician, he should bring a list of all prescription medications and herbal products he regularly takes.
  2. He should look up the side effects of each herbal product he takes so he can be aware of them.
  3. He should never take more than one herbal product at a time.
  4. Herbal products should never be taken at the same time he takes his prescription medications.


Nutrition in Practice – Complementary and Alternative Therapies


425 48.                  The popularity of CAM can be explained by all of the following except:

  1. consumers’ interest in self-help measures.
  2. the noninvasive nature of CAM therapies.
  3. the tendency of CAM practitioners to spend more time with patients.
  4. growing evidence of the effectiveness of CAM.


425, 427                49.  The one characteristic that all alternative therapies have in common is:

  1. their effectiveness.
  2. research as to their safety.
  3. a lack of evidence about their effectiveness.
  4. the absence of any interactions or effects with mainstream medical care.


426 50.  Which of the following forms of alternative medicine proposes that a person’s “life force” can foster self-healing?

  1. homeopathic medicine
  2. naturopathic medicine
  3. bioelectrical medicine
  4. chiropractic medicine


426 51.  Which of the following is a form of traditional Chinese medicine?

  1. bioelectromagnetic therapy
  2. acupuncture
  3. chiropractic
  4. therapeutic touch


425 52.                  A common biologically based therapy is the use of:

  1. dietary supplements and herbal products.
  2. chiropractic medicine.
  3. massage therapy.
  4. aromatherapy.


425, 426                53.  Which of the following alternative therapies involves the alleged curative power of “energy”?

  1. qi gong
  2. massage therapy
  3. biofeedback training
  4. faith healing


428 54.                  Concerns about the use of CAM by consumers include all of the following except:

  1. consumers may assume that all CAM therapies are safe.
  2. the use of CAM therapies may delay the use of reliable treatments.
  3. most CAM therapies are not regulated or monitored.
  4. CAM therapies are more expensive than traditional medical care.


Nursing Exam Review Questions


417 55.                  The nurse recognizes that a patient placed on the anticoagulant drug warfarin will need:

  1. supplements of vitamin K.
  2. a high-kcalorie diet.
  3. education regarding diet-drug interactions.
  4. education regarding increasing iron intake.


418 56.                  A patient is taking an MAO inhibitor and is on a tyramine-controlled diet. Which of the following foods should be avoided?

  1. American cheese
  2. peanuts
  3. mushrooms
  4. spinach




412-413         1.     Describe which types of individuals are at high risk for adverse effects from medications.


414                 2.     What are three general ways in which diet and drugs can interact?


414                 3.     Discuss the ways in which drugs can affect food intake.


420-422         4.     Describe how you would counsel a patient who is taking herbal supplements to treat a medical condition.


Case Study Essay Questions


Ernest Hare is a 75-year-old retired railroad engineer. He has a history of myocardial infarction, hypertension, congestive heart failure, and anxiety. His medications include warfarin, simvastatin, Lopressor, lorazepam, and Lasix. In addition to these prescription drugs, Mr. Hare takes garlic tablets and St. John’s wort.


  1. As a health professional, what steps should you take to determine if any of the medications and supplements Mr. Hare is taking has the potential for diet-drug or drug-drug interactions?
  2. Do any of the drugs Mr. Hare is taking prevent him from safely consuming grapefruit? If so, which ones and why?
  3. Which medication that Mr. Hare is taking interacts with vitamin K? How does this interaction occur?
  4. How should Mr. Hare be counseled regarding his vitamin K intake?
  5. Could either of the dietary supplements Mr. Hare is taking interact with his prescription medications? If so, which ones and why?


  1. Yes. Grapefruit should not be consumed when taking simvastatin. Compounds in grapefruit juice (or whole grapefruit) have been found to inhibit or inactivate enzymes that metabolize a number of different drugs, including simvastatin. As a result of the reduced enzyme action, blood levels of the drugs increase, leading to stronger physiological effects. The effect of the grapefruit juice lasts for a substantial period after the juice is consumed.
  2. Warfarin interacts with vitamin K. The two are structurally similar. Warfarin acts by blocking the enzyme that activates vitamin K, thereby preventing the synthesis of blood-clotting factors. The amount of warfarin prescribed is dependent, in part, on how much vitamin K is in the diet. If vitamin K consumption from foods or supplements changes substantially, it can alter the effect of the drug.
  3. Individuals using warfarin are advised to consume similar amounts of vitamin K daily to keep warfarin activity stable. The dietary sources highest in vitamin K are green leafy vegetables such as spinach, kale, Brussels sprouts, collard greens, and mustard greens. A registered dietitian can provide individualized guidance.
  4. Both St. John’s wort and garlic can interact with the warfarin Mr. Hare is taking. They enhance the activity of warfarin.





a.     healing methods based on the belief that illnesses can be healed by manipulating energy fields that purportedly surround and penetrate the body.

b.     a practice based on the theory substances believed to cause certain symptoms are prescribed for curing the same symptoms, but are given in extremely diluted amounts.

c.     an alternative medical system based on the unproven theory that spinal manipulation can restore health.

d.     a therapy that involves inserting thin needles into the skin at specific anatomical points, allegedly to correct disruptions in the flow of energy within the body.

e.     a technique in which individuals are trained to gain voluntary control of certain physiological processes, such as skin temperature or brain wave activity, to help reduce stress and anxiety.

f.     therapies that involve the unconventional use of electric or magnetic fields to cure illness.



Chapter 16 – Specialized Nutrition Support: Enteral and Parenteral Nutrition


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




433 1.                     Enteral nutrition is more costly than parenteral nutrition.


433 2.                     Enteral nutrition is preferred over parenteral nutrition because enteral nutrition helps stimulate or maintain normal gut function.


433, 441                3.     When a patient is being tube fed, he or she cannot eat food.


438 4.                     Most intestinal feedings are delivered by continuous drip.


440 5.                     If a patient tolerates a formula after it is initiated, the rate of a continuous feeding should be increased by 30 milliliters per hour every 8 hours.


440 6.                     Any drug-nutrient interaction that occurs between conventional foods and drugs can occur between formulas and drugs as well.


441, 442                7.     Complications of tube feedings can be gastrointestinal, mechanical, or metabolic in nature.


443 8.                     Parenteral nutrition is usually reserved for patients who cannot meet their nutrient needs using the enteral route.


444 9.                     Highly concentrated nutrient solutions are not suitable for peripheral parenteral nutrition.


444 10.                  In PPN, the osmolarity of a feeding solution is usually limited to 500 milliosmoles per liter.


444 11.                  The use of PPN is not possible if a patient’s peripheral veins are weak.


446 12.                  Standard IV amino acid solutions contain essential amino acids but no nonessential amino acids.


448 13.                  Once the need for intravenous nutrition has resolved, the patient should be immediately taken off of the solution and put onto an oral diet.


448-449                 14.  One method of making the transition from an intravenous feeding to an oral diet is to place the patient on a tube feeding.


449 15.                  A patient’s appetite may remain suppressed for several weeks after parenteral nutrition is terminated.


449 16.                  Patients undergoing severe metabolic stress may develop hyperglycemia, which is a common complication associated with TPN.


451 17.                  The cost of home nutrition support is a concern for people who require it.


451 18.                  Low-profile gastrostomy tubes are often preferred by active children and adults because they allow these individuals to lead a more normal lifestyle.


Multiple Choice


430 1.                     Enteral nutrition includes:

  1. TPN.
  2. PPN.
  3. tube feedings.
  4. simple IVs.


430 2.     Enteral nutrition provides nutrients using:

  1. the lymphatic system.
  2. the gastrointestinal tract.
  3. central veins.
  4. peripheral veins.


430 3.     Parenteral nutrition refers to the delivery of nutrient solutions into:

  1. the mouth.
  2. a vein.
  3. the intestines.
  4. the stomach.


431 4.                     Types of formulas that contain intact proteins are called:

  1. disease-specific formulas.
  2. hydrolyzed formulas.
  3. standard formulas.
  4. modular formulas.


431 5.                     Enteral formulas that consist of pureed whole foods are called:

  1. standard.
  2. hydrolyzed.
  3. blenderized.
  4. modular.


431 6.     All of the following are characteristics of elemental formulas except:

  1. they contain broken-down molecules of protein.
  2. they require only minimal digestion.
  3. they are used for patients who have compromised digestive or absorptive functions.
  4. they are recommended for patients who are able to digest and absorb nutrients without difficulty.


431 7.                     A drawback to using specialized or disease-specific formulas is:

  1. they are expensive.
  2. patients do not tolerate them well.
  3. they cause high gastric residuals.
  4. they are not available for common chronic conditions.


431 8.                     Which of the following statements about modular formulas is false? Modular formulas:

  1. are prepared for patients who require specific nutrient combinations.
  2. are created from individual macronutrients.
  3. are general-use, complete formulas.
  4. may be added to other enteral formulas to adjust the nutrient composition.


431 9.     Standard formulas provide approximately:

  1. 0.5 kcalories per mL.
  2. 1 kcalorie per mL.
  3. 1.5 kcalories per mL.
  4. 2 kcalories per mL.


431 10.                  Fiber in an enteral formula provides all of the following benefits except:

  1. normalizing intestinal function.
  2. helping to treat diarrhea and constipation.
  3. increasing the caloric content of the formula.
  4. assisting with blood glucose control.


431 11.  A formula that approximates the osmolality of normal blood serum:

  1. is called a hypertonic formula.
  2. is referred to as an isotonic formula.
  3. has an osmolality of approximately 500 milliosmoles per liter.
  4. is usually a hydrolyzed formula.


431-432                 12.  Which type of enteral formula usually has the highest osmolality?

  1. standard formulas
  2. modular formulas
  3. specialized formulas
  4. elemental formulas


432 13.                  An ideal formula for a patient is one that:

  1. meets his/her medical and nutrient needs.
  2. is the least expensive.
  3. provides fiber.
  4. contains lactose.


431 14.                  You are working with a patient whose ability to digest and absorb food is impaired, but whose nutrient needs are not elevated. Which of the following formulas would you select?

  1. a standard formula
  2. an elemental formula
  3. a combination of modular formulas
  4. a disease-specific formula


433 15.                  Enteral formulas may be used orally to supplement a patient’s diet. When this occurs, _____ becomes an important consideration.

  1. taste
  2. cost
  3. osmolality
  4. calorie content


434 16.                  Tube feedings are commonly used for individuals with:

  1. malabsorption disorders.
  2. pancreatitis.
  3. severe swallowing difficulties.
  4. nonfunctional GI tracts.


434 17.                  Which of the following feeding tube placement sites would be the most appropriate for a patient who is expected to be on a tube feeding for less than 4 weeks?

  1. gastrostomy
  2. jejunostomy
  3. nasogastric
  4. duodenostomy


435 18.                  The appropriate placement of a tube feeding in an infant is:

  1. nasogastric.
  2. nasoduodenal.
  3. orogastric.
  4. nasojejunal.


436 19.  Aspiration is a risk for all of the following except:

  1. patients with esophageal disorders.
  2. patients with neuromuscular diseases.
  3. patients who are unconscious.
  4. patients with renal disease.


436 20.                  All of the following are characteristics of feeding tubes except:

  1. they are all the same diameter.
  2. they come in a variety of lengths.
  3. they are soft and flexible.
  4. they come with special characteristics for specific purposes.


436 21.  The outer diameter of a feeding tube is measured in:

  1. millimeters.
  2. French units.
  3. milliliters.
  4. English units.


436 22.  A “12 French” feeding tube has a diameter of:

  1. 2 mm.
  2. 4 mm.
  3. 6 mm.
  4. 8 mm.


436, 437                23.  A procedure in which the stomach contents of a patient are removed by suction is called:

  1. gastric decompression.
  2. enterostomy.
  3. gastric residuals.
  4. aspiration.


437 24.                  The advantages of a closed feeding system include:

  1. less likelihood of contamination.
  2. lower initial cost.
  3. increased nurse contact with the patient.
  4. increased patient tolerance.


437 25.                  All of the following are ways to prevent bacterial contamination of tube feedings except:

  1. using fresh formula every 48 hours.
  2. storing open or mixed formula in the refrigerator.
  3. never adding fresh formula to formula that has been hanging.
  4. changing the feeding container and tubing every 24 hours.


438 26.                  To minimize the risk of aspiration of formula in tube-fed patients, the head of the patient’s bed should be elevated:

  1. after administering the feeding.
  2. during administration of the feeding.
  3. during and for 30 minutes after administration of the feeding.
  4. during and for 1 hour after administration of the feeding.


439 27.                  Delivering 250 to 500 milliliters of formula in less than 20 minutes is referred to as:

  1. a bolus feeding.
  2. a continuous drip feeding.
  3. an intermittent feeding.
  4. a slow drip feeding.


440 28.                  An adult’s requirement for water is about:

  1. 1000 mL/day.
  2. 1500 mL/day.
  3. 2000 mL/day.
  4. 2500 mL/day.


440 29.                  Which of the following conditions does not raise a patient’s water requirements?

  1. heart disease
  2. severe vomiting
  3. fever
  4. blood loss


440 30.                  Estimate the daily fluid needs of a 70-year-old female who weighs 110 pounds.

  1. 850-1050 mL
  2. 1000-1200 mL
  3. 1250-1500 mL
  4. 1500-2000 mL


441 31.                  Which of the following statements regarding transitioning from tube feeding to an oral diet is correct?

  1. The patient must begin the transition by orally consuming the formula they have been receiving as via tube feeding.
  2. The tube feeding should be discontinued and an oral diet started immediately.
  3. The patient should shift to an oral diet as the volume of the tube feeding is gradually decreased.
  4. Oral intake should be about 1/3 of estimated nutrient needs when the tube feeding is discontinued.


441 32.                  Before discontinuing a tube feeding, the patient’s oral intake should be about _____ of estimated nutrient needs.

  1. 1/3
  2. ½
  3. ¾
  4. 2/3


441 33.                  Which of the following statements is true regarding the administration of medications to patients who are tube fed?

  1. Medications should be given by mouth when possible.
  2. All medications should be crushed before placing them in the feeding tube.
  3. Place the patient in a prone position before administering medications.
  4. Give all medications before flushing the feeding tube.


443 34.                  Compared to enteral nutrition, parenteral nutrition:

  1. carries a greater risk of complications.
  2. is less expensive.
  3. can be used for longer periods of time.
  4. requires hospitalization.


443 35.  Which of the following medical conditions or treatments indicates the need for TPN?

  1. severe swallowing disorders
  2. mechanical ventilation
  3. extremely high nutrient needs
  4. short bowel syndrome


444 36.                  Phelebitis may develop as a result of:

  1. tube feeding intolerance.
  2. refeeding syndrome.
  3. peripheral parenteral nutrition.
  4. the use of hypertonic formulas.


443-444 37.                  TPN is indicated for each of the following except:

  1. patients who cannot be fed through the GI tract.
  2. situations where long-term parenteral nutrition will be required.
  3. situations where nutrient requirements are high.
  4. patients who are moderately malnourished.


444 38.  Candidates for peripheral parenteral nutrition include patients who:

  1. have fragile peripheral veins.
  2. have fluid restrictions.
  3. have high nutrient needs.
  4. require short-term nutrition support.


446 39.                  The amino acids in a parenteral solution provide _____ kcal per gram.

  1. 2
  2. 3.4
  3. 4
  4. 4.4


446 40.  The main source of energy in parenteral solutions is:

  1. amino acids.
  2. glucose.
  3. lipid emulsions.
  4. fluids and electrolytes.


446 41.                  Dextrose monohydrate provides _____ kcal/g.

  1. 0.9
  2. 1.8
  3. 2.5
  4. 3.4


446 42.  A 5% dextrose solution contains:

  1. 2.5 grams of dextrose monohydrate per 100 mL.
  2. 5 grams of dextrose monohydrate per 100 mL.
  3. 2.5 grams of dextrose monohydrate per liter.
  4. 5 grams of dextrose monohydrate per liter.


446 43.  All of the following are true statements concerning IV lipid emulsions except that:

  1. they provide essential fatty acids.
  2. they are hypertonic.
  3. they are a concentrated source of energy.
  4. they are isotonic.


446 44.                  A parenteral solution containing 500 mL of a 20% lipid emulsion would provide _____ kcalories from lipids.

  1. 550
  2. 1000
  3. 1500
  4. 1800


446 45.  Lipid infusions must be restricted in patients with:

  1. diseases that require fluid restriction.
  2. hypertriglyceridemia.
  3. hyperglycemia.
  4. hyperkalemia.


446 46.                  Lipid emulsions that contain excessive linoleic acid may:

  1. hamper immune responses.
  2. minimize negative nitrogen balance.
  3. spare vital protein.
  4. contribute to hyperglycemia.


446 47.                  Which of the following trace minerals is not included in a parenteral solution?

  1. zinc
  2. copper
  3. iron
  4. selenium


447 48.                  A parenteral solution that contains dextrose, amino acids, and lipids is called a:

  1. standard formula.
  2. modular formula.
  3. 2-in-1 solution.
  4. 3-in-1 solution.


447 49.                  How many kcalories would a patient receive from an IV solution containing 1000 mL of 50 percent dextrose and 1200 mL of 7 percent amino acid solution?

  1. 1785
  2. 1942
  3. 2036
  4. 2124


448 50.                  The appropriate method for administering TPN to a critically ill and malnourished patient is:

  1. bolus.
  2. continuous.
  3. cyclic.
  4. as needed.


448 51.                  Rapid changes in infusion rates of a parenteral solution can cause:

  1. fluctuations in blood glucose levels.
  2. diarrhea.
  3. obstructions.
  4. infection.

449 52.                  Parenteral nutrition can be discontinued when _____ of estimated energy needs are being met by oral intake, tube feeding, or a combination of the two.

  1. 1/3-1/2
  2. 1/4-1/3
  3. 1/3-3/4
  4. 2/3-3/4


449 53.                  To prevent refeeding syndrome in a severely stressed individual you would:

  1. start feedings at a slow rate.
  2. introduce nutrients by vein.
  3. provide vitamin supplements.
  4. delay enteral feedings.


449 54.  A condition that may develop when a severely malnourished person is aggressively fed is called:

  1. shock.
  2. refeeding syndrome.
  3. translocation.
  4. systemic inflammatory response syndrome.


449 55.                  Long-term TPN may result in complications such as:

  1. gallbladder disease.
  2. heart disease.


450-451                 56.  All of the following are criteria for the selection of candidates for home parenteral and enteral nutrition except:

  1. the cleanliness of the home environment.
  2. the patient’s financial resources.
  3. the ability of the patient or caregiver to learn the necessary procedures.
  4. the patient’s expected lifespan.


Case Study Questions


Use the following case study to answer questions 57-62.

Mr. Avery is a 77-year-old retired engineer. He is 5’10” tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.


434 57.                  Which form of nutrition support is appropriate for Mr. Avery at this time?

  1. total parenteral nutrition
  2. tube feeding
  3. oral enteral supplement
  4. peripheral parenteral nutrition


434-435                 58.  Mr. Avery’s physician is hopeful that his swallowing ability will improve in the coming weeks. Which feeding route would be most appropriate for Mr. Avery at this time?

  1. orogastric
  2. nasojejunal
  3. nasogastric
  4. parenteral


431, 432                59.  In the absence of any pre-existing medical problems or problems with digestion and absorption, the type of enteral formula that would be most appropriate for Mr. Avery is a(n):

  1. standard formula.
  2. elemental formula.
  3. specialized formula.
  4. 3-in-1 solution.


438-439                 60.  Mr. Avery’s feeding is being delivered continuously by an infusion pump. The advantage of a continuous feeding is:

  1. an accurate and steady flow rate.
  2. less expense.
  3. more freedom of movement for the patient.
  4. less risk of diarrhea.


439 61.                  After two weeks, Mr. Avery is moved to a rehab facility. It would be appropriate at this time to change his feeding method to:

  1. total parenteral nutrition.
  2. an intermittent feeding.
  3. an oral supplement.
  4. peripheral parenteral nutrition.


441 62.                  Mr. Avery’s swallowing ability and oral intake are improving. He is now consuming about 2/3 of his estimated nutrient needs from oral intake. It would be appropriate at this time to:

  1. discontinue the tube feeding.
  2. increase the rate of the tube feeding.
  3. decrease the rate of the parenteral feeding.
  4. discontinue the parenteral feeding.


Nutrition in Practice – Inborn Errors of Metabolism


456 63.                  An inborn error of metabolism results in the absence, deficiency, or malfunction of a:

  1. carbohydrate.
  2. lipid.
  3. protein.
  4. fat.


456 64.                  Currently, the primary treatment for many inborn errors that involve nutrient metabolism is:

  1. medical nutrition therapy.
  2. gene therapy.
  3. the use of dietary supplements.
  4. genetic counseling.


458 65.  Lifelong adherence to dietary restrictions is recommended for individuals with PKU in order to protect their:

  1. lung function.
  2. brain function.
  3. muscle function.
  4. kidney function.


457 66.                  Dietary treatment of PKU includes:

  1. restriction of phenylalanine.
  2. avoidance of simple sugars.
  3. restriction of galactose.
  4. avoidance of milk and dairy foods.


459 67.  Dietary treatment of galactosemia depends primarily on the elimination of:

  1. chicken and fish.
  2. milk and milk products.
  3. fruits and vegetables.
  4. cereals and pasta.


459 68.  Infants diagnosed with galactosemia are given formulas that do not contain:

  1. iron.
  2. lactose.
  3. tyrosine.
  4. soy.


Nursing Exam Review Questions


430, 433                69.  The nurse recognizes all of the following as advantages of enteral nutrition over parenteral nutrition except:

  1. better maintenance of normal gut function.
  2. fewer complications.
  3. greater acceptance by patients, psychologically and physically.
  4. lower cost.


431 70.                  The nurse understands that a characteristic of a hydrolyzed enteral formula is that it:

  1. contains only one nutrient source.
  2. contains lactose.
  3. contains partially or fully broken down nutrients.
  4. contains intact proteins.


432 71.                  The nurse understands that infusing medications along with an enteral formula increases the osmolality of the tube feeding and may cause a patient to experience:

  1. diarrhea.
  2. elevated blood glucose levels.
  3. high blood pressure.
  4. constipation.


433 72.                  The nurse is working with a patient who is orally consuming an enteral formula, but is having problems accepting it. The nurse realizes that she should:

  1. insist the patient not change formulas for at least 3 days.
  2. serve the formula to the patient in a can which is very cold.
  3. allow the patient to stop drinking the formula.
  4. get the patient different flavors of the formula to try.


433-434                 73.  The nurse is working with a bed-ridden patient who is under severe stress, is malnourished, and is not expected to be able to eat within 7-10 days. This patient should receive:

  1. an oral diet.
  2. a tube feeding.
  3. a simple IV solution.
  4. a liquid dietary supplement.


434 74.                  Mrs. Grant is in a coma following a motor vehicle accident. The nurse recognizes that the most appropriate way to feed her is:

  1. TPN.
  2. PPN.
  3. a tube feeding.
  4. an enteral supplement.


435 75.                  The nurse in the neonatal intensive care unit understands that the preferred feeding tube placement for an infant is orogastic because:

  1. it allows the infant to learn the suck-swallow reflex.
  2. it provides the infant with a more direct route for feeding.
  3. it allows the infant to breathe more normally during feeding.
  4. it decreases the chance of overfeeding the infant.


435 76.                  The nurse understands that a gastric feeding is preferred when possible because:

  1. the stomach controls the rate at which nutrients enter the intestine.
  2. there is less risk of aspiration.
  3. it is more cost efficient than intestinal feedings.
  4. it enhances nutrient absorption.


436 77.                  If a patient requires a tube feeding and gastric decompression, the nurse understands that the appropriate feeding tube is:

  1. a 12 French tube.
  2. a double-lumen tube.
  3. an 8 French tube.
  4. a single-lumen tube.


431 78.                  Mr. Frank has a functioning GI tract, but minimal digestive and absorptive capacity. The nurse suggests that this patient receive a(n) _____ formula.

  1. modular
  2. elemental
  3. parenteral
  4. standard


435-436                 79.  The nurse recognizes which of the following as one of the possible preventive and/or corrective measures for aspiration pneumonia in tube-fed patients?

  1. Use nasoenteric feedings.
  2. Use a large-diameter transnasal tube.
  3. Use an intermittent method of delivery.
  4. Dilute the formula with water.


433 80.  Mr. White is feeling anxious about being on a tube feeding. The nurse can help alleviate his fears by all of the following except:

  1. allowing him to see and touch the feeding tube.
  2. allowing him to taste the enteral product.
  3. explaining how the tube feeding will work.
  4. assuring him that he can still swallow foods and beverages with the tube in place.


440 81.                  A tube-fed patient requires 2175 mL of water to meet his fluid needs. The tube feeding provides 1995 mL of water per day. How many 60 mL flushes with water will the nurse need to deliver to meet the patient’s fluid needs?

  1. 2
  2. 3
  3. 4
  4. 5


444 82.                  The nurse realizes that the intravenous feeding method selected for a patient is based partly on the patient’s:

  1. insurance company.
  2. ability to pay.
  3. anticipated length of time on IV nutrition support.
  4. psychological status.


443-444 83.                  Mr. Johnson is severely malnourished, is at high risk for aspiration, and may need nutrition support for several weeks. The nurse recognizes that Mr. Johnson should be placed on:

  1. conventional foods plus liquid supplements.
  2. a simple IV solution.
  3. peripheral parenteral nutrition.
  4. total parenteral nutrition by central vein.


446 84.                  A patient is receiving intravenous lipid emulsions on a daily basis. The nurse recognizes that these emulsions serve primarily as a source of:

  1. essential fatty acids.
  2. short-chain peptides.
  3. branched-chain amino acids.
  4. concentrated energy.


447 85.                  A patient is receiving 1500 milliliters of 50 percent dextrose and 1500 milliliters of 7 percent amino acid solution. The nurse recognizes that the total kcalories provided equal:

  1. 2850.
  2. 2970.
  3. 3120.
  4. 3215.


447 86.                  A TPN solution provides 750 mL of a 10% amino acid solution. The nurse calculates that the patient is receiving _____ grams of protein.

  1. 7.5
  2. 75
  3. 255
  4. 300


447 87.                  A TPN solution contains 1000 mL of 50% dextrose. The nurse calculates that this solution provides _____ kcalories from carbohydrate.

  1. 500
  2. 1700
  3. 1500
  4. 2200


448-449                 88.  Mr. Baxter’s medical problem that caused the need for IV nutrition has resolved. The nurse recognizes that Mr. Baxter requires a gradual transition from an IV feeding to an oral diet to prevent:

  1. GI problems.
  2. hypoglycemia.
  3. apprehension.
  4. respiratory acidosis.


446 89.  Mrs. Winslow is receiving TPN. Today’s lab work shows that her triglyceride level is 500 mg/dL. The nurse recognizes that:

  1. the TPN should be stopped immediately.
  2. the dextrose concentration of the TPN solution should be decreased.
  3. the rate of the TPN should be decreased.
  4. the infusion of lipids should be reduced or stopped.


449 90.  A severely malnourished patient on TPN has altered electrolyte levels, hyperglycemia, and fluid retention. The nurse recognizes that the patient may be experiencing:

  1. aspiration.
  2. gallbladder disease.
  3. fatty liver.
  4. refeeding syndrome.




a.     the delivery of formulated nutrients by feeding tube or intravenous infusion.

b.     the provision of nutrients using the GI tract, including the use of tube feedings and oral diets.

c.     general-purpose enteral formulas that contain mostly intact proteins and polysaccharides.

d.     enteral formulas that are made by blenderizing whole foods.

e.     enteral formulas that contain macronutrients that have been partially or fully hydrolyzed.

f.     triglycerides that contain fatty acids that are 8 to 10 carbons in length, do not require digestion, and can be absorbed in the absence of lipase or bile.

g.     enteral formulas designed to meet the nutrient needs of patients with specific illnesses.

h.     enteral formulas that contain only one or two macronutrients; used to enhance other formulas.

i.      a formula with an osmolality similar to that of blood serum (300 mOsm/kg).

j.      a formula with an osmolality greater than that of blood serum.

k.     the osmotic property of a solution, based on its concentrations of molecules and ionic particles.



a.     treatment for inherited disorders in which DNA sequences are introduced into the chromosomes of affected cells, prompting the cells to express the protein needed to correct the disease.

b.     an inherited bleeding disorder characterized by deficiency or malfunction of a plasma protein needed for blood clotting.

c.     compounds produced by a biochemical pathway.

d.     an inherited trait that causes the absence, deficiency, or malfunction of a protein that has a critical metabolic role.

e.     an inheritable alteration in the DNA sequence of a gene.


a.     the intravenous provision of nutrients that bypasses the GI tract.

b.     small-diameter veins that carry blood from the arms and legs.

c.     large-diameter veins located close to the heart.

d.     a type of nutrition support in which intravenous feedings are delivered into a peripheral vein.

e.     a type of nutrition support in which intravenous feedings are delivered into a central vein.

f.     a thin tube placed within a narrow lumen (such as a blood vessel) or body cavity; can be used to infuse or withdraw fluids or to keep a passage open.

g.     the concentration of osmotically active particles in a solution, expressed as milliosmoles per liter (mOsm/L).

h.     a parenteral solution that contains dextrose, amino acids, and lipids.

i.      a parenteral solution that contains dextrose and amino acids but excludes lipids.





431                 1.     Differentiate between the characteristics and uses of standard formulas and hydrolyzed formulas.


431-432         2.     Why are formulas that approximate the osmolality of blood serum preferred over hypertonic formulas?


432-433         3.     Identify and discuss the major factors that influence the selection of an enteral formula.


436-440         4.     Describe the proper administration of tube feedings.


440-441         5.     Describe the procedures to be followed when administering medications to patients with feeding tubes.


444                 6.     Describe characteristics of patients who are candidates for peripheral parenteral nutrition.


443                 7.     Identify specific conditions that necessitate the use of TPN.


447-448         8.     Describe the current procedure for administering a TPN feeding.


448-449         9.     Describe the ways in which transition from IV feeding to an enteral diet can be accomplished.


449                 10.  What is refeeding syndrome, and how can it be prevented?


449-450         11.  Name and discuss five metabolic complications that may result from parenteral feedings.


449-450         12.  Why are the risks associated with IV nutrition more serious than those associated with enteral nutrition?



Case Study Essay Questions


Jennifer Johnson is a 53-year-old woman with a history of Crohn’s disease and type 2 diabetes. She had surgery two days ago to remove a portion of her small intestine. Her gastrointestinal tract will not be accessible for 10 to 14 days. She is slightly underweight and moderately malnourished due to her ongoing problems with Crohn’s disease.


  1. What type of nutrition support is appropriate for Ms. Johnson at this time? Why?
  2. Carbohydrates will provide approximately 50% of Ms. Johnson’s kcalories. What form of carbohydrate will be used and how is the caloric content different from that of glucose?
  3. The nutrition support prescribed for Ms. Johnson provides 30% of kcalories from lipids. Why do you think the higher end of the recommended range for lipids was prescribed?
  4. What are the potential metabolic complications with her nutrition support regimen, and which one likely poses the greatest risk for Ms. Johnson at this time? What step can be taken to prevent it?
  5. After 10 days, Ms. Johnson’s physician decides to taper her nutrition support and advance her to an oral diet. Describe the process.




Chapter 17 – Foods and Food Consistency for Upper GI Disorders


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




461 1.                     It is possible to meet all nutrient needs using a mechanically altered diet.


462 2.                     A full-liquid diet is sometimes used as a transitional diet between the clear liquid diet and diets that contain solid foods.


462 3.                     Many foods on a full-liquid diet contain lactose.


468, 471                4.     NSAID use may promote gastritis and peptic ulcer disease by damaging the mucosal lining.


463 5.                     Xerostomia is a side effect of many medications and can make chewing and swallowing more difficult.


464 6.                     Oropharyngeal dysphagia is common in elderly persons and frequently follows a stroke.


470-471                 7.     In the dietary treatment of gastritis, irritating foods and beverages should be eliminated regardless of whether the patient is experiencing symptoms.


473 8.                     Sweets and sugars increase osmolarity in the small intestine and contribute to dumping syndrome.


476 9.                     Bariatric surgery is currently considered the most effective treatment for someone with a BMI between 35 and 40 and no weight-related medical problems.


476 10.                  Clinical studies indicate that the gastric bypass surgery generally results in greater weight loss than the gastric banding procedure.


Multiple Choice


461 1.     Diets containing foods that are modified in texture or consistency are prescribed to treat disorders or conditions that primarily affect the:

  1. musculoskelatal system.
  2. upper gastrointestinal tract.
  3. urinary tract.
  4. lower gastrointestinal tract.


461 2.                     Mechanically altered diets are usually ordered for the patient who has:

  1. an inflamed intestine.
  2. diarrhea.
  3. chewing or swallowing problems.
  4. heartburn.


461 3.     Moist, soft-textured foods that easily form a bolus are included in a _____ diet.

  1. pureed
  2. mechanical soft
  3. full liquid
  4. blenderized


461-462                 4.     Among the following, the one criteria that does not determine whether a food is allowed on a clear-liquid diet is:

  1. its transparency.
  2. the amount of digestion required.
  3. its nutrient density.
  4. the amount of residue left in the colon.


462 5.                     Which of the following foods would be allowed on clear-liquid diet?

  1. chicken broth
  2. hot chocolate
  3. sherbet
  4. milkshake


462 6.     Which of the following foods would not be allowed on a full-liquid diet?

  1. pudding
  2. ice cream
  3. cream of wheat
  4. angel food cake


462 7.                     A patient requiring a clear liquid diet for more than two days:

  1. should remain on a clear liquid diet.
  2. should be given added fat.
  3. should be supplemented with a commercially prepared low-residue formula.
  4. should be progressed to the full liquid diet.


463 8.                     Dry mouth can result in all of the following except:

  1. bad breath.
  2. reduced food intake.
  3. dental disease.
  4. achalasia.


464 9.                     Oropharyngeal dysphagia may be characterized by all of the following except:

  1. inability to initiate swallowing.
  2. aspiration.
  3. impaired peristalsis.
  4. hoarse voice.


464 10.                  People with _____ often complain of food “sticking” in the esophagus.

  1. esophageal dysphagia
  2. oropharyngeal dysphagia
  3. dyspepsia
  4. gastritis


463 11.  All of the following are appropriate for a patient suffering from mouth dryness except:

  1. sauces.
  2. potato chips.
  3. gravies.
  4. sugarless gum.


464 12.  Dysphagia can be caused by all of the following except:

  1. Parkinson’s disease.
  2. diabetes.
  3. esophageal cancer.
  4. stroke.


464 13.                  Repeated bouts of pneumonia may be associated with:

  1. dysphagia.
  2. irritable bowel syndrome.
  3. peptic ulcers.
  4. diverticular disease.


464-465                 14.  All of the following foods may be indicated for individuals with dysphagia except:

  1. cream of wheat.
  2. scrambled eggs.
  3. brownies with nuts.
  4. pureed chicken.


465-466                 15.  To improve a patient’s acceptance of pureed foods you would:

  1. make them watery and thin.
  2. use brightly colored foods.
  3. avoid the use of spices and seasonings.
  4. avoid pureeing a patient’s favorite foods.


465 16.                  Which of the following foods would not be appropriate on a Level 1 diet for dysphagia?

  1. pudding
  2. yogurt with fruit
  3. baby cereal
  4. pureed sweet potatoes


466 17.                  A condition in which a portion of the stomach protrudes above the diaphragm is:

  1. hiatal hernia.
  2. Barrett’s esophagus.
  3. gastritis.
  4. gastric ulcer.


466 18.                  Most often, GERD develops as a consequence of:

  1. aging.
  2. drugs.
  3. feeding tubes.
  4. pregnancy.


468 19.  The most effective medications for suppressing gastric acid secretion are:

  1. antibiotics.
  2. proton-pump inhibitors.
  3. antacids.
  4. NSAIDs.


468 20.                  Dietary advice that may help treat GERD includes:

  1. avoiding alcohol.
  2. avoiding gas-forming foods.
  3. eating large servings.
  4. sucking on a peppermint after a meal.


468 21.                  Patients with reflux esophagitis should be instructed to:

  1. eat small meals.
  2. drink liquids with meals.
  3. lie down after eating.
  4. consume caffeine-containing foods and beverages.


469 22.  General discomfort in the upper abdominal area with complaints of stomach pain, gnawing sensations, early satiety, nausea, vomiting, and bloating is descriptive of:

  1. peptic ulcer disease.
  2. dyspepsia.
  3. hiatal hernia.
  4. Sjögren’s syndrome.


469-470                 23.  Foods often associated with dyspepsia include all of the following except:

  1. raw foods.
  2. coffee.
  3. spicy foods.
  4. high-fat foods.


470 24.                  Nutrition interventions to ease the symptoms of nausea include:

  1. eating dry, starchy foods.
  2. drinking warm beverages.
  3. adding fat to foods.
  4. eating raw vegetables.


470 25.                  To alleviate nausea you would tell a patient to:

  1. limit highly spiced foods.
  2. drink liquids with meals.
  3. consume hot meals.
  4. eat as quickly as possible.


470 26.                  One of the most common causes of acute gastritis is:

  1. food allergies.
  2. viral infections.
  3. repeated use of NSAIDS.
  4. radiation therapy.


470 27.                  Hypochlorhydria may result from:

  1. gastritis.
  2. peptic ulcer disease.
  3. dyspepsia.
  4. bariatric surgery.


470, 471                28.  A major factor in the development of both gastritis and peptic ulcer disease is:

  1. infection with H. pylori.
  2. stress.
  3. overeating.
  4. cigarette smoking.


471 29.                  _____ occurs in up to 15% of cases of peptic ulcer disease.

  1. Pain
  2. Dysphagia
  3. Gastrointestinal bleeding
  4. Reflux esophagitis


472 30.                  Which of the following plays the primary role in treatment of ulcers?

  1. surgery
  2. relaxation therapy
  3. drug therapy
  4. diet


472 31.                  Nutrition intervention for peptic ulcer disease includes advising the patient to do all of the following except:

  1. avoid foods that increase acid secretion.
  2. avoid large meals.
  3. avoid eating right before bedtime.
  4. avoid gas-forming foods.


473 32.                  Dietary adjustments after a gastrectomy are influenced by:

  1. the size of the remaining stomach.
  2. the resulting slower gastric emptying.
  3. the type of surgical procedure performed.
  4. the patient’s food preferences.


473 33.  Postgastrectomy diets limit the amounts of:

  1. fat.
  2. sugar.
  3. protein.
  4. complex carbohydrate.


473 34.                  To help delay stomach emptying and reduce diarrhea following a gastrectomy, foods high in _____ may be useful.

  1. fat
  2. insoluble fiber
  3. protein
  4. soluble fiber


473 35.                  Liquids are restricted following a gastrectomy because they:

  1. can speed up the emptying rate of the stomach.
  2. slow down the emptying rate of the stomach.
  3. add unwanted kcalories.
  4. are likely to cause aspiration.


474 36.                  Appropriate foods for a postgastrectomy diet include:

  1. lean, tender meats.
  2. fruit punch.
  3. milk shakes.
  4. frosted flakes.


473-474                 37.  The symptoms of dumping syndrome include all of the following except:

  1. diarrhea.
  2. lightheadedness.
  3. difficulty breathing.
  4. rapid heartbeat.


474 38.                  To minimize or prevent dumping syndrome, you would tell a patient to:

  1. limit the amount of fluid consumed with a meal.
  2. drink a cold beverage with each meal.
  3. avoid fiber-rich foods.
  4. avoid lying down after eating.


474-475                 39.  Frequent complications of gastric surgery include all of the following except:

  1. bone disease.
  2. weight loss.
  3. protein malabsorption.
  4. iron-deficiency anemia.


476 40.  Following bariatric surgery, the gastric pouch will eventually stretch to hold about _____ of food.

  1. 1/3 cup
  2. ½ cup
  3. 1 cup
  4. 1 ½ cups


477 41.  The protein recommendation for bariatric surgery patients is:

  1. 0.8 g/kg to 1.0 g/kg per day.
  2. 1.0 g/kg to 1.5 g/kg per day.
  3. 1.2 g/kg to 1.8 g/kg per day.
  4. 1.5 g/kg to 2.0 g/kg per day.


477-478                 42.  Rapid weight loss following bariatric surgery increases the risk of developing:

  1. gallbladder disease.
  2. hypertension.
  3. type 2 diabetes.
  4. Sjögren’s syndrome.


476-477                 43.  The diet progression following bariatric surgery is:

  1. liquid, pureed, soft, regular.
  2. liquid, mechanical soft, low-fat, regular.
  3. pureed, chopped, regular.
  4. pureed, chopped, soft, regular.


477 44.  All of the following foods can be problematic following bariatric surgery except:

  1. pasta.
  2. grapes.
  3. asparagus.
  4. crackers.


477 45.                  Suggestions for achieving and maintaining weight loss following bariatric surgery include all of the following except:

  1. Eat only during designated mealtimes.
  2. Engage in regular physical activity.
  3. Drink plenty of water and other beverages to suppress appetite.
  4. Eat slowly and chew food thoroughly.


477 46.                  To avoid dehydration, the patient who has undergone bariatric surgery should:

  1. sip water and other noncaloric beverages throughout the day.
  2. drink plenty of fluids with meals.
  3. increase intake of foods with high water content.
  4. drink sports drinks.


Case Study Questions


Use the following case study to answer questions 47-52.

Jennie Wilson is a 42-year-old administrative assistant who recently underwent gastric bypass surgery to treat her obesity and weight-related problems of diabetes and hypertension.


476 47.  Ms. Wilson’s stomach capacity immediately following surgery will be:

  1. a few teaspoons.
  2. a few tablespoons.
  3. ½ cup.
  4. ¾ cup.

476 48.  On the day following surgery, Ms. Wilson will be allowed to consume all of the following except:

  1. sugar-free iced tea.
  2. low-fat broth.
  3. water.
  4. skim milk.


Ms. Wilson will need nutrition education before being discharged from the hospital.


477 49.                  Once she is able to tolerate regular foods, what type of foods should Ms. Wilson be encouraged to eat before consuming other foods in a meal?

  1. complex carbohydrates
  2. high-protein foods
  3. low-fat foods
  4. high-fat foods


477 50.                  Which of the following foods should Ms. Wilson be advised to avoid to prevent possible obstruction of the gastric outlet?

  1. bananas
  2. celery
  3. fish
  4. mashed potatoes


477 51.                  In order to achieve and maintain weight loss after surgery, Ms. Wilson should be encouraged to:

  1. avoid drinking high-calorie beverages.
  2. eat at least one cup of food at each meal.
  3. limit her physical activity.
  4. snack between meals to avoid feelings of hunger.


477 52.                  Due to reduced food intake and nutrient malabsorption, Ms. Wilson will likely require supplements of:

  1. vitamin B12, iron, and calcium.
  2. zinc, magnesium, and iron.
  3. vitamin B6, folate, and niacin.
  4. calcium, iron, and vitamin D.


Nutrition in Practice – Nutrition and Oral Health


481 53.                  Dental caries are caused by:

  1. bacteria that produce acids that attack tooth enamel.
  2. excessive fluoride intake that attacks tooth enamel.
  3. high-fiber foods that cause carbohydrate to stick to teeth.
  4. excessive consumption of sugar that eats into teeth.


481 54.                  Which of the following factors is not involved in tooth decay?

  1. the type of carbohydrate consumed
  2. the frequency of carbohydrate intake
  3. the stickiness of foods consumed
  4. the fat content of foods consumed


481-482                 55.  Which of the following foods would be most likely to contribute to dental caries?

  1. raw carrots
  2. milk
  3. dried fruits
  4. cheese

482 56.                  Which of the following foods stimulates saliva flow and does not contribute to acid formation in the mouth?

  1. beef
  2. legumes
  3. orange juice
  4. cheese


482 57.                  All of the following are risk factors for developing periodontal disease except:

  1. dental plaque.
  2. smoking.
  3. diabetes.
  4. atherosclerosis.


483 58.                  Current research suggests that periodontal disease may increase the risk of developing:

  1. heart disease.
  2. renal failure.
  3. arthritis.
  4. dermatitis.


Nursing Exam Review Questions


463 59.  The nurse is reviewing a patient’s chart and notices that the patient has a history of Sjögren’s syndrome. The nurse recognizes that the patient may have nutritional problems due to:

  1. low blood sugar.
  2. dry mouth.
  3. impaired digestion.
  4. malabsorption.


464 60.                  The nurse is working with a patient who recently suffered from a stroke. The patient complains of painful swallowing, nasal regurgitation during swallowing, and coughing during meals. The nurse recognizes these as symptoms of:

  1. dysphagia.
  2. gastritis.
  3. reflux esophagitis.
  4. hiatal hernia.


464 61.  The nurse recognizes that finding the best diet for a patient with dysphagia is often challenging, and the most appropriate foods are:

  1. dry foods like crackers.
  2. sticky foods like peanut butter.
  3. foods with mixed textures like casseroles.
  4. soft, cohesive foods like mashed potatoes.


468 62.                  The nurse understands that a patient with GERD will benefit from education on managing the disease. All of the following suggestions would be included in the education except:

  1. Avoid eating at bedtime.
  2. Limit chocolate, high-fat foods, coffee, and tea.
  3. Consume liquids with meals.
  4. Avoid alcohol.


470 63.                  Mr. Green uses NSAIDs regularly to control chronic pain and complains of frequent stomach pain. The nurse recognizes this as gastritis and realizes that he may be at risk for deficiencies of:

  1. calcium and phosphorous.
  2. iron and vitamin B12.
  3. sodium and potassium.
  4. vitamins C and E.


472 64.                  The nurse recognizes that a patient with peptic ulcer disease should avoid foods that may irritate the gastrointestinal lining, such as:

  1. alcohol, coffee, and spicy foods.
  2. eggs, ribs, and cheese.
  3. tea, orange juice, and potato chips.
  4. apples, broccoli, and sweet potatoes.


473 65.                  What should the nurse include in the care plan to address the nutritional needs of a patient who has undergone a partial gastrectomy?

  1. several small meals and snacks
  2. low-fiber diet
  3. low-fat diet
  4. high-kcalorie diet with snacks between meals


473 66.                  The nurse is reinforcing the dietitian’s instructions for a postgastrectomy diet. The nurse realizes the client understands his diet when he states that he should:

  1. emphasize grains, fruits, and vegetables in his diet.
  2. limit the amount of sweets like colas, honey, and jam.
  3. eliminate meats, eggs, and milk.
  4. exclude decaffeinated coffee, tea, and artificially sweetened drinks.


473 67.                  Following gastric resection, the nurse understands the need to limit _____ in the patient’s diet.

  1. fiber
  2. meat
  3. vegetables
  4. sugar


473-474 68.                  A patient experiences nausea, vomiting, abdominal cramping, diarrhea, and lightheadedness after meals following gastric bypass surgery. The nurse recognizes these as symptoms of:

  1. malabsorption.
  2. high blood sugar.
  3. Sjögren’s syndrome.
  4. dumping syndrome.


476 69.  Following bariatric surgery, the nurse understands that the capacity of the stomach is:

  1. a few teaspoons.
  2. a few tablespoons.
  3. about 2/3 cup.
  4. about 1 cup.


477 70.                  The nurse is working with a patient who had bariatric surgery four months ago. The nurse should tell this patient to:

  1. consume only liquids.
  2. eat whatever she wants.
  3. take megadoses of vitamins and minerals.
  4. consume only small amounts of food at a time.

477 71.                  The nurse understands that the educational needs of a patient following bariatric surgery include:

  1. recognizing sensations that occur when the gastric pouch is full.
  2. eating often throughout the day.
  3. drinking adequate fluids with meals.
  4. supplementing meals with milkshakes.




a.     dry mouth caused by reduced salivary flow.

b.     an autoimmune disease characterized by the destruction of secretory glands, resulting in dry mouth and dry eyes.

c.     an inability to transfer food from the mouth and pharynx to the esophagus; usually caused by a neurological or muscular disorder.

d.     an inability to move food through the esophagus; usually caused by an obstruction or a motility disorder.

e.     abnormal narrowing of a passageway due to inflammation, scarring, or a congenital abnormality.

f.     an esophageal disorder characterized by weakened peristalsis and impaired relaxation of the lower esophageal sphincter.

g.     a condition in which the upper portion of the stomach protrudes above the diaphragm.

h.     inflammation in the esophagus related to the reflux of acidic stomach contents.

i.      a condition in which esophageal cells damaged by chronic exposure to stomach acid are replaced by cells that resemble those in the stomach or small intestine, sometimes becoming cancerous.


a.     a film of bacteria and bacterial by-products that accumulates on the tooth surface.

b.     conducive to development of dental caries.

c.     inflammation of the gums; characterized by redness, swelling, and bleeding.

d.     mineralized dental plaque, often associated with inflammation and bleeding.

e.     inflammation or degeneration of the tissues that support the teeth.



a.     the surgical removal of part of the stomach (partial) or the entire stomach (total).

b.     a feeling of pain, bloating, or discomfort in the upper abdominal area.

c.     inflammation of stomach tissue.

d.     a class of drugs that inhibit the enzyme that pumps hydrogen ions into the stomach.

e.     an absence of gastric acid secretions.

f.     symptoms that result from the rapid emptying of an osmotic load from the stomach into the small intestine.

g.     surgery that treats severe obesity.

h.     a class of drugs that suppress acid secretion by inhibiting receptors on acid-producing cells.




461-462         1.     Differentiate between clear-liquid and full-liquid diets.


464-466         2.     Define dysphagia and explain the dietary treatment for this disorder.


468                 3.     What dietary advice would you give someone who is experiencing GERD?


470                 4.     Discuss the complications of gastritis.


473-474         5.     Describe the typical scenario that accompanies dumping syndrome.


474-475         6.     Why does fat malabsorption occur in patients who have undergone gastric surgery that bypasses the duodenum?


476-478         7.     Describe the nutritional concerns for a patient following bariatric surgery.



Case Study Essay Questions


College Student with Peptic Ulcer Disease: Kelly Burgess is a 23-year-old full-time college student who is 5 feet 5 inches tall and weighs 110 pounds. She is the mother of a 1-year-old son, and she works nights and weekends as a waitress. Kelly recently went to her physician complaining of sporadic burning pain in her stomach when she eats. She reports a loss of appetite as well as a ten-pound weight loss in the last two months. Kelly’s doctor diagnoses peptic ulcer disease.


  1. What type of ulcer does Kelly likely have? Why? Is this the most common type of ulcer?
  2. Explain to Kelly how emotional stress can contribute to peptic ulcer disease.
  3. What is the most common cause of peptic ulcer disease?
  4. Explain the goals of ulcer treatment.
  5. What types of medications might Kelly’s doctor prescribe and why?
  6. What foods would you recommend that Kelly avoid?





Chapter 18 – Fiber-Modified Diets
for Lower Gastrointestinal Tract Disorders


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




485 1.                     The DRI for fiber for an adult male is 38 grams per day.


485 2.                     Flatulence can be an unpleasant side effect of consuming a high-fiber diet.


486 3.                     Constipation is diagnosed when a person does not have a daily bowel movement.


490 4.                     Diverticulitis and ulcerative colitis are the two most prevalent inflammatory bowel diseases.


493 5.                     Diverticulitis is a relatively mild, non-life threatening condition.


486 6.                     A high-fiber diet increases stool weight and fecal water content.


T     A     486                 7.     Daily exercise can help treat constipation if it stimulates peristalsis.


487 8.                     Psyllium may be effective in the treatment of diarrhea by reducing the liquidity of the stool.


488 9.                     People with irritable bowel syndrome tend to have excessive colonic responses to meals, GI hormones, and stress.


493 10.                  The development of diverticulosis is influenced by the type of dietary protein one consumes.


494, 495                11.  A colostomy involves removal of the entire colon.


495 12.                  The patient with a colostomy or ileostomy should have a diet that is restricted in fluids.


Multiple Choice


485 1.                     All of the following are indications for modifying fiber intake except:

  1. constipation.
  2. irritable bowel syndrome.
  3. inflammatory bowel diseases.
  4. gallbladder disease.


486 2.                     Constipation may be caused by all of the following except:

  1. a low-fiber diet.
  2. physical inactivity.
  3. medications.
  4. a viral infection.


486 3.     Dietary suggestions for treating constipation are aimed at:

  1. decreasing dietary fiber and fluids.
  2. increasing dietary fiber and fluids.
  3. increasing dietary protein.
  4. increasing carbohydrate intake.


485 4.     Foods useful in increasing dietary fiber are:

  1. bran, milk, and mashed potatoes.
  2. peanut butter, oranges, and strawberry jam.
  3. saltine crackers, watermelon, and eggs.
  4. whole-wheat bread, black beans, and popcorn.


485 5.                     Charlie is trying to change his eating behaviors and start following a high-fiber diet. The best advice you can give Charlie is to:

  1. purchase a bulk-forming agent.
  2. gradually add high-fiber foods to his diet.
  3. avoid milk products that contain residue.
  4. limit his fluid intake.


487 6.     Which of the following bulk-forming agents may cause an allergic reaction?

  1. methylcellulose
  2. psyllium
  3. polycarbophil
  4. malt soup extract


487 7.                     Use of stimulant laxatives can lead to:

  1. fluid and electrolyte imbalances.
  2. anemia.
  3. increased appetite.
  4. hyperglycemia.


485 8.                     A side effect of consuming a high-fiber diet is:

  1. flatulence.
  2. ostomy.
  3. bacterial overgrowth.
  4. diverticulosis.


485 9.     Of the following beverages, which is least likely to increase intestinal gas?

  1. orange juice
  2. beer
  3. carbonated lemon-lime soda
  4. tea


485 10.                  Which of the following foods is most likely to increase intestinal gas?

  1. cabbage
  2. tomatoes
  3. green beans
  4. walnuts


485 11.  Billy consumed the following foods at lunch: A hamburger with lettuce, tomato, and catsup on a bun; potato salad; and a diet carbonated beverage. Later that afternoon Billy began to experience gas. Which of the following foods was most likely to be responsible for production of the gas?

  1. hamburger meat
  2. tomato
  3. potato salad
  4. diet carbonated beverage


487 12.                  Bacterial food poisoning causes:

  1. osmotic diarrhea.
  2. steatorrhea.
  3. secretory diarrhea.
  4. chronic diarrhea.


487 13.                  Diarrhea is often classified according to the cause of the fluid loss. Nutrient malabsorption causes:

  1. osmotic diarrhea.
  2. secretory diarrhea.
  3. intractable diarrhea.
  4. acute diarrhea.


487 14.                  Secretory diarrhea  may be caused by:

  1. bacterial food poisoning.
  2. lactose intolerance.
  3. irritable bowel syndrome.
  4. swallowed air.


487 15.                  Which of the following would be the first step in the treatment of someone with diarrhea?

  1. correct the underlying medical condition
  2. place the patient on NPO
  3. start parenteral nutrition
  4. start an oral rehydration solution


488 16.                  Which of the following would not be included in a homemade oral rehydration solution?

  1. table salt
  2. sugar
  3. baking soda
  4. cornstarch


488 17.                  Commercial sports drinks are not recommended for the treatment of severe diarrhea because they are too:

  1. expensive.
  2. high in sodium.
  3. low in sodium.
  4. low in potassium.


488 18.                  Which of the following foods may help to lessen diarrhea?

  1. applesauce
  2. pear juice
  3. milk
  4. sugar-free candies


488 19.                  Lily is experiencing a sudden bout of diarrhea. Which of the following may worsen her symptoms?

  1. adding salt to foods
  2. whole-wheat breads and cereals
  3. noodles and couscous
  4. bananas and peeled apples


488 20.                  The mother of a toddler is concerned about her child’s frequent episodes of diarrhea. The dietitian suggests that the mother reduce the child’s intake of:

  1. oatmeal.
  2. fruit juice.
  3. rice.
  4. yogurt.


490 21.                  Inflammation that may extend deeply into intestinal tissue and be accompanied by ulcerations, fissures, and fistulas is characteristic of _____.

  1. Crohn’s disease
  2. ulcerative colitis
  3. celiac disease
  4. irritable bowel syndrome


490 22.                  Which form of inflammatory bowel disease is characterized by “skip” lesions?

  1. Crohn’s disease
  2. ulcerative colitis
  3. irritable bowel syndrome
  4. diverticulosis


490-491 23.                  Mr. Taylor seeks medical treatment for frequent, urgent bowel movements streaked with mucus and blood, and tests reveal a large, continuous area of inflammation affecting the first two layers of tissue in his rectum. What is Mr. Taylor’s likely diagnosis?

  1. Crohn’s disease
  2. ulcerative colitis
  3. celiac disease
  4. irritable bowel syndrome


492 24.                  Anti-inflammatory drugs used to treat the symptoms of inflammatory bowel disease may contribute to:

  1. malabsorption.
  2. fluid and electrolyte imbalances.
  3. anemia.
  4. weight loss.


491 25.                  Aggressive dietary management of Crohn’s disease is required in children because this disorder can lead to all of the following except:

  1. growth failure.
  2. nutrient deficiencies.
  3. protein-energy malnutrition.
  4. impaired glucose tolerance.


491 26.                  During an  exacerbation of  inflammatory bowel disease, the patient should be placed on _____ to minimize stool output and reduce symptoms of malabsorption.

  1. a low-sodium diet
  2. a low-fat, low-fiber diet
  3. a low-protein diet
  4. parenteral nutrition


491-493                 27.  The dietary management for ulcerative colitis includes all of the following principles except:

  1. restoration of fluid and electrolyte balance.
  2. repletion of protein stores.
  3. a high-fiber diet to manage diarrhea.
  4. a low-fiber diet to reduce irritation in the colon.


488 28.                  An excessive colonic response to meals, GI hormones, and stress is characteristic of:

  1. celiac disease.
  2. ulcerative colitis.
  3. Crohn’s disease.
  4. irritable bowel syndrome.


488-489 29.                  Which of the following statements concerning irritable bowel syndrome is true?

  1. Symptoms often improve during periods of psychological stress.
  2. It is associated with alternating episodes of diarrhea and constipation.
  3. Herbal remedies are very effective at relieving the symptoms.
  4. The most common recommendation is to gradually decrease fiber intake.


489 30.                  The treatment for irritable bowel syndrome includes all of the following except:

  1. surgery.
  2. dietary adjustments.
  3. stress management.
  4. behavioral therapy.


489 31.                  The dietary adjustments frequently recommended for the person with irritable bowel syndrome include all of the following except:

  1. avoiding fried and fatty foods.
  2. avoiding alcohol.
  3. consuming small, frequent meals.
  4. consuming a high-protein diet.


489 32.                  Mary has been diagnosed with irritable bowel syndrome. Which of the following would the dietitian recommend?

  1. a high-fiber diet
  2. a low-fiber diet
  3. a liquid diet
  4. a low-salt diet


493 33.  Diverticular disease often occurs with:

  1. a bacterial infection.
  2. aging.
  3. constipation.
  4. food intolerances.


493 34.                  The incidence of diverticulosis may be reduced by recommending a diet:

  1. low in dietary fiber and residue.
  2. high in dietary fiber and fat.
  3. high in dietary fiber.
  4. high in dietary protein.


491 35.  Removal of a portion or all of the colon is referred to as a:

  1. colostomy.
  2. colectomy.
  3. ileostomy.
  4. gastrectomy.


485,493-94           36.  Low-fiber diets are used in the treatment of all of the following conditions except:

  1. diverticulosis.
  2. post-surgery.
  3. diverticulitis.
  4. inflammatory bowel diseases (active episodes).


495 37.                  The primary purpose of a low-fiber diet for ostomy patients is to:

  1. stimulate peristalsis.
  2. increase bulk in the colon.
  3. decrease stool output.
  4. decrease hydrochloric acid production.


495 38.                  All of the following foods may cause difficulty for ostomy patients except:

  1. bananas.
  2. corn.
  3. coconut.
  4. grapes.


495 39.                  The patient with a colostomy or ileostomy is usually concerned about foods that cause:

  1. gas and odor.
  2. weight gain.
  3. fluid retention.
  4. anemia.


495 40.                  To help control diarrhea, people with ostomies should consume:

  1. applesauce.
  2. caffeine.
  3. sugar-free candy.
  4. grapes.


Case Study Questions


Use the following case study to answer questions 41-46.

Noel is a 33-year-old kindergarten teacher who recently visited her doctor complaining of the sudden onset of diarrhea, abdominal pain, and bloody stools. Lab tests, imaging studies, and an endoscopy were used to diagnose Crohn’s disease. Drug therapy has helped to control the symptoms, but Noel has been told that there is no cure for the disease and she may experience exacerbations from time to time for the rest of her life.


490 41.  Noel’s Crohn’s disease has most likely resulted in inflammation of her:

  1. gallbladder.
  2. ileum and/or colon.
  3. duodenum and/or jejunum.
  4. pancreas.


491 42.                  If Noel’s Crohn’s disease worsens, it could place her at risk for malnutrition due to all of the following reasons except:

  1. reduced food intake.
  2. surgery that shortens the small intestine.
  3. malabsorption of nutrients.
  4. ulceration in the esophagus.


492 43.  Noel was prescribed a corticosteroid to help with the inflammation associated with Crohn’s disease. Which of the following side effects might she experience?

  1. diarrhea
  2. fluid retention
  3. dehydration
  4. loss of appetite


491 44.                  Noel requires aggressive dietary management of her disease because it can lead to:

  1. nutrient deficiencies and protein-energy malnutrition.
  2. problems with chronic constipation and laxative use.
  3. dehydration and electrolyte imbalances.
  4. a higher risk of pancreatic cancer.


491 45.                  During a flare-up of her disease, Noel should follow a ______ diet.

  1. high-fiber, high-fat
  2. low-sodium
  3. low-fiber, low-fat
  4. high-fat


492 46.                  One year after her diagnosis, Noel is hospitalized due to a severe exacerbation of her disease and requires a tube feeding. The best choice for an enteral formula is a/an:

  1. standard formula.
  2. elemental formula.
  3. disease-specific formula.
  4. modular formula.


Nutrition in Practice: Probiotics and Intestinal Health


499 47.                  Nonpathogenic bacteria in the intestinal tract perform all of the following functions except:

  1. degrade undigested or unabsorbed dietary carbohydrate.
  2. produce certain vitamins.
  3. prevent invasion of tissues by pathogenic bacteria.
  4. stimulate the production of proteins.


499 48.  Nondigestible substances in foods that stimulate the growth of nonpathogenic bacteria within the large intestine are called:

  1. probiotics.
  2. prebiotics.
  3. intestinal flora.
  4. pathogenic bacteria.


499 49.                  To be considered “probiotic,” bacteria must meet all of the following criteria except:

  1. they must be nonpathogenic when consumed.
  2. they must be able to survive transit through the digestive tract.
  3. they must be able to alter the intestinal environment in a beneficial way.
  4. they must produce gas as a by-product of their activity.


499 50.                  Which of the following foods will provide sufficient probiotic bacteria to influence the bacterial population in the large intestine?

  1. two servings of margarine
  2. one serving of yogurt
  3. two servings of cottage cheese
  4. one serving of honey


500 51.                  Much of the research investigating probiotics and intestinal illness has focused on the prevention and treatment of:

  1. irritable bowel syndrome.
  2. diverticular disease.
  3. infectious diarrhea.
  4. Crohn’s disease.


500 52.                  The possible benefits of probiotics include all of the following except:

  1. altering the susceptibility to food allergies.
  2. improving the immune response.
  3. relieving the symptoms of lactose intolerance.
  4. treating AIDS.


Nursing Exam Review Questions


486 53.                  Mrs. Burgess is a 67-year-old female who was recently diagnosed with depression and prescribed a tricyclic antidepressant drug. In addition, she is on medication for high blood pressure and takes a calcium supplement. She phones her physician’s office complaining of problems with constipation. The nurse suspects that the problems may be due to:

  1. depression.
  2. age.
  3. medications.
  4. high blood pressure.


486 54.                  Mr. Purcell is an elderly gentleman who complains of frequent constipation. To deal with this problem, the nurse tells Mr. Purcell to:

  1. drink plenty of fluids.
  2. decrease intake of high-fiber foods.
  3. drink more apple juice.
  4. avoid fried foods.


488 55.                  A patient is experiencing a mild case of diarrhea and phones the health clinic to find out how she should treat it. The nurse recommends that she consume all of the following except:

  1. yogurt.
  2. broth with crackers.
  3. applesauce.
  4. a regular carbonated beverage.


491-492                 56.  Sarah is a 21-year-old college student who has been diagnosed with Crohn’s disease. She is underweight and has a poor appetite. Realizing that Sarah is at nutritional risk, the nurse advises that Sarah:

  1. consume an enteral nutrition supplement two to three times a day.
  2. increase the fiber in her diet.
  3. increase her intake of milk to four cups a day.
  4. eat more high-fat foods.


488-489                 57.  Mr. Simpson complains of abdominal pain, distention, and flatulence. He frequently experiences chronic diarrhea but at times he also has constipation. He states that his symptoms usually occur shortly after he eats and often stop after defecation. The nurse correctly believes that Mr. Simpson suffers from:

  1. irritable bowel syndrome.
  2. an intestinal obstruction.
  3. diverticulitis.
  4. ileus.


489 58.                  A patient is newly diagnosed with irritable bowel syndrome and is concerned about preventing future flare-ups. The nurse advises the patient to:

  1. follow a low-fat diet.
  2. drink plenty of water.
  3. seek support for stress management.
  4. drink a glass of wine with dinner.


493 59.                  A patient is newly diagnosed with diverticulosis and voices concern about future complications. What is the nurse’s most appropriate response?

  1. “Follow a low-fiber diet.”
  2. “Follow a high-fiber diet.”
  3. “Avoid nuts, popcorn, and foods with seeds.”
  4. “Drink plenty of fluids.”


493 60.                  The nurse is instructing a patient with diverticular disease on appropriate foods to include in his diet in order to prevent progression of the disease. She will tell him to consume all of the following except:

  1. whole-grain breads.
  2. enriched pasta.
  3. legumes.
  4. fresh vegetables.


495 61.                  A patient with an ileostomy complains about excessive odor. What information would the nurse suspect as revealing a cause for this?

  1. The patient eats yogurt for breakfast every morning.
  2. The patient smokes.
  3. The patient eats eggs for breakfast every morning.
  4. The patient consumes cranberry juice regularly.





a.     the condition of having excessive intestinal gas, which causes abdominal discomfort.

b.     an inflammatory bowel disease that usually occurs in the lower portion of the small intestine and the colon. Inflammation may pervade the entire intestinal wall.

c.     an inflammatory bowel disease that involves the colon. Inflammation affects the mucosa and submucosa.

d.     an intestinal disorder of unknown cause that affects the functioning of the lower bowel. Symptoms include abdominal pain, flatulence, diarrhea, and constipation.

e.     a disorder characterized by the presence of small herniations in the intestinal wall, which often develop by middle age.

f.     an inflammation or infection that involves diverticula.





485                 1.     Briefly explain the benefits associated with a high-fiber diet. What advice would you give to a patient during the first few weeks on a high-fiber diet?


487-488         2.     Identify the possible causes of diarrhea and describe the appropriate treatment for both acute and chronic diarrhea.


493-494         3.     Differentiate between diverticulosis and diverticulitis and the appropriate dietary treatment for each.


495                 4.     Describe important components of nutrition management for people with ostomies.


Case Study Essay Questions


Mr. Fruge is 60 years old. After performing a routine colonoscopy, his gastroenterologist tells him everything is normal except that she noticed the presence of several diverticula in his colon. The physician suggestsed he speak with the clinic dietitian regarding dietary recommendations.


  1. What causes diverticula to develop?
  2. Differentiate between diverticulosis and diverticulitis.
  3. Why was Mr. Fruge unaware of his condition until now?
  4. What dietary recommendations should the dietitian discuss with Mr. Fruge?
  5. Mr. Fruge tells the dietitian that his mother had diverticulosis and he remembers that she was told to avoid nuts, seeds, and popcorn. How should the dietitian reply to this comment?
  6. Should Mr. Fruge develop diverticulitis in the future, how would the dietary recommendations change?




Chapter 19 – Carbohydrate- and Fat-Modified Diets
for Malabsorption Disorders


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




505 1.                     MCT oil does not require bile for digestion and absorption.


507 2.                     Many lactose-intolerant individuals can tolerate up to 2 cups of milk a day when intake is divided throughout the day and taken with food.


508 3.                     Most often, acute pancreatitis is caused by high blood triglycerides.


511 4.                     Celiac disease is characterized by an abnormal immune response to certain amino acids.


Multiple Choice


503, 514                1.     Vitamin B12 is absorbed through the:

  1. duodenum.
  2. stomach.
  3. ileum.
  4. colon.


503 2.                     Malabsorptive disorders and their treatments can cause all of the following problems except:

  1. altered food intake.
  2. increased nutrient needs.
  3. altered nutrient absorption.
  4. weight gain.


503 3.                     What laboratory test can help to diagnosis lactose intolerance?

  1. stool fat test
  2. Schilling test
  3. hydrogen breath test
  4. D-xylose test


503 4.     The Schilling test helps to diagnose malabsorption of:

  1. fat.
  2. vitamin B12.
  3. lactose.
  4. vitamin B6.


503 5.                     Severe liver disease can lead to fat malabsorption because:

  1. it reduces the availability of bile.
  2. it decreases the production of pancreatic lipase.
  3. it results in damage to the intestinal wall.
  4. it causes motility disorders.


503 6.                     Malabsorption of fat results in:

  1. steatorrhea.
  2. loss of amino acids.
  3. loss of water-soluble vitamins.
  4. weight gain.


504 7.                     Fat malabsorption is associated with all of the following except:

  1. weight loss.
  2. essential fatty acid deficiency.
  3. loss of sodium and potassium.
  4. increased risk of kidney stones.


504 8.     Malabsorption of certain minerals is common in persons with fat malabsorption. This can ultimately result in:

  1. fluid and electrolyte imbalances.
  2. increased risk of bone loss.
  3. loss of taste acuity.
  4. insulin resistance.


504 9.                     Two minerals commonly malabsorbed as a consequence of fat malabsorption are:

  1. iron and selenium.
  2. zinc and manganese.
  3. calcium and magnesium.
  4. phosphorous and calcium.


504 10.                  Mr. Kaufman has fat malabsorption and is at risk for developing oxalate stones. Which of the following foods should he avoid?

  1. green beans
  2. spinach
  3. potatoes
  4. milk


504 11.                  When fat is not absorbed, there may be an accompanying deficiency in:

  1. fat-soluble vitamins. 5.             sodium.
  2. water-soluble vitamins. 6.             magnesium.
  3. calcium. 7.             essential fatty acids.
  4. potassium. 8.             iron.
  5. 2, 4, 5, 8
  6. 1, 2, 6, 8
  7. 1, 3, 6, 7
  8. 3, 4, 5, 7


508 12.                  Forty to eighty percent of patients with long-term chronic pancreatitis will develop:

  1. diabetes.
  2. thickened pancreatic secretions.
  3. celiac disease.
  4. fluid and electrolyte imbalances.


506 13.                  Bacterial overgrowth in the stomach and small intestine can result in:

  1. a deficiency of fat-soluble vitamins.
  2. weight gain.
  3. vitamin B6 deficiency.
  4. abnormal glucose tolerance.


505, 506                14.  Which of the following are not allowed on a fat-controlled diet?

  1. angel food cake, fat-free milk, and pears
  2. cherry pie, chocolate milk, and spareribs
  3. marshmallows, fat-free yogurt, and green beans
  4. oranges, jelly beans, and noodles


506 15.                  For patients with fat malabsorption problems, fat is better tolerated if it is:

  1. provided in small portions.
  2. monounsaturated.
  3. limited to one meal per day.
  4. consumed as fried food.


506 16.                  Which of the following is not true of MCT oil?

  1. It is inexpensive.
  2. It should not be used to fry food.
  3. It should be added to the diet gradually.
  4. It may have an unpleasant taste.


506 17.                  Someone with malabsorption problems who is experiencing flatulence and diarrhea may benefit from avoiding:

  1. decaffeinated beverages.
  2. lightly seasoned foods.
  3. lactose-containing foods.
  4. low-fat foods.


507 18.                  Lactose intolerance is prevalent among all of the following ethnic groups except:

  1. Native Americans.
  2. Asians.
  3. Latinos.
  4. Caucasians.


507 19.                  People with lactose intolerance may tolerate all of the following except:

  1. chocolate milk.
  2. nonfat milk.
  3. aged cheese.
  4. yogurt with active bacterial cultures.


508 20.                  Pancreatitis may develop as a complication of all of the following except:

  1. gallstones.
  2. exposure to toxins.
  3. stress.
  4. alcohol abuse.


508 21.                  The primary goal of initial therapy for the patient with acute pancreatitis is:

  1. to reduce stimulation of the pancreas by withholding oral foods and fluids.
  2. to increase insulin production.
  3. stimulation of the pancreas to release protective enzymes.
  4. to reduce hydrochloric acid in the stomach.


508 22.                  The initial diet order for the patient with acute pancreatitis should be:

  1. clear liquids.
  2. a fat-controlled diet.
  3. nothing by mouth.
  4. a regular diet.


508 23.                  Nutrient deficiencies may occur with chronic pancreatitis due to:

  1. malabsorption and alcohol abuse.
  2. malabsorption of water-soluble vitamins.
  3. malabsorption of protein and abdominal pain.
  4. malabsorption of carbohydrate.


510 24.                  Evidence that a child with cystic fibrosis needs an increase in enzyme dosages might include any of the following except:

  1. poor growth.
  2. steatorrhea.
  3. abdominal pain.
  4. dysphagia.


510 25.                  Which of the following would you recommend for a patient with cystic fibrosis who experiences persistent steatorrhea, gas, and abdominal distention?

  1. an increase in pancreatic enzyme replacements
  2. a severely fat-restricted diet
  3. a hydrolyzed formula
  4. liberal use of table salt


506 26.                  Which of the following conditions is not a potential cause of bacterial overgrowth?

  1. atrophic gastritis
  2. use of acid-suppressing medications
  3. lactose intolerance
  4. certain gastrectomy procedures


509-510                 27.  Nutritional therapy for cystic fibrosis involves all of the following except:

  1. liberal use of table salt.
  2. multivitamin supplements.
  3. pancreatic enzyme replacement therapy.
  4. a low-protein diet.


511 28.                  Patients with celiac disease must avoid foods that contain:

  1. iron.
  2. protein.
  3. gluten.
  4. sugar.


511 29.                  Celiac disease affects intestinal tissue and results in:

  1. a significant reduction in mucosal surface area.
  2. ulceration, irritation, and bleeding.
  3. cessation of the production of digestive enzymes.
  4. bacterial overgrowth.


511 30.  Patients with celiac disease often cannot tolerate:

  1. vitamin B6.
  2. lactose.
  3. fat.
  4. glucose.


511-512 31.                  Which of the following foods is included in a gluten-restricted diet?

  1. wheat
  2. rice
  3. barley
  4. rye


513 32.                  Generally, up to _____% of the small intestine can be resected without serious nutrition consequences.

  1. 25
  2. 30
  3. 45
  4. 50

513 33.                  After intestinal resection, the absorptive efficiency of the intestine is improved through:

  1. intestinal adaptation.
  2. enzyme replacement therapy.
  3. following a high-fiber diet.
  4. further surgery.


514 34.                  The absorption of vitamins and minerals begins in the _____.

  1. duodenum/jejunum
  2. jejunum/ileum
  3. ileum
  4. colon


Case Study Questions


Use the following case study to answer questions 35-40.

Kati is a 27-year-old Caucasian who works as a bank teller. She is 5’3” tall and weighs 102 pounds. She began experiencing recurrent gastrointestinal disturbances such as diarrhea, steatorrhea, and flatulence several months ago. She made an appointment with her physician after noticing that she was losing weight. Laboratory tests confirmed a diagnosis of celiac disease.


511 35.                  The gastrointestinal symptoms Kati is experiencing are due to:

  1. severe damage to the intestinal mucosa and subsequent malabsorption.
  2. a lack of pancreatic enzymes and resulting malabsorption.
  3. gastrointestinal obstructions caused by the secretion of thick mucus.
  4. bacterial overgrowth causing a disruption in fat digestion and absorption.


511 36.                  After Kati’s diagnosis, she should be instructed to avoid _____ until her intestine has recovered.

  1. sodium
  2. fat
  3. lactose
  4. fructose


511 37.                  Kati is at greatest risk of malabsorption of:

  1. the macronutrients.
  2. the water-soluble vitamins.
  3. the B vitamins.
  4. sodium, potassium, and chloride.


511 38.                  If Kati does not eliminate gluten from her diet, she could likely experience all of the following except:

  1. anemia.
  2. infertility.
  3. bone disorders.
  4. hypertension.


512 39.                  Kati will require nutrition education aimed at eliminating gluten from her diet. The dietitian will teach Kati to:

  1. avoid all cereal and grain products.
  2. substitute whole-wheat flour for enriched wheat flour when cooking.
  3. check ingredient lists on food labels carefully.
  4. avoid all milk and milk products.


512-513                 40.  What does Kati need to understand about the role of oats in her diet?

  1. She should purchase only uncontaminated oats and consume limited quantities.
  2. She should not consume oats in any form.
  3. She should limit her consumption of oats to 1 cup of dry rolled oats per day.
  4. She will need to learn how to prepare oats correctly for consumption.


Nutrition in Practice: Anemia in Illness


517 41.                  Anemia may develop for all of the following reasons except:

  1. inadequate production of erythrocytes.
  2. rapid destruction of red blood cells.
  3. loss of erythrocytes due to bleeding.
  4. deficiency of oxygen in the tissues.


517 42.                  The nutrient deficiencies that most frequently cause anemia are those of:

  1. iron, folate, and vitamin B12.
  2. carbohydrate, protein, and fat.
  3. iron, folate, and vitamin B6.
  4. essential fatty acids.


517 43.                  Hemolytic anemia is associated with a deficiency of:

  1. iron.
  2. vitamin C.
  3. folate.
  4. vitamin E.


517 44.  The type of anemia associated with vitamin B12 and folate deficiency is called:

  1. hemolytic anemia.
  2. macrocytic anemia.
  3. microcytic anemia.
  4. anemia of chronic disease.


519 45.                  Iron deficiency may manifest itself as low levels of all of the following laboratory tests except:

  1. serum iron.
  2. serum ferritin.
  3. serum transferrin.
  4. bone marrow iron.


Nursing Exam Review Questions


507 46.  Mrs. Hernandez, a 59-year-old female, has been experiencing diarrhea and increased intestinal gas after drinking milk. She is diagnosed with lactose intolerance and subsequently worries about her bone health if she cannot drink milk. The nurse reassures her that she may still be able to tolerate some dairy foods and consume adequate calcium by all of the following means except:

  1. drinking chocolate milk.
  2. consuming yogurt with live bacterial cultures.
  3. dividing her milk intake into small portions throughout the day.
  4. consuming processed cheeses.


508 47.                  The nurse is planning for the nutritional care of a patient with acute pancreatitis. The nurse understands that initially:

  1. all oral fluids and food should be withheld.
  2. the patient can have liquids only.
  3. tube feeding with an elemental formula should begin immediately.
  4. TPN should be started immediately.


508 48.                  A 35-year-old male has developed chronic pancreatitis due to long-term excessive alcohol consumption. The nurse recognizes that he may be at nutritional risk. The best recommendation the nurse can make to this patient is to:

  1. increase his fat intake.
  2. avoid alcohol.
  3. increase his protein intake.
  4. choose high-kcalorie snacks.


509 49.                  What type of diet should the nurse provide to help a patient with cystic fibrosis?

  1. high-kcalorie, high-fat
  2. low-kcalorie, low-protein
  3. high-protein, low-fat
  4. high-fiber


511-512                 50.  Which of the following foods will the nurse include in the diet plan for a patient with celiac disease?

  1. oatmeal
  2. scrambled eggs
  3. whole-wheat toast
  4. pasta


511-512                 51.  The nurse is reinforcing the dietitian’s gluten-restricted diet instruction to a patient with celiac disease. The nurse correctly tells the patient that he may consume:

  1. grilled chicken breast.
  2. chicken-fried steak.
  3. chicken and noodle soup.
  4. creamed chicken and biscuits.





508, 509        1.     Explain how enzyme replacement preparations avoid being digested by the acid of the stomach.


509                 2.     Why are young people with cystic fibrosis short and very lean for their age?


511-513         3.     Describe the dietary restrictions for a patient with celiac disease.



Case Study Essay Questions


Child with Cystic Fibrosis: Julia Franklin is a 6-year-old child who was diagnosed with cystic fibrosis at age 2. She has a poor appetite, and her height and weight are below normal for her age. Her parents have been instructed to feed her a high-calorie, high-protein, high-fat diet with extra salt and to provide snacks between all meals. She takes supplemental enzymes each time she eats. She experiences frequent respiratory infections, and has had numerous hospitalizations for cystic fibrosis exacerbation since her diagnosis.


  1. What is the cause of cystic fibrosis?
  2. Explain Julia’s short stature and problem maintaining a normal body weight.
  3. Why were her parents instructed to feed Julia a high-calorie, high-protein, high-fat diet? Why does she need extra salt?
  4. If Julia cannot swallow the supplemental enzymes, suggest ways her parents might provide the enzymes to her.
  5. What types of complications might Julia develop as she gets older?






a.     excessive bacterial colonization of the stomach and small intestine.

b.     excessive fat in the stools resulting from fat malabsorption; characterized by stools that are loose, frothy, and foul smelling due to a high fat content.

c.     an inherited disease characterized by the production of abnormally viscous exocrine secretions.

d.     a condition characterized by an abnormal immune reaction to wheat gluten that causes severe intestinal damage and nutrient malabsorption.

e.     a gluten-sensitive disorder characterized by a severe skin rash.

g.     a malabsorption syndrome that follows resection of the small intestine due to insufficient absorptive capacity in the remaining intestine.



Chapter 20 – Nutrition Therapy for Liver and Gallbladder Diseases


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




523 1.                     Hepatomegaly refers to a surgical puncture of a body cavity with an aspirator to draw out excess fluid.


522 2.                     People with malnutrition may experience fatty liver.


522 3.                     Rapid weight loss aids in the recovery from liver disease.


525 4.                     A patient with cirrhosis may present with no symptoms.


525 5.                     Nutrients are carried from the digestive tract to the liver via small blood vessels called collaterals.


526 6.                     Hepatic encephalopathy may be caused by an increased ratio of aromatic amino acids to branched-chain amino acids in brain tissue.


527 7.                     Diuretics are often prescribed to control ascites.


530 8.                     High-fat foods may be restricted in patients with cirrhosis who are experiencing steatorrhea.


529,530                 9.     Fat should be restricted in the diet of all patients with cirrhosis.


530 10.                  Many patients with cirrhosis require medication or insulin to control hyperglycemia.


530 11.                  A strict sodium restriction is part of the treatment for ascites.


530 12.                  An energy-dense, moderate-protein, low-electrolyte nutrient formula is recommended for tube-fed patients with ascites and fluid restrictions.


533 13.                  Most often, gallstones cause symptoms and require medical intervention.


534 14.                  The three most important risk factors for gallstones are body weight, gender, and whether the person smokes cigarettes.


Nutrition in Practice – Alcohol in Health and Disease


F      A     539                 15.  Eating well and taking supplements of protein, vitamins, and minerals protect the body from harmful effects of alcohol.


539, 541                16.  Moderate use of alcohol has been shown to reduce deaths from coronary heart disease in middle-aged and older adults.


Multiple Choice


522 1.                     Fatty liver can develop from all of the following except:

  1. alcoholic liver disease.
  2. celiac disease.
  3. diseases of malnutrition.
  4. obesity.

522 2.                     When triglycerides accumulate in the liver, the liver:

  1. becomes smaller.
  2. turns into scar tissue.
  3. becomes inflamed.
  4. enlarges.


522 3.                     Which of the following is true regarding fatty liver?

  1. It is a clinical finding common to many conditions.
  2. It usually results in liver failure.
  3. It cannot be reversed.
  4. It does not result in elevated liver enzymes.


522 4.                     Laboratory findings associated with fatty liver include all of the following except:

  1. elevated HDL.
  2. elevated ALT and AST.
  3. elevated glucose.
  4. elevated triglycerides.


523 5.                     The most common cause of infection with acute hepatitis A virus is:

  1. exposure to infected blood.
  2. jaundice.
  3. fecal-oral contamination.
  4. sexual contact.


523 6.                     The most common cause of chronic liver disease in the U.S. is:

  1. vitamin B12 deficiency.
  2. alcoholism.
  3. hepatitis C infection.
  4. protein deficiency.


523 7.                     Which of the following results when bilirubin accumulates in the bloodstream?

  1. jaundice
  2. ascites
  3. hepatic coma
  4. mental disturbances


524 8.                     Hepatitis patients should avoid:

  1. fried foods.
  2. high-protein foods.
  3. excessive intakes of sodium.
  4. alcohol.


524 9.                     The most appropriate dietary intervention for a malnourished person with hepatitis is:

  1. a low-protein diet
  2. adequate energy and protein.
  3. a tube feeding.
  4. fluid and electrolyte replacement.


525 10.                  Blood flow is impeded in a cirrhotic liver, causing:

  1. portal hypertension.
  2. elevated cholesterol levels.
  3. jaundice.
  4. fatty liver.


525 11.                  Albumin is not always a good indicator of nutrition status in patients with liver disease because:

  1. it is often low due to the disease.
  2. it is affected by elevated liver enzymes.
  3. liver disease causes elevated levels of albumin.
  4. ammonia levels affect albumin levels.


525-526                 12.  Consequences of cirrhosis include all of the following except:

  1. esophageal varices.
  2. portal hypertension.
  3. ascites.
  4. disorientation.


525 13.  Collaterals are:

  1. small blood vessels in the intestines.
  2. blood vessels that enlarge in order to allow an alternate path for blood flow.
  3. induced by fatty liver disease.
  4. hemorrhages in the esophagus.


526, 527                        14.  Ascites is:

  1. yellowing of the sclera of the eyes, skin, and mucous membranes.
  2. fluid accumulation in the abdomen.
  3. inflammation of the liver.
  4. elevated blood ammonia levels.


526 15.                  Ascites is exacerbated by:

  1. low plasma albumin levels.
  2. abdominal pressure.
  3. hyperglycemia.
  4. amino acid imbalances.


526 16.                  Factors involved in the development of ascites include all of the following except:

  1. portal hypertension.
  2. reduced albumin synthesis.
  3. sodium and water retention by the kidneys.
  4. obesity.


525 17.  All of the following laboratory test results are elevated in liver disease except:

  1. bilirubin.
  2. albumin.
  3. ammonia.
  4. AST.


525 18.                  Prothrombin time in liver disease patients will be:

  1. irrelevant.
  2. decreased.
  3. prolonged.
  4. normal.


526 19.                  A patient with cirrhosis who develops changes in personality and motor function may be exhibiting early symptoms of:

  1. fatigue.
  2. hepatic regression.
  3. hepatitis.
  4. hepatic encephalopathy


526 20.  A patient in the late stage of hepatic encephalopathy may exhibit all of the following symptoms except:

  1. confusion.
  2. cheerfulness.
  3. anger.
  4. muscular rigidity.


526-527                 21.  In liver disease, blood ammonia levels rise because the liver cannot convert the ammonia to:

  1. nitrogen.
  2. amino acids.
  3. urea.
  4. sodium.


527, 530                22.  Among patients with liver disease, _____ may be a factor if malnutrition develops.

  1. low-sodium diets
  2. jaundice
  3. lactulose
  4. impaired memory


527, 528                        23.  Furosemide is a drug often used to treat the symptoms of cirrhosis. It is a(n):

  1. appetite stimulant.
  2. diuretic.
  3. laxative.
  4. antiviral.


527 24.                  To help reduce ammonia production in the colon, patients with cirrhosis may be given a(n):

  1. antibiotic.
  2. appetite stimulant.
  3. enema.
  4. diuretic.


527 25.                  Drug therapy for the treatment of cirrhosis includes all of the following except:

  1. antibiotics.
  2. appetite stimulants.
  3. immunosuppressants.
  4. diuretics.


528-529 26.                  Patients with cirrhosis require _____ in order to prevent wasting.

  1. adequate fluid
  2. adequate kcalories
  3. high-fat diets
  4. six large meals per day


529 27.                  When calculating RMR for patients with ascites, the patient’s _____ must be considered.

  1. appetite
  2. activity level
  3. dry weight
  4. current weight


529 28.  Protein needs for the patient with cirrhosis who does not show signs of impending coma are calculated based on:

  1. 0.5-1.0 grams/kg.
  2. 0.8-1.2 grams/kg.
  3. 1.5-2.0 grams/kg.
  4. 2.0-2.5 grams/kg.


529 29.                  To add energy but not protein to the diet, you would add:

  1. butter.
  2. milkshakes.
  3. vegetables.
  4. hard-boiled eggs.


528, 529                30.  Persons using potassium-sparing diuretics should be cautioned about consuming:

  1. salt substitutes.
  2. herbs and spices.
  3. soft drinks.
  4. dairy foods.


528, 530                31.  Cirrhosis patients frequently develop insulin resistance and consequently must follow a diet that is:

  1. consistent in carbohydrate content.
  2. low in fiber.
  3. consistent in vitamin K intake.
  4. low in sodium.


528, 530                32.  If the patient with cirrhosis develops fat malabsorption and requires extra kcalories, these should be provided by:

  1. carbohydrates.
  2. sugars.
  3. MCT oil.
  4. fruits and vegetables.


530 33.                  The diet of a patient with cirrhosis who has severe steatorrhea may need to be  supplemented with all of the following except:

  1. B vitamins.
  2. calcium.
  3. magnesium.
  4. zinc.


530 34.                  Patients with ascites generally must restrict their intake of:

  1. fat.
  2. carbohydrates.
  3. sodium.
  4. iron.


530 35.  If a patient with ascites experiences a sodium level below 128 milliequivalents per liter, a fluid restriction of _____ per day may be necessary.

  1. 1000-1200 mL
  2. 1200-1500 mL
  3. 1500-1800 mL
  4. 1800-2000 mL


530 36.  An important consideration in tube feeding a patient with esophageal varices is:

  1. the location of the feeding tube.
  2. the size of the feeding tube.
  3. the possibility of aspiration.
  4. the rate of the tube feeding.


531-532 37.                  Performing a nutrition assessment on a patient who is a candidate for liver transplant is complicated by all of the following except:

  1. liver dysfunction and malnutrition have similar metabolic effects.
  2. fluid retention can mask weight loss.
  3. fluid retention can alter lab values.
  4. supplements may mask underlying nutrient deficiencies.


532 38.  All of the following are important factors in medical nutrition therapy following liver transplant except:

  1. enteral supplements.
  2. a high-kcalorie, low-protein diet.
  3. food safety education.
  4. vitamin and mineral supplements.


532 39.  Cholelithiasis affects about _____ percent of the population.

  1. 1
  2. 12
  3. 25
  4. 38


533 40.                  Gallstones may consist of any of the following except:

  1. calcium salts.
  2. cholesterol.
  3. bilirubin.
  4. lipase.


533 41.                  Left untreated for years, a blocked bile duct may lead to:

  1. liver damage.
  2. kidney failure.
  3. neuropathy.
  4. gastritis.


534 42.  Which of the following individuals is at highest risk of gallstones?

  1. a female athlete with sports anemia
  2. a woman who uses estrogen replacement therapy
  3. an overweight African-American male
  4. a male patient on long-term tube feeding


535 43.                  All of the following are possible treatment options for symptomatic gallstones except:

  1. cholecystectomy.
  2. urosodiol.
  3. a sodium-controlled diet.
  4. shock-wave lithotripsy.


534 44.  All of the following are risk factors for the formation of gallstones except:

  1. long-term parenteral nutrition.
  2. head injuries.
  3. clofibrate use.
  4. rapid weight loss.


536 45.                  In patients with liver dysfunction, the risk of diet-drug interactions is especially high for patients with:

  1. heart disease.
  2. diabetes.
  3. renal failure.
  4. anemia.



Case Study Questions


Use the following case study to answer questions 46-51.

Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5’10” tall and currently weighs 145 pounds.


525, 527                46.  Of the following laboratory tests performed on Mr. Jamison, which one would you expect to see elevated?

  1. albumin
  2. transferrin
  3. ammonia
  4. HDL


525-526                 47.  Complications of cirrhosis that Mr. Jamison may be facing in the future include all of the following except:

  1. ascites.
  2. portal hypertension.
  3. gastroesophageal varices.
  4. kidney cancer.


527 48.                  To improve Mr. Jamison’s appetite, his physician may prescribe:

  1. megestrol acetate.
  2. spironolactone.
  3. rifaximin.
  4. propranolol.


529 49.                  The dietitian assesses Mr. Jamison’s protein needs based on an appropriate weight for his height and estimates that he requires _____ grams of protein per day.

  1. 25-51
  2. 52-62
  3. 56-83
  4. 98-118


530 50.                  Mr. Jamison begins experiencing hyperglycemia as his disease progresses. The appropriate diet for him is:

  1. low protein.
  2. carbohydrate controlled.
  3. low sodium
  4. fat controlled.


532 51.  Mr. Jamison eventually receives a liver transplant. Due to the risk of foodborne illness, Mr. Jamison should avoid all of the following foods except:

  1. rare steak.
  2. sushi.
  3. unpasteurized milk.
  4. canned vegetables.

Nutrition in Practice – Alcohol in Health and Disease


539 52.                  One drink is equivalent to _____ ounces of beer.

  1. 4
  2. 6
  3. 10
  4. 12


539 53.                  People with diabetes who abuse alcohol are at risk of developing:

  1. hypoglycemia.
  2. hyperglycemia.
  3. hyponatremia.
  4. hyponatremia.


540 54.  The most common complication of alcohol abuse is:

  1. chronic pancreatitis.
  2. liver disease.
  3. chronic renal failure.
  4. heart arrhythmias.


540 55.                  Organs affected by alcohol abuse include all of the following except the:

  1. lungs.
  2. liver.
  3. GI tract.
  4. heart.


541 56.  Examples of common nutrient deficiencies seen as a result of alcohol abuse include all of these except:

  1. folate.
  2. thiamin.
  3. vitamin A.
  4. sodium.


541 57.                  The beneficial effects of moderate alcohol intake are mainly seen in:

  1. women who have type 2 diabetes.
  2. people with risk factors for liver disease.
  3. older people with risk factors for heart disease.
  4. men who work in the petrochemical industry.


Nursing Exam Review Questions


536 58.                  The risk of diet-drug interactions is high in patients with liver disease. The nurse understands that this is due to the fact that:

  1. most drugs are metabolized in the liver.
  2. most drugs are absorbed in the liver.
  3. most people with liver disease do not eat well.
  4. most nutrients are absorbed in the liver.


524 59.  Kelly is a 27-year-old well-nourished female who has been diagnosed with hepatitis A. Which of the following nutrition interventions is needed?

  1. high-kcalorie, high-protein diet
  2. high-protein, low-fat diet
  3. low-sodium, fluid-restricted diet
  4. no dietary change is needed


524 60.                  The nurse is working with a hepatitis patient who is malnourished. Which of the following would be the most appropriate type of nutrition support for this patient?

  1. a regular, balanced diet
  2. frequent, small meals
  3. enteral formula supplements
  4. high-kcalorie, high-protein diet


525 61.  A patient is admitted to the hospital with decreased albumin, elevated alkaline phosphatase, and elevated bilirubin. The nurse recognizes these clinical findings as evidence of:

  1. portal hypertension.
  2. liver disease.
  3. esophageal varices.
  4. hepatic coma.


526 62.                  The nurse understands the implication of fluid retention in patients with ascites and knows that _____ may not be a good indicator of nutritional status.

  1. height
  2. weight
  3. blood cholesterol
  4. appetite


527 63.                  The nurse recognizes the fact that patients with cirrhosis are likely to develop PEM. The nurse should plan to monitor the _____ of a patient with cirrhosis.

  1. weight
  2. meal intake
  3. diet-drug interactions
  4. lab values


528 64.                  The nurse notices abnormal electrolyte levels in a patient with cirrhosis and understands that it is likely a side effect of:

  1. poor nutrition.
  2. nitroglycerin.
  3. lactulose.
  4. appetite stimulants.


528 65.                  Mark is a 52-year-old construction worker who was recently diagnosed with cirrhosis. The dietitian estimates his RMR to be 2145 kcalories per day. With the added stress of cirrhosis, his kcalorie needs would increase to a minimum of _____ kcal.

  1. 2574
  2. 1716
  3. 2145
  4. 2789


528, 529                66.  Mrs. Juarez is diagnosed with cirrhosis and has developed ascites. Her appetite is poor and she is losing weight. The nurse realizes that she is at risk for malnutrition and encourages Mrs. Juarez to:

  1. eat four to six times per day.
  2. try to eat three large meals per day.
  3. consume a liquid nutritional supplement with each meal.
  4. drink more fruit juice.


528-529 67.                  The nurse recognizes that the most appropriate diet therapy for a patient with cirrhosis who is not sensitive to protein provides:

  1. adequate carbohydrate and restricted fat.
  2. adequate energy and adequate protein.
  3. adequate energy and restricted protein.
  4. adequate carbohydrate and protein and restricted fat.


528-529 68.                  Mr. Rahman is an alcoholic patient with cirrhosis. He is malnourished and is experiencing protein catabolism. Which of the following is most important to minimize the loss of lean body mass?

  1. increased protein intake
  2. adequate protein and kcalorie intake
  3. increased fat intake
  4. decreased carbohydrate intake


530 69.                  A patient has developed ascites and the dietitian has been consulted to assess the patient and recommend appropriate medical nutrition therapy. The most helpful information that the nurse can provide to the dietitian is:

  1. the patient’s usual weight.
  2. the patient’s usual meal intake.
  3. the patient’s preference for salty snacks.
  4. the patient’s dry weight.


530 70.  Paracentesis is performed in order to:

  1. normalize plasma amino acid ratios.
  2. remove fluid from the abdomen.
  3. correct liver enzyme levels.
  4. treat esophageal varices.


532 71.                  The nurse understands that recovery from liver transplant surgery can be hastened by:

  1. correcting malnutrition prior to the surgery.
  2. encouraging the patient to lose weight prior to surgery.
  3. advising the patient to take large doses of vitamins and minerals before surgery.
  4. encouraging the patient to use herbal remedies before surgery.


532 72.                  Following a liver transplant, immunosuppressive drugs are given to reduce the immune responses that cause rejection. The nurse recognizes that these drugs can affect nutrition status because of their effects on:

  1. kidney function.
  2. pancreatic function.
  3. the GI tract.
  4. the absorption of nutrients.





a.     an accumulation of fat in the liver.

b.     enlargement of the liver.

c.     an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure.

d.     elevated blood pressure in the portal vein due to obstructed blood flow through the liver.

e.     blood vessels that enlarge in order to allow an alternative pathway for diverted blood.

f.     abnormally dilated blood vessels.

g.     yellow discoloration of the skin and eyes due to an accumulation of bilirubin.

h.     liver inflammation that is associated with fatty liver.

i.      an abnormal accumulation of fluid in the abdominal cavity.





525-526         1.     Describe why ascites, portal hypertension, and esophageal varices occur in patients with cirrhosis.


525                 2.     What laboratory values should be monitored to assess liver function?


526                 3.     Describe the possible causes of hepatic encephalopathy.


527                 4.     What are some of the possible causes of wasting seen in people with cirrhosis?


529                 5.     Describe ways to help a patient with cirrhosis eat enough food.


531-532         6.     Describe appropriate nutrition intervention before and after a liver transplant.



Case Study Essay Questions


Cook with Cholelithiasis: Marcia Brown is a 42-year-old Pima Indian who works as a cook in a casino in Arizona. She has just been diagnosed with cholelithiasis. She is 5’4” tall and once weighed 210 pounds. One year ago she underwent gastric bypass surgery and has lost 75 pounds. For several months she had been experiencing episodes of pain in the right upper part of her abdomen. The pain usually began after eating and lasted for several hours. Lately she began to experience nausea and vomiting with the pain and began to run a fever.


  1. What are Marcia’s risk factors for cholelithiasis?
  2. What symptoms did Marcia have that are consistent with a diagnosis of cholelithiasis?
  3. What is the cause of the pain associated with cholelithiasis?
  4. What are the treatment options for cholelithiasis? Explain each.
  5. Explain the relationship between rapid weight loss and the development of cholelithiasis.






Chapter 21 – Carbohydrate-Controlled Diets for Diabetes Mellitus


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




544 1.                     Prediabetes is diagnosed when a person has a fasting blood glucose level that falls between 100 and 125 mg/dL.


544, 545                2.     The primary defect in type 2 diabetes is autoimmune destruction of the beta cells in the pancreas.


545 3.                     Obesity alone can cause some degree of insulin resistance.


546 4.                     In severe cases of diabetic ketoacidosis, blood glucose levels can exceed 1000 mg/dL.


547 5.                     Acetone breath is characteristic of hypoglycemia.


547 6.                     The hyperosmolar hyperglycemic syndrome is usually a complication of type 2 diabetes.


547 7.                     Chronic complications of diabetes typically affect the blood vessels and the bones.


548 8.                     In people with diabetes, claudication may be due to polyuria.


549 9.                     Clinical trials have demonstrated that intensive treatment can keep blood glucose levels tightly controlled and reduce the incidence and severity of the chronic complications of diabetes.


550 10.                  Routine checks for microalbuminuria help to determine if diabetes is affecting the eyes.


550 11.                  The presence of ketones can be detected in both the blood and the urine.


550 12.                  Weight-loss diets are often prescribed for people with type 2 diabetes.


F      A     549, 557        13.  It is appropriate for clients diagnosed with type 2 diabetes to take oral antidiabetic agents and ignore their prescribed diet.


558 14.                  Physical activity has not been shown to aid blood glucose control in people with type 1 diabetes.


560-561                 15.  Close monitoring of glucose levels is especially important for the pregnant woman with diabetes.


Multiple Choice


543 1.                     Diabetes mellitus describes a group of metabolic disorders characterized by:

  1. elevated blood glucose.
  2. low hemoglobin.
  3. dumping syndrome.
  4. lactose intolerance.


543 2.                     If a person does not produce sufficient insulin, he is prone to have:

  1. hyperglycemia.
  2. poor appetite.
  3. low albumin levels.
  4. hypoglycemia.


543 3.                     Glycosuria generally occurs when blood glucose exceeds _____ milligrams per deciliter.

  1. 120
  2. 140
  3. 160
  4. 200


543, 544                        4.     Excessive urine production is called:

  1. polydipsia.
  2. polyuria.
  3. ketonuria.
  4. glycosuria.


546-547                 5.     Which of the following are associated with the acute complications of diabetes?

  1. hyperglycemia 4.             polyuria
  2. vomiting 5.             lack of thirst
  3. dehydration 6.             infections of urinary tract
  4. 1, 2, 3
  5. 2, 4, 6
  6. 1, 3, 4
  7. 3, 4, 5


543 6.                     All of the following are symptoms of diabetes except:

  1. polyuria.
  2. polyphagia.
  3. polydipsia.
  4. polyglycosuria.


543 7.                     People with diabetes are prone to _____ due to poor circulation and weakened immune function.

  1. ketoacidosis
  2. hyperglycemia
  3. infections
  4. fatigue


545 8.                     The first sign of type 1 diabetes is often:

  1. ketoacidosis.
  2. hypoglycemia.
  3. high blood lipids.
  4. microalbuminuria.


545 9.     The predominant type of diabetes:

  1. usually results from an autoimmune disorder.
  2. develops most often in people over 40.
  3. is called type 1 diabetes.
  4. develops as a result of drastic weight loss.


545 10.  Type 2 diabetes is associated with:

  1. autoimmune diseases.
  2. insulin resistance.
  3. destruction of pancreatic beta cells.
  4. viral infection.


545 11.                  The risk of developing type 2 diabetes is increased by all of the following except:

  1. abdominal obesity.
  2. aging.
  3. sedentary lifestyle.
  4. hypertension.


545 12.  Type 2 diabetes often goes undiagnosed in overweight children and teens because:

  1. their glucose levels vary with their stage of growth.
  2. there are frequently no symptoms.
  3. blood glucose tests are not accurate in children and teens.
  4. their lifestyles are not conducive to screening for the disease.


546 13.                  Diabetic ketoacidosis is characterized by all of the following except:

  1. severe ketosis.
  2. blood glucose > 250 mg/dL.
  3. acidosis.
  4. blood cholesterol > 250 mg/dL.


547 14.                  People with type 2 diabetes are prone to:

  1. ketosis.
  2. weight loss.
  3. acidosis.
  4. hyperosmolar hyperglycemic syndrome.


547 15.                  Hypoglycemia is frequently caused by:

  1. overeating.
  2. skipping insulin doses.
  3. eating too many carbohydrates.
  4. poor management of diabetes.


547-548 16.                  People with diabetes are at increased risk for cardiovascular diseases because they:

  1. tend to eat poorly.
  2. have an increased tendency for thrombosis and abnormal ventricle function.
  3. experience claudication and foot ulcers.
  4. are usually unable to participate in any form of physical activity.


548 17.                  A major cause of disability among people with diabetes is:

  1. foot amputation.
  2. hypertension.
  3. hypoglycemia.
  4. foot ulcers.


547-548                 18.  Which of the following is not one of the chronic complications of diabetes?

  1. nephropathy
  2. neuropathy
  3. retinopathy
  4. myopathy


547 19.  A major cause of death in people with diabetes is:

  1. neuropathy.
  2. cardiovascular disease.
  3. infections.
  4. gangrene.


548 20.                  Generally, the initial treatment for type 2 diabetes is:

  1. nutrition therapy and exercise.
  2. antidiabetic medications.
  3. insulin therapy.
  4. enzyme replacement therapy.


549 21.                  Which of the following is the most important goal for both medical and nutrition therapy for diabetes?

  1. blood glucose control
  2. blood pressure control
  3. optimal blood lipid levels
  4. prevention of complications


549, 550                22.  Intensive insulin therapy can cause:

  1. hyperglycemia.
  2. a loss of appetite.
  3. weight gain.
  4. low albumin levels.


549, 557                23.  A disadvantage of intensive therapy for type 1 diabetes is:

  1. a greater risk of severe hypoglycemia.
  2. greater expense due to lack of insurance reimbursement.
  3. fewer incidences of severe hypoglycemia.
  4. more rapid progression of chronic complications.


549 24.                  Patients diagnosed with diabetes need education in all of the following areas except:

  1. meal planning.
  2. blood glucose monitoring.
  3. physical activity.
  4. dialysis.


549 25.                  Good glycemic control requires:

  1. eating small amounts of food.
  2. restricting carbohydrate in the diet.
  3. self-monitoring of blood glucose.
  4. frequent visits to the doctor.


550 26.                  Which of the following glycated hemoglobin values is normal?

  1. <6%
  2. >6%
  3. >7%
  4. >8%


550 27.  The HbA1C test is used to determine:

  1. average blood glucose over the preceding two weeks.
  2. glycemic control for the preceding two to three months.
  3. the level of fructose in the blood.
  4. the presence of ketones in the blood.


551 28.                  The nutrient that has the greatest influence on blood glucose levels is:

  1. protein.
  2. fat.
  3. carbohydrate.
  4. calcium.


551-552                 29.  Characteristics of an appropriate diet for diabetes include all of the following except:

  1. low in carbohydrate.
  2. adequate in fiber.
  3. low in saturated fat.
  4. moderate in protein.


551 30.                  Which of the following statements is true regarding carbohydrate in the diabetic diet?

  1. Low-carbohydrate diets are recommended.
  2. All concentrated sweets should be avoided.
  3. High-fiber, minimally processed carbohydrates should be emphasized.
  4. Simple carbohydrates should be emphasized.


551-552                 31.  All of the following foods would be appropriate to include in the diet of a person with diabetes except:

  1. dried beans and peas.
  2. fruits.
  3. whole milk.
  4. whole-grain breads.


551 32.                  Which food would have the least effect on blood glucose levels?

  1. fruit juice
  2. whole-grain cereal
  3. biscuit
  4. vanilla wafer


551-552                 33.  To reduce the saturated fat content of the diabetic diet, all of the following should be emphasized except:

  1. lean meats.
  2. legumes.
  3. cheese.
  4. vegetable oils.


552 34.  The diet for diabetes should provide less than _____ milligrams of cholesterol per day.

  1. 100
  2. 200
  3. 300
  4. 500


552 35.  Protein needs for people with diabetes are estimated using:

  1. 0.6 g/kg body weight.
  2. 0.8 g/kg body weight.
  3. 1.0 g/kg body weight.
  4. 1.2 g/kg body weight.


552 36.                  Which of the following statements best describes the appropriate use of alcohol by individuals with diabetes who use insulin or medications that promote insulin secretion?

  1. It should not be used.
  2. It should be used 3-4 times/week only.
  3. It should be consumed in moderation with meals.
  4. It should be consumed on an empty stomach.

552-553                 37.  Consistent carbohydrate intake:

  1. can be varied as the client desires.
  2. is important for glycemic control.
  3. is only important if a client is overweight.
  4. is only important in the treatment of type 1 diabetes.


554 38.                  A benefit to using the carbohydrate counting method of education over exchange lists is:

  1. it is easier to learn.
  2. the portion sizes are larger in the carbohydrate counting method.
  3. a person doesn’t have to restrict their fat intake with the carbohydrate counting method.
  4. exchange lists only allow a limited number of foods.


553 39.                  A patient with diabetes is allowed 60 grams of carbohydrate for lunch. This equals _____ portions of carbohydrate foods.

  1. 2
  2. 3
  3. 4
  4. 5


553 40.                  All of the following examples represent one portion of a carbohydrate-containing food except:

  1. 1 medium apple.
  2. 1 slice of bread.
  3. 1 cup cooked pasta.
  4. 1 small baked potato.


553 41.                  A patient’s diabetic diet prescription is for 1800 kcalories with 50% of kcalories from carbohydrate. How many portions of carbohydrates is the patient allowed each day?

  1. 15
  2. 60
  3. 12
  4. 23


555 42.                  Which insulin has the quickest onset of action?

  1. lispro
  2. regular
  3. NPH
  4. glargine


555 43.                  Which insulin has the longest duration of action?

  1. lispro
  2. regular
  3. NPH
  4. glargine


558 44.                  Oral antidiabetic agents work in all of the following ways except:

  1. stimulating the pancreas to produce insulin.
  2. inhibiting liver production of glucose.
  3. delaying carbohydrate digestion and absorption.
  4. stimulating the liver to produce insulin.


558 45.                  The mode of action of sulfonylureas is to:

  1. stimulate insulin secretion by the pancreas.
  2. decrease insulin resistance.
  3. improve glucose utilization.
  4. delay carbohydrate digestion and absorption.


558 46.                  Which of the following receives a high priority in the treatment of type 2 diabetes because of its beneficial effects in improving blood glucose control, improving blood lipids, and reducing blood pressure?

  1. physical activity
  2. a low-fat diet
  3. sulfonylureas
  4. a sodium-controlled diet


559 47.                  Dietary supplements that contain ginseng, garlic, fenugreek, coriander, and celery should not be taken with the:

  1. alpha-glucosidase inhibitors.
  2. biguanides.
  3. thiazolidinediones.
  4. sulfonylureas.


560-561                 48.  Diet therapy for the pregnant woman with diabetes includes all of the following except:

  1. decreased kcalories to aid in blood glucose control.
  2. regular meals and snacks.
  3. an evening snack.
  4. monitoring of insulin therapy.


561 49.                  Women with gestational diabetes who are overweight or obese should be encouraged to:

  1. engage in strenuous exercise.
  2. severely restrict carbohydrate intake.
  3. adjust energy intake as needed.
  4. limit protein intake.


Case Study Questions


Use the following case study to answer questions 50-55.

Jared Joiner is a 56-year-old African American insurance agent. He is single, eats most meals at restaurants, and leads a sedentary lifestyle. He is 5’9” tall and weighs 204 pounds. Mr. Joiner has been feeling particularly fatigued lately and decided to make an appointment with his physician for a check-up. The results of his laboratory tests include a fasting blood glucose level of 121 mg/dL.


544 50.                  Mr. Joiner’s blood glucose level meets the criteria for a diagnosis of:

  1. type 1 diabetes.
  2. type 2 diabetes.
  3. prediabetes.
  4. ketoacidosis.


544, 545                51.  How many risk factors does Mr. Joiner have for type 2 diabetes?

  1. 2
  2. 3
  3. 4
  4. 5


544, 545                52.  How many of his risk factors for type 2 diabetes can Mr. Joiner control?

  1. 1
  2. 2
  3. 3
  4. 4


  1. 545 53. All of the following are practical recommendations that Mr. Joiner can follow to reduce his risk of developing diabetes except:
  2. lose weight.
  3. increase physical activity.
  4. learn to make better food choices at restaurants.
  5. learn to cook.


Four months later Mr. Joiner returns to his physician for a follow-up appointment. He has lost 10 pounds, but his fasting blood glucose level is now 131 mg/dL.


543, 545                        54.  Mr. Joiner’s disease has progressed to:

  1. type 1 diabetes.
  2. type 2 diabetes.
  3. gestational diabetes.
  4. hyperosmolar hyperglycemic syndrome.


552 55.                  The simplest and most flexible approach to teaching Mr. Joiner the principles of the diet for optimal management of his blood glucose level is:

  1. carbohydrate counting.
  2. exchange lists.
  3. MyPyramid.
  4. a high-protein diet.


Nutrition in Practice – Metabolic Syndrome


565 56.  Metabolic syndrome consists of a cluster of disorders that increase the risk of developing type 2 diabetes and:

  1. liver disease.
  2. cardiovascular disease.
  3. gout.
  4. renal failure.


565 57.                  Which group of symptoms is characteristic of the metabolic syndrome?

  1. obesity, reduced HDL cholesterol levels, hyperglycemia
  2. hypertension, hypoglycemia, abdominal obesity
  3. elevated liver enzymes, insulin resistance, microalbuminuria
  4. polyuria, polydipsia, polyphagia


565 58.  Though the exact cause of metabolic syndrome is unknown, it is believed to be associated with:

  1. poverty.
  2. obesity.
  3. hypoglycemia.
  4. liver disease.


566 59.                  Individuals with hypertriglyceridemia should reduce their intake of:

  1. desserts.
  2. fruit.
  3. fatty fish.
  4. nuts.

567 60.                  The progression of metabolic syndrome is worsened by:

  1. a sedentary lifestyle.
  2. low-carbohydrate diets.
  3. low blood lipids.
  4. drug therapy.


Nursing Exam Review Questions


544, 545                61.  Sam is an African-American male who is obese and has a family history of diabetes. The nurse recognizes that Sam has _____ of the major risk factors for type 2 diabetes.

  1. 1
  2. 2
  3. 3
  4. 4


547 62.                  A patient with diabetes is admitted to the hospital with symptoms of headache, sweating, shakiness, confusion, and slurred speech. The nurse recognizes these as symptoms of:

  1. hypoglycemia.
  2. hyperglycemia.
  3. alcohol intoxication.
  4. ketosis.


552 63.                  The nurse recognizes that the diabetic patient understands the principles of her diet when she states:

  1. “I need to restrict my carbohydrate intake and avoid concentrated sweets.”
  2. “I need to severely limit my fat intake and choose only complex carbohydrates.”
  3. “I need to eat about the same amount of carbohydrate at about the same time each day.”
  4. “I need to restrict my carbohydrate and fat intakes, but increase my protein intake.”


553 64.                  The nurse understands that a patient on a 1500-kilocalorie diabetic diet should limit her carbohydrate intake to approximately _____ grams per day.

  1. 150
  2. 375
  3. 190
  4. 210


553 65.                  A patient with diabetes asks the nurse for ice cream. The nurse is aware that this will count as a carbohydrate portion and the amount that equals 1 portion is:

  1. ¼ cup.
  2. 1/3 cup.
  3. ½ cup.
  4. 1 cup.


553 66.                  A diabetic client is placed on a 2500-kcalorie diet with the following distribution of kcalories: 55% carbohydrate, 15% protein, and 30% fat. The nurse recognizes that these percentages translate into:

  1. 250 grams CHO; 100 grams protein; 75 grams fat.
  2. 343 grams CHO; 94 grams protein; 83 grams fat.
  3. 360 grams CHO; 86 grams protein; 89 grams fat.
  4. 374 grams CHO; 92 grams protein; 81 grams fat.


556 67.                  In educating a patient on intensive insulin therapy, the nurse stresses that the amount of insulin required before each meal will depend on all of the following except:

  1. the patient’s blood glucose level before eating.
  2. the carbohydrate content of the meal.
  3. the patient’s weight.
  4. the fat content of the meal.


557 68.  A 12-year-old girl is diagnosed with type 1 diabetes and is placed on insulin. Her mother expresses concern about the ability of her daughter to administer the injections. The nurse reassures the mother that:

  1. she can’t do it wrong.
  2. most children can be taught to administer the insulin they require.
  3. most children aren’t afraid of needles.
  4. too much insulin can’t hurt her.


557 69.                  The nurse teaches a newly diagnosed diabetic patient to treat an episode of hypoglycemia by:

  1. eating 15 jelly beans.
  2. drinking a 12-oz. Coke.
  3. eating a candy bar.
  4. sucking slowly on a hard candy.


557 70.                  A patient’s blood glucose log shows several episodes of hyperglycemia upon rising in the morning. The nurse explains that this is:

  1. due to taking too much insulin.
  2. caused by eating too much protein.
  3. called the dawn phenomenon.
  4. a normal occurrence.


558 71.                  The nurse is counseling a young athlete with type 1 diabetes. The nurse knows that the athlete understands the instructions when he verbalizes:

  1. “If my blood sugar is below 100 before practice, I should consume some carbohydrate before beginning.”
  2. “I should drink plenty of Gatorade during practice.”
  3. “I don’t need to check my blood sugar during practice.”
  4. “I should not eat during practice.”


558 72.  An obese patient with type 2 diabetes wants to begin an exercise program. The nurse recommends that the patient:

  1. start by walking 30 minutes a day.
  2. join a gym.
  3. hire a personal trainer.
  4. seek a medical evaluation.


559 73.                  A patient with type 1 diabetes calls her physician’s office complaining of nausea, vomiting, and diarrhea. The nurse should advise the patient to:

  1. cease her insulin injections until she can tolerate food.
  2. continue her insulin injections and eat tolerated foods that provide the prescribed amount of carbohydrate.
  3. avoid consuming carbohydrates, but continue her insulin injections.
  4. cease her insulin injections and eat tolerated foods that provide the prescribed amount of carbohydrate.


561 74.                  A Hispanic pregnant woman is visiting the community clinic for her first prenatal visit. She has a family history of diabetes, she is obese, and her last baby weighed 9 pounds, 8 ounces. The nurse realizes that she is at risk for:

  1. poor weight gain.
  2. gestational diabetes.
  3. anemia.
  4. malnutrition.





a.     a group of metabolic disorders characterized by hyperglycemia and disordered insulin metabolism.

b.     elevated blood glucose concentrations.

c.     the condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.

d.     the type of diabetes that accounts for 5 to 10% of diabetes cases and is caused by autoimmune destruction of pancreatic beta cells.

e.     the type of diabetes that accounts for 90 to 95% of diabetes cases and is a result of insulin resistance coupled with insufficient insulin secretion.

f.     a coma that occurs in uncontrolled diabetes; may be due to diabetic ketoacidosis, the hyperosmolar hyperglycemic state, or severe hypoglycemia.

g.     extreme hyperglycemia that is associated with hyperosmolar blood, dehydration, and altered mental status.

h.     abnormally low concentrations of blood glucose.

i.      hyperglycemia that results from the release of counterregulatory hormones following nighttime hypoglycemia; also called the Somogyi effect.

j.      pain in the legs while walking; usually due to an inadequate supply of blood to the muscles.

k.     delayed stomach emptying.

l.      the presence of albumin in the urine; a sign of diabetic nephropathy.

m.   a distinctive fruity odor on the breath of a person with ketosis.





543                 1.     Describe the primary criteria used to confirm a diagnosis of diabetes.


546-547         2.     Identify the acute complications of diabetes and describe why they occur.


550                 3.     Describe how glycated hemoglobin is used to evaluate long-term glycemic control.


552-555         4.     Compare and contrast the use of carbohydrate counting and exchange lists for meal planning.


555-556         5.     Describe the different methods of insulin delivery.


556-557         6.     What is the “honeymoon period”?


557, 558        7.     Explain how hypoglycemia should be treated.


559                 8.     Explain “sick-day management” for a patient with diabetes.


561                 9.     Describe the appropriate medical nutrition therapy for pregnant women with diabetes.


561                 10.  Describe the medical nutrition therapy for a woman with gestational diabetes.



Case Study Essay Questions


Gestational Diabetes: Maria Hinojosa is a 24-year-old Hispanic woman who is in the 26th week of her second pregnancy. She is 5’5” tall and weighs 182 pounds. Maria’s first baby weighed 9 lb. 10 oz. Her family history reveals that her father has type 2 diabetes. After a routine screening for gestational diabetes, Maria was diagnosed with the disease and referred to a registered dietitian for nutrition counseling.


  1. At what point in pregnancy is screening for gestational diabetes performed?
  2. What are Maria’s risk factors for developing gestational diabetes?
  3. What recommendations might the dietitian give to Maria to help control her blood glucose levels?
  4. Why is reducing carbohydrate intake at breakfast recommended?
  5. If Maria does not achieve blood glucose control with diet and exercise, what treatment option is available?
  6. After she delivers her baby, how can Maria reduce her risk of developing type 2 diabetes?





Chapter 22 – Fat-Controlled, Mineral-Modified Diets
for Cardiovascular Diseases


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




570 1.                     Deprivation of oxygen and nutrients to the heart can cause a myocardial infarction.


572 2.                     Coronary heart disease is the leading cause of death in the United States.


569 3.                     The number of deaths from CVD is greater among men than women.


569, 570                4.     Ischemia refers to a deficiency of blood and oxygen delivery to the tissues.


571 5.                     The most common cause of an aneurysm is high blood pressure.


572 6.                     Several of the major risk factors for CHD can be modified by diet and lifestyle.


572 7.                     Much of the treatment for coronary heart disease focuses on lowering LDL cholesterol.


571, 578                8.     Researchers have determined that elevated homocysteine is a known cause of atherosclerosis.


574 9.                     Of the dietary lipids, cholesterol has the strongest effect on blood cholesterol levels.


583 10.                  Clinical studies suggest that an overweight hypertensive individual can reduce blood pressure by losing weight.


583-584                 11.  The DASH diet is useful for treating hypertension and also reduces the risk of CHD.


T     A     585                 12.  Cottage cheese, American cheese, and parmesan cheese should be avoided by a person who needs to restrict their sodium intake.


587 13.                  The primary dietary recommendation for heart failure is a protein restriction.


581 14.                  Patients who have had a stroke may develop nutritional problems due to their inability to communicate their food preferences.


Nutrition in Practice – Helping People with Feeding Disabilities


592 15.                  Adaptive utensils and adequate training enable some people with feeding disabilities to be independent.


Multiple Choice


569 1.     Diseases of the heart and blood vessels are collectively referred to as:

  1. coronary artery disease.
  2. cardiovascular disease.
  3. coronary heart disease.
  4. ischemic heart disease.


569 2.                     Plaque consists of all of the following except:

  1. fatty deposits.
  2. smooth muscle cells.
  3. fibrous connective tissue.
  4. cancerous cells.


569-570                 3.     Atherosclerosis is dangerous to arterial function because:

  1. it causes decreased blood pressure on artery walls.
  2. it increases arterial elasticity.
  3. it narrows the arterial lumen so a clot can easily block it.
  4. it changes the heart rate.


570 4.                     Which of the following statements about atherosclerosis is true?

  1. It can affect almost any organ in the body.
  2. It results in malabsorption.
  3. It can interfere with the secretion of digestive enzymes.
  4. It is rare in women.


569 5.     The formation of plaque is:

  1. unrelated to high blood pressure.
  2. an inflammatory response.
  3. an autoimmune disorder.
  4. limited to smaller blood vessels.


571 6.     The risk of atherosclerosis increases with all of the following except:

  1. smoking.
  2. exercise.
  3. aging.
  4. diabetes.


572 7.                     The four classic risk factors for CHD are:

  1. smoking, high LDL, high blood pressure, and diabetes.
  2. age, gender, family history, and diet.
  3. smoking, high HDL, high blood pressure, and diabetes.
  4. age, smoking, diet, and diabetes.


572 8.                     In order to assess a person’s risk for CHD, a complete lipoprotein profile should be obtained every five years beginning at age:

  1. 20.
  2. 35.
  3. 45.
  4. 50.


572 9.                     The primary blood cholesterol linked to increased CHD risk is:

  1. HDL.
  2. LDL.
  3. triglycerides.
  4. VLDL.


574 10.                  Low HDL levels:

  1. are highly predictive of CHD risk.
  2. are associated with underweight.
  3. are not a good predictor of CHD risk.
  4. are more prevalent in females.


574 11.                  If the TLC diet is adhered to closely, substantial lowering of cholesterol may be seen after:

  1. two weeks.
  2. three weeks.
  3. six weeks.
  4. twelve weeks.


574 12.                  In the TLC diet for lowering LDL cholesterol levels, saturated fatty acids are restricted to _____% of daily kcalories.

  1. 7
  2. 10
  3. 15
  4. 22


574 13.                  A person needing to lower her or his intake of saturated fat should avoid:

  1. nuts.
  2. baked goods.
  3. fish.
  4. legumes.


575 14.  The TLC diet to reduce elevated LDL cholesterol includes a total fat intake of _____ of daily kcalories.

  1. 20-25%
  2. 25-35%
  3. 35-40%
  4. 10-15%


575 15.  The TLC diet advocates a cholesterol intake of less than _____ milligrams per day.

  1. 100
  2. 200
  3. 300
  4. 400


575 16.                  The largest contributor of cholesterol in the American diet is:

  1. meat.
  2. fish.
  3. milk.
  4. eggs.


575 17.                  Which of the following is not true regarding trans fats?

  1. They raise LDL levels.
  2. They are found in foods made with partially hydrogenated oils.
  3. Their intake should be kept as low as possible.
  4. They raise HDL levels.


575 18.                  A fiber source that may be taken in supplement form to reduce cholesterol levels is:

  1. oat fiber.
  2. wheat bran.
  3. psyllium seed husks.
  4. fruit skins.


575 19.                  Plant stanols and sterols help to lower LDL and are often added to food products such as:

  1. margarine.
  2. bread.
  3. milk.
  4. cereal.

575-576                 20.  The benefits of eating fish for those who have previously suffered a heart attack include all of the following except:

  1. reducing blood clotting.
  2. stabilizing heart rhythm.
  3. lowering triglyceride levels.
  4. lowering LDL levels.


576 21.  Which of the following forms of exercise is not considered aerobic activity?

  1. cycling
  2. weight training
  3. stair-stepping
  4. cross-country skiing


576, 583                22.  Weight loss is associated with all of the following except:

  1. a decline in blood pressure.
  2. a decrease in LDL cholesterol.
  3. an increase in triglycerides.
  4. a decrease in insulin resistance.


578 23.                  Which of the following dietary factors raises triglyceride levels?

  1. high refined carbohydrate intake
  2. low soluble fiber intake
  3. high protein intake
  4. low fat intake


578 24.  Clinical trials have shown that a daily intake of _____ grams of fish oil supplements (EPA and DHA combined) taken under the supervision of a physician can lower triglyceride levels.

  1. 1 to 2
  2. 2 to 4
  3. 4 to 6
  4. 5 to 10


574-576                 25.  All of the following have been found to be protective against CHD except:

  1. antioxidant nutrient supplements.
  2. eating 2 fatty fish meals per week.
  3. dietary fiber.
  4. moderate consumption of alcohol.


579 26.                  A common side effect of diuretic medications is:

  1. dry mouth.
  2. nausea.
  3. increased taste perception.
  4. increased appetite.


578 27.                  Niacin taken in large doses:

  1. lowers blood triglycerides and raises HDL.
  2. lowers HDL and increases LDL.
  3. lowers blood triglycerides and lowers HDL.
  4. has no effect on blood lipid levels.


580 28.                  Several hours after a MI, the patient’s diet should consist of:

  1. foods restricted in sodium.
  2. increased portion sizes.
  3. more frequent meals.
  4. decreased carbohydrates.

582 29.                  Optimal resting blood pressure for adults is _____.

  1. <105 over <55 mm Hg
  2. <115 over <60 mm Hg
  3. <120 over <80 mm Hg
  4. <140 over <90 mm Hg


583 30.                  Which of the following is not a risk factor for hypertension?

  1. aging
  2. salt sensitivity
  3. alcohol abuse
  4. excessive calcium intake


583 31.  Lifestyle modifications that help in the treatment of hypertension include all of the following except:

  1. reducing weight, if overweight.
  2. reducing sodium intake.
  3. increasing calcium intake.
  4. restricting fluid intake.


583 32.                  Health authorities recommend that the diet for treatment of hypertension include increased amounts of these three nutrients:

  1. sodium, chloride, and potassium.
  2. calcium, phosphorus, and zinc.
  3. potassium, calcium, and magnesium.
  4. folate, vitamin B12, and calcium.


583-584                 33.  Compared to the typical American diet, the DASH diet provides:

  1. more fruits and vegetables.
  2. less milk and dairy products.
  3. more grains and fat.
  4. more meat.


583-584                 34.  The DASH diet limits the intake of:

  1. fiber.
  2. potassium.
  3. magnesium.
  4. saturated fat.


584 35.                  Which of the following increases the effectiveness of the DASH diet?

  1. low sodium intake
  2. high protein intake
  3. supplements of the water-soluble vitamins
  4. low potassium intake


584 36.                  To follow the DASH diet, you would tell patients to:

  1. choose fruit and unsalted pretzels as snacks.
  2. use bouillon cubes and soy sauce to flavor foods.
  3. avoid nuts and seeds.
  4. reduce the amount of fiber consumed.


584 37.                  The DASH diet for a person who needs 2000 kcal/day includes _____ servings from the fruit group per day.

  1. < 2
  2. 2-3
  3. 4-5
  4. 7-8

585 38.                  A patient who is following a low-sodium diet should avoid:

  1. canned fruit.
  2. fresh meat.
  3. tomato-based products.
  4. milk.


587 39.                  Chronic protein-energy malnutrition that develops as a consequence of heart failure is called _____.

  1. CHF
  2. cardiomegaly
  3. cardiac cachexia
  4. tachycardia


Case Study Questions


Use the following case study to answer questions 40-45.


572 40.                  How many diet-related risk factors for coronary heart disease does Mrs. Winslow have?

  1. 2
  2. 3
  3. 4
  4. 5


574 41.                  Assuming Mrs. Winslow’s 24-hour recall is typical of her eating habits, her high cholesterol is most likely due to a :

  1. high intake of saturated fat.
  2. high intake of fiber.
  3. low intake of polyunsaturated fat.
  4. low intake of simple sugars.


572 42.                  To reduce her risk of CHD, Mrs. Winslow’s LDL should be:

  1. <100 mg/dL
  2. <130 mg/dL.
  3. >140 mg/dL.
  4. >120 mg/dL.

572 43.  Mrs. Winslow’s HDL level is considered:

  1. desirable.
  2. borderline risk.
  3. high risk.
  4. no risk.



575 44.                  An alternate choice for the butter that Mrs. Winslow uses that could help lower her cholesterol is:

  1. stick margarine.
  2. margarine that contains plant sterols or stanols.
  3. soft margarine.
  4. margarine made from corn oil.


574 45.                  Based on her 24-hour recall, which of the following dietary recommendations is appropriate for Mrs. Winslow if she is to lower her blood lipids with diet alone?

  1. Eat more whole grains, legumes, fruits, and vegetables.
  2. Drink less milk and eat less ice cream.
  3. Choose foods high in insoluble fibers.
  4. Eat fewer carbohydrates and choose more high-protein foods.


Nutrition in Practice – Helping People with Feeding Disabilities


591 46.                  A common nutritional problem among people with disabilities is:

  1. decreased energy needs.
  2. increased protein needs.
  3. inadequate food intake.
  4. increased fluid needs.


591 47.                  All of the following health professionals become involved in the care of patients with feeding disabilities except the:

  1. nurse.
  2. occupational therapist.
  3. pharmacist.
  4. dietitian.


591 48.                  Which of the following team members works with the patient to demonstrate alternative feeding strategies?

  1. speech-language pathologist
  2. physical therapist
  3. occupational therapist
  4. dietitian


591 49.  In working with patients with disabilities, a valuable method for assessing current eating behaviors is:

  1. interviewing the patients.
  2. directly observing patients during mealtimes.
  3. conducting nutrition histories.
  4. talking with the occupational therapist.


593 50.                  People with tremors, spasticity, and uneven or jerky movements may benefit from the use of:

  1. a rocker knife.
  2. a cutout plastic cup.
  3. weighted utensils.
  4. a battery-powered feeding machine.


593 51.                  People with only one arm or hand may benefit from using a _____ when eating.

  1. utensil holder
  2. rocker knife
  3. flexible straw
  4. two-handed cup


Nursing Exam Review Questions


571 52.                  Mrs. Smith is a 59-year-old African-American female who is 5’ 2” tall and weighs 180 pounds. She is a smoker who engages in no physical activity, and her diet history shows a high intake of saturated fat and sodium as well as excess kcalories. Her lipid profile shows elevated LDL and decreased levels of HDL. In order to raise her HDL levels, the nurse recommends that Mrs. Smith:

  1. quit smoking.
  2. eat less saturated fat.
  3. consume less sodium.
  4. take fish oils.


574 53.                  A patient’s lipid profile shows elevated total cholesterol and LDL. The nurse recommends which of the following nutrition interventions?

  1. eat less fiber
  2. consume less saturated fat
  3. consume less polyunsaturated fat
  4. eat more protein


575 54.                  A patient is advised to follow the TLC diet to lower LDL cholesterol. If the patient’s daily caloric intake is 2000 kcalories, fat intake should be restricted to _____ grams per day.

  1. 44-78
  2. 56-78
  3. 44-67
  4. 56-67


574-575                 55.  The nurse is working with a patient who has been placed on the TLC diet to reduce his elevated LDL cholesterol. This patient needs 2800 kcalories/day to maintain his desirable body weight. Which of the following is consistent with this patient’s diet prescription?

  1. 98-123 grams fat; < 50 grams saturated fat; < 75 milligrams cholesterol
  2. 62-109 grams fat; < 45 grams saturated fat; < 300 milligrams cholesterol
  3. 78-109 grams fat; < 21 grams saturated fat; < 200 milligrams cholesterol
  4. 90-112 grams fat; < 24 grams saturated fat; < 200 milligrams cholesterol


575 56.                  The nurse recognizes that an effective way to lower LDL cholesterol levels is to:

  1. use reduced-fat margarine.
  2. use margarines made with plant sterols.
  3. switch from butter to margarine.
  4. use butter instead of margarine.


575 57.                  The nurse is counseling a patient who recently had a heart attack. Which of the following dietary recommendations would be most appropriate?

  1. eat two servings of fatty fish per week
  2. consume more whole grains
  3. consume fewer fruits and vegetables
  4. use salt substitutes


576 58.                  The patient asks the nurse about the effects of physical activity on CHD risk. The nurse states that:

  1. physical activity is not important in a program to reduce CHD risk.
  2. weight training can dramatically raise HDL if undertaken regularly.
  3. diet, rather than physical activity, should be the primary focus of reducing CHD risk.
  4. 30 minutes of moderate exercise on most days can reverse many risk factors for CHD.


578 59.  A patient’s lab work shows severe hypertriglyceridemia. The nurse understands that the patient’s fat intake should be limited to _____% of kcalories per day.

  1. 5
  2. 15
  3. 20
  4. 35


583-584                 60.  The nurse is instructing a patient on a diet for the treatment of his hypertension. The nurse recognizes that the patient understands his diet when he says:

  1. “I can freely use salt substitutes and low-sodium products.”
  2. “I can eat any foods I want in moderate amounts.”
  3. “I need to increase my intake of fresh fruits, vegetables, whole grains, and milk and milk products.”
  4. “I don’t need to be concerned about the amount of alcohol I drink.”


583-584                 61.  The patient demonstrates understanding of the DASH diet when he can verbalize:

  1. “I should drink less milk.”
  2. “I should avoid red meat and alcohol.”
  3. “I should consume more fruits and vegetables.”
  4. “I should restrict my intake of fatty fish.”


579 62.                  A patient has begun taking furosemide to manage heart failure. Which of the following foods should the nurse recommend that the patient consume frequently?

  1. legumes
  2. peanut butter
  3. bananas
  4. milk


587 63.                  A patient with heart failure complains of a poor appetite and weakness, and the nurse notices that the patient has begun losing weight. The nurse recognizes this as:

  1. cardiac cachexia.
  2. anorexia nervosa.
  3. cardiomyopathy.
  4. myocardial infarction.


581 64.                  The nurse feeding a patient who has had a stroke observes that the patient is having difficulty swallowing the foods on her tray. The nurse recognizes this as:

  1. angina.
  2. Syndrome X.
  3. dysphagia.
  4. cardiac cachexia.

581 65.                  The nurse is working with a patient who recently had a stroke. The patient frequently chokes and coughs when eating and is having difficulty feeding herself. The nurse understands that the best way to insure adequate nutrition for the patient may be:

  1. to have an aid feed her each meal.
  2. to tube feed the patient.
  3. to ask a family member to be present at each meal.
  4. to place the patient on TPN.





569-570         1.     Describe how atherosclerosis develops.


574-576         2.     Describe the TLC diet.


574-576         3.     Summarize the therapeutic lifestyle changes for lowering the risk of coronary heart disease.


578                 4.     Explain the medical nutrition therapy for hypertriglyceridemia.


580                 5.     Describe the appropriate dietary intervention for a heart attack victim once he or she has been stabilized.


582-583         6.     Describe the risk factors for the development of hypertension.


583-585         7.     Describe characteristics of the DASH diet and results of using the diet in clinical trials.


581                 8.     Describe complications that affect the food intake of stroke victims.



Case Study Essay Questions


HR Manager with Stroke: Steve Daniels is a 53-year-old male who works as a human resource manager. He is obese (BMI of 34), has a history of hypertension, and has smoked a pack of cigarettes a day for the past 32 years. He recently had an episode in which he experienced weakness on one side, double vision, and slurred speech for approximately 20 minutes. His wife called 911 and he was taken to the emergency room. Examination by emergency room personnel determined his blood pressure to be 172/105. A serum lipid profile was performed and the results were as follows: Triglycerides 250 mg/dL; Total cholesterol 265 mg/dL; LDL 217 mg/dL; HDL 29 mg/dL. The physician diagnosed Mr. Daniels as having had a stroke.


  1. What are Mr. Daniels’s risk factors for stroke?
  2. Name and describe three different types of stroke.
  3. What is the most common type of stroke?
  4. Mr. Daniels’ stroke was short-lived. What is the term used for this type of stroke?
  5. What lifestyle changes can Mr. Daniels make to reduce his risk of another, possibly more severe stroke?






a.     a blood clot formed within a blood vessel that remains attached to its place of origin.

b.     a chronic, progressive disease characterized by obstructed blood flow in the coronary arteries.

c.     a condition caused by ischemia in the heart muscle that results in discomfort or dull pain in the chest region.

d.     a general term describing diseases of the heart and blood vessels.

e.     an accumulation of fatty deposits, smooth muscle cells, and fibrous connective tissue in blood vessels.

f.     an abnormal enlargement or bulging of a blood vessel caused by damage to or weakness in the blood vessel wall.

g.     an abnormal particle, such as a blood clot or air bubble, that travels in the blood.

h.     a sudden injury to brain tissue resulting from impaired blood flow through an artery that supplies blood to the brain; also called a cerebrovascular accident.

i.      a type of artery disease characterized by accumulations of fatty material on the inner walls of arteries.

j.      death of heart muscle caused by a sudden reduction in coronary blood flow; also called a heart attack or cardiac arrest.

k.     inadequate blood supply within tissues due to obstructed blood flow in the arteries.

l.      the formation or presence of a blood clot in blood vessels.

m.   the obstruction of a blood vessel by an embolus, causing sudden tissue death.

n.     severe pain and weakness in the legs caused by inadequate blood supply to the muscles.



a.     desirable total blood cholesterol

b.     high-risk total blood cholesterol

c.     desirable LDL

d.     high-risk LDL

e.     desirable HDL

f.     high-risk HDL

g.     desirable fasting triglycerides

h.     high-risk fasting triglycerides

i.      desirable blood pressure

j.      high-risk blood pressure



Chapter 23 – Protein-, Mineral-, and Fluid-Modified Diets
for Kidney Diseases


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




596 1.                     The medical nutrition therapy for nephrotic syndrome helps to prevent protein-energy malnutrition, correct lipid abnormalities, and alleviate edema.


600 2.                     Recovery from kidney injury may begin with a period of diuresis and a patient’s fluid status should be monitored closely.


602 3.                     A glomerular filtration rate < 29 indicates kidney failure and the need for dialysis.


603 4.                     Adults with chronic kidney disease frequently develop wasting and PEM.


604, 605                5.     Predialysis chronic kidney disease patients have higher protein needs than those on hemodialysis.


605 6.                     Prior to the need for dialysis, most renal patients are unable to handle normal intakes of potassium.


606 7.                     Supplementation of all fat-soluble vitamins is necessary in patients with chronic kidney disease.


Nutrition in Practice – Dialysis


616 8.                     Dialysis removes excess fluids and wastes from the blood by employing the principles of diffusion, osmosis, and ultrafiltration.


Multiple Choice


595 1.                     Which of the following is not a function of the kidneys?

  1. maintaining blood pressure
  2. regulating electrolyte concentrations
  3. maintaining acid-base balance
  4. converting vitamin K to its active form


595 2.     The part of the kidney that acts like a sieve to filter wastes is the:

  1. filtrate.
  2. glomerulus.
  3. tubule.
  4. lobe.


596 3.                     Nephrotic syndrome is a result of:

  1. damage to the glomeruli.
  2. damage to the tubules.
  3. excessive protein intake.
  4. excessive fat intake.


596 4.                     Manifestations of the nephrotic syndrome include:

  1. low serum albumin.
  2. uremia.
  3. low blood lipids.
  4. dehydration.


596 5.                     One of the effects of nephrotic syndrome is a loss of vitamin D. This can result in _____ in children.

  1. growth failure
  2. poor appetite
  3. rickets
  4. type 1 diabetes


596-597                 6.     Which of the following dietary components is controlled in nephrotic syndrome?

  1. sodium
  2. protein
  3. carbohydrate
  4. calcium


597 7.                     Patients with nephrotic syndrome may require supplements of:

  1. vitamin D and calcium.
  2. essential fatty acids.
  3. essential amino acids.
  4. thiamin and magnesium.


599 8.                     If heart failure leads to acute renal failure, it is considered a _____ factor.

  1. primary
  2. prerenal
  3. preventable
  4. postrenal


599 9.                     Consequences of acute kidney injury include all of the following except:

  1. oliguria or anuria.
  2. sodium retention.
  3. the inability to metabolize nutrients.
  4. elevated levels of potassium, phosphate, and magnesium.


599 10.                  In patients with acute kidney injury, oliguria leads to:

  1. bone loss due to hyperphosphatemia.
  2. edema due to increased urine production.
  3. an increase in blood potassium levels due to excessive excretion of parathyroid hormone.
  4. production of at least 800 mL of urine per day.


595, 599                11.  In kidney disease, the kidneys cannot excrete _____ in the urine.

  1. ammonia
  2. iron
  3. potassium
  4. urea


599-602                 12.  Which of the following statements is true?

  1. BUN typically falls suddenly after an acute kidney injury.
  2. Creatine is a nitrogenous waste product derived from creatinine.
  3. The terms uremia and azotemia are interchangeable.
  4. Parathyroid hormone secretion typically increases in chronic kidney disease.


599 13.                  About half of patients with acute kidney injury experience oliguria. This means that they produce less than _____ milliliters of urine per day.

  1. 400
  2. 600
  3. 800
  4. 1,000


600 14.                  Lasix is a drug used to:

  1. mobilize fluids.
  2. lower cholesterol.
  3. prevent PEM.
  4. activate vitamin D.


600 15.                  The diet for acute kidney injury is usually restricted to about _____ grams of protein per kilogram of body weight per day for those patients who are not on dialysis.

  1. 0.2-0.5
  2. 0.4-0.8
  3. 0.8-1.2
  4. 1.0-1.5


601 16.                  In acute kidney injury, fluid needs are determined by measuring urine output and adding _____ milliliters.

  1. 200
  2. 300
  3. 400
  4. 500


600-601                 17.  In patients with acute renal failure, all of the following may be restricted except:

  1. fluids.
  2. potassium.
  3. sodium.
  4. carbohydrate.


602 18.                  One of the most common causes of chronic kidney disease is:

  1. diabetes.
  2. infectious diseases.
  3. genetic disorders.
  4. inflammatory diseases.


603 19.                  The treatment of _____ is critical for slowing the progression of chronic kidney disease and reducing the risk of cardiovascular disease.

  1. anemia
  2. gout
  3. hypertension
  4. depression


602 20.                  Kidney disease is classified according to:

  1. GFR.
  2. the ratio of albumin to creatinine in a urine sample.
  3. BUN levels.
  4. the degree of proteinuria.


602-603 21.                  Secondary complications of chronic kidney disease include:

  1. type 1 diabetes.
  2. bone disease.
  3. stroke.
  4. hypotension.


603 22.                  Acidosis can worsen:

  1. blood pressure.
  2. malnutrition.
  3. renal osteodystrophy.
  4. GFR.


603 23.                  The various symptoms and complications that develop in the final stages of chronic kidney disease are collectively referred to as:

  1. anemia.
  2. PEM.
  3. uremic syndrome.
  4. syndrome X.


603 24.                  Common clinical symptoms of uremic syndrome include all of the following except:

  1. anemia.
  2. mental dysfunctions.
  3. heart muscle enlargement.
  4. hypokalemia.


603 25.  Likely potential causes for the anorexia associated with chronic kidney disease include all of the following except:

  1. hormonal disturbances.
  2. infection.
  3. restrictive diets.
  4. medications.


604 26.  If a patient is on peritoneal dialysis, his diet should contain less _____ than other renal diets.

  1. fat
  2. protein
  3. vitamins
  4. carbohydrate


604 27.                  Weight gain can become a problem when peritoneal dialysis continues for an extended period of time. This is likely due to:

  1. the kcalories contributed by the dialysate.
  2. a less restrictive diet.
  3. food cravings experienced by the patient.
  4. the body’s adaptation to dialysis.


604, 605                28.  Mrs. Clark weighs 59 kilograms, is in an early stage of chronic kidney disease, and is not yet on dialysis. How much protein should her daily diet include?

  1. 24 – 30 grams
  2. 35 – 44 grams
  3. 47 – 71 grams
  4. 59 – 66 grams


604-605                 29.  Which of the following needs takes priority in planning a renal diet?

  1. adjustment of protein
  2. adjustment of simple carbohydrate
  3. adjustment of fat
  4. adjustment of fiber


604-605 30.                  The ideal renal diet provides enough protein to:

  1. give the patient an adequate kcaloric intake.
  2. keep blood ammonia levels stable.
  3. decrease liver hyperactivity.
  4. meet the patient’s needs and prevent wasting.


605 31.                  To ensure an adequate intake of the essential amino acids, a patient with chronic kidney disease should consume:

  1. animal protein sources only.
  2. plant protein sources only.
  3. 50% of protein from high-quality protein sources.
  4. essential amino acid supplements.


604, 605                32.  Once dialysis is initiated in a patient with chronic kidney disease, protein intake:

  1. is less restrictive.
  2. is more restrictive.
  3. remains the same.
  4. emphasizes the addition of nonessential amino acid sources.


605 33.                  Patients with chronic kidney disease are often encouraged to consume high-fat foods to improve their energy intake. An appropriate high-fat food choice for a renal patient is:

  1. fried fish.
  2. peanuts.
  3. cheese.
  4. ice cream.


605 34.                  Foods considered part of the fluid allowance in a renal diet include all of the following except:

  1. gelatin.
  2. popsicles.
  3. grapes.
  4. ice milk.


604, 605                35.  Compared to a hemodialysis patient, a peritoneal dialysis patient is allowed a more liberal intake of:

  1. kcalories.
  2. phosphorus.
  3. potassium.
  4. calcium.


604 36.  Protein-restricted diets naturally curb the intake of:

  1. sodium.
  2. phosphorous.
  3. potassium.
  4. vitamin B6.


606-607                 37.  People with chronic kidney disease frequently develop vitamin deficiencies due to all of the following except:

  1. restrictive diets.
  2. loss of vitamins during dialysis.
  3. steatorrhea.
  4. altered metabolism.


606 38.                  Which of the following foods is high in phosphorus?

  1. cheese
  2. oatmeal
  3. carrots
  4. broccoli


606 39.  The patient on a renal diet will usually need supplements of:

  1. sodium, potassium, and fat-soluble vitamins.
  2. vitamin B6, folate, and calcium.
  3. phosphorus, iron, and calcium.
  4. potassium, phosphorus, and vitamin D.


605 40.                  The most appropriate food to recommend for supplementing kcalories in the renal diet is:

  1. margarine.
  2. cheese.
  3. whole milk.
  4. a chocolate candy bar.


607 41.                  The most effective way to improve the iron status of patients undergoing dialysis is:

  1. oral supplements in conjunction with erythropoietin therapy.
  2. IV administration.
  3. IV administration in conjunction with erythropoietin therapy.
  4. increasing intake of iron-rich foods.


608 42.                  For patients on fluid-restricted diets who experience extreme thirst, you should suggest:

  1. adding lemon juice to water to make it more refreshing.
  2. drinking black coffee, as it has no kcalories.
  3. eating salt-free saltines (soda crackers).
  4. eating ice, as it doesn’t count as a liquid.


608 43.                  The potassium content of vegetables can be reduced by a process called:

  1. steaming.
  2. sautéing.
  3. leaching.
  4. boiling.


607 44.                  As compared to standard formulas, enteral formulas suitable for chronic kidney disease have all of the following characteristics except:

  1. they are more calorically dense.
  2. they are lower in protein.
  3. they are lower in electrolytes.
  4. they contain more water.


609 45.                  Side effects of immunosuppressive drug therapy following a kidney transplant may include all of the following except:

  1. glucose intolerance.
  2. fluid retention.
  3. malabsorption of nutrients.
  4. foodborne infection.

609 46.  Following kidney transplantation, dietary restrictions:

  1. are more strict.
  2. are more liberalized.
  3. can replace immunosuppressive therapy.
  4. determine whether the body rejects the kidney.


609 47.                  All of the following dietary guidelines are appropriate immediately after a kidney transplant except:

  1. sodium is generally unrestricted.
  2. < 300 milligrams cholesterol.
  3. protein intake based on the RDA.
  4. £ 7-10% of total kcalories from saturated fat.


610 48.                  Calcium oxalate stones usually result from:

  1. hypercalciuria.
  2. hyperkalemia.
  3. hyperphosphatemia.
  4. hypercholesterolemia.


610 49.                  Hypercalciuria can result from all of the following except:

  1. excessive calcium absorption.
  2. impaired calcium reabsorption.
  3. elevated serum levels of parathyroid hormone.
  4. impaired absorption of vitamin C.


611 50.                  Foods high in oxalate include:

  1. spinach.
  2. milk.
  3. bread.
  4. apples.


611 51.  The best way to prevent the formation of kidney stones is to:

  1. minimize calcium intake.
  2. eat less meat.
  3. eat fewer oxalate-containing vegetables.
  4. drink 12 to 16 cups of fluids per day.


Case Study Questions


Use the following case study to answer questions 52-57.

Dennis Wilson is a 57-year-old chemical engineer who has had type 1 diabetes since he was 12 years old. He spent 34 years working in oil refineries, and he is a smoker. He is 5’11” tall and weighs 160 pounds. Over the past several years, he has experienced a gradual decline in kidney function. His GFR has declined to 27 mL/min per 1.73 m2.


602 52.                  Mr. Wilson’s GFR is indicative of Stage _____ chronic kidney disease.

  1. 2
  2. 3
  3. 4
  4. 5


603 53.                  The primary goal(s) of medical nutrition therapy for Mr. Wilson at this time should be:

  1. lowering his blood cholesterol level.
  2. preventing PEM and weight loss.
  3. treating him for iron-deficiency anemia.
  4. preventing osteoporosis.

604 54.                  Mr. Wilson’s energy needs should be estimated using:

  1. 25 kcal/kg.
  2. 30 kcal/kg.
  3. 35 kcal/kg.
  4. 40 kcal/kg.


604 55.                  Protein intake for Mr. Wilson should:

  1. be restricted due to the lack of renal function.
  2. be increased due to PEM.
  3. be limited to plant protein foods.
  4. be limited to animal protein foods.


604, 605                56.  Mr. Wilson’s laboratory reports indicate hyperkalemia. His intake of _____ should be restricted.

  1. protein
  2. sodium
  3. phosphorus
  4. potassium


602 57.                  The likely cause of Mr. Wilson’s chronic kidney disease is:

  1. his history of type 1 diabetes.
  2. exposure to chemicals in the workplace.
  3. his history of smoking.
  4. unknown.


Nutrition in Practice – Dialysis


617 58.  Which of the following statements is true?

  1. The chemical composition of the dialysate does not affect the movement of solutes across the semipermeable membrane.
  2. Bicarbonates are added to a dialysate for a person with acidosis.
  3. When the concentration of a substance is higher in the dialysate than in the blood, the substance will diffuse out of the blood.
  4. Dialysate contains no urea or potassium.


617 59.                  Which of the following is the most common method used to gauge the adequacy of dialysis treatment?

  1. pressure gradient
  2. serum phosphorus
  3. serum albumin
  4. urea kinetic modeling


617 60.                  One potential complication of hemodialysis is:

  1. infections.
  2. hypertension.
  3. edema.
  4. hemochromatosis.


616-617 61.                  Dialysis reduces all of the following symptoms except:

  1. uremia.
  2. edema.
  3. hypertension.
  4. anemia.


617 62.                  The nurse in the dialysis unit understands that patients may experience various complications during hemodialysis. Which of the following is not a common complication during hemodialysis?

  1. headache
  2. hypotension
  3. muscle cramps
  4. severe pain


617 63.                  The nurse understands that patients on peritoneal dialysis may experience all of the following side effects except:

  1. weight gain.
  2. hyperglycemia.
  3. lactose intolerance.
  4. hypertriglyceridemia.


Nursing Exam Review Questions


596 64.                  A patient is admitted to the emergency room and is found to have proteinuria, a low serum albumin, edema, and elevated blood lipids. The nurse recognizes these symptoms as those associated with:

  1. rejection of a kidney transplant.
  2. acute kidney injury.
  3. nephrotic syndrome.
  4. kidney stones.


596 65.                  A patient with nephrotic syndrome has an albumin level of 2.1 mg/dL. The nurse realizes that this is likely to cause _____ in the patient.

  1. edema
  2. infection
  3. rickets
  4. altered blood lipids


600 66.                  A patient presents with elevated BUN and creatinine and elevated blood pressure. He complains of fatigue, nausea, vomiting, confusion, and anorexia. The nurse recognizes these as symptoms of:

  1. uremia.
  2. diuresis.
  3. renal osteodystrophy.
  4. gout.


600-601                 67.  It is necessary to monitor the fluid status of renal patients. The nurse understands that all of the following are indicative of fluid status except:

  1. condition of the nails.
  2. blood pressure.
  3. appearance of the skin.
  4. pulse rate.


601 68.                  A patient with acute kidney injury has a urine output of 500 milliliters per day. The nurse determines his daily fluid needs to be:

  1. 500 milliliters.
  2. 800 milliliters.
  3. 1000 milliliters.
  4. 1200 milliliters.


605 69.                  The nurse recognizes that a rise in body weight and blood pressure suggests that a patient:

  1. is retaining sodium and fluid.
  2. is experiencing improved appetite.
  3. needs to increase his/her intake of potassium.
  4. needs to increase his/her fluid intake.


604 70.                  John is a 56-year-old male who started hemodialysis a week ago. He weighs 174 pounds. The nurse recognizes that an appropriate diet prescription for him should read:

  1. 1975 kcalories; 95 grams protein; 4 grams sodium.
  2. 2370 kcalories; 63 grams protein; 3 grams sodium.
  3. 2768 kcalories; 95 grams protein; 2 grams sodium; 2 grams potassium.
  4. 2768 kcalories; 63 grams protein; 3 grams sodium; 3 grams potassium.


606 71.                  The nurse is instructing a hemodialysis patient on her diet. She correctly tells the patient to:

  1. use low-sodium products as desired.
  2. consume foods high in phosphorus such as milk, fish, and nuts.
  3. place an emphasis on fresh fruits and vegetables in the diet.
  4. avoid salt substitutes that contain potassium.


606 72.                  The nurse recognizes that patients with chronic kidney disease need generous amounts of these water-soluble vitamins:

  1. vitamin B6 and folate.
  2. folate and vitamin C.
  3. vitamin C and vitamin B6.
  4. vitamins B6 and B12.


603, 607                73.  The nurse understands that patients with diseased kidneys will lack adequate production of erythropoietin, which will cause the development of:

  1. rickets.
  2. uremic syndrome.
  3. pernicious anemia.
  4. iron-deficiency anemia.


608 74.                  A patient with renal disease is restricted to 2 liters of water per day and complains of thirst. The nurse offers the following suggestion for controlling thirst:

  1. “Gargle with refrigerated mouthwash.”
  2. “Suck on ice chips throughout the day.”
  3. “Consume more melons and other fruits high in water.”
  4. “Use popsicles to control thirst.”


609 75.  Following kidney transplantation, dietary restrictions are generally liberalized; however, if fluid retention and hypertension are present, the nurse understands that a restriction in _____ may be necessary.

  1. protein
  2. potassium
  3. calcium
  4. sodium


611 76.                  A 52-year-old male patient recently required surgery for the removal of a large calcium oxalate stone. To prevent further stone formation, the nurse instructs him to consume plenty of fluids, but advises against drinking:

  1. apple juice.
  2. coffee.
  3. tea.
  4. draft beer.





604                 1.     Why is kcalorie intake extremely important in the nutrition care of patients with chronic kidney disease?


604-606         2.     Suggest appropriate amounts of protein, sodium, potassium, and fluids for a patient on hemodialysis.


607                 3.     Why is the renal diet a difficult diet to adhere to?


608                 4.     Discuss techniques to use in increasing a patient’s compliance with renal diets.


611-612         5.     Describe the appropriate dietary treatment for different types of kidney stones, including calcium, oxalate, uric acid, and cystine.



Case Study Essay Questions


Refinery Worker with History of Kidney Stones: Steve Forbes is a 52-year-old refinery worker who wrecked his motorcycle on the way to work one morning. He was taken to the emergency room with multiple broken bones, and a CT scan was performed to rule out internal injuries. Incidentally, the results of the CT scan showed that Mr. Forbes had two large stones in his right kidney. After Mr. Forbes’s broken bones healed, he underwent surgery to have the kidney stones removed. An analysis of the stones determined that they were calcium oxalate stones. Two years later, Mr. Forbes experienced severe back pain, nausea, and the inability to urinate. He returned to the emergency room for treatment.


  1. What is a kidney stone and how does one develop?
  2. What are the possible causes of Mr. Forbes’s calcium oxalate stone?
  3. What is the likely cause of Mr. Forbes’ second trip to the emergency room with back pain?
  4. Describe the medical nutrition therapy for calcium oxalate stones.
  5. What types of medications are used to treat calcium oxalate stones?






a.     a syndrome associated with kidney disorders characterized by urinary protein losses exceeding 3.5 g per day.

b.     an advanced stage of chronic kidney disease in which dialysis or a kidney transplant is necessary to sustain life.

c.     the cluster of symptoms associated with inadequate kidney function; the symptoms reflect fluid, electrolyte, and hormonal imbalances; altered heart function; neuromuscular disturbances; and other metabolic derangements.

d.     crystalline masses that form in the urinary tract; also called renal calculi and nephrolithiasis.

e.     a metabolic disorder characterized by elevated uric acid in the blood and urine and the deposition of uric acid in and around the joints, causing acute joint inflammation.

f.     an inherited disorder characterized by elevated urinary excretion of several amino acids, including cystine.

g.     a bone disorder that develops in patients with chronic kidney disease as a consequence of increased secretion of parathyroid hormone, reduced serum calcium, acidosis, and impaired vitamin D activation by the kidneys.

h.     the substances that pass through the glomerulus and travel through the nephron’s tubules, eventually forming urine.

i.      a hormone made by the kidneys that stimulates red blood cell production.



a.     loss of protein, especially albumin, in the urine; also known as albuminuria.

b.     abrupt decline in kidney function over a period of hours or days.

c.     an abnormally low amount of urine, often less than 400 mL per day.

d.     elevated serum potassium levels.

e.     elevated serum phosphate levels.

f.     the accumulation of nitrogenous and various other waste products in the blood.

g.     increased urine production.

h.     low serum potassium levels.

i.      elevated serum calcium levels.

j.      elevated urinary calcium levels.

k.     elevated urinary oxalate levels.

l.      the intense pain that occurs when a kidney stone passes through the ureter.

m.   blood in the urine.

n.     the solution used in dialysis to draw wastes and fluids from the blood.



Chapter 24 – Energy- and Protein-Modified Diets
for Metabolic and Respiratory Stress


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




620 1.                     Metabolic stress can result from uncontrolled infection or extensive tissue injury.


622 2.                     The inflammatory process can alter immune cell function in the body.


622 3.                     The symptoms associated with the whole-body inflammatory response to severe illness are collectively called the systemic inflammatory response syndrome.


621, 632                4.     An excessive response to metabolic stress can worsen illness and lead to death.


621, 623                5.     Recovery from an injury or illness can be hastened by hypermetabolism and positive nitrogen balance.


623 6.                     Overfeeding an acutely stressed patient improves nitrogen balance and decreases lean tissue losses.


625 7.                     The high nutrient requirements of acutely stressed patients often require a patient to be fed via the enteral or parenteral route to meet his or her nutritional needs.


627 8.                     Smoking is the primary risk factor in most cases of COPD.


630 9.                     Nutrition care for patients in acute respiratory failure is aimed at providing a low-fat, high-carbohydrate diet.


630 10.                  Excessive energy intake in patients with ARDS can worsen  respiratory function.


Multiple Choice


620 1.                     The increase in basal metabolic rate as a part of the stress response can be attributed to:

  1. catecholamines.
  2. cortisol.
  3. eicosanoids.
  4. cytokines.


621 2.                     Protein synthesis is inhibited by excess production of:

  1. cortisol.
  2. eicosanoids.
  3. mast cells.
  4. phagocytes.


621 3.                     The adverse effects of cortisol in prolonged stress include all of the following except:

  1. muscle wasting.
  2. bone loss.
  3. impaired wound healing.
  4. hypoglycemia.


622 4.     Which of the following substances is derived from fatty acids?

  1. cortisol
  2. eicosanoids
  3. antihistamines
  4. cytokines


622 5.                     Which of the following compounds is produced by white blood cells and participates in the inflammatory process?

  1. glucagon
  2. catecholamines
  3. cytokines
  4. cortisol


622 6.                     Complications associated with SIRS or sepsis include all of the following except:

  1. tissue edema.
  2. low blood pressure.
  3. hypertriglyceridemia.
  4. impaired blood flow.


623 7.                     One of the initial concerns for the medical team for patients hospitalized with acute stress is to:

  1. maintain immune function.
  2. achieve positive nitrogen balance.
  3. minimize nutrient losses.
  4. restore lost fluids and electrolytes.


623 8.                     Clinical findings typical of patients undergoing metabolic stress include all of the following except:

  1. hyperglycemia.
  2. hypermetabolism.
  3. insulin resistance.
  4. positive nitrogen balance.


623-624                 9.     The nutrition objectives during stress are to provide a diet that does all of the following except:

  1. maintains immune defenses.
  2. promotes healing.
  3. increases hypermetabolism.
  4. preserves muscle tissue.


623 10.                  The energy expenditure of acutely stressed patients may be raised due to all of the following except:

  1. fever.
  2. mechanical ventilation.
  3. presence of open wounds.
  4. inactivity.


623 11.                  Which of the following methods was developed for estimating energy needs in a ventilator-dependent patient with traumatic and/or burn injuries?

  1. Ireton-Jones energy equation
  2. indirect calorimetry
  3. Harris-Benedict equation
  4. 25-30 kcalories/kg body weight


623 12.                  Estimate the energy needs of a patient with sepsis who weighs 180 pounds.

  1. 2045-2455 kcal
  2. 2250-2700 kcal
  3. 1980-2125 kcal
  4. 2365-3050 kcal


624 13.  Laura is a burn patient. She is 5’4” tall and weighs 150 pounds. What are Laura’s protein needs?

  1. 34-40 grams
  2. 54-60 grams
  3. 105-136 grams
  4. 136-204 grams


624 14.  Which of the following amino acids has been shown to have beneficial effects on critically ill patients?

  1. leucine
  2. glutamine
  3. valine
  4. isoleucine


624 15.                  Which amino acid may have beneficial effects on the immune response of postoperative patients?

  1. glutamine
  2. tyrosine
  3. arginine
  4. phenylalanine


624 16.                  A parenteral feeding should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute.

  1. 2
  2. 3
  3. 4
  4. 5


624 17.                  In critically ill patients, a high intake of _____ may suppress immune function and increase the risk of developing infections.

  1. fat
  2. dextrose
  3. protein
  4. zinc


625 18.                  All of the following nutrients play a critical role in immunity and wound healing except:

  1. zinc.
  2. vitamin A.
  3. vitamin C.
  4. potassium.


625 19.                  Increased energy metabolism in hypermetabolic patients is associated with the need for increased amounts of:

  1. vitamin C.
  2. zinc.
  3. B vitamins.
  4. vitamin E.


627-628                 20.  Medical nutrition therapy for COPD involves all of the following except:

  1. promoting a healthy body weight.
  2. preventing muscle loss.
  3. improving food intake.
  4. relieving chronic cough.


628 21.                  Which of the following is not a cause of poor food intake in persons with severe COPD?

  1. medications
  2. dyspnea
  3. lower energy needs
  4. change in taste perception


628 22.                  A COPD patient who complains of abdominal discomfort and dyspnea may benefit from:

  1. small, frequent meals.
  2. a low-fat diet.
  3. a high-fiber diet.
  4. consuming more liquids.


628 23.  Adequate fluid intake will help the person with COPD by:

  1. decreasing carbon dioxide output.
  2. preventing the secretion of overly thick mucus.
  3. aiding in weight loss.
  4. improving oxygen consumption.


628 24.                  Excessive kcalorie intake in COPD patients may:

  1. increase respiratory distress.
  2. alter taste perception.
  3. interfere with drug therapy.
  4. increase gas formation.


630 25.  When pulmonary edema is present, a patient requires:

  1. tube feeding.
  2. a fluid restriction.
  3. increased fluids.
  4. decreased protein.


Case Study Questions


Use the following case study to answer questions 26-31.

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5’2” tall and weighs 115 pounds.


623 26.                  The most immediate nutrition concern for Kati is:

  1. restoring fluid and electrolyte balance.
  2. starting parenteral nutrition.
  3. estimating her energy needs.
  4. assessing her swallowing ability.


623 27.                  Estimate Kati’s energy needs using the Ireton-Jones equation:
1925 + [5 ´ wt (kg)] – [10 ´ age (yr)] + (281 ´ sex) + (292 ´ trauma) + (851 ´ burn). You must insert the appropriate numbers for gender, trauma, and burn.

  1. 2288
  2. 2569
  3. 3420
  4. 3240


624 28.                  Kati’s protein needs will likely be calculated using a range of:

  1. 0.6 to 0.8 g/kg.
  2. 0.8 to 1.0 g/kg.
  3. 1.2 to 2 g/kg.
  4. 2 to 3 g/kg.


622, 625                29.  As a result of the acute-phase response, you would expect Kati’s plasma concentrations of _____ to decrease.

  1. glucose and cholesterol
  2. sodium and potassium
  3. iron and glucose
  4. albumin and iron


623 30.                  To decrease the risk of infection, it will be important to keep Kati’s _____ under control while she is recovering.

  1. serum albumin
  2. blood glucose
  3. blood pressure
  4. serum prealbumin


623-624                 31.  If Kati’s enteral feeding is not providing adequate energy and protein to meet her nutritional needs, she will experience:

  1. a loss of lean tissue.
  2. hyperglycemia.
  3. pulmonary edema.
  4. sepsis.


Nutrition in Practice – Multiple Organ Dysfunction Syndrome


634 32.                  A frequent cause of death among older intensive care patients with multiple or severe injuries is:

  1. pulmonary edema.
  2. heart attack.
  3. multiple organ dysfunction syndrome.
  4. stroke.


634 33.                  The first organ to fail in MODS is normally the:

  1. lungs.
  2. liver.
  3. kidneys.
  4. heart.


635 34.                  One of the factors that increases the risk of MODS is:

  1. age over 40 years.
  2. length of hospital stay.
  3. malnutrition.
  4. obesity.


635 35.                  The principal infection associated with MODS is:

  1. pneumonia.
  2. a fungal infection.
  3. herpes simplex.
  4. a viral infection.


635 36.                  All of the following are therapies used to manage MODS except:

  1. mechanical ventilation.
  2. fluid resuscitation.
  3. hemofiltration or dialysis.
  4. physical therapy.


635 37.                  Nutrition support plays a role in the therapy for MODS in all of the following ways except:

  1. providing nutrients.
  2. preventing excessive wasting.
  3. promoting recovery.
  4. maintaining blood pressure.


Nursing Exam Review Questions


621 38.                  The nurse recognizes all of the following as the classic signs of inflammation except:

  1. hyperglycemia.
  2. swelling.
  3. redness.
  4. heat.


622 39.                  John has been hospitalized with a severe infection in his foot. The nurse recognizes that increasing his intake of _____ may help to suppress the inflammation.

  1. protein
  2. omega-3 fatty acids
  3. carbohydrate
  4. omega 6-fatty acids


622 40.                  The nurse understands that the inflammatory process can cause a variety of systemic effects and monitors her patient’s:

  1. heart rate, respiratory rate, and temperature.
  2. heart rate, appetite, and blood pressure.
  3. blood pressure, temperature, and appetite.
  4. blood pressure, heart rate, and weight.


623 41.                  A patient is admitted to the ER with multiple gunshot wounds. The nurse understands that the initial treatment includes:

  1. beginning enteral nutrition.
  2. administering IV fluids.
  3. beginning PPN.
  4. referral to the dietitian.


630 42.                  A patient who is on a tube feeding gains nine pounds in three days. The nurse realizes that this may indicate:

  1. adequate nutrition.
  2. excess protein intake.
  3. fluid imbalance.
  4. nutrient imbalance.


623, 631                43.  Mr. Morgan is an acutely stressed patient in the ICU who is on TPN. The nurse understands that monitoring the patient’s _____ can help to determine if the patient is being overfed.

  1. glucose levels
  2. cholesterol levels
  3. iron levels
  4. albumin levels


623 44.                  Mrs. White is in the ICU for complications following surgery. She has been diagnosed with sepsis and is on a ventilator. In order to most accurately estimate her energy needs, the nurse recognizes that the preferred method to use is:

  1. the Harris-Benedict equation.
  2. the Ireton-Jones equation.
  3. direct calorimetry.
  4. the Mifflin-St. Jeor equation.


624 45.                  Mr. Jones experienced a burn and is currently in a state of stress. Mr. Jones is 5’9” tall and weighs 176 pounds. The nurse recommends that he receive a minimum of _____ grams of protein per day.

  1. 80
  2. 120
  3. 160
  4. 240


624 46.                  Mary is a 59-year-old patient who suffered multiple broken bones in a motor vehicle accident. She weighs 138 pounds. The nurse chooses a protein factor of 1.5 g/kg to estimate her protein needs and calculates that Mary’s protein requirements are approximately _____ grams per day.

  1. 94
  2. 103
  3. 121
  4. 207


625 47.                  Mark is a 23-year-old firefighter who experienced severe burns while fighting a house fire. The nurse recognizes the fact that he may benefit from supplements of minerals such as _____ to reduce the risk of infection.

  1. zinc, copper, and selenium
  2. iron, zinc, and calcium
  3. sodium, potassium, and chloride
  4. zinc, thiamin, and riboflavin


628 48.  Mr. Winslett is a COPD patient who is complaining of poor appetite, abdominal discomfort, and bloating. Which of the following is the nurse’s appropriate suggestion for improving his food intake?

  1. Consume larger meals.
  2. Substitute beans for meat.
  3. Drink a supplement before eating.
  4. Eat smaller, more frequent meals.


630 49.                  A patient with ARDS requires mechanical ventilation. The nurse recognizes that fluid accumulation is a potential problem and understands that this may make it difficult to assess his:

  1. weight.
  2. temperature.
  3. kcalorie intake.
  4. fluid intake.

630 50.                  A critically ill patient with ARDS is on a tube feeding and requires a fluid restriction. The nurse understands that an appropriate enteral formula will be:

  1. low residue.
  2. high protein.
  3. nutrient dense.
  4. hydrolyzed.




620-621         1.     Describe the body’s hormonal responses to stress.


622                 2.     Describe the symptoms and complications associated with SIRS.


623-624         3.     Differentiate between how energy needs are estimated for a non-obese patient versus an obese patient.


623-624         4.     What is a “stress factor”?


628                 5.     Describe the diet-drug interactions that may be experienced by a patient using bronchodilators.


621, 628        6.     Explain the metabolic effects of corticosteroid drugs.


630                 7.     Why are intestinal tube feedings preferred over gastric feedings for patients with acute respiratory failure?


Case Study Essay Questions


Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling. She suffered head and chest trauma as well as multiple broken bones. Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS. She is being fed enterally. Her mother reports that she is 5’7” tall and weighs approximately 140 pounds.


  1. a. Estimate Caroline’s energy needs using the Ireton-Jones equation:

1925 + [5 × wt (kg)] – [10 × age (yr)] + (281 × sex) + (292 × trauma) + (851 × burn).

You must insert the appropriate numbers for gender and trauma.

  1. Estimate Caroline’s protein needs based on mild to moderation lung injury.
  2. Why is Caroline likely to experience negative nitrogen balance despite being provided with adequate protein?
  3. Where is Caroline’s feeding tube likely located? Why?
  4. What type of enteral formula is best for Caroline at this time?
  5. What kind of medications might be prescribed for Caroline? Why?
  6. What are the potential diet-drug interactions Caroline might experience?





a.     a disruption in the body’s chemical environment due to the effects of disease or injury.

b.     abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels.

c.     a higher-than-normal metabolic rate.

d.     the breakdown of lean tissue that results from disease or malnutrition.

e.     relating to the entire body.

f.     a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature.

g.     acid accumulation in the body tissues.

h.     a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema.

i.      shortness of breath.

j.      respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation.


a.     the chemical and physical changes that occur within the body during stress.

b.             a group of nonspecific immune responses to infection or injury.

c.     changes in body chemistry resulting from infection, inflammation, or injury; characterized by alterations in plasma proteins.

d.     a whole-body inflammatory response caused by infection; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and elevated body temperature.

e.     a severe reduction in blood flow that deprives the body’s tissues of oxygen and nutrients.

f.     accumulations of pus.

g.     the surgical removal of dead, damaged, or contaminated tissue resulting from burns or wounds.

h.     signaling proteins produced by the body’s cells; those produced by white blood cells regulate various aspects of immune function

i.      20-carbon molecules derived from dietary fatty acids that help to regulate blood pressure, blood clotting, and other body functions.

j.      white blood cells that have the ability to engulf and destroy antigens.



Chapter 25 – Energy- and Protein-Modified Diets
for Cancer and HIV Infection


Answer, K/A, page(s)                                                                             K = knowledge question; A = application question




639 1.                     Most often, cancer is caused by interactions between a person’s genes and environmental agents.


640 2.                     Nutrition-related factors may increase or decrease the risk of developing cancer.


639-641                 3.     Research indicates that high-fat diets often correlate with cancer rates; thus, low-fat diets can reduce the risk of developing cancer.


641 4.                     Cancer cachexia affects over 80 percent of people with cancer.


642 5.                     Some people with cancer fail to regain lean body mass even when they are receiving adequate nutrients and energy.


643 6.                     Inflammation of the mouth that is caused by exposure to radiation is called radiation enteritis.


644 7.                     Most cancer patients abandon conventional treatments and use alternative therapies in the place of conventional therapies.


649 8.                     Recurrent bacterial pneumonia is classified as an AIDS-defining illness.


649 9.                     A buffalo hump and lipomas are common side effects of drug treatments for HIV infection.


649-650                 10.  Herpes simplex is a fungal infection of the mouth and throat that often occurs in patients with HIV.


650 11.                  Untreated HIV infection can increase a person’s susceptibility to opportunistic infections such as Kaposi’s sarcoma.


650 12.                  HAART is a combination of two antiretroviral drugs aimed at slowing the progression of cancer.


651 13.                  The medication megestrol acetate can improve appetite and increase weight in HIV patients.


653 14.                  Water can be a source of foodborne illness in HIV-infected individuals.


Nutrition in Practice – Ethical Issues in Nutrition Care


657-658                 15.  Patients have a right to refuse medical treatment—including nourishment and hydration—even if refusing the treatment could result in death.


659 16.                  A copy of any advance directive should be part of a client’s medical record.


659 17.                  A durable power of attorney indicates one’s preference for medical treatment in the event of incapacitation.


659 18.                  Laws regarding advance directives are standardized from state to state.


Multiple Choice


638 1.                     A cancer that arises from muscle or bone is referred to as a(n):

  1. sarcoma.
  2. adenoma.
  3. carcinoma.
  4. melanoma.


638-639                 2.     All of the following are involved in the development of cancer except:

  1. mutations in the genes that control cell division.
  2. chronic inflammation.
  3. bacterial infection.
  4. exposure to carcinogens.


639 3.                     Obese women have a higher risk of breast cancer than lean women because:

  1. excess adipose causes higher levels of estrogen in the body.
  2. obese women eat high-fat diets.
  3. lean women exercise more.
  4. lean women have higher levels of estrogen in the body.


640 4.                     Nutrition-related factors that may increase the risk of developing cancer include all of the following except:

  1. obesity.
  2. red meat intake.
  3. intake of salt-preserved foods.
  4. consumption of citrus fruits.


640 5.                     Which of the following has been associated with a high incidence of stomach cancer?

  1. alcohol
  2. fat
  3. salt-preserved foods
  4. sodium


640 6.     There appears to be a link between the consumption of _____ and a decreased risk of prostate cancer.

  1. milk and dairy products
  2. tomato products
  3. citrus fruits
  4. whole grains


640 7.                     Fruits and vegetables have been shown to have a protective effect against all of the following types of cancers except:

  1. lung.
  2. prostate.
  3. liver.
  4. stomach.


639, 640                8.     Alcohol consumption correlates strongly with development of all of the following types of cancer except:

  1. head.
  2. neck.
  3. prostate.
  4. colon.


640 9.                     The foods most likely to decrease the risk of cancer are fruits and vegetables, for all of the following reasons except:

  1. they contain phytochemicals.
  2. many are rich in folate.
  3. they contain nutrients that have antioxidant activity.
  4. they are high in carbohydrate.


641 10.                  Cancer cachexia is characterized by:

  1. anorexia.
  2. weight gain.
  3. slowed metabolism.
  4. increased appetite.


641 11.                  Factors that play a role in the wasting associated with cancer include all of the following except:

  1. cytokines.
  2. poor appetite.
  3. diversion of nutrients to support tumor growth.
  4. hormone levels.


641 12.                  Current recommendations for reducing cancer risk include all of the following except:

  1. Limit the amount of physical activity performed on a daily basis.
  2. Maintain a healthy body weight throughout life.
  3. Choose a healthy diet that emphasizes plant sources.
  4. Aim to meet nutritional needs through the diet.


641 13.  Which of the following is a major contributor to wasting associated with cancer?

  1. obstruction
  2. anorexia
  3. insulin resistance
  4. stomatitis


642 14.                  Factors contributing to anorexia in the person with cancer include all of the following except:

  1. early satiety.
  2. mental stress.
  3. fatigue.
  4. oral infections.


643 15.                  All of the following problems frequently accompany cancer therapies except:

  1. altered taste perception.
  2. mouth sores.
  3. chronic blood loss.
  4. diarrhea.


642 16.                  The structure of methotrexate, a drug used to treat cancer, resembles that of:

  1. vitamin C.
  2. vitamin E.
  3. folate.
  4. pyridoxine.


644 17.                  The drug dronabinol is sometimes used with cancer patients to:

  1. increase lean body mass.
  2. shrink tumors.
  3. stimulate appetite.
  4. combat diarrhea.

644 18.                  Immunotherapy can interfere with nutritional status in all of the following ways except:

  1. causing anorexia.
  2. interfering with appetite.
  3. causing GI problems.
  4. decreasing immune response.


644 19.  Weight gain often occurs in patients with cancer of the:

  1. colon.
  2. breast.
  3. stomach.
  4. pancreas.


645 20.  In order to increase caloric intake, an individual with cancer could substitute _____ for the milk normally used in recipes.

  1. Lactaid milk
  2. chicken broth
  3. fat-free evaporated milk
  4. Half-and-Half


645 21.                  To improve energy intake and compensate for weight loss during cancer treatment, clients should be encouraged to:

  1. use fats liberally.
  2. eat extra food immediately after treatment.
  3. avoid butter and margarine.
  4. eat more vegetables.


646 22.                  A cancer patient complains that foods just don’t taste right. An appropriate recommendation to help the patient handle this problems is:

  1. Consume smaller meals, and eat slowly.
  2. Cut foods into smaller pieces.
  3. Brush your teeth or use mouthwash before you eat.
  4. Ask your doctor about appetite-enhancing medications.


645, 647                23.  Tube feeding or TPN may be indicated for any of the following patients except:

  1. an individual who must undergo chemotherapy.
  2. an individual who has long-term gastrointestinal impairment.
  3. an individual who has permanent gastrointestinal impairment.
  4. an individual who is experiencing complications that interfere with food intake.


647 24.                  An example of a patient who may require long-term tube feeding is a patient:

  1. with breast cancer.
  2. with neck cancer.
  3. with bone cancer.
  4. with skin cancer.


643 25.                  Hematopoietic stem cell transplantation increases the risk of:

  1. foodborne illness.
  2. metastasis.
  3. dysphagia.
  4. Kaposi’s sarcoma.


649 26.                  The progression of HIV can be evaluated by monitoring:

  1. the viral load.
  2. serum albumin levels.
  3. weight.
  4. body composition.

649 27.  All of the following are characteristics of HIV-lipodystrophy syndrome except:

  1. abnormal lipid levels.
  2. accumulation of body fat in the hips.
  3. breast enlargement in both men and women.
  4. insulin resistance.


649 28.                  The reason for the development of HIV-lipodystrophy syndrome is:

  1. malnutrition.
  2. overeating.
  3. hormone imbalances.
  4. unknown.


649 29.                  HIV-related causes of wasting include all of the following except:

  1. anorexia.
  2. chronic diarrhea.
  3. altered metabolism.
  4. lipodystrophy.


649-650                 30.  All of the following contribute to malnutrition in HIV infection except:

  1. increased gastric acid secretion.
  2. medication side-effects.
  3. diarrhea.
  4. malabsorption.


649-650 31.                  HIV-related causes of anorexia and reduced food intake include all of the following except:

  1. oral infections.
  2. early satiety.
  3. medications.
  4. respiratory disorders.


650 32.                  In HIV patients, thrush is associated with all of the following except:

  1. altered taste sensation.
  2. mouth pain.
  3. lesions around the lips.
  4. dysphagia.


650 33.                  A type of cancer frequently associated with HIV infection is:

  1. Kaposi’s sarcoma.
  2. thrush.
  3. Kaposi’s adenoma.
  4. cryptosporidiosis.


650 34.  Kaposi’s sarcoma can contribute to wasting in cancer patients due to:

  1. malabsorption of nutrients.
  2. lesions in the mouth and throat.
  3. depletion of lean body mass.
  4. respiratory disorders.


650 35.  HIV-infected patients face an extremely high risk of malnutrition due to all of the following except:

  1. intestinal malabsorption.
  2. lipid abnormalities.
  3. bacterial overgrowth.
  4. vomiting and diarrhea.


650 36.                  The standard treatment for suppressing HIV infection is called:

  1. HAART.
  2. DASH.
  3. TLC.
  4. CD4+.


652 37.                  Lipodystrophy can be treated using all of the following except:

  1. resistance training.
  2. aerobic activity.
  3. medication.
  4. a low-kcalorie diet.


650-651                 38.  Which of the following drugs improve(s) nitrogen balance and lean tissue mass in HIV patients?

  1. megestrol acetate
  2. dronabinol
  3. testosterone
  4. antiretroviral agents


Case Study Questions


Use the following case study to answer questions 39-44.

Hannah Arther is a 53-year-old marketing executive who was recently diagnosed with uterine cancer. She had a complete hysterectomy and is currently undergoing radiation therapy. She is experiencing nausea, vomiting, and diarrhea as well as anorexia.


643 39.                  The symptoms that Ms. Arther is experiencing are consistent with:

  1. radiation enteritis.
  2. tissue rejection.
  3. steatorrhea.
  4. lipodystrophy.


643 40.  Because of the symptoms Ms. Arther is experiencing, she is at risk for all of the following except:

  1. weight loss.
  2. fluid and electrolyte imbalances.
  3. negative nitrogen balance.
  4. dysphagia.


646 41.                  Ms. Arther complains that she is too tired to fix meals and eat. Appropriate recommendations for her include all of the following except:

  1. Engage in physical activity to build your strength.
  2. Let family members and friends prepare food for you.
  3. Obtain foods that are easy to prepare and easy to eat.
  4. Find time to rest before attempting to prepare a large meal.


645 42.                  Ms. Arther enjoys pudding and is able to tolerate it pretty well. To increase her caloric intake, you suggest that she make her pudding with:

  1. Half-and-Half.
  2. whole milk.
  3. 2% milk.
  4. powered milk.


645 43.                  In order to increase Ms. Arther’s protein intake, you suggest that she use _____ freely.

  1. fruit spreads
  2. mayonnaise
  3. cheese
  4. butter


644 44.                  The primary focus of nutrition care for Ms. Arther is:

  1. educating her on ways to prevent the recurrence of cancer.
  2. ensuring appropriate intakes of calories and protein.
  3. ensuring an adequate intake of vitamins and minerals.
  4. preventing iron-deficiency anemia.


Nutrition in Practice – Ethical Issues in Nutrition Care


657 45.                  A patient’s right to make decisions concerning his or her own medical care is called:

  1. patient autonomy.
  2. informed consent.
  3. beneficence.
  4. distributive justice.


657 46.                  Disclosure refers to:

  1. a patient’s right to be fully informed of a treatment’s benefits and risks in a fair and honest manner.
  2. a comparison of the potential benefits and harm of any treatment.
  3. a patient’s right to life-sustaining treatments.
  4. the ability to understand pertinent information and make appropriate decisions.


657, 659                47.  Which of the following legal documents allows a competent adult to clearly express directions regarding medical treatment in the event that the person is unable to make the necessary decisions at that time?

  1. living trust
  2. power of attorney
  3. living will
  4. medical record


659 48.  An individual can provide detailed instructions about life-sustaining procedures that he or she does or does not want in the event he/she becomes incapacitated by completing a:

  1. legal will.
  2. living will.
  3. power of attorney.
  4. disclosure document.


657, 659                        49.  A durable power of attorney is used to:

  1. state one’s wishes about treatments one does or does not want at the end of life.
  2. appoint a health care agent.
  3. withhold CPR in the event of cardiopulmonary arrest.
  4. allow a physician to write a DNR order.


Nursing Exam Review Questions


639 50.                  Mrs. Watson is a 55-year-old female with a family history of breast cancer. To reduce Mrs. Watson’s risk of breast cancer, the nurse advises her to:

  1. avoid alcohol and maintain a healthy weight.
  2. take a calcium supplement daily.
  3. eat less red meat.
  4. drink a glass of red wine with dinner.

639-640 51.                  The nurse is teaching a class on cancer prevention. Someone in the audience asks if one’s diet affects his or her risk of developing cancer. The nurse makes the following statements. Which one is incorrect?

  1. “Citrus fruits may decrease the risk of esophageal cancer.”
  2. “Fruits and nonstarchy vegetables may reduce the risk of several types of cancer.”
  3. “Foods rich in folate seem to prevent pancreatic cancer.”
  4. “Dairy foods have been implicated in many types of cancer.”


640, 641                        52.  The nurse is working with a client admitted to the hospital with complaints of loss of appetite and weight loss. An assessment of the client also reveals depletion of lean body mass and serum protein. The nurse accurately recognizes these as characteristics of:

  1. graft-versus-host disease.
  2. human immunodeficiency virus.
  3. thrush.
  4. cancer cachexia.


642 53.                  Cancer patients exhibit an increased rate of protein turnover. The nurse understands that this means patients:

  1. may have a difficult time maintaining a healthy body weight.
  2. require less protein in their diets.
  3. should increase their intake of fats.
  4. may experience early satiety.


642 54.  The nurse understands that methotrexate is a chemotherapeutic agent used in the treatment of cancer and that it can cause a patient to become deficient in:

  1. essential fatty acids.
  2. folate.
  3. vitamin B12.
  4. calcium.


643 55.                  Mrs. Dwyer is a 48-year-old patient who is undergoing radiation therapy for uterine cancer. She complains of nausea, vomiting, and diarrhea, and has experienced significant weight loss. The nurse recognizes that the likely cause of this is:

  1. tissue rejection.
  2. radiation enteritis.
  3. steatorrhea.
  4. mental stress.


644 56.                  A female cancer patient tells the nurse that she has begun taking St. John’s wort in conjunction with her cancer therapy. The nurse should respond by saying:

  1. “Be sure you take the dose as prescribed on the bottle.”
  2. “Be sure you are buying a brand-name supplement.”
  3. “St. John’s wort may reduce the effectiveness of your cancer therapy.”
  4. “I’ve read that St. John’s wort can cure cancer, too.”


645 57.                  The nurse is working with a cancer client who needs to add kcalories and protein to his diet. The best advice the nurse could offer would be to suggest that he:

  1. try new foods and experiment with herbs and spices.
  2. eat nutrient-dense foods first.
  3. use plenty of butter and margarine and add milk powder to casseroles.
  4. save most liquids for after meals.


646 58.                  Which of the following nutrition interventions is most appropriate for a patient who complains that food doesn’t taste right?

  1. “Consume foods chilled or at room temperature.”
  2. “Let family members prepare food for you.”
  3. “Avoid foods with strong odors.”
  4. “Talk a walk before you eat.“


647 59.                  For a patient with chronic radiation enteritis, the nurse recognizes that the best form of nutrition support is:

  1. an oral liquid supplement.
  2. enteral nutrition.
  3. parenteral nutrition.
  4. a pureed diet.


643, 645                60.  To minimize the risk of food-borne bacterial infections in a cancer client who has received a bone marrow transplant, the nurse would tell the client to:

  1. cook all meats, poultry, and eggs until they are well done.
  2. consume adequate amounts of fruits and vegetables.
  3. increase consumption of dishes that use ground meats.
  4. consume lactose-free, low-residue, low-fat liquids.


650 61.                  A patient with HIV is admitted to the hospital with a diagnosis of dehydration. The patient complains of chronic diarrhea. The nurse notes a 15-pound weight loss over a 4-week period. The most likely explanation for the patient’s condition is:

  1. AIDS enteropathy.
  2. thrush.
  3. herpes simplex virus.
  4. HIV-lipodystrophy syndrome.


652 62.                  Bobby is a 25-year-old client with HIV infection who is experiencing weight loss and a loss of lean body mass. He currently weighs 160 pounds. The nurse suggests that his diet include at least _____ grams of protein per day.

  1. 37
  2. 58
  3. 87
  4. 165


652 63.                  An HIV patient develops metabolic complications resulting in insulin resistance and an abnormal lipid profile. The nurse recommends the following nutrition intervention:

  1. “Avoid fatty fish.”
  2. “Replace whole-milk dairy products with low- or nonfat dairy products.”
  3. “Drink 4 glasses of grapefruit juice per day.”
  4. “Use margarine instead of butter.”





641                 1.     What factors contribute to the development of cancer cachexia?


646                 2.     What suggestions would you give a cancer patient concerning ways to control nausea and vomiting?


645, 647        3.     Discuss the use of enteral and parenteral nutrition in cancer patients.


649, 652        4.     Describe HIV-lipodystrophy syndrome and discuss current treatment strategies.


650                 5.     Explain how GI tract complications can contribute to malnutrition in HIV patients.


653                 6.     Why should AIDS patients be concerned about food-borne illnesses?



Case Study Essay Questions


Ellen is a 45-year-old woman who was diagnosed with breast cancer three months ago. She is currently undergoing chemotherapy. Ellen is 5’2” tall and has weighs 125 pounds. Both her mother and her sister have had breast cancer. Ellen is currently experiencing problems with reduced taste sensation, anorexia, and nausea, and she has lost 8 pounds since beginning chemotherapy.


  1. What is the most likely reason that Ellen developed breast cancer?
  2. Estimate Ellen’s kcalorie and protein needs based on her normal weight.
  3. Discuss three strategies that might help Ellen cope with her reduced taste sensation.
  4. Discuss three strategies that might help Ellen cope with the nausea she is experiencing.
  5. Is it likely that Ellen will eventually require enteral or parenteral nutrition?
  6. What may happen to Ellen’s weight over the next two years? What advice would you give her concerning her weight?





a.     describes a cancerous cell or tumor, which can injure healthy tissue and spread cancer to other regions of the body.

b.     the process of cancer development.

c.     an abnormal tissue mass that has no physiological function; also called a neoplasm.

d.     to spread from one part of the body to another.

e.     substances that can cause cancer.

f.     a wasting syndrome, associated with cancer, that is characterized by anorexia, muscle wasting, weight loss, and fatigue.

g.     the use of drugs to arrest or destroy cancer cells.

h.     the use of X-rays, gamma rays, or atomic particles to destroy cancer cells.

i.      inflammation of intestinal tissue caused by exposure to radiation.

j.      transplantation of the stem cells that produce red blood cells and white blood cells.

k.     destruction of donor tissue by the recipient’s immune system, which recognizes the donor cells as foreign.

l.      infections from microorganisms that normally do not cause disease in healthy people, but are damaging to persons with compromised immune function.

m.   the accumulation of fatty tissue at the base of the neck.

n.     benign tumor composed of fatty tissue.

o.     a fungal infection of the mouth and throat.

p.     a common virus that can cause blister-like lesions on the lips and in the mouth.




[1] Derived from the BMI calculation: 703 × (IBW in lb ÷ ht in inches2) = 22. “How to Estimate and Evaluate %UBW and %IBW” in the text defines IBW as the weight at which the patient will have a BMI of 22.