RD Exam Practice Questions and Answers 2024, Exams of Medicine

Download RD Exam Practice Questions and Answers 2024 and more Exams Medicine in PDF only on Docsity! RD Exam Practice Questions and Answers 2024 Which of the following carbohydrates is not a monosaccharide? a. fructose b. galactose c. maltose d. glucose Correct Answer is C. Maltose Fructose found in fruit and is sweetest of all monosaccharides. Galactose is derived from hydrolysis of lactose (milk sugar) during digestion. Not found freely in foods. Glucose is the primary monosaccharide used for energy. Generally part of sucrose (disaccharide; glucose + fructose) or linked to lactose to form galactose (disaccharide; glucose + lactose). When glucose is linked to another glucose molecule, it forms maltose and is considered a disaccharide. Which of the following statements about glycogen is true? a. Glycogen is a long-term energy source. b. The liver stores approximately 100 grams of glycogen. c. Glycogen is stored primarily in the liver but also appears in skeletal and heart muscles. d. The glycogen found in skeletal muscles is catabolized for use anywhere in the body. Correct Answer is B. The liver stores approximately 100 grams of glycogen. glycogen is short-term carbohydrate storage for the body. ~100g of glycogen is stored in the liver, which when catabolized provides ~400 kcals. About 300-400g of glycogen is stored in the skeletal muscles, which yields less than 1600kcal. Glycogen is NOT stored in the heart muscle. The glycogen stored in the liver provides energy anywhere in the body, whereas the glycogen stored in the skeletal muscles provides energy only to skeletal muscle cells. The amount of stored glycogen is sufficient to sustain an 70kg male for approximately 1 day. Which of the following statements about controlling blood glucose levels is false? a. Beta cells in the islets of Langerhans produce insulin, which is released when blood glucose levels rise in response to a meal. b. Alpha cells in the islets of Langerhans secrete glucagon when the patient is fasting, which stimulates the liver to break down glycogen to maintain blood glucose levels in the normal range of 80 to 120 mg/dl. c. The adrenals secrete epinephrine and norepinephrine when the patient is fasting, which stimulates muscles to release glycogen to maintain blood glucose levels. d. Glucocorticoids, such as cortisol stimulate glycolysis to increase blood glucose levels. Correct Answer is D. Glucocorticoids, such as cortisol, stimulate glycolysis to increase blood glucose levels. Blood glucose levels are influenced by hormones, drugs, and vagus nerve activity. The islets of Langerhans in the pancreas produce insulin when the patient feeds and glucagon when the patient fasts. In the postprandial period beta cells release insulin to normalize blood glucose levels. In the fasting state, alpha cells release glucagon to stimulate glycogenolysis, which is glycogen breakdown. Epinephrine and norepinephrine increase glucose levels during stress by promoting catabolism of muscle cells for glycogen and adipose cells for triglycerides. Glucocorticoids increase blood glucose levels by stimulating gluconeogenesis, not glycolysis. Glycolysis is the breakdown of glucose. Gluconeogenesis is glucose formation, which occurs mainly in the liver. Glycolysis and gluconeogenesis do not occur at the same time. Body fat performs all of the following except: a. Provides a concentrated source of energy b. Protects bones and internal organs by cushioning them and regulating their temperature. c. Provides a source of eicosapentaenoic (EPA) and docosahexaenoic (DHA) essential fatty acids. d. Aids in absorption of the fat soluble vitamins A,D,E, and K. Correct Answer is C. Provides a source of eicosapentaenic (EPA) and docosahexaenoic (DHA) essential fatty acids. Fat plays a very important role in the body. It provides a concentrated energy, at 9 kcal per gram, whereas protein and carbohydrate only provide 4kcal/g. Structural fat pads cushion and protect the body from injury, especially bones and internal organs. Fat provides a source of essential fatty acids, which the body does not manufacture, but mostly obtain from seeds, oils, cold-water fish, or supplements. The three essential fatty acids (EFAs) are arachnoidic, linoleic, and linolenic. EFAs are important for blood clotting and brain development. Eicosapentaenoic (EPA) and docosahexaenoic (DHA) derive from alpha-linolenic acid, but are not themselves essential fatty acids. Fats are also required for the absorption of the fat-soluble vitamins A,D,E, & K. Which of the following are not essential amino acids? a. Lysine, leucine, valine b. Isoleucine, tryptophan, phenylalanine c. methionine, threonine, lysine d. tyrosine, glycine, alanine Correct Answer is D. Tyrosine, glycine, alanine. Amino acids are the building blocks of protein. There are 20 amino acids in total. Nine AA are essential and cannot be made by the body: Isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, and histidine. Often, adults can synthesize enough histidine, but infants and children cannot. Essential AAs must be obtained from food. The best sources of essential AAs are animal products, such as meat, poultry, fish, dairy, and eggs. A diet containing 10% to 12% of calories from protein should meet essential AAs requirements. The non-essential AAs are arginine, alanine, asparagine, aspartic acid, cysteine, glutamine, glutamic acid, glycine, proline, serine, and tyrosine. -the 1st occurs in the liver and produces 25-hydroxycholecalciferol, the main circulating form -the 2nd hydroxylation occurs in the kidney where 1,25-dihydroxyvitamin D is produced, the most active form of vitamin D (also called calcitriol) Vitamin D has many functions, but mainly it promotes calcium and phosphorus homeostasis. Vitamin D also plays a role in skin, muscle and nerve function, cell differentiation, and immune function. All of the following are good sources of niacin except: a. chicken b. tuna c. mushrooms d. baked potato Correct Answer is d. baked potato Niacin is found in many foods including chicken, turkey, lean meats, and fish. Niacin is one of four vitamins added to enriched grain products (flours, cereals, breads) Beans, seeds, legumes (peanuts and lentils) are good sources of niacin. Milk, coffee, and tea provide some niacin. Vegetables except mushroom's are not a good source of niacin. Most people get plenty of niacin from their diets and do not require supplementation. Significant side effects may occur, such as severe flushing or itching skin, and liver damage. Which of the following statements about zinc absorption is true? a. Zinc absorption is lower in during pregnancy and lactation. b. consuming a high protein meal promotes zinc absorption through the formation of zinc amino acid chelates, a more easily absorbed form of zinc c. both phyates and tannins affect zinc absorption d. consuming soy protein inhibits zinc absorption Correct Answer is b. consuming a high protein meal promotes zinc absorption through the formation of zinc amino acid chelates, a more easily absorbed form of zinc A high protein meal does promote zinc absorption. Zinc is absorbed at the brush border of the small intestine. The human body typically absorbs 20-40% of ingested zinc. Zinc must be protein bound to be absorbed. Therefore the protein in the meal helps to form zinc-amino acid chelates that enhances absorption. Phyates interfere with the absorption of zinc; however, it appears that tannins do not. Soy protein improves zinc absorption. Which of the following statements best describes a normal infant's growth during the first year of life? a. an infant loses weight initially after birth, regains it by Day 10, double birth weight by 6 months, triples birth weight and doubles length by his/ her first birthday. b. An infant losses weight initially after birth, regains it by Day 10, doubles birth weight by 4 months, quadruples weight and triple length during the first year. c. After birth, the growth of an infant depends solely on the nutrition he/she receives d. the growth percentiles determined at birth are the best predictor of the infant's growth during infancy and childhood. Correct Answer is a. an infant losses weight initially after birth, regains it by day 10, doubles birth weight by 6 months, triples birth weight and doubles length by his/her first birthday. An infant's birth weight is determined by gestational age, mother's weight before pregnancy, and weight gain during the gestation period. It is normal for a newborn infant to lose up to 10% of its birth weight in the first few days of life. This is not cause for concern, unless the infant continues to lose weight after the tenth day of life. Most infants double their birthweight by 6 months and triple it by their first birthday. Length usually doubles within the first year. Weight gain and growth are influenced by both nutrition and genetics. The growth percentiles determined at birth are not usually the best indicators of overall growth. The majority of infants settle into their own growth curve somewhere between 3 & 6 months of age. Physiologic changes in an older person may include all of the following except: a. loss of lean body mass and an increase in adipose tissue b. loss of kidney function from age 30, due to gradual loss of nephrons and reduced blood flow c. Up to 40% reduction in resting metabolic rate, due to reduced lean body mass, since muscle is the most metabolically active tissue. d. Achlorhydria, resulting in a Vitamin B12 deficiency, because stomach acid is required to absorb vitamin B12 Correct Answer is c. Up to 40% reduction in resting metabolic, due to reduced lean body mass, since muscle is the most metabolically active tissue. The aging process essentially begins after the age of 30. The body has reached physiological maturity and the rate of catabolism is greater than the rate of anabolism. The aging process is influenced by genetics, socioeconomic status, overall health, activity level and lifestyle. Lean body mass is lost at a rate of 2-3% per decade and it is often replaced with fat. Lean body mass is the most metabolically active tissue, so its loss reduces the resting metabolic rate by 15-20% over the course of a lifetime. Other physiological changes include nephrons loss in the kidneys and achlorhydria, which is reduced stomach acid affecting the absorption of vitamin B12 and subsequent pernicious anemia in elders. A very young child is at highest risk for a deficiency in: a. protein b. vitamin c c. calcium d. iron Correct Answer is d. iron A child grows rapidly from the ages of 1-3 years. Some children are at risk for malnutrition because they are very fussy eaters, or are not offered appropriate foods to meet nutritional needs, or have a reduced appetite. The need for protein decreases as the child gets older. Most children consume more protein than is needed by the body. It is easy to meet the requirements for Vitamin C with a daily serving of juice. Calcium deficiency occurs if a child does not consume any sources of calcium. Iron deficiency is most likely to occur following the rapid growth of infancy, as there is an increase in hemoglobin. Many children's diets lack iron and its absorption rate can be decreased by many factors. Which of the following statements most accurately describes nutrition screening? a. A registered dietitian must complete nutrition screening b. The purpose of a nutrition screen is to identify people with malnutrition or who are high-risk for developing malnutrition c. The elderly population benefits most from nutrition screening d. A proper nutritional screen requires the patient's height, weight, and laboratory data. Correct Answer is b. the purpose of a nutrition screen is to identify people with malnutrition or who are high-risk for developing malnutrition. Nutrition screening is a part of the nutrition assessment process. Screening can be completed by a registered dietitian, dietetic technician, physician, nurse, or an appropriately trained delegate. The main purpose of the nutrition screen is to identify malnourished individuals or those who are at risk for developing malnutrition. Screening enables the practitioner to identify those individuals who are in need of a full nutrition assessment by the Registered Dietitian. Although the elderly do greatly benefit from frequent nutrition screening, the tool is useful for all age groups. The major components of a nutritional screen are: measuring height, weight; determining weight changes; and checking laboratory data. However, the information gathered for the screen varies, depending on its setting, the target population, and it's identified goals. The Nutrition Screening Initiative is a joint project between all of the following groups except the: a. American Diabetes Association b. American Academy of Family Physicians c. National Council on Aging d. American Medical Association Correct Answer is d. American Medical Association The Nutrition Screening Initiative of 1990 was a partnership between the American Academy of Family Physicians, the American Dietetic Association, and the National Council on Aging. The partners wanted to develop a tool to improve nutritional care for the elderly. They developed a simple checklist screening tool and two levels for further evaluation, which the patient can complete independently, or a medical professional can administer. Many community agencies administer the screen to populations they serve. The Nutrition Screening Initiative uses a checklist with the acronym DETERMINE, which stands for: a. Dental problems, Eating Poorly, Transportation issues, Economic Hardship, Reduced Social Contact, Multiple Medicines, Involuntary Weight Loss/ Gain, Needs Assistance in Self-Care, Elder Years Above Age 80 b. Disease, Eating Problems, Transportation Issues, Economic Hardships, Reduced Mobility, Multiple Medicines, Involuntary Weight Loss/Gain, Needs Assistance in Self- care, Elder Years Above Age 80 Healthy People 2020 is an extension of a health prevention program that originated in 1979 through the Surgeon General's report on health promotion and disease prevention. The programs two top goals are: To increase the overall quality of life and the number of years spent in good health, and to eliminate disparities in health between different parts of the population. There are 42 topic areas and hundreds of specific objectives that can be used by states, local communities, and various organizations and institutions. Some of the focus areas include cancer, obesity, diabetes, health communication, oral health and food safety. Data obtained for the Nutrition Assessment piece of the Nutrition Care Process is organized into these five categories: a. food/nutrition-related history; laboratory data and medical tests; social history; nutrition-focused physical findings; and client history b. food/ nutrition-related history; laboratory data; anthropometric measurements; physician exam; and client history c. food/nutrition-related history; biochemical data and medical tests; anthropometric measurements; nutrition-focused physical findings and client history d. Diet history; biochemical data and medical tests; anthropometric measurements; nutrition-focused physical findings; and medical exam findings. Correct Answer is C Food/nutrition-related history; biochemical data and medical tests; anthropometric measurements; nutrition-focused physical findings; and client history Which of the following categories does not represent how the Nutrition Diagnosis portion of the Nutrition Care Process is organized? a. nutrition-focused etiology b. intake c. clinical d. behavioral/ environmental Correct Answer is a nutrition-focused etiology. The second step of the Nutrition Care Process is Nutrition Diagnosis. The goal of a Nutrition Diagnosis is to recognize and delineate a particular nutrition issue that can be treated with nutrition intervention, with positive results. A registered dietitian (RD) completes a Nutrition Diagnosis. The RD utilizes the data gathered in step 1 of the Nutrition Care Process to identify and assign a specific nutrition diagnosis. Nutrition Diagnoses are organized into 3 different categories: 1) Intake, which compares the amount of food or specific nutrient consumed to what the estimated or actual requirements are 2) clinical, which links nutrition issues to a particular medical disorder 3) Behavioral/environmental which looks at the specific nutrition knowledge, belief, and access to nutrition and food safety. Critical thinking skills the dietitian requires to evaluate the PES statement in the Nutrition Care Process are: a. To evaluate which nutrition diagnosis to use for a patient and to select the broadest scope to maximize impact b. To evaluate the etiology, determine if the best "root cause" has been identified, and determine if the signs and symptoms can at least be improved with nutrition intervention c. To evaluate changes in the patient's signs and symptoms but to use clinical judgement to ultimately determine the appropriate resolution for the nutritional diagnosis d. To select the nutrition diagnosis most likely to be treated quickly and efficiently, with a clear resolution of symptoms. Correct Answer is B. To evaluate the etiology, determine if the best "root cause" has been identified, and determine if the signs and symptoms can at least be improved with nutrition intervention. The RD critical thinking skills to preform nutrition care, particularly when assigning a nutrition diagnosis. The RD documents the nutrition diagnosis with a PES statement (Problem-Etiology-Signs/Symptoms). The nutrition diagnosis the RD selects should be the most important that requires the most immediate attention. It is not necessarily the diagnosis that will see the fastest results. The diagnosis the RD selects should be related to the RDs role in the Nutrition Care Process and be specific enough to measure concrete improvement. Clinical judgement is still important. However, nutrition intervention must be measured and documented. At the very least, the RD's involvement should help to minimize any symptoms that are present. Select the statement concerning medical and nutrition diagnoses that is true: a. The physician determines the medical diagnosis, while the RD determines the nutrition diagnosis b. The physician must determine both the medical diagnosis and the nutrition diagnosis c. The medical diagnosis and the nutrition diagnosis must be identical d. The nutrition diagnosis cannot be resolved unless the medical diagnosis is also resolved Correct Answer is A. The physician determines that medical diagnosis, while the RD determines nutrition diagnosis. Part of the reason for introducing the Nutrition Care Process was to standardize nutrition care in a systematic way. Using standardized terminology is a step in this direction. Medical diagnoses are made by the physician, whereas nutrition diagnoses are determined by the RD. Both diagnoses can be mutually exclusive. Nutrition diagnoses can be different, based on individual patients with the same diagnosis. For instance, two different patients have heart disease, but one is overweight and the other is not. The RD must address the overweight patient's weight reduction in the nutrition diagnosis as excessive energy intake. Your patient is a 65 year old man, diagnosed with heart disease. He lives alone and has limited cooking skills. He frequents fast food restaurants because they are within walking distance of his house. He is 20 pounds overweight with a BMI of 26. Select an appropriate PES based on the information you have: a. Heart disease related to fast food consumption, as evidenced by diet history b. Excessive energy intake related to limited cooking skills, as evidenced by obesity c. Excessive energy intake related to frequent consumption of fast food, as evidenced by BMI an diet history. d. Inadequate exercise related to heart disease, as evidenced by BMI and weight gain Correct Answer is c. Excessive energy intake related to frequent consumption of fast food, as evidenced by BMI and diet history. The new RD develops and appropriate PES as his/her skills increase. In this scenario, we do not know what additional exercise the patient gets besides walking to restaurants. He is 20lbs overweight and has been diagnosed with heart disease, which we know is a modifiable risk factor. We do not know the period in which he gained weight. the best PES would be defining the problem as excessive energy intake. The etiology of the problem would be increased consumption of fast foods. The signs and symptoms would be the BMI of 26 and his diet history. Your referral patient is a 52 year old female with elevated glucose levels, diagnosed with diabetes mellitus. Her fasting blood glucose level is 132mg/dl. Her BMI is 28, which has increased from 25 over the past several months. She performs physical exercise two or three times per week for approximately 15 minutes. Select nutrition diagnoses based on the above information a. excessive carbohydrate intake, physical activity, or diabetes mellitus b. Inappropriate carbohydrate intake, inadequate physical activity or excessive energy intake c. excessive carbohydrate intake, impaired nutrient utilization, or diabetes mellitus d. altered nutrition-related lab values, physical activity, or overweight/ obesity Correct Answer is d. Altered nutrition-related lab values, physical activity, or overweight/ obesity. The nutrition diagnosis is a problem the RD labels, addresses, improves, and resolves. Diabetes mellitus is a medical diagnosis but not a nutrition diagnosis. Instead of using diabetes mellitus, it would be appropriate to use the nutrition diagnosis of altered nutrition-related lab values. In this case, fasting blood glucose falls under behavioral- environmental. From the information provided, we do not know what this women's diet history is. We are then unable to assign a nutrition diagnosis related to her carbohydrate intake or energy intake, until we obtain this information. We do know that her physical activity is inadequate, which also falls under behavioral-environmental. We do know from her BMI of 28 that she is overweight and this is a clinical finding. Your patient is a 46 year old man, who is 6ft tall and weight 160lbs. He presents with difficulty swallowing and weight loss of 20lbs. He states he usually weighs 180lbs. He has a long history of cigarette smoking but no other medical issues. The doctor admits your patient to the hospital to evaluate him for possible esophageal cancer. Admission blood work reveals a serum albumin of 2.8g/dL. During the nutrition interview, his diet history shows your patient consumes approximately 1,500 calories per day, and he has altered his diet to soft/ semi-soft consistency to accommodate his dysphagia. Based on above information, all of the following are possible nutrition diagnoses except: a. Inadequate energy intake b. excessive smoking c. Swallowing difficulty (dysphagia) d. Involuntary weight loss Correct Answer is b. Excessive smoking. CVD, but without other major risk factors, such as smoking, hypertension, or high serum cholesterol. Metabolic syndrome can be identified by the presence of: a. Central obesity (waist circumference greater than 40 inches for men, 35 for women), fasting glucose levels greater than or equal to 100mg/dl, blood pressure greater than 130/85 mmHg b. central obesity (waist circumference greater than 40 inches for men, 35 for women), blood pressure greater than 130/90mmHg, fasting glucose greater than 110 mg/dl. c. Central obesity (waist circumference greater than 40 inches for men, 35 for women), serum triglyceride levels greater than or equal to 150mg/dl, HDL cholesterol level less than 35 mg/dl for Men and 45 or less for women. d. Serum triglyceride levels greater than or equal to 150mg/dl, blood pressure greater than 130/85mmHg, fasting glucose levels greater than or equal to 120mg/dl Correct Answer is A. Central obesity (waist circumference greater than 40 inches for men, 35 inches for women), fasting glucose levels greater than or equal to 100mg/dL, blood pressure greater than 130/85 mmHg. Metabolic syndrome means the patient has a group of risk factors related to overweight or obesity, lack of exercise, and predisposing genetic factors, which increases his/her risk of developing coronary heart disease. At least three of the following risk factors are required for a diagnosis of metabolic syndrome: Central or abdominal obesity with a waist circumference of 40 inches for men and 35 inches for women; fasting serum triglyceride levels greater than or equal to 150mg/dl; an HDL level less than 40mg/dl for men and 50 mg/dl for women; fasting glucose level greater than or equal to 100mg/dl; or a blood pressure reading greater than or equal to 130/85 mmHg Which of the following best describes the nutritional care for dumping syndrome? a. Small frequent meals with high protein, moderately fatty foods, limited concentrated sweets, and drinking liquids separately from meals. b. Three moderately sized meals and three snacks containing moderate protein and fat, lactose-free foods, and fluids limited to 4 ounces per day. c. Small frequent meals, with high protein, low fat, and high fiber foods, ingesting liquids and concentrated sweets separately from meals, avoiding foods containing lactose d. Three moderately sized meals and three snacks with moderate protein, low fat, and low fiber, liquids limited to 4 ounces per meal, concentrated sweets limited to one or two servings per day Correct Answer is A. Small frequent meals with high protein, moderately fatty foods; limited concentrated sweets; and drinking liquids separately from meals. Dumping syndrome may occur following GI surgery, due to changes in gastric emptying in response to a meal. The goal of medical nutrition therapy is to prevent dumping symptoms from occurring by manipulating the diet and timing of meals. -small frequent meals spread throughout the day -moderate fat intake of 35-45% of total calories to slow transit time -protein intake increased to 20% of total calories -complex carbohydrate intake - fluids consumed separately from meals, as too many fluids may increase transit time -lactose avoidance Fiber does help to slow transit time; however, fibrous foods may cause bowel obstruction. Crohn's disease and ulcerative colitis are the two main forms of inflammatory bowel disease (IBD). All of the following are true about IBD except: a. The average age of onset for IBD is 15 to 30 years old, and IBD occurs equally in both males and females b. Nutrition is a major issue for both Crohn's disease and ulcerative colitis patients; however, malnutrition is likely to be more of a lifelong concern for patients with ulcerative colitis c. Crohn's disease can present in any part of the GI tract; however, it most frequently involves the distal ileum and the colon d. Ulcerative colitis involves the colon and is a continuous disease Correct Answer is B. Nutrition is a major issue for both Crohn's disease and ulcerative colitis patients; however, malnutrition is likely to be more of a lifelong concern for patients with ulcerative colitis. Crohn's disease and ulcerative colitis are the two main forms of IBD. The age of onset is usually between 15-30 and sometimes between 50 and 60. Both diseases have similar symptoms, including diarrhea, weight loss, fever, anemia, and food intolerances. Both types of IBD are likely have prolonged malnutrition over the course of al lifetime, due to management issues. Crohn's disease can occur in segments anywhere within the GI tract but is most likely to occur in the distal ileum and colon. Patients with Crohn's disease often require surgical treatment but surgery does not cure the disease. Many Crohn's patients develop additional complications, such as short bowel syndrome. Ulcerative colitis occurs only in the colon. Which of the following must the dietitian consider to assess the nutritional status of a patient with end-stage liver disease accurately? a. Nitrogen balance studies b. Creatinine height index c. Anthropometric data including information on weight changes and visual assessment d. Serum albumin level Correct Answer is C. Anthropometric data, including information on weight changes and visual assessment. Nutritional assessment of patients with end stage liver disease is often difficult because many test parameters are adversely affected. -BUN is useless because nitrogen builds up in the form of ammonia, so BUN cannot be interpreted in the usual way -Creatinine height index is compromised be decreased liver function (synthesis of creatine to creatinine occurs in the liver) -Serum albumin and other visceral protein levels are unreliable, as the liver synthesizes visceral proteins -Anthropometrics are unreliable, due to fluid retention and use of diuretics Instead, take a weight history and perform a visual assessment. Look for muscle wasting and the presence of fat stores. Added to the overall subjective global assessment, these two parameters are most useful. Which statement best describes protein requirements in liver disease? a. In uncomplicated hepatitis or cirrhosis without encephalopathy, protein requirements are 1 to 1.2 grams per kilogram of actual weight to promote nitrogen balance. b. In uncomplicated hepatitis or cirrhosis without encephalopathy, protein requirements are 1 to 1.2 grams per kilogram of dry weight to promote nitrogen balance c. A protein restriction of less than 0.6 grams per kilogram is recommended for acute encephalopathy d. Protein requirements for most patients with compensated liver disease are 1.5 to 2 grams per kilogram Correct Answer is B. In uncomplicated hepatitis or cirrhosis without encephalopathy, protein requirements are 1 to 1.2 grams per kilogram of dry weight to promote nitrogen balance. Protein requirements in chronic liver disease remain controversial. The European Society of Parenteral and Enteral Nutrition (ESPEN) recommends giving patients with compensated liver disease 1 to 1.3 grams of protein per kilogram including patients with chronic cirrhosis without encephalopathy. Measure the patient's dry weight to calculate his/her protein requirements as many patients with liver disease have ascites. For patients with acute encephalopathy, the generally accepted practice is to restrict protein intake to 0.6 to 0.8grams per kilogram, but only during the acute phase. After the encephalopathy clears, restore protein intake to 1 to 1.2 grams per kilogram, providing their renal function is normal The initial treatment for acute pancreatitis is to allow the pancreas to rest and: a. Provide IV fluids for hydration until the patient is pain-free and nausea and vomiting have resolved. Initiate a clear liquid diet and gradually advance to soft, low fat diet based on patient tolerance b. Initiate parenteral nutrition immediately. When patient is pain-free and nausea and vomiting have resolved, initiate clear liquid diet. Gradually advance to a soft, low fat diet based on patient tolerance. c. Initiate enteral feeding immediately, using a defined formula fed into the jejunum. When the patient is stable, initiate clear liquid diet. Slowly advance to a soft, low fat diet. d. Initiate a clear liquid diet when the patient's pain has subsided. Advance to a soft, low fat diet with supplemental pancreatic enzymes to improve tolerance Correct Answer is A. Provide IV fluids for hydration until the patient is pain-free and nausea and vomiting have resolved. Initiate a clear liquid diet and gradually advance to a soft, low fat diet based on patient tolerance. Acute pancreatitis is sudden inflammation of the pancreas, causing intense abdominal pain, nausea, and vomiting. Symptoms worsen when the patient consumes food, due to pancreatic stimulation. Treatment for acute pancreatitis is: 1. Allow the pancreas to rest by keeping the patient NPO (nothing by mouth) 2. Start IV fluids for hydration developed. NPH and Lente are examples of intermediate-acting insulin. Give intermediate-acting insulin twice per day, once before breakfast and the other later at dinner or bedtime. The onset of action is approximately 2 to 4 hours. The peak action occurs around 6 to 10 hours. The duration of intermediate insulin is between 10 and 16 hours. Check the effects of intermediate insulin within 8 to 12 hours to ensure the patients blood glucose is in proper range. Short-acting insulin begins to work within 1 hour. Its peak is within 2 to 3 hours. Its duration is 3 to 6 hours. Long acting insulin begins to work within 6 to 10 hours. It peaks around 10 to 16 hours. Its duration is 18 to 24 hours. When discussing sick day guidelines with a diabetic patient, you would include all of the following except: a. Continue to take insulin as ordered by your physician, because your insulin requirements may increase due to sickness causing fever or stress b. Consume only sugar-free fluids to prevent hyperglycemia from an excessive sugar intake. c. Consume adequate fluids, especially if you vomit. Drink 1 ounce every 15 to 30 minutes in small sips d. Check your blood glucose levels and your urine ketones at least 4 times daily. Call your doctor if ketones appear or if your blood glucose is greater than 240mg/dl Correct Answer is B. Consume only sugar-free fluids to prevent hyperglycemia from an excessive sugar intake. Emphasize the importance of sick day management to your Type I diabetic patients. Failure to follow these guidelines could cause diabetic ketoacidosis (DKA) -always take insulin as prescribed during an illness. Sometimes insulin requirements increase due to infection, fever, or stress -Test blood glucose levels, urine or blood ketones at least four times throughout the day. The presence of ketones along with a blood glucose level greater than 240mg/dl signals DKA is developing - If regular foods are intolerable, substitute soft foods or liquids containing carbohydrates. Sugar-free or low carbohydrate foods are not indicated. -Consume at least 50 grams of carbohydrate every 3 to 4 hours and maintain adequate hydration. - If the illness continues beyond 24 hours, contact a physician Choose the appropriate treatment for hypoglycemia: a. If the patient's blood glucose level is less than 70 mg/dl, give 4 ounces of juice or 1 tablespoon of sugar. Recheck the patient's blood glucose level in 15minutes . The level remains less than 70mg/dl, give another 15 grams of carbohydrate b. If the patient's blood glucose level is less than 70mg/dl, give 8 ounces of juice or 6 glucose tablets. Recheck the blood glucose level in 30 minutes. If the level remains less than 70mg/dl, give another 15 to 30 grams of carbohydrate c. If the patient's blood glucose level is less than 70mg/dl, give 8 ounces of juice or 4 glucose tablets. Recheck the blood glucose level in 30minutes. If the level remains less than 70mg/dl, give another 15 to 30grams of carbohydrate d. If the patient's blood glucose level is less than 70mg/dl, give 8 ounces or 10 to 12 Lifesavers. Recheck the blood glucose level in 15 minutes. If the level r Correct Answer is A, If the patient's blood glucose level is less than 70mg/dl, give 4 ounces of juice or 1 tablespoon of sugar. Recheck the patient's blood glucose level in 15 minutes. If the level remain less than 70mg/dl, give another 15 grams of carbohydrate. A blood glucose level less than 70mg/dl is hypoglycemia and requires immediate attention. Use the "Rule of 15" to remember the treatment guidelines: If the blood glucose level is low, give 15 grams of carbohydrate. For example, 4 ounces of juice or other sugary beverage, 3 to 4 glucose tablets, 6 to 8 Lifesavers, or 1 Tablespoon of sugar or honey. Recheck the blood glucose level again in 15 minutes and if it is still low give, another 15grams of carbohydrate. Recheck the blood glucose level again in 15 minutes. Blood glucose levels may drop again within an hour. Therefore if a meal or substantial snack is not planned within an hour, give another 15 grams of carbohydrate Choose the best description of cardiac risk, according to the ATP III guidelines of the National Cholesterol Education Program (NCEP): a. The HDL level is the primary marker, followed by the presence of any type of atherosclerotic disease, such as coronary heart disease, carotid artery disease, or peripheral arterial disease, and risk factors (smoking, hypertension, LDL levels greater than 100mg/dl, age greater than 45, or significant family history) b. The LDL cholesterol level is the primary marker, followed by the presence of coronary heart disease, and risk factors (smoking, hypertension, HDL levels less than 40mg/dl, age greater than 45, or significant family history) c. The total cholesterol level is the primary marker, followed by the presence of coronary heat disease, and risk factors, such as smoking, hypertension, HDL levels less than 40mg/dl, age greater than 45, or significant family history. d. The pati Correct Answer is B. The LDL cholesterol level is the primary marker, followed by the presence of coronary heart disease, and risk factors (smoking, hypertension, HDL levels less than 40mg/dl., age greater than 45, or significant family history). The ATP III guidelines are part of the National Cholesterol Education Program (NCEP). Use the patients LDL cholesterol level as the primary marker for initiating therapy. A level less than 100 is optimal, 100-129 near optimal, 130-159 is borderline high, 160- 189 is high, greater than 190 is very high and dangerous. ATP III also uses total cholesterol and HDL levels as secondary markers. Evaluate the presence of coronary heart disease or other types of of atherosclerotic disease, such as carotid artery disease or smoking, HDL level less than 40mg/dl; hypertension family history of early heart disease, such as a make first degree relative diagnosed prior to age 55 or a female first degree relative diagnosed earlier than 65, patient's age (men older than 45 or women older than 55). Categorize the patient's overall risk. Base initial treatment on LDL cholesterol levels. Choose the American Heart Association's healthy eating recommendations for children to prevent heart disease: a. A child must have: A nutritious diet containing a variety of food groups, less than 35% of total calories from fat intake and less than 10% from saturated fat, cholesterol intake less than 300mg per day, sufficient calorie intake to promote normal growth and development but if the child is overweight, adjust calories to promote slow weight loss. b. A child must have: A nutritious diet containing a variety of food groups, total fat intake less than 30% of total calories, caloric intake tailored to achieve a healthy body weight, while maintaining normal growth and development, limited juice intake and low fat or fat- free diary products. c. A child must have: A nutritious diet containing a variety of food groups total fat intake of 25 to 35% of total calories for children older than 4, mostly monounsaturat Correct Answer is C. A child must have: A nutritious diet containing a variety of food groups, total fat intake of 25-35% of total calories for children older than 4, mostly monounsaturated or polyunsaturated fat, five fruits and vegetables/day, whole grain products whenever possible, low fat or fat-free dairy products for children older than 2, and at least one hour of exercise per day. The American Heart Association recommends heart-healthy choices parents can make for their children. Start healthy choices in infancy. Children 2-3y/o should have a fat intake that is 30-35% of total calories. After age 4, reduce total fat intake to 25-35% of total calories. Offer a variety of foods, starting as early as possible. Restrict juice intake but encourage intake of whole fruits and vegetables. Offer whole grains and low fat or fat-free dairy products for child older than 2. Provide enough calories for normal growth and development, without overfeeding. Weight loss is not necessarily the goal for most children who are overweight. Adjust their calorie intake to slow the rate of weight gain and increase their amount of physical activity, with a goal of 60 minutes/day. The dietitian who begins nutrition therapy for a cardiovascular disease patient realizes the outcome measures are influenced most by: a. Family history, age, gender, socioeconomic status, and cigarette smoking b. HDL cholesterol, dietary modifications, and LDL cholesterol c. Oxidative stress, triglycerides, HDL cholesterol, and total cholesterol d. Obesity, physical activity, and thrombogenic factors, such as fibrinogen Correct Answer is B. HDL cholesterol, dietary modifications, and LDL cholesterol. Reducing or eliminating modifiable risk factors has a direct impact on lowering cardiovascular events. Modifiable risk factors include: quitting smoking, lowering LDL cholesterol, lowering blood pressure, making dietary changes to reduce fat and cholesterol, effective diabetes control, exercise, increasing HDL cholesterol, weight loss, and lowering triglyceride levels. Modifiable risk factors are measurable. Document patient outcomes to measure progress. Other modifiable risk factors that may or may not influence CVD risk are reducing oxidative stress levels, lowering homocysteine, and reducing alcohol intake. Non-modifiable risk factors are age, gender, family history, and the mere presence of diabetes. Identify the contents of the Therapeutic Lifestyle Change (TLC) diet: a. Less than 35% of total calories from fat, with less than 10% saturated fat, up to 10% polyunsaturated fat, up to 20% monounsaturated fat, and cholesterol intake less than delivery. Stocking the freezer with frozen dinners is not a good option because it increases sodium intake. Commercially prepared supplements (eg Ensure) provide calories and protein, but they should not be used consistently as meal replacements. If the patient is using diuretics, discuss the amount of fluid needed each day with the physician. The correct nutritional management for a chronic kidney disease (CKD) patient receiving hemodialysis is: a. 30kcal/kg, 0.8-1g/kg protein, 2-4g sodium, 2g potassium, 800-1200mg phosphorus, restrict fluid to 1500ml/day. b. 30-35kcal/kg, 1-1.3g/kg protein, 3-4g sodium, unrestricted potassium, restrict phosphorus by limiting dairy to one 8oz serving or the equivalent per day, unrestricted fluid c. Minimum 30-35kcal/kg, 1.2g/kg of protein, 2-4g sodium, 2-3g potassium, restrict phosphorus by limiting dairy to one 8oz serving or equivalent per day, fluid intake of 1000ml plus the amount of daily urinary output. d. 25-30 kcal/kg, 1.5g/kg of protein, 4g sodium, 2g potassium, restrict phosphorus by limiting diary to one 8oz serving or equivalent per day, fluid intake of 1500ml plus the amount of daily urinary output. Correct Answer is C. Minimum 30-35kcal/kg, 1.2 g/kg protein, 2-4g sodium, 2-3g potassium, restrict phosphorus by limiting diary to one 8oz serving or the equivalent per day, fluid intake of 1000ml plus the amount of daily urinary output. An ESRD patient receiving hemodialysis treatments does require nutritional management. Energy intake should be 30-35kcal/kg but can vary, based on patient's overall clinical condition. Protein requirements are 1.2grams/kg or higher depending on protein status. Sodium restriction is required for blood pressure management and fluid status. When the patient's kidney function has deteriorated enough to require hemodialysis, a potassium restriction of 2-3g/day is usually sufficient to maintain serum potassium in the normal range, but adjust potassium as needed. Phosphorus restriction of 800-1200mg/day is usually required, even if the patient already uses phosphorus binders. Limit fluids to the amount of urinary output plus 1000ml. Monitor weight gain between treatments. Weight gain from dry weight should be less than 3kg. Which vitamin is least likely to be deficient in patients with chronic kidney disease receiving hemodialysis? a. Vitamin D b. Vitamin C c. Vitamin B6 d. Vitamin A Correct Answer is D. Vitamin A Vitamin deficiency is a concern for patients with chronic kidney disease because their diets are restricted for fruits, vegetables, and dairy products. Adding dialysis to the equation increases their risk for Vitamin C and Vitamin B deficiencies, as these vitamins are lost through dialysis. Rarely do patients with ESRD develop Vitamin A deficiency. The amount of retinol-binding protein is usually elevated in the blood of patients with CKD, indicating potential toxicity. Supplementation of Vitamin A is not recommended. Vitamin D is converted to its active form in the kidney. With kidney failure this process cannot occur. Provide the active form of Vitamin D as calcitriol to prevent deficiency. Enteral nutrition support for oncology patients is contraindicated for all of the following conditions except: a. bowel obstruction b. nausea and vomiting for one to two days following chemotherapy c. low platelet count d. serve nausea, vomiting, or diarrhea Correct Answer is B. Nausea and vomiting for one or two days following chemotherapy. Enteral nutrition may be appropriate for cancer patients who are not expected to regain improved oral nutrition within five to seven days after chemotherapy. If the patient's GI tract is fully functional, then choose enteral nutrition in the form of tube feedings. If the patient is only symptomatic for one to two days following chemotherapy, but is then able to maintain reasonable oral intake, tube feedings are not indicated. Definite contraindications to tube feeding include bowel obstruction, severe nausea or vomiting, and diarrhea. Oncology patients with low platelet counts should not receive tube feedings, as the risk of bleeding is increased. Other contraindications include overall low white or red counts, as these may signify infection. Megestrol acetate is for: a. nausea and vomiting b. stimulating appetite c. mucositis d. saliva replacement Correct Answer is B. Stimulating appetite. Megestrol acetate is commonly used to stimulate appetite in oncology and other disease states that produce anorexia, such as HIV. It is synthetic form of progesterone. Do not use megestrol as a preventative measure. It helps to increase weight gain by increasing the appetite, and thus food intake. Known side effects of megestrol acetate include endocrine suppression, edema of the hands and feet, thrombophlebitis, and changes in blood glucose levels. Therefore, monitor fluid balance, hormone levels, and clotters closely. Other medications used to stimulate appetite include dronabinol and dexamethasone. The nutrition care process is documented on the following forms: a. ADIME or PGIE b. SOAP or PAR c. PIE or PAR d. PGIE or ADIOP Correct Answer is A. ADIME or PGIE Documentation of the nutrition care process may include one of six formats using acronyms. It helps to incorporate the PES statements, interventions, monitoring, and evaluation as part of the nutrition care process. The first is called ADIME and stands for Assessment, Diagnosis, or PES statement, Intervention, Monitoring, and Evaluation. The second is PGIE, which stands for Problem or diagnosis, Goal, Intervention, and Evaluation. Next is SOAP, which stands for Subjective, Objective, Assessment/diagnosis, and Plan. DAR stands for Data/diagnosis, Action/nutrient prescription/ nutrition intervention and Response. This can also be documented as DAR-O if it includes Output. Lastly, PIE is another format that stands for Problem/diagnosis, Intervention, and Evaluation. The School Breakfast Program and National School Lunch Programs are administered by the: a. USDA b. CDC c. EFNEP d. HHS Correct Answer is A. USDA The School Breakfast Program and National School Lunch Program are administered by the United States Department of Agriculture (USDA). The CDC stands for Centers for Dieses Control. EFNEP stands for Expanded Food and Nutrition Education Program. HHS stands for Department of Health and Human Services. HHS is responsible for protecting the health of all Americans and for providing essential human services, such as the Headstart Program or improving child and maternal health. The USDA administers other types of programs, such as WIC, SNAP (food stamps), Child and Adult Care Food Program, and the Special Milk Program. HHS is also involved in other nutrition initiatives, such as the Web site nutrition.gov for consumer nutrition information, and meat and poultry hotlines for consumer food safety information. The purpose of the Child and Adult Care Food Program is to: a. Provide guidelines for serving nutritious meals and snacks to daycare programs for children and adults b. Provide guidelines for meal patterns and reimbursement for nutritious meals and snacks to child care centers, emergency shelters, and adult day care programs, based on income eligibility c. Provide food for meals and snacks for child care centers, emergency shelters, adult day care programs d. Provide guidance and resources on appropriate feeding practices throughout the lifecycle for income-eligible participants Correct Answer is B. Provide guidelines for meal patterns and reimbursement for nutritious meals and snacks to child care centers, emergency shelters, and adult day care programs, based on income eligibility. The Child and Adult Care Food Program is a program administered by the USDA. It is geared to low income individuals and families. The program provides meal-planning guidelines for all ages, including infants up to the elderly. The location of the program may include childcare centers, after school programs for at risk children, group daycare homes, emergency shelters and adult daycare centers. Meal reimbursement is provided according to guidelines set forth by the agency. Eligibility is based on income levels between 130-185% of the federal poverty level. The federal program provides funds to state agencies to distribute. not yet thought about making any changes. In the contemplation stage, the patient begins to think of reasons why he should or should not make changes. In the preparation stage, the patient may be ready to move ahead and requires assistance finding a strategy that will work. In the action phase, the patient begins to make the necessary changes. In the maintenance stage, the patient must continue to follow through with positive behaviors. Lastly, in the relapse stage, the patient must begin the change process again after a failure, to achieve the action phase. Identify the true statement for implementing dietary change: a. Resistance and denial signal noncompliance with the intervention b. A patient progresses through the stages of change in a fluid. forward-moving process c. A patient will only change when he or she is good and ready d. The RD's counseling style has no impact on a patient in denial, who does not accept the need for change Correct Answer is C. A patient will only change when he or she is good and ready. When an RD tries to help a patient make dietary changes, the RD must remember the patient will only make a change when he or she is ready to do so. The patient who is in the action or maintenance stage of change is ready adjust. A patient who resists or is in denial may eventually make dietary changes, but al the moment, he or she is not yet ready. The rate of progress through the stages of change is an individual journey. The patient may move forward or backward at any time. People do not move along in a predetermined sequence. It is important for the RD to determine which stage of change the patient is in to tailor counseling efforts appropriately. The RD's counseling style, personality, and what he or she addresses motivate the patient to make a change. All of the following techniques are appropriate for the client who resists dietary changes, except: a. Ignore the individual's perception b. Be empathetic to the client's issues. c. Recognize cultural factors that create resistance to change d. Prevent the client from becoming defensive about his or her lack of motivation Correct Answer is A. Ignore the individual's perception. An effective counselor recognizes certain behaviors on the dietitian's part influence client behavior. The RD should always try to be empathetic when a client expresses concerns about implementing change. Empathy is an important tool for effecting change. Cultural issues have a significant impact on change and the RD should be aware of these. For example, Koreans may automatically agree with everything someone in charge says, even though they may have no intention of implementing any of the suggestions. The RD must not place the client in a position where he/she becomes defensive. The RD tries to offer support and encouragement. An impasse means a change in counseling strategy is in order. The RD should not ignore the client's perceptions, though. Identify any perception that may interfere with change and explore it. During the first counseling session, the RD uses the intervention model to: a. Get as much information from the client as quickly as possible. b. Establish rapport with the client and set the tone for future sessions c. Sit across the desk from the client and take better notes on what the client is saying d. Take charge and recommend dietary changes for immediate implementation Correct Answer is B. Establish rapport with the client and set the tone for future sessions. Establishing a rapport with a client is essential to the counseling process. Establish rapport by asking a few general questions about the client's personal life. Try to find a common ground. Examples of this may be mutual enjoyment of a certain sport or type of animal. Use your first session for information gathering. Do not rush due to time constraints or money. Use the corner of a desk for note taking, but do not use it as a barrier between you and the client. Seating yourself beside the client is less intimidating than sitting across from the client, behind a desk. Never try to take charge of the session immediately, as this does not invite effective change. First, complete the assessment piece and identify the patient's stage of readiness. Give positive reinforcement for changes the client has already made or is already performing correctly. What communication strategies might an RD employ for a client who is not ready to make any dietary changes? a. Reflective listening and affirming the client's issues b. Summarizing and making an action plan for change c. Problem recognition and goal setting d. Sending the client away to reflect on the barriers to change and booking a follow-up session for 1 week later. Correct Answer is A. Reflective listening and affirming the client's issues. Effective communication skills help a client address reasons why change will be difficult. Reflective listening means listening closely to what a client is saying, then rephrasing as a short statement to show you comprehend the issue. Affirmation means demonstrating your appreciation of a client's attempts at changing behavior. Let the client know you understand the issues and that it is normal to have roadblocks to progress. Summarize what your client says. Identify and label the conflicting issues. Ask open-ended questions that allow your client to expand on his or her thoughts, rather than provide a yes or no answer. Do no immediately set goals or an action plan for a client who is not yet ready to change. The RD documents all of the following nutrition education items except: a. Reason for visit and current diagnosis b. Short-term and long-term goals, meal planning, and topics covered during education c. RD's thoughts on the client's progress, expected compliance level, and what changes the client has already succeeded in making. d. Fee schedule, erasing any charting errors, and client's perception of medical care he or she is receiving. Correct Answer is D. Fee scheduling, erasing any charting errors, and client's perception of medical care he or she is receiving. Do not include the client's fee schedule when documenting patient education, as this is not pertinent information. Remember that the patient's chart is a subpoenable document that a judge may review. It is illegal to erase or paint correction fluid on a charting error. Draw a single line through the error in dark blue or black ink. Write the correction above the error, initial and date it. You must document the reason for the patient's visit, his or her current diagnosis, any relevant lab results, medications, and the name of the physician who referred the patient to you. Briefly outline the History, the nutrition problem list, and the care provided by the physician, including goals set and expected level of compliance. Document all topics you address during the session, dietary changes successfully implemented, and a follow-up plan. The purpose of evidence-based practice is to: a. Search the Internet to find new therapies to treat patients b. Use data from cohort studies to change practice c. Improve patients' outcomes by incorporating the best research available in new treatments and therapies d. Use meta-analyses, review articles, or consensus statements to change the way patient care is provided. Correct Answer is C. Improve patients' outcomes by incorporating the best research in new treatments and therapies. Evidence-based practice incorporates the best available research with clinical expertise, and an individual patient's beliefs and situation into a comprehensive treatment plan. The gold standard for research is randomized, controlled trials that are well designed. Cohort studies, meta-analysis, review articles and consensus statements are useful supplements, but are not the primary mode of obtaining information. Beware of Internet misinformation; ensure any Web addresses you rely on end in .edu, .gov, or .org. Utilizing evidence-based practice is a way for clinicians to remain well informed and to change practice when new treatments or therapies are available. National accreditation standards require dietitians to follow best practice guidelines and evidence-based practice. Which internet source is not a primary source for evidenced-based practice? a. WebMD b. Ovid c. PubMed d. American Dietetic Association Evidence Analysis Library Correct Answer is A. WebMD Many legitimate Internet resources for evidence-based research exist, such as the U.S. National Library of Medicine's PubMed and Ovid, and the Centers of Disease Control . Do not use WebMD as a primary information source because it is geared to patients, rather than professionals. It may contain valuable information for consumers, but is too simplistic for healthcare professionals. Use Web sites ending .org, .edu, or .gov for reliable research. The American Dietetic Association's Evidence Analysis Library is a database that sorts through important and relevant nutrition research. Two other appropriate databases are SCHARR (School of Health and Related Research) and EMBASE (the Excerpta Medical Database). Individual resources for medical professionals include UpToDate, Harrison's Principles of Internal Medicine, and Clinical Evidence. Correct Answer is D. Help the client see the advantages and disadvantages of making changes. A client in the contemplative stage of change remains indifferent or uncertain about making dietary changes. The contemplative client thinks about making a change but may find a reason to opt out of it. The RD's job in the contemplative stage is to help the client see why making changes would benefit him/her. Do not begin goal setting, as the client will likely tune out. Help your client to adjust before proceeding to the action stage. Prevent your client from feeling discouraged. Move forward by making positive changes until the maintenance stage. A hospital menu that rotates daily on a predetermined schedule, such as every three days or every week, is called a: a. Limited menu b. Rotating menu c. Cycle menu d. Table d'hotel menu Correct Answer is C. A cycle menu A cycle menu rotates every day on a predetermined schedule such as every week or two weeks. Due to shorter patient stays in hospitals, some food services reduce their cycle to a three-day rotation. At the end of the cycle, the menu repeats. The purpose of a cycle menu is to help the patient or visitor feel that meals are not repetitive. Cycle menus save time because when the cycle is planned once, menu planning and recipes are complete. The menu planner should take seasonal produce into account. The purchaser knows what foods need to be ordered and available for each day of the cycle, which helps control costs. Training of production and preparation personnel is tailored to the cycle. Select the major reason an institution implements a nonselective or preselected menu: a. Financial b. Quality c. Balanced diet d. Catering for special requests Correct Answer is A. Financial Healthcare institutions implement nonselective or preselected menus for financial benefit. Dietary staff or the ward clerk visits the patient on admission to obtain food preferences and potential allergies. A computer-generated menu is released for the patient each day, based on the master menu that has already been planned. Labor costs are reduced because the patient is not seen by staff every day for menu selection. Fewer personnel are required for food production and the tray line. Nonselective and preselective menus also decrease food costs up to 20% because of less waste and leftovers. Other benefits of preselection are limiting the menu to a few items provides a balanced diet and allows excellent preparation of specialties. All of the following characterize restaurant style except: a. Clear, concise, easy to understand menu selections b. Short explanations about modified diets c. Room service, where meals ordered by telephone are delivered at the patient's request d. Less interaction between the patient and food service personnel Correct Answer is D. Less interaction between the patient and food service personnel. A restaurant style menu in a hospital increases patient satisfaction and menu variety. A room service option may be available, where the patient phones the kitchen to order a meal at will and has it delivered in a timely manner. A restaurant style menu should be clear, concise, and easy to read and understand. Remember that patients are incapacitated or medicated and may have difficulty focusing their eyes. Offer explanations about diet modifications and basic nutrition advice on the menu. Restaurant style menus are not designed for less interaction with food service personnel. Frequent, positive interaction with food service personnel improves patient satisfaction. If a patient in a long-term care facility requests a write-in or substitution on the menu, the RD's response should be: a. Immediately disregard the request because it increases food costs b. Inform the patient you considered the request but the policy is no substitutions c. Provide the request or offer another option d. Inform the patient you need at least 48 hours to plan for social requests Correct Answer is C. Provide the request or offer another option. Many institutions, especially long-term care facilities, try to provide increased choices for patients or may liberalize diet modifications. Still, patients may have special requests known as substitutions or write-ins. The Centers for Medicare and Medicaid Services (CMS) require that substitutions should be honored in long-term care facilities. Other types of institutions should either provide the request or find another option that is amenable to the patient. Exotic requests may be difficult or impossible to provide. Most are reasonable, do not take much effort to provide, and increase patient satisfaction. Keep a list of potential write-in requests available in the kitchen to ease the process. Your first task when planning a cycle menu is: a. Plan salads, side dishes and appetizers b. Plan breakfast entrees c. Plan starch items and sauces d. Plan dinner entrees for the whole cycle Correct Answer is D. Plan dinner entrees for the whole cycle. The RD must plan the dinner entrees first when preparing a cycle menu because dinner is the most expensive meal of the day. All entrees must be balanced, varied, and within budget. Consider alternatives for vegetarian clients or those with cultural restrictions (e.g. Kosher for Jews and Halal for Muslims). Secondly, plan the lunch entrees. Thirdly plan the starch choices, followed by salads, side dishes, and appetizers. Plan desserts after the balanced dinners and lunches. Finally plan the breakfast meal. Perform a final review to ensure the overall menu is balanced and meets any required government regulations and accreditation standards. Review the results of the last accreditation survey for your department to pinpoint the weak areas in your kitchen. The School Meals Initiative for Healthy Children (SIM) requires schools to do all of the following except: a. Decrease the amount salt and sugar in reimbursed meals b. Use one of the four menu-planning options, such as NuMenus or Enhanced food- based menus c. Provide meals consistent with the Dietary Guidelines for Americans d Limit total fat to 40% of total calories for reimbursed meals over the course of a week Correct Answer is D. Limit total fat to 40% of total calories for reimbursed meals over the course of a week. The School Meals Initiative for Healthy Children (SIM) requires schools to implement guidelines within food service operations to help improve the health of our children through improved nutrition. Meal planning must be consistent with the Dietary Guidelines for Americans. Four choices are available for assistance with menu planning: NuMenus, Assisted NuMenus, Enhanced Food-Based, and Traditional Food- Based. Some of these require computer resources, which may not be an option for all schools. Other guidelines include reducing the amount of salt and sugar found in meals, and to limit fat to 30% of total calories and saturated fat to 10% of total calories for meals that are reimbursable. Increase fruit and vegetable choices for your students. Provide one-third of the Recommended Dietary Allowances for protein, calcium, iron, and Vitamins A and C for lunch and one-quarter for breakfast. What are Standards of Identity? a. Any food that crosses the U.S. borders must be appropriately labeled b. Food must contain specific ingredients in specified amounts to be labeled with a certain name, such as ice cream c. All foods purchased by food service institutions are labeled with nutrition information and omit any health claims d. A voluntary program that institutions can participate to receive federal funding. Correct Answer is B. Food must contain specific ingredients in specified amounts to be labeled with a certain name, such as ice cream. Standards of Identity is part of the Food Drug Cosmetic Act of 1938, which requires any food item that is shipped across state lines to be labeled in a way that accurately reflects what is in the package. If a product is given a certain name, then it must contain specific ingredients in a certain percentage to qualify for that name. For example, ice cream is a frozen product that must contain no less than 10% milk fat and 20% total milk solids by weight. If it does not meet these standards, it is labeled with another name, such as reduced-fat, light or fat-free ice cream. Standards of Identity help the consumer identify what a food product actually contains. Which best qualifies as a Standard of Quality for apple juice? a. The quantity of apples used to make apple juice b. The type of container used to package the apple juice c. The Brix-Acid Ratio d. The type of apple used to make the apple juice Correct Answer is C. The Brix-Acid Ratio for cutting meats and vegetables. Cook foods thoroughly. Wash raw food extremely well before consuming and peel them, if possible, to prevent transmission. Which of the following temperature ranges is the danger zone? a. 50-150 F b. 40-140 F c. 60-160 F d. 45-145 Correct Answer is B. 40-140 F. The danger zone is the temperature range at which bacteria are likely to grow and cause illness if consumed. The danger zone spans 40-140 degrees F. Bacteria multiply very quickly within this temperature range. Keep serving dishes hot with warmers or the range. Do not leave serving dishes at room temperature for more than 2 hours. Cool cooked foods as quickly as possible. Refrigerator all cooked foods within 2 hours. Do not thaw frozen food on the counter at room temperature. Thaw frozen foods in the refrigerator, instead. Reheat foods to an internal temperature greater than 145 degrees F. Follow the USDA guidelines for cooking meats, chicken, and egg products to the proper internal temperature at: http://www.fsis.usda.gov/Factsheets/Basics for Handling Food Safety/index.asp/ Which form of hepatitis do infected food service workers transmit? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis E Correct Answer is A. Hepatitis A. Hepatitis is an inflammation the liver caused by one of five viruses. The five known types of hepatitis are A,B,C,D, and E. Usually hepatitis A spreads through contaminated food or water. Sometimes, it spreads through oral/anal contact with an infected person. Hepatitis A spreads quickly in food service establishments when an infected employee does not wash his/her hands thoroughly after using the bathroom. The incubation period for Hepatitis A is 28 days. Hepatitis A is transmissible for 2 weeks before these symptoms appear: Fever, anorexia, nausea, abdominal pain, and jaundice. Instruct any food service worker infected with Hepatitis A to stay out of work for at least 2 weeks after symptoms appear. Most people who get Hepatitis A recover completely. Hepatitis E spreads through infected water. Hepatitis B,C, and D spread through infected blood or sexual contact with an infected person. Twinrix vaccine prevents the spread of Hepatitis A and B only and Employee Health offers it free to hospital workers. The Hazard Analysis Critical Control Point (HACCP) Model is a concept that: a. Deals with hazardous waste disposal in food service environments b. Implements quality control procedures for the prevention of potential microbial or other contaminations c. Addresses proper hand washing techniques within the food service environment d. Is a mandatory program run by the Food and Drug Administration to promote food safety and to protect the general public. Correct Answer is B. Implements quality control procedures for the prevention of potential microbial or other contaminations. The Hazard Analysis Critical Control Point (HACCP) Model is plan to prevent microbial contamination through Quality Control. HACCP is voluntary program sponsored by the Food and Drug Administration that aims to protect public health through food sanitation and safety. Its seven guiding principles are: 1. Analyze hazards 2. Identify critical control points (CCPS, a certain step in the preparation of a recipe or in the cooling process) 3. Institute preventive measures 4. Develop procedures to monitor CCPs 5. Develop a corrective action plan and rewrite procedures to fix the faulty CCPS 6. Keep records diligently 7. Base the QA program on appropriate research and studies. Identify the food service system that partially cooks food, quickly chills it, stores it, and reheats it before client service: a. Centralized b. Decentralized c. Commissary d. Cook-chill Correct Answer is D. Cook-chill A cook-chill system is part of a ready prepared food service system. A cook-chill system means the food is partially cooked, then quickly chilled, and stored until it is needed. Food is then reheated and served immediately. Hospitals frequently use the cook-chill method using microwaves, convection ovens, or specially made rethermalization carts. Commissary service is a centralized facility that ships food to several distant facilities, where preparation is finished and food is served. Centralized service means patient trays are prepared trays are prepared in the main kitchen and production area, then delivered and served to patients. Decentralized service means food is sent to galley kitchens for heating and tray assembly, and then food is served to the patients in designated areas, rather than a dinning hall. What is the appropriate temperature for sanitizing utensils and dinnerware in a dishwasher? a. 195F b. 180F c. 120F d. 150F Correct Answer is B. 180F The two types of dishwasher machines available to food service establishments are high temperature machines and chemical sanitizing machines. A human dishwasher is also required to scrape plates, load and unload, troubleshoot, inspect the results, discard rejects, and store clean dishes. The wash cycle's temperature varies between different dishwasher machines. However, the Food and Drug Administration's (FDA) Food code requires the final rinse temperature must be 180F for proper sanitization. A 180F rinse is hot enough to kill most fungi, bacteria, and viruses but does not kill spores. The plate and cutlery are clean but not sterile. A rinse temperature above 195F vaporizes water and does not flush any debris stuck on the plates and utensils. Take all of the following precautions to prevent slips and falls in your work area except: a. Duct tape electrical cords to equipment to prevent tripping b. keep aisles free from obstructions and excessive storage c. Clean spills immediately and mark wet areas with appropriate signage d. Provide adequate lighting and clean only one side of the work area at a time to allow safe passage through the dry side Correct Answer is A. Duct tape electrical cords to equipment to prevent tripping. Slips and falls can cause very serious injuries to employees and customers. The RD is responsible for ensuring all kitchen staff take proper precautions to prevent injuries. The Occupational Safety and Health Administration (OSHA) has many regulations in place to help maintain a safe environment, online at http://www.osha.gov/. Ideally, plug electrical equipment into floor or ceiling outlets to prevent tripping on the cord. If you require a wall plug temporarily, tape the cord into place. This should not be a permanent solution. Keep aisles and hallways free from and clutter. Ensure the kitchen and dinning room are well lit. Inspect carpets to ensure they are appropriately installed, so no bunching occurs. Remove worn carpeting. Remember that tile floors are more hygienic. Report spills and wet areas to Housekeeping immediately for clean-up. Mark wet area with warning signs. Provide staff with ladders or step stools, instead of chairs or boxes, so they can reach items on high shelves safely. You plan to serve employees hamburgers and hotdogs at an outdoor luncheon. You must purchase enough 80% lean ground beef to yield 300 hamburgers weighing 3.5 ounces each. Calculate how much ground beef you need: a. 66 pounds b. 53 pounds c. 82 pounds d. 95 pounds Correct Answer is C. 82 pounds. Yield is how many product is produced at the end of the production process. As purchased (AP) is the amount of product you need to buy to achieve the yield. Edible portion (EP) is how much product is available after the production process, including peeling and cooking. In the above example, if the final yield is 300 hamburgers at 3.5oz after cooking, a total of 1050 ounces of 80% ground beef is required (after cooking weight). One pound of 80% lean ground beef yields 0.8 pounds of edible portion. The AP will be 1312.5oz (1050oz/0.8). Divide by 16 to convert to pounds. Your result should equal 82 pounds of 80% lean ground beef. You are serving a 4-ounce portion of mashed potatoes on the serving line. What size of dish is appropriate? a. 16 b. 12 c. 10 3) Explain the result and what you learned from the situation If you do not have any experience in Dietary, then draw an example from your schooling, personal life, or unrelated jobs. Orientation familiarizes new employees with the organization and teaches them how to perform their new job functions. Select the best orientation process. a. The new employee tours the department and reads the Policy & Procedure manual b. The preceptor gives the new employee a tour, explains the job requirements, and directs the initial assignment c. The departmental director welcomes the new employee, gives a tour, completes the paperwork, and tells the new employee to observe another employee who performs the same job d. The RD: meets the new employee, explains the purpose of Orientation, completes the paperwork, discusses the department's purpose and objectives, introduces other employees, gives a tour of the department and overall facility, reviews Policies & Procedures, explains and demonstrates job duties, arranges additional observation and training with a preceptor Correct Answer is D. The RD: Meets the new employee, explains the purpose of Orientation, completes the paperwork, discusses the department's purpose and objectives, introduces other employees, gives a tour of the facility, reviews Policies & Procedures, explains and demonstrates job duties, arranges additional observation and training with a preceptor. A proper orientation reduces employee turnover and improves job performance. The orientation process prepares the new employee to perform his/her new job to an acceptable standard and to integrate smoothly with new coworkers. Orientate the new employee where his/her job fits into it, and the supervisor to whom the employee will report. Review the organization's mission and departmental objectives. Take the employee on a comprehensive tour of the facility, especially restrooms, notice boards, change rooms, break rooms, and cafeteria. Point out restricted areas. Get the employee photographed for identification. Sign out necessary keys. Show the new employee the Policies & Procedures manual and give him/her a copy of necessary forms. Demonstrate his/her job duties. Allow sufficient time for observation and training, so the employee can perform job duties safely and effectively. A Performance Appraisal is all the following except: a. An opportunity for the employee to demand more salary, regardless of the details of the appraisal b. A chance for the employee and the manager to discuss job performance c. A method of identifying goals and objectives in the coming year for the employee d. A chance to list strengths and weaknesses and to identify strategies for meeting unmet job performance standards Correct Answer is A. An opportunity for the employee to demand more salary, regardless of the details of the appraisal. Although the performance appraisal is the time when pay raises, promotions, or transfers are awarded, its primary objective is not to obtain more money or a more desirable position. Ideally, the PA is a way to review the employee's past performance and set his/her course for the future. Identify the employee's strengths and weaknesses. Gently point out any performance standards that have not been met. Agree on a plan that will help the employee address these weak areas. Set goals and objectives for the coming year. The PA is a good opportunity for the employee and manager to meet one- on-one, to discuss performance and other pertinent issues, such as tuition bursaries and time off for classes and teach-back. What is an advantage of scheduling personnel for a cook-chill food service? a. Fewer FTE's are required overall because it is a simpler type of food service system to operate. b. Most production and inventory FTEs are scheduled during off-peak hours Monday to Friday, leaving a few FTE's for meal-times and weekends c. Most FTE's are scheduled in the early morning hours or weekends d. Scheduling is closely related to the tray line operation, and this type of system has peak and trough employee activities Correct Answer is B. Most production and inventory FTEs are scheduled during off- peak hours Monday to Friday, leaving a few FTE's for mealtimes and weekends. A cook-chill system streamlines the scheduling process. Many FTE's required for production and inventory can be scheduled Monday to Friday, leaving a limited number of FTE's for rethermalization and patient service. Cook-chill also helps the RD to tailor the schedule to provide more flexible shifts for employee satisfaction. Often times, the early morning and weekend production shifts are undesirable to employees. Therefore, the RD can adjust the shifts to give most full-time staff the weekends off, and schedule students and part-timers on the weekends. The overall schedule is not directly related to the tray line operation. Cook-chill allows you to schedule employees for when they are needed, with less down time. For example, employees can be scheduled for a 3-hour meal service shift. Production employees do not rush to prepare food for tray line operation, to be served immediately, which can reduce accidents. A food service manager is often responsible for scheduling the: a. Production schedule b. Master schedule c. Shift schedule d. All of the above Correct Answer is D. All of the above. The three types of schedules that a food service manager is responsible for writing are the master schedule, shift schedule, and production schedule. The master schedule is written on a set rotation, such as every two weeks or three weeks. The master schedule indicates employees' days off and vacation time. Include the weekend and rotation on the master schedule, do not separate weekdays from weekends. Ensure the kitchen work gets done in the most cost-effective way. For example, do not allow all cooks to take the same week off as vacation, so that you do not pay for overtime coverage unnecessarily. Base the shift schedule on the master schedule. The shift schedule lets the employees know the hours they will work. The production schedule lets the employees know their daily tasks and the period for completion. All of the following are reasons for an employee to join a union except: a. Dissatisfaction with management rules and policies b. Compensation and benefit packages c. Worries about job security d. Unions require all employees to join if the workplace is an open shop Correct Answer is D. Unions require all employees to join if the workplace is an open shop. Junior dietitians may be union members. Senior dietitians are usually management. Kitchen staff are often union members. The usual reasons for employees to join a union are dissatisfaction with management rules and policies, low compensation, and lack of job satisfaction. Membership in a union protects workers from unfair management practices or management decisions made unjustifiably. Examples of union protection are unfair dismissal cases or job demotion without a sound reason. Union negotiators can help secure higher pay and improved benefits packages in employment contracts. There are federal laws to protect an employee regarding unions: -If the workplace is an open shop, the employee is not required to join the union -If the workplace is an agency shop, the employee does not have to join but does pay dues, even if he/she is not a member. - If the workplace is a union shop, the employee must join the union after a certain amount of time on the job, usually three to six months. All of the following are components of a total budget except the: a. Operating budget b. Labor budget c. Master budget d. Capital budget Correct Answer is B. Labor budget A total budget has four parts: the operating budget, cash budget, capital budget, and master budget. The operating budget is the amount of sales, expenses, and revenue that is predicted for a certain period of time, usually one fiscal year, which does not necessarily begin in January and end in December. The cash budget is the predicted cash flow to ensure money is available when financial obligations must be met. The capital budget is the amount of money planned for equipment, buildings, grounds keeping, or renovations. The master budget puts all these pieces together to provide the organization's Financial plan. If you are responsible for kitchen finances, ask the accountant assigned to Dietary to outline your department's financial picture when you start your new job, and again at six-month intervals. An effective manager possesses the following skills: a. Interpersonal, technical, conceptual b. Interpersonal, supervisory, technical c. Conceptual, analytical, contractual d. Technical, behavioral, conceptual Correct Answer is A. Interpersonal, technical, conceptual The three main skills that make an effective manager, who is likely to be promoted, are interpersonal, technical , and conceptual. Interpersonal skills help the manager relate to diet technician, registered (DTR), is tightly regulated by the Commission on Accreditation for Dietetics Education (CADE). Misuse of either title can result in legal action. RDs complete specific academic requirements and a supervised practice in the form of an internship or didactic program. The RD passes a national registration exam and in in good standing with CADE. The RD keeps current by fulfilling a continuing education requirement, required to maintain registration. By contrast, the term nutritionist varies widely by education requirements. Some nutritionists may actually have no formal training or education in nutrition. Many states licensure laws help define who is entitled to use the title nutritionist. Consumers are safest consulting an RD or DTR for credible nutrition advice. Total Quality Management includes all of the following maxims except: a. Processes are changed, not people b. The customer is the main focus c. Employees must follow their job descriptions with minimal variation from procedure d. A team approach is the optimal way to improve quality and ensure long-term change. Correct Answer is C. Employees must follow their job descriptions with minimal variation form procedure. Total quality management (TQM) is a strategy to improve customer satisfaction through best practices. W. Edwards Deming created TQM. TQM was used heavily in the 1990s but has gradually evolved to quality improvement. The bottom line remains customer satisfaction. Teamwork is integral to the success of TQM. A facilitator, usually the facilities CPHQ moves the process forward. The facilitator empowers employees and encourages them to suggest better ways to accomplish tasks. The CPHQ, Quality Assurance Manager, Risk Manager, and Infection Control Practitioner analyze workflows closely. Explain to your staff that the goals of a TQM review are to eliminate waste and continues improvement. The steps of TQM are: Identify the problem; determine the possible causes; develop measurable and identifiable improvements; implement a solution; measure outcomes; fine tune the improvements through feedback. Emphasize to your staff that the QA team scrutinizes flaws in the process. The QA team does not seek to lay blame on individuals. What is the purpose of Press Ganey Associates, Inc.? a. Consulting b. Benchmarking c. Job redesign d. Quality Assurance Correct Answer is B. Benchmarking Press Ganey Associates, Inc. is a company that provides benchmarking data to food service organizations. Benchmarking compares your team's current performance against those who are widely considered to be the best. Press Ganey distributes satisfaction questionnaires to patients who received inpatient hospital care or who used outpatient services. Press Ganey performs a comparative analysis for all healthcare facilities that participate in this benchmarking process. Press Ganey owns an extensive database and validates its results. Benchmarking is a tool that food service operations can use to help improve overall patient/customer satisfaction. Choose the process The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) uses to survey healthcare organizations: a. Tracer process b. Performance measurement process c. Self-study process d. Patient-centered process Correct Answer is A. Tracer process. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) oversees a voluntary accreditation process. The mission of JCAHO is to ensure patient safety and a high standard for quality of care. In 2004, JACHO changed the way it conducts its surveys to the tracer process. JCAHO selects certain patients and follows the care the patient receives throughout his/her hospital stay or outpatient clinical visits. All care, services, procedures, and tests are evaluated for quality and adherence to regulations, such as safety initiatives. JCAHO evaluates the relationships between various departments and disciplines for continuity and patient focus. For example JCHAO looks at how Dietary, Biochemistry, and Nursing interact to provide diabetics with the correct diet and insulin. Which documentation is prohibited according to The Joint Commission on Accreditation of Healthcare Organizations (JCHO)'s Do Not Use List? a. 90mL of sterile water b. 10.0 mg of Lipitor QD c. 10mg morphine sulfate d. 400 international units vitamin D Correct Answer is B. 10.0 mg of Lipitor QD The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) developed a Do Not Use list to reduce potential medication errors due to unclear or erroneous documentation. These question breaches the Do Not Use List in 5 ways. 1)Including the decimal point in 10.0- if the nurse misses the decimal point, an incorrect dose of 100 could be delivered 2) Unacceptable abbreviation-The nurse or pharmacists could mistake QD for QOD, so the doctor should write out "daily" for clarity 3) Obsolete abbreviation- The USA prefers the Systeme Internationale "mL" over the Empirical "cc" since the 1970s 4) Confusing abbreviation-Write out morphine sulfate because it can be confused with magnesium sulfate 5) Illegible abbreviation- Write out International Units instead of abbreviating IU because it can be mistaken for IV (intravenous) or the number 10 All of the following are valid ways to reduce food costs except: a. Set up security measures in production areas b. Use seasonal items for special menus or meals whenever possible c. Change menu prices in the employee cafeteria all at once, rather than one at a time. d. Frequently compare competitive vendors' prices to ensure you receive the lowest prices Correct Answer is C. Change menu prices in the employee cafeteria all at once, rather than one at a time. To control or reduce food costs: -Reduce theft by setting up security measures in tempting areas -Buy seasonal items and plan around cheap and abundant produce -Rotate inventory so it does not spoil, thereby decreasing discards -Create standardized recipes and do not add extraneous ingredients to recipes -Use portion control -Schedule production for the greatest efficiency -Create par levels for ingredients to avoid too much or too little of a product being prepared -Implement price increases gradually, to prevent loyal customers from getting angry and taking their business elsewhere You are a food service manager. Two of your workers do not work well together. You frequently hear them bicker and yell at each other. You call a conflict resolution meeting with both of them. How should you initiate conflict resolution? a. Ask each worker for his/her side of the story. Assess the situation. Gently point out the person who needs to make changes. b. Ask each worker to relate his/her version of events calmly. Restate the issue in your own words. Get additional information. Mutually agree on what the problem actually is. Brainstorm possible resolutions. Negotiate an acceptable resolution for both of them c. Tell your two employees their behavior is inappropriate. Listen to both sides. Determine if there is an easy fix to the problem. Warn the employees they must both resolve the issue or they will be disciplined d. Allow the senior employee to tell his/her side of the story first. Reprimand the employe Correct Answer is B. Ask each worker to relate his/her version of events calmly. Restate the issue in your own words. Get additional information. Mutually agree on what the problem actually is. Brainstorm possible resolutions. Negotiate an acceptable resolution both parties respect. Convey that you understand the situation by rephrasing it in your own words. Use active listening skills and assertiveness. Obtain any additional information you require to clarify the situation, such as checking old schedules to identify an attendance pattern. Get both parties to agree on what the problem really is, then make them work together to find possible solutions. Negotiate to ensure everyone is satisfied with the outcome. Remember, conflict in the workplace is dangerous and should not be ignored. Kitchen tools can be weapons and there is an opportunity for poising. The manager's positive attitude is leadership in the right direction. If you think a threat is likely to become reality, then you are legally liable to report the situation to the police. A customer evaluating a meal's quality is least likely to consider: a. Taste, appearance, and portion size b. Service and preparation method c. Quality of ingredients d. Popularity of the item in the cafeteria practitioner to see his or her patient and to provide care beyond the scope of that provider's own practice. The term referral may also be used to describe the actual document that authorizes a visit to another health care professional and is necessary for billing purposes. The NCPM is designed for use with all except a. Clients b. RDs c. Groups d. Patients Correct Answer is B. RDs The Nutrition Care Process Model (NCPM) is an approach to solving patient problems relating to nutrition. It is designed for use with those to whom a dietitian provides nutritional care and guidance through referral. These include patients in a primary or tertiary health care setting, such as clinic, office, or hospital and in the community. It is designed for use with all ages and conditions of health or disease. The NCPM was put together after a literature review and was meant to replace previous nutritional care tools. Which process is not typically completed by an RD? a. Analyze data b. Identify problem c. Evaluate of outcomes d. Perform nutritional screening Correct Answer is D. Perform nutritional screening The Nutrition Care Process Model (NCPM) is an approach to solving patient problems relating to nutrition. Nutrition screening is performed by another healthcare professional, usually a physician. It occurs prior to the referral and designates patients at nutritional risk. Screening is defined as "a test or standardized examination procedure to identify patients requiring special intervention." Within the NCPM, a well written nutritional diagnostic statement is all of these except: a. Related to observations by interdisciplinary team b. Clear and concise c. Accurately related to etiology d. Nonjudgmental Correct Answer is A. Related to observations by interdisciplinary teams The Nutrition Care Process Model (NCPM) is an approach to solving patient problems relating to nutrition. The nutritional diagnosis is the second step in the NCPM. It follows the nutrition assessment and contains solely the observations and assessment of the RD. The nutritional diagnosis, must be succinct and use the International Nutrition and Dietetics Terminology (INDT), a standard vocabulary for nutrition documentation. In this way, it is unambiguous and easily read and understood by other health care providers. The nutritional diagnosis must be correctly connected to etiology and based on the signs and symptoms of the assessment so that it follows as a logical conclusion. It must also be objective, based on data and observations in the assessment, without any personal judgement. Elements of the nutritional care plan implementation in the NCPM include all but: a. Formulation of goals b. Care delivery c. Review with MD for approval d. Documentation Correct Answer is C. Review with the MD for approval The Nutrition Care Process Model (NCPM) is an organized way to solve patient problems relating to nutrition. The NCPM is solely the domain of the RD and does not require physician approval. The role of the physician in the NCPM is to provide a nutritional screening and referral for nutritional intervention. The MD also collaborates with other health care professionals to provide smooth implementation of the NCP. Otherwise, implementation of NCP involves formulation of achievable patient goals, a realistic plan for care delivery, good communication, follow-up to ensure that the plan is implemented, and modification as necessary. The vision for the combined tools of NCPM and IDNT was that they should do all of the following except: a. Make the RD's work easier b. Enable more accurate description of nutrition problems c. Describe results of nutritional intervention d. Facilitate medical documentation Correct Answer is A. Make the RD's work easier The Nutrition Care Process Model (NCPM) is an organized way to solving patient problems relating to nutrition. The International Nutrition and Dietetics Terminology (IDNT) is a standard vocabulary designed to put into words each step of the NCPM and each step's data or observations. The idea for using these tools together is to aid in communication concerning nutritional care, and also to allow researchers to better document nutrition problems, care plans, and outcomes. These tools will also enhance electronic medical record keeping and provide information for policies, legislation, and reimbursement. A primary use of IDNT is: a. To get other health care providers involved in nutrition care b. To document nutritional care in the medical record c. To get reimbursement for nutritional care d. To develop a logic model for nutritional care Correct Answer is B. To document nutrition care in the medical record. The International Nutrition and Dietetics Terminology (INDT) is a standard vocabulary designed to put into words each step of the NCPM and each step's data or observations. The primary purpose is to well document nutritional care in the patient's medical record. According to the American Health Information Management Association, a medical record becomes a legal record of health care services received and their rationale, an avenue of communication among health care providers, and supporting documentation for reimbursement of services provided. The INDT was developed for RDs to describe their nutritional-related findings and decisions within the NCPM. The use of a standardized language with a care plan will contribute to the visibility of the RD as a unique and competent provider of nutritional care and give more ready access to this information in an electronic medical record. In the INDT, the development of diagnostic language includes all the following domains except: a. Food and/or nutritional intake b. Clinical c. Medical d. Behavioral/environmental Correct Answer is C. Medical Diagnosis is the second of four steps in the NCPM, which is a problem-solving model for nutritional care. The International Nutrition and Dietetics Terminology (IDNT) is a standard vocabulary designed to put into words each critical step of the NCPM and each step's data or observations. The nutritional diagnosis follows the nutritional assessment and uses its findings. The food and nutrition professional is responsible for identification and labeling of an existing problem that is to be treated. According to the IDNT, there are three language domains in the diagnosis section. They are food and nutrition intake, clinical, and behavioral/environmental. The purpose of the NCP is to a. Optimize nutrition-related outcomes b. Increase communication with an interdisciplinary team c. Establish the importance of the RD in patient care d. Demonstrate the need for nutrition management Correct Answer is A. Optimize nutrition-related outcomes. The Nutrition Care Process (NCP) is a problem solving process intended for nutritional practice that was developed within the Nutrition Care Process Model (NCPM). The NCP gives the RD the ability to tailor nutritional care to specific patients, using the best evidence and considering their needs and value systems. The NCP consists of four activities. The first area is assessment of nutritional status by analysis of data and physical observations to recognize nutritional problems. Following the assessment and using its data is the nutritional diagnosis. The third step is planning and prioritizing nutritional intervention to meet the patient's needs. Last is the evaluation of outcomes, determining if additional nutrition care is needed. When used with computerized systems, standardized terminologies such as IDNT support accurate: a. Diagnosis b. Communication c. Data entry and analysis d. Decision making Correct Answer is C. Data entry and analysis Correct Answer is B. "Related to" Diagnosis is the second step in the Nutrition Care Process (NCP), which is a nutrition problem-solving system. It labels a specific nutritional condition. Etiology refers to the factors that cause disease and how the patient acquired that disease. In the NCP, the nutritional diagnosis, is linked to a medical cause and contributing factors. According to the Nutritional Care Plan Model (NCPM) and the International Nutrition and Dietetics Terminology (IDNT), the best way to link etiology to the nutritional diagnosis is by using the phrase "related to". A nutrition intervention should most importantly a. Educate patients about their nutritional needs b. Consider the patient's socioeconomic and cultural background c. Resolve or improve the patient's nutritional problem d. Validate the nutritional diagnosis Correct Answer is C. Resolve or improve the patient's nutritional problem Nutrition intervention is the third step in the Nutrition Care Process (NCP), which is a nutrition problem solving system. The purpose of nutrition Intervention is to correct or ameliorate the identified nutrition problem by planning an implementing appropriate nutrition interventions tailored to the patient's specific needs. Nutrition intervention strategies are purposefully selected to change nutritional intake, nutrition-related knowledge or behavior, environmental conditions, or access to supportive care and services. Nutrition intervention establishes goals by which to monitor and measure progress. These goals may be changed or modified, depending on outcome. In the NCP, the determination of the nutritional intervention is primarily guided by a. Prioritizing nutritional diagnosis b. Patient's education level c. Environmental conditions d. Nutrition diagnosis and etiology Correct Answer is D. Nutrition diagnosis and etiology In the Nutrition Care Process (NCP), which is a nutrition problem solving system, diagnosis establishes the nutritional problem, and etiology includes the factors that cause the problem. The two terms represent the problem and the source of the problem, so they are the primary drivers in determining the nutrition intervention most suitable to the patient. The nutritional diagnosis and etiology are key in the process of developing and delivering nutrition education. They determine the type of education, nutrient (i.e. carbohydrate, fat, or sodium) to be modified. Also, the approach to the educational process is driven by these factors. Did the patient become obese and develop diabetes, or is a sodium-modified food intake advised as a precaution in the development of heart disease? All of the following are factors affecting the nutritional requirements except a. Infection and fever b. Disease c. Socioeconomics d. Psychologic stress Correct Answer is C. Socioeconomics. Nutritional requirements are affected by many physiological and psychological factors. These factors differ from factors affecting food intake. While food intake depends on a wide number of issues, including environmental, psychological, and physiological nutritional requirements reflect the physiologic and psychological state of the individual's body. Infection and fever may cause an anabolic state, increasing metabolism and nutritional needs. Diseases of the GI tract may cause limited absorption of nutrients, increasing requirements for nutrients. GI disorders may also cause blockage or another altered state in the stomach or intestines, necessitating a change of food consistency. Diabetes causes altered glucose metabolism, demanding a modified meal plan timed to complement medication, with limitations on carbohydrate in the diet as well as on overall calories. Psychological stress may cause an inability to consume food, leading to a malnourished state. In the nutrition monitoring and evaluation phase of the NCP, all of the following are elements except a. Nutrition related history b. Biochemical data c. Anthropometrics d. Signs and symptoms Correct Answer is D. Signs and symptoms Nutrition monitoring and evaluation is the fourth and final step in the Nutrition Care Process (NCP), which is a problem solving system for nutritional care. The purpose of nutrition evaluation and monitoring is to determine the amount of progress made by the client/ patient and whether goals/ expected outcomes are being met. Nutrition monitoring and evaluation identifies patient/ client outcomes relevant to the nutrition diagnosis, intervention, plans, and goals. The four elements of the nutrition monitoring and evaluation are food/nutrition-related history outcomes, pertinent biochemical data and test results, anthropometric measurement, and nutrition-focused physical finding outcomes. In metabolic syndrome, all the risk factors are primarily related to a. Hypertension b. Type 2 diabetes c. Obesity d. Cardiovascular disease Correct Answer is C. Obesity Metabolic syndrome is increasingly common and is even seen in children. It is a name for a group of risk factors that occur together and increase the risk for development of coronary artery disease, stroke, and type 2 diabetes. This group of risk factors includes obesity, insulin resistance, hypertriglyceridemia, low HDL cholesterol, and hypertension. All the other factors are related to obesity with abdominal being the most outstanding symptom. Diagnosis is made when three or more of the above factors are present. Trans fatty acids should be ____ of total caloric intake a. <15% b. <10% c. <5% d. <1% Correct Answer is B. <10% Of all the dietary fats, trans fatty acids have the most significant negative impact on serum lipids. Trans fatty acids occur when polyunsaturated fats are partially hydrogenated, as in the hardening of oil into margarine. The hydrogenation of vegetable oils produces elaidic acid, the most common trans fatty acid. Other sources include hydrogenated/ partially hydrogenated vegetable oils that are used to make shortening and commercially prepared baked goods, snack foods, and fried foods. The most common naturally occurring trans fatty acid is trans-vaccenic acid found in animals (e.g. beef, and lamb) and dairy products. The RDA suggests that less than 10% of caloric intake come from trans fatty acids. In the NCP, PES stands for a. Patient Estimated Status b. Problem, Etiology, Symptoms c. Principle Etiology Signs d. Problem Evaluation Statement Correct Answer is B. Problem, Etiology, Symptoms The PES statement refers to problem, etiology, and symptoms. It is a way to organize the information relating to the nutritional diagnosis. Problem refers to the nutritional diagnosis and etiology and symptoms are the history/derivation and presentation of the nutritional diagnosis respectively. It is part of the second step in the Nutrition Care Process (NCP), which is a problem solving system for nutritional care. It utilizes the Nutrition and Dietetics Terminology (INDT), a nutrition specific standard language. In the monitoring and evaluation step of the NCP, indication that new needs have arisen prompts a. Restatement of the diagnosis, including the new problem b. Expansion of the evaluation to include the new problem c. Incorporation of the new problem into the care plan d. Restarting the NCP Correct Answer is D. Restarting the NCP. Monitoring and Evaluation is the fourth and final step in the Nutrition Care Process (NCP), a problem-solving system for nutritional care. Monitoring and evaluation determine whether the nutritional goals are being met and identify outcomes relevant to the nutrition diagnosis and intervention. It is possible that the monitoring and evaluation phase may reveal nutritional problems not previously seen. At this point it is necessary to start the NCP over again. A new assessment is needed to verify, analyze, and translate the data relevant to the new nutritional problem, it's causes, and importance. A second nutritional diagnosis may be determined if the new problem is either related or unrelated to the first nutrition diagnosis. After establishing a new nutrition diagnosis, the dietitian continues with a new NCP. Nutrition intervention is the third step in the Nutrition Care Process (NCP), a problem- solving system for nutritional care. Nutrition intervention relates to etiology and translates assessment into actions that will help the patient. Once nutritional diagnosis is established, intervention can begin. The nutritional goals are an essential element in the intervention step of the NCP. They determine what nutritional objectives should be met to treat the diagnosis and what educational format and counseling process be used. They further determine what anthropometric measurements, lab data, and food-related measurements should be used in the nutritional monitoring and evaluation. Rationales for choosing enteral nutrition support include all the following except a. Need to preserve gastrointestinal immunity b. Need to preserve pulmonary mucosal immunity c. Inadequate oral intake to maintain optimal nutritional status d. Patient with at least five to six feet of functioning small bowel Correct Answer is d. Patent has at least five or six feet of functioning small bowel. When food and fluid intake by mouth are not sufficient to maintain the patient in a balanced nutritional state, enteral nutrition therapy may be considered. There is considerable evidence that enteral nutrition support preserves mucosal immunity in critical illness. The underlying mechanisms maintain not only gastrointestinal mucosal immunity, but also pulmonary mucosal immunity from bacterial and viral infections. Higher rates of infection are seen with parenteral nutrition support. If there is any less bowel, parenteral nutrition support must be considered. Standard enteral formulas contain what percent of lipid? a. 10-20% b. 20-30% c. 30-40% d. 40-50% Correct Answer is C. 30-40% Standard enteral nutrition support formulas typically contain 30 to 40% of their kilocalories in the form of lipids. Lipids in the formulas are usually from corn, soy, sunflower, safflower, or canola oils. Approximately 2-4% of the daily calories should be in the form of linoleic acid to prevent essential fatty acid deficiency. High doses of linoleic acid may suppress immune function, so they are not recommended. Short- and medium-chain saturated fatty acids, monosaturated fatty acids, and omega-3 polyunsaturated acids are used in disease-specific formulas in varying amounts. Omega-3 fatty acids have been used in specialized formulas because of their modulating effect on immune function. Nonessential amino acids for standard parenteral nutrition are supplied by a. Glutamine and arginine b. Alanine and glycine c. Glutamate and cysteine d. Taurine and homocysteine Correct Answer is B. Alanine and glycine Commercial parenteral nutrition solutions contain all the essential amino acids and some of the nonessential crystalline amino acids. Nonessential nitrogen is provided principally by the amino acids alanine and glycine, without aspartate, glutamine, cysteine, or taurine. Specialized products are available for pediatric use, renal disease, and liver disease, but they are used infrequently because of their expense. In most solutions, protein ranges form 3 to 20% of calories and provides 100gm protein per liter. At 4kcal per gram, protein should supply about 15-20% of calories. At a BMI of 27-35, the NIH suggests a weight loss of a. 1/2 to 1 lb/week b. 1 to 2 lb/wk c. 2.5 to 3lb/wk d. 3.5 to 4lbs/wk Correct Answer is A. 1/2 to 1 lb/ week A BMI of 27-35 represents moderately overweight through class II obesity. Theoretically, since 3500 calories represents one pound of fat, if a person subtracts 500 calories from his or her daily intake for a week, there will be a weight loss of one pound per week. This would be a sensible food intake that encourage a reasonable weight loss and an opportunity to learn better eating habits. The goal in obesity management should be refocused on weight management, rather than achieving an ideal body weight. This means setting achievable weight-loss goals and aiming toward the best achievable weight for optimal overall health. Morbid obesity is described as a. BMI of 25 or more b. BMI of 30 or more c. BMI of 35 or more d. BMI of 40 or more Correct Answer is D. BMI or 40 or more. Body Mass Index (BMI) is a calculated number that attempts to describe the level of body fat a person has. It is found by taking the weight in kilograms and dividing it by height in meters squared. Normal BMI is 18.5-24.9, Overweight is 25-29.9, Class I obesity is 30-34.9, Class II obesity is 35-39.9, Class III obesity is 40+. In the morbidly obese, where diet and exercise plans have failed in the past, more drastic measures, such as bariatric surgery, may be called for. Although there may be risks with such surgery, it is the most assured way to lose a significant amount relatively quickly and may even boost the patient's motivation to follow a nutrition and exercise plan. The goal of treatment for an overweight child is a. Loss of 1 lb per month b. Loss of 2 lbs per month c. Weight maintenance d. No treatment Correct Answer is C. Weight maintenance Childhood obesity significantly increases the risk of obesity in adulthood, along with abnormalities in blood pressure, lipid, lipoprotein, and insulin levels. Nevertheless, the weight management goal in children is weight maintenance, rather than weight loss. The primary goal for nutrition in childhood is normal growth and development; thus, all food plans should be geared toward this end. Since severe or even moderate calorie restriction may hinder growth and development, the commonly-held belief is that the obese child should grow into his or her weight. The dietitian should develop a weight maintenance plan for the next few years until current weight is appropriate for height. Only in extreme cases would weight loss be recommended. Which of the following is characteristic of only type 1 diabetes mellitus? a. Auto-antibodies b. Insulin resistance c. Hypoglycemia d. Insulin requiring Correct Answer is A. Auto-antibodies Type 1 diabetes mellitus is an autoimmune disease in which the body's immune system develops anti beta cell antibodies that destroy the insulin-producing beta cells of the pancreas. Therefore, exogenous insulin is needed for life. Insulin resistance is a characteristic of type 2 diabetes mellitus, in which there is decreased tissue sensitivity to insulin, resulting in an increased insulin requirement. Hypoglycemia or low blood sugar is seen in both type 1 and type 2 diabetes. Insulin-requiring diabetes is a condition in type 2 where the pancreas can no longer produce insulin; thus, oral mediations cannot control the situation, and exogenous insulin is required. Type 2 diabetes may account for what percent of all diabetes mellitus? a. 50-60% b. 60-75% c. 75-90% d. 90-95% Correct Answer is D 90-95% The incidence of type 2 diabetes is far greater than that of type 1. Risk factors for type 2 diabetes include genetic and environmental factors, including a family history of diabetes, older age, obesity, especially intraabdominal obesity, level of physical inactivity, prior history of gestational diabetes or pre-diabetes, and race or ethnicity. Because of its slow onset and because it often lacks dramatic symptoms, microvascular and macrovascular complications are frequently seen at diagnosis. The initial treatment is often diet and exercise or oral medications, but insulin may eventually be required. Which nutrition diagnosis is not related to diabetes mellitus? a. Excessive energy intake b. Intake of unsafe foods c. Altered GI function d. Disordered eating pattern Correct Answer is B. Intake of unsafe food. Excessive energy intake is associated with overweight and obesity. Obesity is one of the primary conditions associated with type 2 diabetes mellitus. Altered GI function may be present in both type 1 and type 2 diabetes. The microvascular complication of to control fluid retention with a limit of 2 liters of fluid and less than 2mg sodium per day. Because of underlying atherlosclerosis, a heart-healthy diet is usually given - one low in saturated fatty acids and trans fatty acids with increased fiber, fruits and vegetables. Supplements recommended include potassium, calcium, vitamin D, thiamin, and magnesium At the onset of acute renal failure, the nutritional treatment of choice is often a. Fluid, protein, and sodium restriction b. TPN c. Fluid and sodium restriction d. Enteral feeding modified in protein and electrolytes Correct Answer is B TPN. MNT is especially important in acute renal failure because the patient is suffering from uremia, metabolic acidosis, fluid and electrolyte imbalance, and physiologic stress that increases protein needs. Malnourished patient with ARF have a higher mortality rate. Because oral intake is not tolerated well and enteral feeding runs into many of the same problems, TPN often is the feeding method of choice. A solution of glucose, lipids, and both essential and nonessential amino acids is initiated, with higher proportions of carbohydrate and lipids to spare protein, and fluid and electrolytes matched to output. Nutritional goals of end-stage renal disease include all of the following except a. Preventing uremia with significant protein restriction b. Preventing nutritional deficiencies c. Controlling edema and serum electrolytes d. Preventing renal osteodystrophy Correct Answer is a. Preventing uremia with significant protein restriction. In the past it was thought that protein should be severely limited in end-stage renal disease (ESRD). But thinking has changed, and protein requirement varies, depending on treatment, from .06-1.0 gm/kg. before dialysis to 1.2 gm/kg on hemodialysis and 1.2- 1.5 gm/kg on peritoneal dialysis. Nutrition care plans should be designed to prevent nutritional deficiencies from malnutrition or nutrient loss in dialysate. Fluid and electrolyte balance is also a consideration in nutritional planning, along with adjustment of calcium, phosphorus, and vitamin D to prevent osteodystrophy. Metabolic/ medical complications of HIV include all the following except a. Diabetes mellitus b. Hyperlipidemia c. Osteoporosis d. Urticaria Correct Answer is D. Urticaria In HIV, the combination of the disease itself and its treatment may cause a number of metabolic medical complications. Insulin resistance and elevated blood glucose are often seen in individuals with HIV, in a great part due to medication side effects. Oral hypoglycemia agents and even insulin may be needed to control the onset diabetes. Dyslipidemia is frequently present, including elevated triglycerides, increased LDL, and low HDL. This necessitates a diet high in fiber, fruits, and vegetables and low in saturated fat and trans fatty acids. Osteoporosis is also frequently present, due to low body mass, wasting, hormone deficiency, and previous corticosteroid use. Drug therapy may cause greater bone turnover and loss of mineral density. Supplements of calcium and vitamin D are necessary, along with a calcium-rich diet. Urticaria is an allergic skin reaction not usually associated with HIV. Addition of which substance is the most commonly recommended in MNT of many psychiatric disorders? a. Vitamin D b. Omega-3 fatty acids c. Vitamin B6 d. Polyunsaturated oils Correct Answer is B. Omega-3 fatty acids Sixty percent of the brain's dry weight is fat, and twenty-five percent of this is docosahexaenoic acid (DHA), an omega-3 fatty acid. In fact, omega-3 fatty acids seem to be the substrate preferred by the brain and nervous system. They are the brains building blocks, providing a structure for neurons and an anchoring point for neurotransmitter receptors. Eicosapentaenoic acid (EPA), another omega-3 fatty acid, can be converted to DHA. Both are found in fish and algae. Omega-3 fatty acids may also have anti-inflammatory and antioxidant effects on the brain. What measurements of obesity indicates a risk for metabolic syndrome, diabetes, and heart disease? a. RMS b. Skinfold thickness c. Waist circumference d. BMI Correct Answer is C Waist circumference. Waist circumference measures abdominal obesity, an important risk factor for metabolic syndrome, heart disease, and diabetes. The measurement is taken below the rib cage and above the umbilicus. A measurement of greater than 40 inches for men and 35 inches for women presents a risk factor. Regional fat deposits are genetically determined, so the tendency toward abdominal obesity is inherited. This is called android or "apple-shaped" obesity, and is most often seen in men, but can occur in women as well. This type of obesity is highly related to insulin resistance. The other type of obesity, not related to insulin resistance, is pear-shaped obesity, where fat accumulates in the hips, buttocks, and highs. Models for behavior change include all of the following but a. Psychosocial behavior analysis b. Transtheoretical model of change c. Motivational interviewing d. Cognitive behavioral therapy Correct Answer is A. Psychosocial behavior analysis The models for behavioral change describe the method of education and counseling used by the RD. The most common models include the transtheoretical model (TM) or stage of change, cognitive behavior therapy (CBT), and motivational interviewing (MI). TM describes change as a process where individuals advance through six stages of change. These six stages of change are 1) Precontemplation 2) Contemplation 3) Preparation 4) Action 5) Maintenance 6) Relapse The counselor determines the stage of change and uses the change process matched to that stage. CBT assumes that thinking determines behavior and relative beliefs may be identified and altered to cause a desired change in thinking and thus change behavior. Motivational interviewing (MI) can be used to help clients recognize their problems and begin to resolve them. The goal is to increase intrinsic motivation so clients can express rational for change. Persuasion and support are the needed input from the counselor. Key deterrents to nutritional change include all the following except a. Readiness b. Nutritionist's style c. Education d. Ambivalence Correct Answer is C. Education. Understanding elements that deter to facilitate change is essential for effective nutritional counseling. People make behavioral changes only when they are ready. It is up to the RD to determine the patient's readiness or resistance to change and act accordingly. The nutritionist's style also affects the willingness to change. The RD should be positive, culturally sensitive, empathetic, and should avoid arguments and defensiveness while supporting self-efficacy. Patients may display ambivalence. As they think about their lifestyles and certain situations in their lives, they may see behavioral change related to nutrition as too difficult to manage. On one hand, they want to make the required change, but on the other, they may not see it as important enough. Ambivalence is normal, and it is the job of the nutrition counselor to present change in such a way that the patient sees it as possible. What model for behavioral change relates thinking to behavior? a. Cognitive behavioral therapy b. Transtheoretical model c. Motivational interviewing d. Reflective listening Correct Answer is A. Cognitive behavioral therapy. Cognitive behavioral therapy related thinking and beliefs to behavior. For example, the patient states that he believes he must have a big dish of ice cream every evening; it is soothing, it makes him feel good after a tough day at work, and it helps him fall asleep. So, he eats ice cream before going to bed. Changing the belief, "I must have ice cream," will lead to a change in eating behavior. The counselor may ask the patient nation's health. Traditional low calorie diets alone do not work to combat the problem. The very concept of "going on a diet" implies that it is a transitory thing and that one will eventually go off it. Treating obesity involves lifestyle change, a new pattern of eating, and exercise, which must become permanent. Research on lifestyle change and how to implement it into the obese person's life is a priority in nutrition research. To be an effective multicultural communicator, the dietitian must be aware of all the following except a. Vocabulary b. Eye contact c. Eating habits d. Intelligence Correct Answer is D. Intelligence The vocabulary and speech pattern of the dietitian are important when approaching someone who is not fluent in the English language. The dietitian should look directly at the patient, speak slowly and clearly, and choose simple words that do not have multiple meanings. In our culture, we are taught to make eye-contact when speaking. This shows self-confidence and interest. Other cultures may find eye-contact to be threatening or disrespectful. It is important that the dietitian make an effort to determine how best to approach the individual patient. It is also important to be aware of another culture's eating habits. For example, it is common among some Latinos to use a large serving spoon to dish out portions. This spoon holds 3/4cup to 1 cup, and the dietitian will do better to describe serving sizes in terms of "spoons" Nutritional goals should be all of the following except a. Achievable b. Focused on the short term c. Set by the dietitian according to diagnosis d. The basis of a plan Correct Answer is C. Set by the dietitian according to diagnosis. The dietitian should not set his own goals for a patient of present a standard diet plan. Everything should be tailored to the individual patient. Goals should be achievable. They should be set by the dietitian together with the patient after an in-depth discussion with the patient to determine what is realistic for the individual. Goals should be the basis for the action plan. The plan should be developed along with the patient to show how the goal of one pound per week weight loss cab be achieved. Which is the most important counseling session? a. The first session, in which the dietitian establishes rapport b. The second session, in which the dietitian presents vital information c. The third session, in which the patient completes learning tasks d. The fourth and last session, in which the dietitian summarizes the information, takes questions, and reestablishes goals. Correct Answer is A. The first session, in which the dietitian establishes rapport. It is the first session that sets the tone for the counseling relationship. The dietitian may be the patient's first contact with nutrition and patient education. Quiet and privacy are important. For example, when dealing with a mobile hospital patient, it would be a good idea for the dietitian to use a small meeting or examining room to avoid hospital activity and provide privacy. At the first meeting, the dietitian can make an assessment of the patient, taking note of his background, lifestyle, readiness to learn, and barriers to change and can then present some general information to get an idea of how to proceed. The following are all enzymes secreted in the small intestine except a. Sucrase b. Nucleotidases c. Amylase d. Enterokinases Correct Answer is C. Amylase Amylase is secreted from the salivary glands into the mouth where its salivary form, ptyalin, begins the hydrolysis of starch. It is also secreted by the pancreas into the small intestine to hydrolyze starch and produce maltose and dextrins. Sucrase, necleotidases, and enterokinase are secreted in the small intestine and have very specific roles. Sucrase breaks sucrose down to glucose and fructose. Nucleotidases hydrolyze nucleic acids to form nucleotides and phosphates. Enterokinase works on trypsinogen to activate trypsin to produce dipeptides and tripeptides. What is the area of the absorptive surface of the small intestine? a. 3 square miles b. 10 meters2 c. 200 to 300m2 d. 500 to 600m2 Correct Answer is C. 200 to 300m2 The absorptive surface of the small intestine is 200 to 300m2. It is the primary place in the gastrointestinal tract for absorption of water and nutrients. The large absorptive surface area is due to its great length and folds, valvulae conniventes. The surface area is covered with small finger-like projections, villi, which are then covered by mircovilli, the brush border. The great surface area is due to all these tiny projections and the intestinal folds. The villi are set on supporting structure, lamina propria, containing connective tissue with blood and lymph vessels that absorb the products of digestion. Which of the following is not a monosaccharide? a. Sucrose b. Glucose c. Dextrose d. Galactose Correct Answer is A. Sucrose. Sucrose is a disaccharide; it is a combination of glucose and fructose. Glucose is the most widely available sugar in nature. It is usually combined with another sugar or sugars to for disaccharides or polysaccharides. Dextrose is the glucose that results from the hydrolysis of cornstarch. Galactose is the result of the hydrolysis of lactose (milk sugar) during digestion. Major regulators of blood glucose after a meal are all of the following except a. Amount of digestible carbohydrate b. Uptake and absorption by the liver c. Insulin secretion and tissue sensitivity to it d. Level on the glycemic index Correct Answer is D. Level on the glycemic index. Postprandial blood glucose is dose dependent, so it varies with the amount of carbohydrate consumed. The availability or digestibility of carbohydrate is also an important issue in post-meal glucose levels. Fiber can slow or hasten the digestion of carbohydrate, depending on its type. Nonsoluble fiber increases the water holding ability of undigested material and speeds the transit time, making carbohydrates available sooner. Soluble fiber, on the other hand, can form soluble gels, increasing transit time and thereby slowing transit and decreasing nutrient absorption. After digestion, glucose enters the portal vein for transport to the liver, where depending on physiological circumstances, it is absorbed. Then glucose is available to the bloodstream for insulin- dependent absorption by tissues. The amount of available insulin and any insulin resistance will affect glucose uptake. Approximately how much of portal glucose is taken up by the liver? a. 20% b. 30% c. 50% d. 65% Correct Answer is C. 50% After carbohydrate is ingested, digested, and broken down to monosaccharides in the small intestine, it is transported via the portal vein to the liver. In the liver, glucose is available for oxidation and storage as glycogen. Galactose and fructose are also made available for the glucose metabolic pathways. About 50% of glucose is absorbed by the liver. Which statement about omega-3 fatty acids is true? a. They are synthesized by seaweed b. They influence neurotransmission. c. They maintain the integrity of the GI tract d. They are short-chain fatty acids Correct Answer is b. They influence neurotransmission. Omega-3 fatty acids are found in marine algae and consumed by fish. By eating fish, humans ingest omega-3 fatty acids. Omega-3 include docohexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which converts to DHA. These long-chain fatty acids form the brain's structure. DHA is preferred by the brain and provides structure for neurons and, among other things, is the substance that provides and maintains the density of dopamine and serotonin neurotransmitter receptors; thus, is crucial in neurotransmission and may be essential for effectiveness of antidepressants. The absorption of vitamin E is dependent on all the following except -1 cup Fettucine Alfredo -1 cup broccoli with 1 tsp butter -salad greens with 2T Italian dressing -2 dinner rolls with 2 tsp butter -12oz white wine -Coffee/2Tbl half & half -1/2 cup chocolate ice cream Approximately how many calories are in this meal? a. 800 to 1000 b. 1100 to 1300 c. 1400 to 1600 d. 1700 to 2000 Correct Answer is c. 1400 to 1600 Pasta 1 cup, 186 kcal, 6g PRO Dinner roll 2, 172 kcal, 4.8g PRO, 28.6g CHO, 2.1g Fat Chicken leg 2, 408 kcal, 42g PRO, 22.8g Fat Alfredo sauce, 172 kcal, 28.6g CHO, 4g Fat Salad dressing 2Tl, 4.6gCHO, 22.8g Fat Broccoli 1cup, 44kcals Butter 3tsp, 135kcals, 8g CHO, 13.4g Fat Greens White wine 10oz, 200kcals coffee/ 1/2 & 1/2 2Tbl, 39kcals, 1.3g CHO, 3.5g Fat Choc. ice cream .5c, 165kcals, 15gCHO, 10g Fat Total calories 1521 Total Protein 52.8 Total Cho 86.1 Total Fat 69.2 Restaurant meals typically have more fat and calories than those prepared at home by a careful cook. At home, rolls and butter are not frequently served with dinner. Here, rolls and butter account for extra calories and fat. Meat and poultry are prepared for taste, not nutrition, and fancy sauces may be the rule, rather than the exception. -2 roasted chicken legs -1 cup Fettucine Alfredo -1 cup broccoli with 1 tsp butter -salad greens with 2T Italian dressing -2 dinner rolls with 2 tsp butter -12oz white wine -Coffee/2Tbl half&half -1/2 cup chocolate ice cream Approximately how many grams of fat are in this meal? a. 30 to 50 b. 51 to 85 c. 86 to 110 d. 111 to 130 Correct Answer is b 51 to 85 Pasta 1 cup, 186 kcal, 6g PRO Dinner roll 2, 172 kcal, 4.8g PRO, 28.6g CHO, 2.1g Fat Chicken leg 2, 408 kcal, 42g PRO, 22.8g Fat Alfredo sauce, 172 kcal, 28.6g CHO, 4g Fat Salad dressing 2Tl, 4.6gCHO, 22.8g Fat Broccoli 1cup, 44kcals Butter 3tsp, 135kcals, 8g CHO, 13.4g Fat Greens White wine 10oz, 200kcals coffee/ 1/2 & 1/2 2Tbl, 39kcals, 1.3g CHO, 3.5g Fat Choc. ice cream .5c, 165kcals, 15gCHO, 10g Fat Total calories 1521 Total Protein 52.8 Total Cho 86.1 Total Fat 69.2 Restaurant meals typically have more fat and calories than those prepared at home by a careful cook. At home, rolls and butter are not frequently served with dinner. Here, rolls and butter account for extra calories and fat. Meat and poultry are prepared for taste, not nutrition, and fancy sauces may be the rule, rather than the exception. What is the acronym for a storage and stock rotation principle? a. LILO b. FIFO c. APPM d. SSRP Correct Answer is b. FIFO FIFO stands for First In First Out. It describes a storage and stock rotation principle that ensures that foods are used in the order in which they were delivered. In effect, the first lot of a product that was delivered and came into the storeroom would be the first taken out of the storeroom and used. This keeps the latest delivery in the back of storage area or shelf and allows for the older delivery to be placed in the front and used first. As the first supply is used, the next moves up to the font, and a new delivery would be placed in the back. So stock is rotated according to its age. Which of the following is a variable cost? a. Labor b. Equipment c. Insurance d. Utilities Correct Answer is a. Labor Labor is a variable cost. Variable costs depend on the number of meals served. If the number of meals served increases, labor will be directly and immediately affected, since more meals require mare employees to prepare and serve them. Initially, this would likely mean overtime pay for some of the current staff, who would have to stay extra hours or come to work on days off. Eventually, if the increase in meals served were to persist, new employees would have to be hired in permanent positions to accommodate the increased work load, and labor costs would rise. An ideal storage location will have all of the following effects excepts: a. Reducing labor requirements b. Speeding the storing and issuing of food c. Minimizing security risks d. Decreasing transit time between the preparation and serving areas Correct Answer is d. Decreasing transit time between the preparation and serving areas. An ideal storage area should be located so that labor requirements for issuing items and transit time between storage and preparation areas are minimized. The storage room should be positioned so delivery and receiving time and labor requirements for those tasks are kept to a minimum. The storage room should not be located where anyone passing by could enter and leave without being seen. There should be no extra entrances, and the entrance that is used should be attended by a clerk at all times. The location of the storage area has no bearing on transit time between preparation and service areas. Which items should be stored near the entrance of the storeroom? a. Freshest items b. First items delivered c. Frequently used items d. Perishable items Correct Answer is c. Frequently used items. Frequently used items are those that are most in demand by preparation staff and that necessitate the most trips to the storeroom. These items should be placed at the entrance of the storeroom where they can be quickly retrieved by the preparation and service staff, minimizing transit belong in a refrigerator or freezer. The exception is items that frequently used. All the following will help prevent bacterial growth in food except a. Keeping foods dry b. Keeping cold food at 40F or less c. Keeping hot foods at 140F or over d. Not leaving food out for more than 30 minutes Correct Answer is d. Not leaving food out for more than 30 minutes. Food should never be left out in the open where it can be exposed to bacteria in the surrounding environment. Bacteria thrive in moisture-rich environments, so food should be kept dry. Bacteria if food grow more slowly at 40F or below and at 140F or higher. Heating to a temperature of 170F to 212F will kill most bacteria. Bacteria grow more current title holder in a box at the top, with vertical lines connecting it to boxes below indicating the positions that directly report to the top, and so on down the chain of command. Horizontal lines connecting job title boxes show equal status, with cooperation rather than supervision being the main interaction. A thorough understanding of the hierarchy of personnel is essential when designing an organizational chart. Boxes contain only job titles and names, not job descriptions. Costs have no bearing on an organizational chart, nor do pathways of an operation. In order to write a job description, the manager must be aware of all the following except a. Job objectives b. Performance standards c. Required tasks d. Suggested age for the job Correct Answer is d. Suggested age for the job. It is against federal law to assign an age designation to a particular job. It would be considered discrimination. Job objectives are important so the manager is aware of what each employee's duties entail. The required tasks are the steps to reach the job's objectives. They are the actual steps an employee must take to achieve the job's designated outcome. These duties, associated with meeting objectives, must be clearly defined and performance standards must be established. Standards include things such as the amount of time it should take an employee to perform a particular task, the tools to be used in accomplishing the task, and characteristics of the finished product. When would long-time employees need training? a. When they have been away from work on an extended sick leave b. When new employees have been hired c. When work standards or standard procedures have been changed d. Yearly Correct Answer is c. When work standards or standard procedures have been changed. When new work standards or standard procedures are instituted, employees need training to meet these new standards or to follow new procedures effectively. When employees return from extended sick leave, unless some change has occurred in standards and procedures, training should not be necessary. Unless a new employee is hired into a new position that will affect the existing employees, no training is needed. Training should reflect the needs of the organization and should not recur at a particular time. The Systems Approach states that all systems have 4 basic characteristics. Which of the following is not one of those characteristics? a. All systems have a general purpose b. All systems operate within an environment c. All systems have subsystems d. Outside factors are an important consideration Correct Answer is d. Outside factors are an important consideration. Outside factors may affect an organization, but they are usually beyond its control. For instance, a food service department may be affected by nursing or house keeping departments, but these departments are beyond the scope of work of food service. All systems do have a general purpose. A hospital food service may consider its purpose to serve healthy, temperature-specific, attractive, and prescription correct meals to patients in a timely fashion. The food service is a closed environment, with goods coming in and finished products going out. All systems have subsystems that operate within them. All of the following are functions of food service managers except a. Monitoring staff performance b. Selecting and training staff c. Orienting staff to the interaction of union policies and department practices d. Preparing financial reports Correct Answer is c. Orienting staff to the interaction of union policies and department practices. Policies and practices relating to union affairs are handled by union representatives. Management has nothing to do with union activities. The food service manager is responsible for the selection of new employees, usually with the help of human resources. The manager orients and trains new employees to the overall organization, the foods service department, and to their specific duties. He also monitors employees to make sure that they are performing their job activities as trained and decides on the proper steps to take if they are not. Finally, although he may have a bookkeeper, the food service manager is responsible for all the financial aspects of his department, including financial reports. What are the 3 types of food service systems? a. Cook chill, cook freeze, rethermalization b. Conventional, commissary, assembly/serve c. Ready-prepared, conventional, rethermalization d. Commissary, satellite, decentralized production. Correct Answer is b. Conventional, commissary, assembly/serve. In the conventional system, foods are prepared and held a short time prior to serving. This is the type of service commonly used in hospitals and needs sufficient labor and access to foods. Some prepared/ processed foods may be used to limit production time and labor costs. With the assembly/serve system, all food preparation is done off-site. Frozen meals are purchased and stored, and are then assembled, heated, and served. Often, disposable dishes and tableware are used to avoid having to buy and maintain a dishwasher. The commissary-style system has a central kitchen, which may provide meals for consumers on site but also sends food to remote locations for final preparation and service. Because food is transported to multiple locations, this type of system is open to more contamination than some others. FAT-TOM refers to a. Hazardous foods b. Tomato selection c. Fast cooking method d. Frequent hand washing Correct Answer is a. Hazardous foods. F-food A- acid T-time T-temperature O-oxygen M- moisture These relate to the conditions that favor rapid growth of mircoorganisms. Which of the following does not cause food-borne intoxication? a. Staphylococcus aureus b. Listeria monocytogenes c. Clostridium botulinum d. Clostridium perfringens Correct Answer is b. Listeria monocytogenes. Agents of food-borne intoxication produce toxins that can cause illness when ingested; they include staphylococcus aureus, clostridium botulinum, clostridium perfringens, and some molds. The most frequently seen is staphylococcus aureus. It is found in human skin, nose, pimples, and wounds. It can be found in meat, poultry, eggs, milk, and dairy- based products such as cream pie. There is usually no sign of the food that the toxin is present. Staphylococcus aureus is not killed by heat, so refrigeration is essential. Symptoms appear .5 to 6 hours after ingestion and include nausea and diarrhea. Listeria monocytogenes is an infectious microorganism. Which microorganism accounts for the most cases of GI upset? a. Salmonella b. Escherichia coli c. Clostridium perfringens d. Campylobacter jejuni Correct Answer is b. Escherichia coli Infectious organisms cause the majority of cases with food-borne illness in humans. It is found in the feces of humans and animals, so it may contaminate soil, water, and plants. Escherichia coli may cause many GI disturbances from diarrhea to potentially fatal hemolytic uremic syndrome. Outbreaks have been reported due to undercooked hamburger, soft cheese, lettuce, spinach, and tomatoes. Escherichia coli is destroyed by heat. The role of the food service manager in food safety includes knowledge of all the following except a. Symptoms associated with food-borne illness b. Federal, state, and local guidelines and regulations c. Interaction of food service employees d. Proper care of equipment and facilities Correct Answer is c. Interaction of food service employees. that would meet the nutritional needs of 97-98% of a healthy population and are the standards most commonly used. The AI, Adequate Intake, is the scientifically determined or observed nutritional needs when RDAs are not available. The UL, upper limit, is the highest safe level of nutrient that can be consumed by healthy individuals. This is individuals who believe that these are beneficial. All of the following describe the customer and his food needs except a. Psychosocial b. Demographic c. Sociocultural d. Nutritional Correct Answer is a. Psychosocial Psychosocial needs do not necessarily relate to food unless food is misused, as in an eating disorder. Demographics include gender, age, health, ethnicity, education, and income level. For example, an elderly, urban, mostly female Russian population with limited income would have different needs from a young, Anglo-Saxon, suburban population with children. The term sociocultural includes social and cultural factors, such as marital status, lifestyle, ethnicity, values, and religion. This would mean adding more ethnic foods to the menu and giving special consideration for the needs of groups such as Orthodox Jews, Seventh-Day Adventists, and Muslims, who observe dietary laws. Nutrition requirements for a geriatric population would be different from those of young adults and children. Which of the following is a food group described in the Dietary Guidelines for Americans? a. Proteins b. Vitamins c. Fats d. Minerals Correct Answer is c. Fats The Dietary Guidelines for Americans do not address all nutrients; rather, they focus on some particularly problematic nutritional issues. Under the heading Food Groups to Encourage are more servings of fruits and vegetables from a wider variety of sources. Three of more servings of whole grain products are encouraged, along with at least three servings of low fat milk or equivalent. Under the Fats category, Americans are advised to consume only 20-35% of their calories from fat, with only 10% from saturated fat, and to choose lean meats and poultry prepared by a low fat cooking method. In carbohydrates, whole grains are recommended, along with a minimum of sweeteners. Under sodium and Potassium, sodium should be limited to 2300mg and potassium-rich foods are encouraged. Lastly, the section Alcoholic Beverages advises those who drink to do so in moderation and discourages alcohol consumption in a number of groups. Which kind of menu is most often used in major medical centers? a. Cycle b. Static c. Single use d. Du jour Correct Answer is a. Cycle Cycle menus have two or more weeks' menus rotated or cycled throughout a specific period of time. This cuts down on repetition and keeps the food served more interesting. While the cycle menu cuts down on repetition for hospital patients, who seldom stay in the hospital much more than a week, it is repetitive enough for the food service staff to use standards procedures for food preparation. A static menu may offer several choices, but it is repeated daily. These are more common in restaurants and coffee shops. The single-occasion, usually a special event of a holiday. A du jour menu is literally a menu "of the day" and is rewritten daily. It is used in better restaurants. In menu planning, the characteristics and combinations of foods should be considered. These include all of the following except a. Presentation b. Color c. Nutrition d. Texture Correct Answer is C. Nutrition Presentation is a broad concept, covering how foods appear on the plate, their sensory and aesthetic appeal, the blending of flavors, and contrasts in color, consistency, taste, texture, and shape. An example of poor presentation would have a sliced chicken, mashed potatoes, and mashed yellow squash, because it lacks variation in color and texture. Using broccoli spears as the vegetable would enhance both color and texture. Texture refers to the shape and mouth feel of food. By adding broccoli to the above meal, you are introducing a new texture. Nutrition should have been considered in earlier steps of menu planning. Step by step in menu planning includes all of the following except a. Entrée b. Beverage c. Vegetables d. Sandwiches Correct Answer is b. Beverage The entrée is the first item to determine for a menu. It is the main part of the meal and the most expensive. Other parts of the main course are planned around it, including either two vegetables or a starch and a vegetable. Soups and sandwiches are planned as alternates to the meal, or the soup may be an elective item with the entrée. Sandwiches may change, or the same sandwich may be offered as a substitution for the entrée. Beverages are usually standard items that do not change, coffee, tea, soda, fruit juice, and milk are common beverages. All the following are categories of factors affecting menu planning except a. Organizational b. Personnel c. Customer d. Operational Correct Answer is B. Personnel. Personnel would come under operational. The type of organization would be the first area to consider in menu planning. There would be vast differences among menus for a primary school, a general hospital, a long-term care facility, and for-profit restaurant. A conscientious and objective study of the population served will have a significant impact on menu planning. Demographics to be considered would include age, sex, ethnicity, income, health status, and education. Sociocultural factors include religion, ethnicity, lifestyle, and values. Operational would include facility, equipment, budget, and personnel. What is the extended menu? a. One with extra items b. One that lasts for more than one season c. One that includes three meals and three snacks d. One that includes modified diets Correct Answer is D. One that includes modified diets An extended menu includes therapeutic diets and makes provisions for several modifications of the same meal. A low sodium modification would include foods prepared without salt and would use low sodium food in the place of a food high in sodium. A low fat diet would be prepared by low fat cooking methods, and high fat foods like ice cream substituted with a low fat one, such as sorbet. A soft diet is modified in consistency to exclude tough meats and high-fiber foods, such as broccoli spears or mixed greens. A bland diet would omit high fiber and spicy foods. Elements to be considered in the printed menu include all the following except a. Design and format b. Type of food served c. Wording d. Truth in menu legislation Correct Answer is b. Type of food served. The menu is a marketing tool. The design and format are what makes a menu appealing and interesting. If a menu is appealing, the customer will want to read it and will have a more positive attitude toward the food being served. The menu should be clean, with appropriate-size type and lots of white space. Too many design elements and too little white space will detract from the food being offered. Descriptive wording like fresh, green, crispy, or homemade add to the appeal of food listed, but must be accurate. Truth-in-menu advertising has made it illegal to use misleading wording on menus, so items described as "fresh" must be fresh, and "homemade" items should be made on the premises. Theory X and Theory Y held that managers' attitudes were of two distinct types. They were a. Balanced and unbalanced b. Optimistic and pessimistic c. Structured and unstructured d. Linear and circular a. Trust b. Loyalty c. Effective leader-follower relationships d. Organizational respect Correct Answer is d. Organizational respect Ethics can be defined as the rightness or wrongness of actions and the goodness or badness of these actions' objectives. Eli Wiesel once said that the ethical man is the who hesitates and asks himself, am I doing the right thing? In the history of management and leadership, the original goals were profit and productivity. In subsequent years, management theories have evolved to include ethics and social responsibility. The leader/ manager must deal with several issues in this area, including employee's rights, the right to privacy, unethical behavior, and various cultural values. The most important resource in any enterprise is a. A well-educated and experienced manager b. A strong financial base c. The human factor d. Inspiring leadership Correct Answer is c. The human factor The staff creates the product and interacts with customers. It is essential that the food service manager have a positive relationship with his staff. He must be able to understand people and see their potential for growth and development. While the food service manager must follow strict operating procedures, he must also be empathetic and provide avenues for two-way communication. Communicating to employees that they are useful and highly valued leads to the efficient functioning of the department. It gives them a sense of pride, responsibility, and belonging, while encouraging a sense of self-worth. Major marketing strategies are based on the 4Ps. They include all of the following except a. Product b. Persuasion c. Price d. Promotion Correct Answer is b. Persuasion The product should be unique in some way and have proprietary advantages; that is, it should be patented, copyrighted, or trademarked to prevent duplication by competitors. Place and distribution are other major factors in marketing a product or service. Manufacturing site and distribution process should be soundly investigated and established before marketing a product. Location of a private practice should accessible, with ample parking, and should preferable by near other places customers habitually go. Establishing a price is key to creating perceivable value in the customer's mind, and it places your services or product in relation to that of your competitor. Which of the following must be identified in order to define competition? a. Target market b. Goals c. Mission d. Objectives Correct Answer is a. Target market Missions, goals, and objectives are used to determine an organization and determine what it will do. The target market is where the competition will be found. Once a business is defined, the target market must be established. The question that must be asked is, Who is my customer? Define the desired customer in order to identify the target market. Also, understanding the customer's perspective will determine what benefits of a business must be stressed. All of the following are the primary keys to successful product marketing except a. Characteristics of product b. Product developer's image c. Timing in the marketplace d. Competitive positioning of the product Correct Answer is b. Product developer's image The primary keys to successful product marketing include characteristics of the product, timing in the marketplace, and competitive positioning of the product. The product must have new advantages and be copyrighted, patented, or trademarked. The target market must be ready for the product. The product must also have a competitive market, such as young, senior, elite, or others. Whichever target niche is chosen, the advertising must be specific for that market. All of the following show good ethical practice except which of these scenarios? a. A dietitian is asked to be a consultant and spokesperson for a new artificial sweetener. She reads all the available research literature in peer-reviewed journals and decides that the product is safe and has some advantages over the other artificial sweeteners. b. A dietitian is asked to do a television interview. It is on the "Twinkie" - sugar causing adverse behavior- defense for a court case. The TV news producer wants an explanation of how sugar could cause this adverse behavior. The dietitian consults with several physicians and determines that sugar does not cause adverse behavior, so he refuses the interview c. A dietitian is a spokesperson for an energy bar product. The marketing department wants him to support their statement that a particular nutrient is more important than others. Although this is an exaggeration, he decid Correct Answer is c. A dietitian is a spokesperson for an energy bar product. This situation violates the dietitian's code of ethics in a number of ways. The actual principles from the Code of Ethics for the Profession of Dietetics are shown below: -The dietetics practitioner provides professional services with objectivity and with respect for the unique needs and values of individuals. In this case, the dietitian did not show objectivity, nor did she show respect for the needs and values of individuals. She exhibited the bias of the food company. and by misrepresenting nutritional requirements, showed that she did not have respect for individuals. -The dietetics practitioner conducts herself with honesty, integrity, and fairness. This case showed that the dietitian let a business practice supersede honesty and integrity. -The dietetic practitioner promotes or endorses products in a manner that is neither false nor misleading. Clearly this dietitian took a position that was false and misleading. Six common pricing strategies include all the following except a. Skimming b. Trading down c. Underbidding d. Being customer specific Correct Answer is d. Being customer specific. Skimming is setting a very high price aimed at a small, elite, and profitable market. Examples might be an upscale gym or a personalized service in an expensive neighborhood. Trading down is the act of adding a less expensive service to an elite one to expand market share and profit . Underbidding is setting a price lower than competitors and allowing for a lower profit margin to make a business more attractive. It is often used to introduce a new business to the market. Which of the following pieces of legislation did not deal with the acquisition of human resources? a. Civil Rights Act of 1964 b. Occupational Safety and Health Act of 1970 c. Age Discrimination in Employment Act of 1967 d. Americans with Disabilities Act of 1990 Correct Answer is b. Occupational Safety and Health Act of 1970 The Occupation Safety and Health Act of 1970 provides for improvement in workplace conditions, while the others concern the rights of the workers. The Civil Rights Act of 1964 states that employers cannot deny employment on the basis of race, color, religion, sex, or national origin. The Age Discrimination in Employment Act of 1967 forbids employers from denying employment or discharging anyone because of age. The Americans with Disabilities Act of 1990 states that employers cannot deny employment to a qualified applicant with a disability. These acts ensure that groups of individuals who were once denies employment have an equal opportunity in the workplace. All of the following are elements of the QWL approach except a. Work design b. Safety and health c. Human resources d. Equipment design Correct Answer is c. Human resources QWL refers to quality of work life. Increased employee satisfaction and productivity are the purpose of good work design. Design of work should improve work content and should aim at a safe and healthy work environment, a staff of people fit for their jobs,