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MNT RD Exam With 100% Correct
Answers 2023
NCP - Correct Answer-Nutrition Care Process. A standardized, consistent structure and framework used to provide nutrition care. This is different from standardized care, which infers that all patients receive the same care. NCP Steps - Correct Answer-ADIME
- Assess, 2. Diagnose, 3. Intervention, 4. Monitor & Evaluate Critical thinking - Correct Answer-integrates facts, informed opinions, active listening, and observations. It is a reasoning process where ideas are produced and evaluated. It includes the ability to conceptualize, think rationally, think creatively, be inquiring, and think autonomously. Nutrition screening - Correct Answer-use of preliminary nutrition assessment techniques to identify people who are malnourished or who are at risk for malnutrition. All health care team members can participate. Brief 5-10 minutes. Nutrition screening review - Correct Answer-client's history, lab results, weight, physical signs For nutrition screening to be effective - Correct Answer-the mechanism must be accurate based on: specificity (can it ID patients without a condition), sensitivity (can it ID those who have the condition. Mechanism must be effective as related to the chances that positive health outcomes will be achieved with the intervention. If no emerging nutrition problem exists - Correct Answer-document that discharge from nutrition care is appropriate The Joint Commission and nutrition screening - Correct Answer-nutrition risk identified in hospitalized patient within 24 hours of admission, but does not mandate a method of screening Nutrition screening includes - Correct Answer-1. Subjective Goal Assessment
- Mini Nutritional Assessment
- Nutrition Screening Initiative Subjective Goal Assessment - Correct Answer-History, intake, GI symptoms, functional capacity, physical appearance, edema, weight change
NO lab values, just talking Mini Nutritional Assessment - Correct Answer-Evaluates independence, medication therapy, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding. Often done in older population. Nutrition Screening Initiative - Correct Answer-Elderly Nutrition assessment of individuals - Correct Answer-Initiated by referral/screening of individuals or groups for nutritional risk factors. Assessment makes comparisons between data collected and reliable standards. Assessment is an on-going, dynamic process that involves continual reassessment and analysis of patient/client/group needs. Assessment provides the basis for nutrition diagnosis. Critical thinking skills needed in nutrition assessment include - Correct Answer-1. Observe verbal/nonverbal cues that can guide effective interviewing methods
- Determine appropriate data to collect
- Select tools and procedures and apply in valid, reliable ways
- Distinguish relevant from irrelevant, and important from unimportant data
- Validate, organize and categorize the data Nutrition assessment component - Correct Answer-1. Review: review data for factors that affect nutritional and health status
- Cluster: assessment data clustered for comparison with characteristics of a suspected diagnosis; food and nutrition related history, anthropometrics, lab/medical tests (biochemical), nutrition-focused physical findings, client history
- These indicators are compared to identified standards and criteria for interpretation and decision-making Indicators in nutrition assessment - Correct Answer-are clearly defined markers that can be observed and measured. Also used to monitor and evaluate the progress towards nutrition outcomes What indicators are compared against - Correct Answer-nutrition care criteria Documentation in nutrition assessment - Correct Answer-date and time, pertinent data and comparison with standards, patient's perceptions, values and motivation related to
entire arm: 5% of body weight forearm with hand: 2.3% of body weight Amputation Estimated IBW - Correct Answer-Estimated IBW = (100-%amputation)/ x IBW for original body weight Amputation % weight change - Correct Answer-% weight change stresses significance of weight change Used to assess potential nutrition risk** [(usual weight - actual weight)/usual weight] x 100 Triceps skinfold thickness (TSF) - Correct Answer-1. measures body fat reserves; measures calorie reserves
- standard, male: 12.5 mm, female: 16.5 mm Arm muscle area (AMA) - Correct Answer-1. measure SKELETAL muscle mass (SOMATIC protein)
- to determine: use triceps skinfold thickness and arm circumference
- standard: male 25.3 cm; female 23.2 cm
- important to measure GROWING CHILDREN BMI body mass index, Quetelet Index - Correct Answer-compares weight to height
- weight in kg divided by height squared in meters; or weight in pounds divided by height in inches squared x 703
- healthy adult 18.5 - 24.9; healthy for most elderly 24-
- BMI for age charts starting at age 2 when accurate stature can be obtained Waist circumference - Correct Answer->40 males, >35 females is independent risk factor for disease when out of proportion to total body fat (with BMI of 25-34.9) Measured in inches Waist/hip ratio (WHR) - Correct Answer-1. differentiates between android (apple) and gynoid (pear) obesity
- WHR of 1.0 or greater in men, 0.8 or greater in women is indicative of android obesity and an increased risk for obesity-related diseases (diabetes, hypertension) Nutrition focused physical exam - Correct Answer-Hair Skin Eyes Lips Tongue Gums
Teeth Skin Nails Hair - Correct Answer-Assessment: thin, sparse, dull, dry, brittle, easily pluckable Considerations: vitamin C, protein deficiency Eyes - Correct Answer-Assessment: pale, dry, poor vision Considerations: vitamin A, zinc or riboflavin deficiencies Lips - Correct Answer-Assessment: swollen, red, dry, cracked Considerations: riboflavin, pyridoxine, niacin deficiencies Tongue - Correct Answer-Assessment: smooth, slick, purple, white coating Considerations: vitamin or iron deficiencies Gums - Correct Answer-Assessment: sore, red, swollen, bleeding Considerations: vitamin C deficiency Teeth - Correct Answer-Assessment: missing, loose, loss of enamel Considerations: calcium deficiency, poor intake Skin - Correct Answer-Assessment: pale, dry, scaly Considerations: iron, folic acid, zinc deficiency Nails - Correct Answer-Assessment: brittle, thin, spoon-shaped Considerations: iron or protein deficiency Dull, dry, brittle hair, what vitamin deficiency? - Correct Answer-vitamin C Serum albumin - Correct Answer-3.5-5.0 g/dL VISCERAL PROTEIN (BLOOD AND ORGANS) Maintains colloidal osmotic pressure Hypoalbuminemia associated with edema, surgery LEVELS ABOVE NORMAL RANGE LIKELY DUE TO DEHYDRATION LONG HALF-LIFE, DOES NOT REFLECT CURRENT PROTEIN INTAKE Serum transferrin - Correct Answer->200 mg/dl
Related to protein intake Indicator of renal disease BUN:CREATININE RATIO NORMAL = 10-15: Urinary creatinine clearance - Correct Answer-115 +/- 20 ml/minute Measures GFR - glomerular filtration rate, renal function Estimate includes body surface area (height and weight) Total lymphocyte count (TLC) - Correct Answer->2700 cells/cu mm** Measures immunocompetency Moderate depletion: 900- Severe depletion: < Decreased in protein energy malnutrition C-reactive protein (CRP) - Correct Answer-Marker of acute inflammatory stress, INFLAMMATION NOT NUTRITION AS IT DECLINES IT INDICATES WHEN NUTRITIONAL THERAPY WOULD BE BENEFICIAL When elevated CRP decreases, PAB increases Free erythrocyte protoporphyin (FEP) - Correct Answer-Direct measure of toxic effects of lead on heme synthesis. INCREASED IN LEAD POISONING. Lead depletes iron leading to anemia, and displaces calcium in the bone leading to a zinc deficiency Prothrombin time (PT) - Correct Answer-11.0-12.5 seconds**, 85-100% of normal anticoagulants prolong prothrombin time evaluates clotting adequacy; change in vitamin K intake will alter rate Hair analysis - Correct Answer-not for nutritional assessment; useful in measuring intake of toxic metals Activity factors and BEE - Correct Answer-Sedentary: BEE x 1. Active: BEE x 1. Stressed: BEE x 1. EER for age - Correct Answer-For each year below 30, add 7 kcal/day for women and 10 kcal/day for men. For each year above 30, subtract 7 kcal/day for women, and 10 kcal/day for men.
Megestrol acetate (Megace) - Correct Answer-appetite stimulant Megace...Meg stuffs her face Dextroamphetamine - Correct Answer-appetite suppressant, anorexia, nausea, weight loss "MethAMPHETAMINE causes anorexia" Orlistat - Correct Answer-decrease fat absorption by binding lipase; vitamin/mineral supplement "Orlistat decreases the fat (aborsption!)" Marinol - Correct Answer-appetite stimulant "Mari likes to eat!" Methylphenidate (Ritalin) - Correct Answer-anorexia, weight loss, nausea Miranda Lambert song Ritalin, mother was rail thin "Methylphenidate makes you too skinny to date" Statins (HMG CoA reductase inhibitors) - Correct Answer-decreased LDL, TG; increase HDL Cholesterol management medication Chemotherapy - Correct Answer-malabsorption Mineral oil, cholestyramine - Correct Answer-decrease absorption of fat, fat-soluble vitamins Glucocorticoids, antibiotics - Correct Answer-protein deficits Oral contraceptives - Correct Answer-decrease folate, B6, C "Free Birth Control at 6." Loop diuretic - Correct Answer-deplete thiamin, potassium, magnesium, calcium, sodium "Tonks, Potter, Crookshanks, Malfoy and Snape lost their Froot LOOPS." Thiazide diuretics - Correct Answer-decrease potassium and magnesium, absorb calcium Antibiotics - Correct Answer-decrease vitamin K Steroids - Correct Answer-decrease bone growth, CHO intolerance Methotrexate - Correct Answer-decrease folate
Curcumin (turmeric) - Correct Answer-may reduce inflammation, antioxidant, in curry powder Yohimbe - Correct Answer-elevates blood pressure "Yo him be having high blood pressure" How many kcals does propofol provide? - Correct Answer-1.1 kcal/ml How to teach depends on - Correct Answer-the NEEDS AND READINESS of the learner Motivation level will affect - Correct Answer-the attention span High motivation - Correct Answer-Keen interest Presence is voluntary Has high expectations as to applicability of subject to one's life Low motivation - Correct Answer-Mandatory attendance Little interest in topic May feel there are more important things he should do Educational level - Correct Answer-Not always related to amount of formal education High education level - Correct Answer-Has some previous knowledge of topic or has broad base to which new information can be added Understands complex ideas and rationales Verbally oriented Low education level - Correct Answer-Lacks formal education beyond high school Probably not verbally oriented Reinforcement of learning is helpful Allow time for learning Situational assessment - Correct Answer-Sophistication Economics Time needed Availability Environmental "TEASE: Time needed, Economics, Availability, Sophistication, Environmental" Inexperienced sophistication - Correct Answer-Young children Some adults lacking nutrition training Need thorough introduction and background Moderately experienced sophistication - Correct Answer-Teachers Health educators
Patients already instructed Emphasize review of material Recognize it for better use Move on to more complicated concepts Very experienced sophistication - Correct Answer-"Nutrition experts" Limit audience participation at first Establish yourself as the expert Cite credentials Lecture format with audiovisuals Community and group nutrition status indicators - Correct Answer-Obtain overview to determine whether nutritional resources are adequate, what groups are potentially at high nutritional risk, how well health needs are being met by existing programs Most nutrition problems are commonly found among groups or areas which are socially, economically, educationally and/or medically deprived Health Risk Appraisal (HRA) - Correct Answer-survey categorizing a POPULATION'S general health status used in worksites, government agencies as a health education or screening tool consists of questionnaire, calculations that predict risk of disease, educational message to the participant Sources of assessment information - Correct Answer-Demographic Socioeconomic Morbidity and mortality rates Incidence Prevalence Demographic - Correct Answer-population by age, ethnic groups, sex, birth rates, deaths Socioeconomic stratification - Correct Answer-census data, housing statistics Morbidity - Correct Answer-disease rate Mortality - Correct Answer-death rates "Immortal = do not die, mortal you do die." Infant mortality rate - Correct Answer-infant deaths under 1 year of age, expressed as the number of deaths per 1000 live births Incidence - Correct Answer-number of NEW cases of a disease over a period of time divided by total number of people at risk. Multiply this by 100,
Nutritional surveillance - Correct Answer-CONTINUOUS collection of data, doesn't stop
- identifies problem, sets baselines, sets priorities, detects changes in trends
- use height, weight, hematocrit, hemoglobin, serum cholesterol
- on-going system, linked to active health program; WIC, CDC, EPSDT (early periodic screening, diagnosis, treatment)
- Data identifies needs and kind of intervention needed Nutrition Screening Initiative (NSI) - Correct Answer-promote nutrition and improve nutritional care for the ELDERLY to identify nutritional problems early NSI for elderly - Correct Answer-1. DETERMINE checklist - identifies factors placing people at nutritional risk -increases awareness of factors that influence nutritional health -disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care, elder years above age 80
- LEVEL 1 screen identifies those who need more comprehensive assessments
- LEVEL 2 screen provides more specific diagnostic info on NUTRITIONAL status Where are RD's involved in NSI (nutrition screening initiative) programs? - Correct Answer-Level 2 Focus group - Correct Answer-5-12 people brought together to talk about concerns, beliefs, problems obtain advice, insights and information; contributes attitudinal data National Nutrition Monitoring and Related Research Program (NNMRRP) - Correct Answer-Includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health Jointly run by DHHS and USDA Nutritional status and nutrition-related measurements - Correct Answer-PedNSS: Pediatric Nutrition Surveillance System PNSS: Pregnancy Nutrition Surveillance System NHANES: National Health and Nutrition Examination Survey WWEIA: What We Eat in America USDA NFCS: Nationwide Food Consumption Surveys PedNSS (Pediatric Nutrition Surveillance System) - Correct Answer-Low income, high risk children, birth - 17 years, emphasis on birth - 5 years Height, weight, birth-weight, hematocrit, hemoglobin, cholesterol, breast-feeding
Monitors growth and nutritional status, infant-feeding practices PNSS (Pregnancy Nutrition Surveillance System) - Correct Answer-Low income, high risk pregnant women Maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking, alcohol), birth-weight, COUNTS # OF WOMEN WHO BREAST FEED Identify and reduce pregnancy-related health risks NHANES (National Health and Nutrition Examination Survey) - Correct Answer-Ongoing (repeated) survey to obtain info on health of American people Evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24 hour recall, food frequency lists) NHANES III: oversampling of adults > or equal to 65 with NO upper age limit WWEIA (What We Eat in America) - Correct Answer-DIETARY COMPONENT OF NHANES, also known as National Food and Nutrition Survey NFNS Two days of 24 hour dietary recall data with times of eating occasions and sources of foods eaten away from home USDA conducts over-sampling of adults 60 years or older, African Americans, Hispanics NFCS (USDA Nationwide Food Consumption Surveys) - Correct Answer-To obtain info on food intake of individuals and total households from entire U.S. To evaluate 7 nutrients: protein, calcium, iron, thiamin, riboflavin, vitamin C, A Diets rated good if intake equaled or surpasses RDA; rated poor if less than 2/3 of RDA for 1 or more nutrients YRBS (Youth Risk Behavior Survey) - Correct Answer-Under health and human services Grades 9- Smoking, alcohol use, weight control, exercise, eating habits BEHAVIOR HHS - Correct Answer-Health and Human Services Falls under this: YRBS, BRFSS, Health and Diet Survey, PNSS,
WIC Special Supplemental Nutrition Program for WIC EFNEP: Expanded Food and Nutrition Education Program Maternal and Child Health Block Grant Healthy Start NSIP: Nutrition Services Incentive Program SNAP: Supplemental Nutrition Assistance Program CMS: Centers for Medicare and Medicaid CHIP: Children's Health Insurance Program Headstart NET: Nutrition Education Training Program SFMNP: Senior Farmers' Market Nutrition Program USDA Commodity Food Donation/Distribution Program - Correct Answer-************** Provides foods to help meet nutritional needs of children and adults and strengthens agricultural market for products produced by American farmers Food given to School Lunch, elderly feeding, supplemental food programs To help the needy, USDA does this CSFP (COMMODITY SUPPLEMENTAL FOOD PROGRAM): 1. administered by STATE health agencies
- monthly commodity canned or packaged goods
- low income women (pregnant, breast-feeding, postpartum), infants and children up to 6 years, some eldery; at nutritional risk TEFAP (The Emergency Food Assistance Program): 1. quarterly distributions of commodity foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters 2. supplements diets of low income househoulds TANF (Temporary Assistance for Needy Families) - Correct Answer-States determine the eligibility of needy families and the benefits and services those families will receive NSLP (National School Lunch Program) - Correct Answer-USDA Food and Nutrition Service (FNS) ENTITLEMENT PROGRAM TO IMPROVE NUTRITION OF CHILDREN, ESPECIALLY FROM LOW INCOME FAMILIES; UTILIZE SURPLUS PRODUCTION OF FOODS Cash grants and food donations; dollars reimburse schools on basis of numbers of meals served Implement the Dietary Guideline into the lunch and breakfast programs ***Lunch must provide on average over each school week ONE THIRD (1/3) of the recommended intake for protein, vitamins A and C, iron, calcium**** Team Nutrition implements School Meals Initiatives for Healthy Children - Correct Answer-1. Motivate child to make healthy choices; helps schools meet guidelines
- Provides recipes, training, support SBP (School Breakfast Program) - Correct Answer-USDA
ENTITLEMENT PROGRAM, meals must meet Dietary Guidelines Breakfast must provide on average over each school week; ONE FOURTH (1/4) daily recommended levels for protein, calcium, iron, vitamin A, vitamin C ASP (After School Snack Programs) - Correct Answer-USDA provides healthy snacks schools receive cash subsidies for each snack served same eligibility bases as NSLP School breakfast and lunch provide how much of the daily recommended values? - Correct Answer-About 1/ (1/4 at breakfast + 1/3 at lunch = ~1/2 total) Special Milk Program - Correct Answer-USDA Purpose is to encourage consumption of milk by children Objective is to provide subsidy for milk served to children in participating schools, child care centers, summer camps not participating in other federally subsidized meal programs, and free milk to needy SFSP (Summer Food Service Program) - Correct Answer-USDA School Lunch ENTITLEMENT PROGRAM, purpose is to initiate, maintain or expand foodservice programs to children when schools is not in session Objective is to provide meals or snacks to children at participating institutions in poor areas Administered by FNS, state educational agencies, public or private nonprofit residential summer camps CACFP (Child and Adult Care Food Program) - Correct Answer-USDA Supports public and non-profit food service programs for FAMILY DAY CARE CENTERS, neighborhood houses, HOMELESS SHELTERS, nonresidential adult day care centers Reimburses operators for meal costs, provides commodity foods and NUTRITION EDUCATION MATERIALS Must serve meals that meet guidelines; must offer free or reduced-price to eligible Eligibility standards same as NSLP
NSIP (Nutrition Services Incentive Program) - Correct Answer-AoA: Administration on Aging -Developed services to foster independent living; cash and commodities to state agencies Older Americans Act Nutrition Program OAA (Older Americans Act Nutrition Progam) - Correct Answer-Formerly ENP (Elderly Nutrition Program) DHHS Title III
- One hot meal each day, 5 days/week, provide 1/3 recommended intake
- ELIGIBILITY: ALL AGED 60 AND OLDER PLUS SPOUSE, REGARDLESS OF INCOME!
- CONGREGATE MEALS - AMBULATORY; TRANSPORTATION ESSENTIAL FOR RURAL ELDERLY
- HOME DELIVERED MEALS - MEALS ON WHEELS - MUST BE HOMEBOUND
- Counseling, nutrition education, referrals, social interaction SNAP (Supplemental Nutrition Assistance Program) - Correct Answer-USDA -LARGEST FOOD ASSISTANCE PROGRAM - ENTITLEMENT -Assist low income with monthly benefits; net income must be at or below certain % of poverty level; income limits vary by household size and are adjusted to the cost of living -Designed to increase their purchasing power; not for non-food items -Figures are adjusted to reflect cost of food in Thrifty Food Plan for June of preceding year - least costly of USDA four food plans -SNAP nutrition education program: provided to programs participants CMS (Centers for Medicare and Medicaid Services) - Correct Answer-DHHS MEDICARE - HEALTH INSURANCE PROGRAM FOR PEOPLE OVER 65; OF ANY AGE WITH END-STAGE RENAL DISEASE; EMPLOYERS AND EMPLOYEES PAY Medicaid - federal law administered by states ---------payment for medical care for all ages eligible needy: all ages, blind, disabled, dependent children Medicare Parts - Correct Answer-PART A: HOSPITAL INSURANCE PART B: OPTIONAL INSURANCE FOR SUPPLEMENTARY BENEFITS (all things outside hospital, including private practice)
CHIP (Children's Health Insurance Program) - Correct Answer-Under Social Security Act, partnership between federal and state governments Expands health coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage Headstart - Correct Answer-DHHS Helps low income children; 3-5 y.o. Introduce new foods, teaches good food habits Child's participation in food activities is important NET (nutrition Education Training Program) - Correct Answer-USDA 1977 Amendment to School Lunch Act Provides nutrition education training to teachers and school foodservice personnel SFMNP (Senior Farmer's Market Nutrition Program) - Correct Answer-USDA GRANTS TO STATE TO PROVIDE LOW INCOME SENIORS WITH COUPONS TO BE EXCHANGED FOR ELIGIBLE FOODS AT FARMER'S MARKETS, ROADSIDE STANDS, COMMUNITY SUPPORTED AGRICULTURE PROGRAMS (CSA) NOT STORES FRESH, NUTRITIOUS, unprepared fruits, veggies, herbs and honey May be limited to specific LOCALLY GROWN FOODS Nutrition education and info is provided (how to select, store, prepare) Other Assistance Programs - Correct Answer-1. Quasi-governmental programs
- Non-governmental agencies
- International agencies Quasi-governmental programs - Correct Answer-Receive both federal and private funds
- American Red Cross
- National Research Council - Food and Nutrition Board (developed RDAs) Non-governmental agencies - Correct Answer-1. Voluntary health agencies - private, non-profit organizations, chartered and licensed by a government agency, funded by contributions from citizens or organizations: American Heart Association (AHA)
- Professional organizations - Academy of Nutrition and Dietetics
- Foundations, business, industry
