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  1. What effect does fiber have on gastro-intestinal transit time?

    1:
    Dietary fiber in a solid or liquid meal results in delayed gastric emptying
    2: The effects of fiber in the upper GI tract do not differ from the effects of fiber in the colon
    3: Fiber in the distal ileum increases gastric emptying
    4: Consumption of insoluble fiber increases gastric emptying
    • 1: Dietary fiber in a solid or liquid meal results in delayed gastric emptying
    • (1) Effects of fiber in the upper intestinal tract can differ from those in the colon primarily because of partial or complete fiber degradation and fermentation by colonic bacterial enzymes. Dietary fibers included in a liquid and solid meal with a purified source of pectin slowed gastric emptying, as did consumption of a solid meal high in natural food fiber. Consumption of insoluble fiber and the presence of fiber in the distal ileum results in decreased gastric emptying.
  2. Wilson’s disease is characterized by the accumulation of which of the following in the liver?


    1: Copper
    2: Manganese
    3: Selenium
    4: Iron
    • 1: Copper
    • (1) Copper toxicity is rare because the body regulates copper storage via biliary excretion. Chronic ingestion of excessive copper amounts will result in liver cirrhosis (e.g., Wilson’s disease) with an accumulation of copper in the liver and other organs.
  3. The acute phase response has what effect on serum iron and ferritin levels?


    1: Increases serum iron levels and increases serum ferritin levels
    2: Increases serum iron levels and decreases serum ferritin levels
    3: Decreases serum iron levels and decreases serum ferritin levels
    4: Decreases serum iron levels and increases serum ferritin levels
    • 4: Decreases serum iron levels and increases serum ferritin levels
    • (4) The acute phase response to injury and infection suppresses iron transport. Clinically, serum iron levels are depressed, while serum ferritin levels are increased. The sequestering of iron into a storage form following injury and infection is thought to have several protective measures for the host. It reduces the availability of iron for microorganism proliferation and also reduces free radical production and oxidative damage to membranes and DNA.
  4. The majority of dietary folate is reabsorbed via which of the following mechanisms?


    1: Oncotic pressure
    2: Enterohepatic circulation
    3: Plasma hydrostatic pressure
    4: Passive diffusion
    • 2: Enterohepatic circulation
    • (2) Prior to entry into the portal circulation, folate metabolites are secreted into bile and recirculated via enterohepatic circulation. Excretion of folate metabolites is minimal, whereas most of the absorbed dietary folate is reabsorbed via enterohepatic circulation. Oncotic pressure, passive diffusion, and plasma hydrostatic pressure govern the movement of fluid between the plasma and interstitial spaces.
  5. Which of the following is a practical biochemical test for assessing Vitamin A status?


    1: Plasma carotenoid level
    2: Serum retinol concentration
    3: Plasma transthyretin-retinol binding protein (TTR-RBP) concentration
    4: Serum retinol binding protein level
    • 2: Serum retinol concentration
    • (2) Vitamin A represents a subgroup of compounds known as retinoids that have biological activity of retinol. Vitamin A exists in three forms: retinol, retinaldehyde, and retinoic acid. Serum retinol concentration is a practical biochemical test for assessing Vitamin A status as it correlates well with Vitamin A intake. Retinol circulates attached to RBP and TTR as a complex. Carotenoids, which possess vitamin A activity, are included in the vitamin A family.
  6. Choline supplementation has been investigated as a treatment for which of the following disease states?


    1: Myocardial infarction
    2: Pancreatic insufficiency
    3: Hepatic steatosis
    4: Alcoholic encephalopathy
    • 3: Hepatic steatosis
  7. The accuracy of indirect calorimetry may be decreased by


    1: mechanical ventilation with FiO2 >= 60.
    2: holding routine nursing care or activities during the study.
    3: measurements made in a quiet, thermoneutral environment.
    4: keeping the rate and composition of nutrients being infused stable for 12 hours.
    • 1: mechanical ventilation with FiO2 >= 60.
    • (1) The fraction of inspired oxygen (FiO2) needs to remain constant during the measurement. The accuracy of indirect calorimetry is decreased in mechanically-ventilated patients with FiO2>= 60. Measurements should be made in a quiet, theromoneutral environment and routine care during the study should be avoided. The rate and composition of nutrients being infused on a continuous basis should be stable for at least 12 hours for an accurate study.
  8. Indirect calorimetry (IC) calculates


    1: total energy expenditure.
    2: nitrogen balance.
    3: heat released from the subject.
    4: resting energy expenditure (REE) and respiratory quotient (RQ).
    4: resting energy expenditure (REE) and respiratory quotient (RQ).
  9. Potential metabolic causes for a respiratory quotient (RQ) greater than 1 include all of the following EXCEPT


    1: overfeeding.
    2: hypoventilation.
    3: excess CO2 production.
    4: provision of excess buffering agents (e.g., sodium bicarbonate).
    • 2: hypoventilation.
  10. The catabolic phase of the metabolic response to critical illness usually lasts


    1: 1 day.
    2: 3 days.
    3: 5 days.
    4: 7 days.
    • 4: 7 days.
    • (4) The metabolic response to critical illness has three phases: the stress phase, the catabolic phase, and the anabolic phase. The stress phase typically lasts 24 hours. The catabolic phase occurs after resuscitation and usually lasts for 7 to 10 days. It is dominated by fever, hypercatabolism, gluconeogenesis, and increased oxygen demands. Tight glucose control and ongoing metabolic support are the focus of nutrition support during this phase. The anabolic phase of the stress response occurs after the acute phase response has resolved and can last for months.
  11. Which of the following are examples of monosaccharides?


    1: Galactose, sucrose, and amylopectin
    2: Maltose, fructose and lactose
    3: Glucose, fructose, and galactose
    4: Lactose, maltose, and sucrose
    3: Glucose, fructose, and galactose
  12. Phosphofructokinase, a rate-limiting enzyme of glycolysis, is inhibited when ATP is abundant. Why is this inhibition important?


    1: Facilitates gluconeogenesis to maintain euglycemia
    2: Allows the cell to divert glucose to be stored as glycogen
    3: Promotes catabolism
    4: Enhances the TCA cycle
    • 2: Allows the cell to divert glucose to be stored as glycogen
    • (2) Phosphofructokinase, a rate-limiting enzyme of glycolysis, is inhibited when ATP is plentiful. This step is necessary to prevent further breakdown of glucose and allows the cell to divert glucose to be stored as glycogen for later use.
  13. In the body, glycogen is mainly found in
    1: brain and liver.
    2: skeletal muscle and kidneys.
    3: small intestine and brain.
    4: liver and skeletal muscle.
    4: liver and skeletal muscle.
  14. In response to illness and trauma, there is an increase in which of the following hormones?


    1: Cortisol, epinephrine, growth hormone, and glucagon
    2: Insulin, epinephrine, estrogen, and somatostatin
    3: Glucagon, gastrin, insulin-like growth factor, and renin
    4: Leptin, cortisol, growth hormone, and cholecystokinin
    1: Cortisol, epinephrine, growth hormone, and glucagon
  15. Measurement of which of the following reflects the functional status of the trace element selenium?


    1: Plasma selenium level
    2: Erythrocyte concentration
    3: Plasma glutathione peroxidase
    4: Methionine
    3: Plasma glutathione peroxidase
  16. Which of the following is a sign observed in PN patients with inadequate chromium replacement?


    1: Weight gain
    2: Hypoglycemia
    3: Hyperglycemia
    4: Rhabdomyolysis
    3: Hyperglycemia
  17. Which of the following is a common sign seen in a patient with Vitamin D toxicity?


    1: Hypocalcemia
    2: Metabolic bone disease
    3: Soft tissue calcification
    4: Hypohosphatemia
    3: Soft tissue calcification
  18. Presence of dietary fiber in the distal ileum contributes to


    1: increased intestinal transit time.
    2: delayed gastric emptying.
    3: bacterial fermentation.
    4: creation of short-chain fatty acids.
    • 2: delayed gastric emptying.
    • (2) Presence of dietary fiber in the distal ileum produces an inhibitor feedback effect called the "ileal brake," which slows gastric emptying. Fiber is fermented into short-chain fatty acids in the colon.

  19. Intestinal bezoar is a rare but adverse effect of fiber administration via tube feeding formulas. A strategy to prevent this is to


    1: administer fiber separately from formula.
    2: use insoluble bulk-forming fiber.
    3: provide adequate water flushes to maintain hydration.
    4: infuse tube feeds continuously via enteral pump.

    • 3: provide adequate water flushes to maintain hydration.
    • (3) Formation of an intestinal bezoar, a densely packed mass of fibrous material, is an extremely rare complication of fiber administration. This complication is avoided by adequate fluid intake, appropriate mixing of fiber powders, and stool output monitoring.
  20. The best method to administer psyllium soluble fiber via feeding tube is to


    1: mix with formula in a gravity drip feeding bag.
    2: avoid administering via feeding tube due to clogging risk.
    3: mix with water and other medications and give by syringe followed by 10 mL water flush.
    4: dilute in water and give by syringe followed by 10 mL water flush.

    • 4: dilute in water and give by syringe followed by 10 mL water flush.
    • (4) Psyllium has been successfully administered via feeding tubes by diluting 1 tsp with 80 mL water, inject by syringe and follow with 10 mL water flush. There may be an association between the intake of dietary fiber and decreased effectiveness of some medications; therefore, timing of fiber and medication administration should be spaced apart. Manipulation of the feeding bag system is a risk for microbial growth through touch contamination.
  21. All of the following methods to determine energy expenditure account for age EXCEPT


    1: Harris-Benedict Equation.
    2: Owen Equation.
    3: Mifflin-St. Jeor Equation.
    4: Swinamer Equation
    2: Owen Equation.
  22. Underfeeding is associated with


    1: poor wound healing.
    2: hepatic steatosis.
    3: azotemia.
    4: hypertriglyceridemia
    1: poor wound healing.
  23. Albumin has a half-life of approximately


    1: 3 days.
    2: 8 days.
    3: 12 days.
    4: 20 days
    4: 20 days.
  24. Which of the following vitamins requires formation of micelles for intestinal absorption?


    1: A
    2: B1
    3: B12
    4: C
    1: A
  25. A patient awaiting liver transplant has been taking a diuretic to control ascites and peripheral edema. Which of the following acid-base disorders is expected?


    1: Metabolic acidosis
    2: Metabolic alkalosis
    3: Respiratory acidosis
    4: Respiratory alkalosis
    2: Metabolic alkalosis
  26. Which of the following is an example of a short chain fatty acid?


    1: Lauric acid
    2: Stearic acid
    3: Oleic acid
    4: Butyric acid
    4: Butyric acid
  27. The basic structure of a lipid consists of

    1:
    a phospholipid backbone with 3 fatty acid molecules attached via ester linkage.
    2: a fatty acid backbone with 3 glycerol molecules attached via ester linkage.
    3: a cholesterol backbone with 3 fatty acid molecules attached via ester linkage.
    4: a glycerol backbone with 3 fatty acid molecules attached via ester linkage.
    4: a glycerol backbone with 3 fatty acid molecules attached via ester linkage.
  28. Triglycerides that require bile acids to facilitate enzymatic digestion and absorption are typically


    1: 3 carbons in length.
    2: 6 carbons in length.
    3: 9 carbons in length.
    4: 12 carbons in length.
    4: 12 carbons in length.
  29. Oxidation of fatty acids for adenosine triphosphate (ATP) production occurs in


    1: all cells that contain mitochondria.
    2: the mitochondria of the adipocyte only.
    3: the red blood cells only.
    4: the blood stream
    1: all cells that contain mitochondria.
  30. Linoleic acid and α-linolenic acid are referred to as essential fatty acids in humans because


    1: they are the only fatty acids that can be used for adenosine triphosphate (ATP) production.
    2: they cannot be synthesized by humans and must be obtained through diet.
    3: they are the only fatty acids absolutely required to sustain life.
    4: they require L-carnitine to enter the mitochondria.

    2: they cannot be synthesized by humans and must be obtained through diet.
  31. A 50-year-old male weighs 80 kg. Calculate the estimated volume of his intravascular space.


    1: 4 L
    2: 8 L
    3: 12 L
    4: 16 L
    • 1: 4 L
    • (1) Water, the most abundant substance in the body, constitutes approximately 50% to 60% of body weight. Total body water (TBW) is a function not only of weight, age, and gender but also of the relative amount of body fat. TBW is distributed among three main compartments: intracellular, extracellular, and transcellular fluid compartments. Approximately two-thirds is contained in the intracellular fluid, and the remaining one-third is in the extracellular fluid. One-fourth of the extracellular fluid is the intravascular space and three-fourths is in the interstitial space. Calculations for this patient are: TBW = 48 L (80 x 0.6); Extracellular fluid = 16 L (1/3 x 48); Intravascular space = 4 L (1/4 x 16).
  32. Sorbitol-induced hypokalemia is caused by


    1: inadequate dietary intake.
    2: increased renal potassium loss.
    3: excess potassium loss in the stool.
    4: transcellular shift of potassium from the extracellular fluid into cells.

    3: excess potassium loss in the stool.
  33. Mild hypercalcemia, defined as a total serum calcium of 10.3-12.9 mg/dL, should initially be treated with


    1: sodium phosphate.
    2: hydration.
    3: hemodialysis.
    4: bisphosphonates.
    2: hydration.
  34. The majority of protein absorption takes place in the


    1: small intestine.
    2: stomach.
    3: large intestine.
    4: mouth.

    1: small intestine.
  35. When determining nitrogen balance, urea accounts for what percentage of total urine nitrogen losses?


    1: 50%
    2: 60%
    3: 70%
    4: 80%
    • 4: 80%
  36. When administered in high amounts, arginine is considered therapeutic for


    1: immune function and wound healing.
    2: fuel for rapidly dividing cells.
    3: increasing lean body mass.
    4: improving hepatic steatosis.
    1: immune function and wound healing.
  37. Transformation of free long-chain fatty acids into acylcarnitines requires


    1: carnitine.
    2: choline.
    3: arginine.
    4: glutamine
    1: carnitine.
  38. In which part of the body are essential amino acids oxidized?


    1: Muscle
    2: Kidney
    3: Small intestine
    4: Liver
    • 4: Liver
    • (4) The hepatocyte is the only site for oxidation of essential amino acids. About 57% of the amino acids extracted by the liver are used for protein synthesis and oxidation.
  39. Which of the following is a common effect of enteral fiber on the intestinal tract?


    1: Faster transit throughout
    2: Increased fecal bacteria concentrations
    3: Improvement in constipation
    4: Improvement in diarrhea
    4: Improvement in diarrhea
  40. Which of the following is a possible complication of dietary fiber-containing enteral formulas?


    1: Altered absorption of minerals
    2: Bloating and flatulence
    3: Increased effectiveness of some medications
    4: Fluid retention
    2: Bloating and flatulence
  41. Dietary fiber helps to regulate normal defecation by


    1: increasing stool weight and bulk.
    2: inhibiting the growth of colonic bacteria.
    3: reducing incidence of constipation.
    4: removing water from the colon.
    1: increasing stool weight and bulk.
  42. Which statement is true regarding effects of fiber-supplemented diets on altered bowel elimination?


    1: Soluble fiber intake corrects constipation
    2: Fiber-containing formulas will reduce diarrhea in tube fed patients
    3: Wheat bran increases irritable bowel syndrome (IBS) symptoms of abdominal pain and bloating
    4: High fiber diet increases incidence of involuntary stool leakage
    3: Wheat bran increases irritable bowel syndrome (IBS) symptoms of abdominal pain and bloating
  43. Consumption of soluble fiber contributes to


    1: lower levels of high density lipoprotein cholesterol.
    2: lower levels of total and low density lipoprotein cholesterol.
    3: lower risk of developing colon cancer.
    4: increase in blood glucose concentrations.
    2: lower levels of total and low density lipoprotein cholesterol.
  44. During extended periods of fasting (starvation), the main source of energy is from


    1: protein catabolism.
    2: gluconeogenesis.
    3: glycolysis.
    4: ketogenesis
    4: ketogenesis
  45. Glycogen stores can sustain normal activities in a healthy 70 kg man for approximately


    1: 1 day.
    2: 3 days.
    3: 7 days.
    4: 14 days.
    1: 1 day.
  46. Glucose and galactose gain access to enterocytes via


    1: glucose-dependent insulinotropic polypeptide (GIP).
    2: glucokinase.
    3: enterokinase.
    4: sodium-glucose transporter 1 (SGLT-1)
    • 4: sodium-glucose transporter 1 (SGLT-1)
    • (4) Glucose and galactose are transported from the intestinal lumen into the enterocyte via the sodium-glucose transporter 1 (SGLT-1), an ATP-dependent active transporter. The hormone, glucose-dependent insulinotropic polypeptide (GIP), stimulates insulin secretion from the pancreas. Glucokinase is an enzyme involved in the control of the rate of glycolysis and gluconeogenesis. Enterokinase is an enzyme secreted from the brush border of the small intestine and serves to activate trypsinogen into trypsin.
  47. Which water-soluble vitamins do not require Na+ co-transporters for absorption?


    1: Vitamin C and Vitamin B6
    2: Vitamin E and Vitamin D
    3: Vitamin B12 and Folic acid
    4: B1 and Choline
    3: Vitamin B12 and Folic acid
  48. Loss of parietal cells, secondary to a gastectomy, may lead to a deficiency of


    1: vitamin C.
    2: vitamin B12.
    3: vitamin E.
    4: choline.
    2: vitamin B12.
  49. The presence of which of the following facilitates the absorption of sodium in the lumen of the small intestine?


    1: Glucose
    2: Potassium
    3: 1,25-dihydroxycholecalciferol
    4: Protein
    1: Glucose
  50. Medium-chain trigycerides (MCT) do not require the formation of micelles or bile salts because they are


    1: fat-soluble.
    2: 2-5 carbons in length.
    3: water-soluble.
    4: anti-inflammatory.
    3: water-soluble.
  51. Mucosal atrophy that accompanies bowel rest may result from an absence of


    1: short chain fatty acids.
    2: glutamine.
    3: glucose.
    4: L-cysteine.

    2: glutamine.
  52. An enzyme deficiency seen in African Americans and Native Americans is


    1: lactase.
    2: maltase.
    3: amylase.
    4: sucrase
    1: lactase.
  53. Symptoms of diarrhea, bloating, and flatulence after ingestion of sugar are caused by


    1: hydrolysis of lactose into monosaccharides.
    2: deficiency of brush border oligosaccharidases.
    3: decreased osmotic pressure in the colon.
    4: digestion of starches in the small intestine.

    2: deficiency of brush border oligosaccharidases.
  54. The majority of fat digestion occurs in the


    1: ileum.
    2: mouth.
    3: colon.
    4: duodenum
    4: duodenum.
  55. During fat digestion, bile-activated lipase hydolyzes


    1: phospholipids.
    2: triglycerides.
    3: fat soluble vitamins.
    4: all of the above.
    4: all of the above.
  56. RNA and DNA are hydrolyzed to form mononucleotides during the digestion of

    1:
    nucleic acids.
    2: protein.
    3: fats.
    4: carbohydrate.
    1: nucleic acids.
  57. Which of following is an amino acid that is a primary fuel source for the enterocyte and is also used by the immune system?


    1: Tryptophan
    2: Proline
    3: Arginine
    4: Glutamine
    4: Glutamine
  58. A parenteral nutrition (PN) formulation contains 95 grams of protein. How many grams of nitrogen are in the PN formulation?


    1: 15 grams
    2: 75 grams
    3: 95 grams
    4: 105 grams
    1: 15 grams
  59. The initial protein requirements for a critically ill trauma patient weighing 70 kg are


    1: 55-70 grams.
    2: 70-105 grams.
    3: 105-140 grams.
    4: 140-175 grams
    • 3: 105-140 grams.
    • (3) Because of the increased protein loss that is associated with critical illness, protein needs are elevated. The current recommendation for stressed trauma patients is that 20-25% of toal nutrient intake be provided as protein. This equates to roughly 1.5-2.0 g/kg/day. Exceptions include a recent study, which suggested that intensive care unit patients receiving continuous renal replacement therapy should receive 2.0-2.5 g/kg/day.
  60. The primary fuel source for the brain after a 48 hour fast is


    1: essential fatty acids.
    2: ketone bodies.
    3: carbohydrates.
    4: amino acids.
    2: ketone bodies.
  61. Which protein transports oxygen from the lungs to other parts of the body?


    1: Albumin
    2: Hemoglobin
    3: Lipoprotein
    4: Retinol-binding protein
    2: Hemoglobin
  62. The only two organs in the body that have the necessary enzymes for gluconeogenesis are the liver and the


    1: stomach.
    2: brain.
    3: kidney.
    4: small intestine.
    3: kidney.
  63. The only amino acid that is completely oxidized for energy within the muscle is


    1: glycine.
    2: alamine.
    3: leucine.
    4: valine.
    3: leucine.
  64. The acceptable macronutrient distribution range (AMDR)


    1: is defined as the tolerable upper intake level for a particular energy source.
    2: has been set for Omega 3, Omega 6 and total fat.
    3: helps to provide a guide to assist in the treatment of chronic diseases related to fat intake.
    4: is also known as the Estimated Average Intake (EAR).
    2: has been set for Omega 3, Omega 6 and total fat.
  65. To meet essential fatty acid requirements, commercial enteral formulas employ a variety of oils to provide a high supply of linoleic and α-linolenic acids including


    1: corn, olive, safflower and canola oils.
    2: corn, soybean, safflower and canola oils.
    3: coconut, olive, palm and canola oils.
    4: coconut, soybean, safflower and canola oils.
    2: corn, soybean, safflower and canola oils.
  66. In the United States, intravenous fat emulsions (IVFEs)


    1: contain approximately 10% of total calories as linoleic acid.
    2: contain no α-linolenic acids.
    3: are composed mainly of safflower oil.
    4: are composed mainly of soybean oils and safflower oils.

    4: are composed mainly of soybean oils and safflower oils.
  67. The most predominant clinical changes seen with essential fatty acid disorder (EFAD) include


    1: a dry, scaly rash.
    2: increased susceptibility to infection.
    3: impaired wound healing.
    4: weight gain.
    1: a dry, scaly rash.
  68. The energy for glucose transport is provided by active transport of


    1: potassium into the cell.
    2: potassium out of the cell.
    3: sodium into the cell.
    4: sodium out of the cell.
    4: sodium out of the cell.
  69. A 32-year old female presents to the clinic seeking treatment for a sunburn-like rash. She also reports that she feels very sad and has no energy. Which of the following deficiencies should be considered?


    1: Vitamin A
    2: Vitamin K
    3: Lipid
    4: Protein
    4: Protein
  70. Ursodiol facilitates absorption of


    1: carbohydrate.
    2: protein.
    3: fat.
    4: vitamin K
    3: fat.
  71. A 62-year-old female with chronic renal insufficiency was prescribed sulfamethoxazole/trimethoprim for a urinary tract infection. What electrolyte disorder is likely to occur?


    1: Hypermagnesemia
    2: Hyperkalemia
    3: Hypercalcemia
    4: Hyperphosphatemia
    2: Hyperkalemia
  72. First-line therapy for hyperkalemic emergencies is


    1: albuterol.
    2: furosemide.
    3: sodium polystyrene sulfonate.
    4: calcium gluconate.

    4: calcium gluconate.
  73. AF has had a nasogastric tube in place for 48 hours secondary to a post-operative ileus. Which of the following electrolytes will be affected?


    1: Bicarbonate
    2: Potassium
    3: Calcium
    4: Phosphorus
    2: Potassium
  74. A patient in your intensive care unit has severe diarrhea secondary to clostridium difficile toxin. Which of the following acid-base disorders is likely to occur?


    1: Metabolic acidosis
    2: Metabolic alkalosis
    3: Respiratory acidosis
    4: Respiratory alkalosis
    1: Metabolic acidosis
  75. Metastatic calcification is a complication of


    1: hyperkalemia.
    2: hypokalemia.
    3: hyperphosphatemia.
    4: hypophosphatemia
    • 3: hyperphosphatemia.

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