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  1. Which of the following is the inpatient glycemic target for critically ill patients?


    (A) 80-110 mg/dL
    (B) 140-180 mg/dL
    (C) 180-210 mg/dL
    (D) 210-240 mg/dL
    (B) 140-180 mg/dL
  2. Under conditions of sepsis and stress, which of the following metabolic alterations are most likely to occur?


    (A) Increased glucose production and increased glucose uptake
    (B) Increased glucose production and decreased glucose uptake
    (C) Decreased glucose production and decreased glucose uptake
    (D) Decreased glucose production and increased glucose uptake
    (B) Increased glucose production and decreased glucose uptake
  3. Which of the following immunomodulating nutrients may be harmful in patients with severe sepsis?


    (A) Arginine
    (B) Glutamine
    (C) Nucleic acids
    (D) Omega-3 fatty acids
    (A) Arginine
  4. Which of the following best describes enteral glutamine supplementation in the critically ill?


    (A) Enteral glutamine is preferred over parenteral glutamine
    (B) Supplementation of enteral glutamine to glutamine containing immune-modulating formulations improves morbidity and mortality statistics
    (C) Approximately 20-40 g glutamine/day should be administered to all critically ill patients
    (D) The addition of enteral glutamine to a non-glutamine enteral nutrition regimen has shown to reduce the length of stay in some ICU patients
    (D) The addition of enteral glutamine to a non-glutamine enteral nutrition regimen has shown to reduce the length of stay in some ICU patients
  5. Which of the following are counter-regulatory hormones responsible for the hypercatabolism observed in critically ill trauma patients?


    (A) Glycogen, insulin, norepinephrine
    (B) Glucagon, epinephrine, cortisol
    (C) Glycerol, serotonin, thymoglobulin
    (D) Glycerin, leptin, adenosine

    (B) Glucagon, epinephrine, cortisol
  6. In patients with burns, providing caloric support above energy expenditure has been found to


    (A) decrease mortality.
    (B) improve wound healing.
    (C) decrease fat mass accumulation.
    (D) have no effect on lean body mass preservation.

    (D) have no effect on lean body mass preservation.
  7. In pulmonary insufficiency, excessive calorie administration may cause increased blood pCO2 resulting in


    (A) metabolic acidosis.
    (B) metabolic alkalosis.
    (C) respiratory acidosis.
    (D) respiratory alkalosis.
    • (C) respiratory acidosis.
  8. Which of the following is NOT true of essential fatty acid deficiency (EFAD) in patients with cystic fibrosis?


    (A) Biochemical EFAD may be seen in both pancreatic sufficient and insufficient patients
    (B) Patients with cystic fibrosis should be routinely supplemented with docosahexaenoic acid (DHA) to prevent development of EFAD
    (C) Canola oil is a good source of linoleic and linolenic acids used to enterally treat EFAD
    (D) Those patients with moderate to severe lung disease are at high risk for EFAD

    (B) Patients with cystic fibrosis should be routinely supplemented with docosahexaenoic acid (DHA) to prevent development of EFAD
  9. Which of the following best describes the use of semi-elemental formula without enzyme replacement or the use of standard formula with enzyme replacement in regards to optimal absorption of fat and nitrogen in a pancreatic insufficient patient with cystic fibrosis?


    (A) Both allow for similar absorption
    (B) Neither provides optimal absorption
    (C) Standard formula with enzyme replacement provides optimal absorption
    (D) Semi-elemental formula without enzyme replacement provides optimal absorption
    (A) Both allow for similar absorption
  10. For a patient requiring nutrition support therapy, which of the following may be necessary for a patient with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT)?


    (A) Low potassium
    (B) Increased phosphorus
    (C) Low protein
    (D) Increased fluid
    (D) Increased fluid
  11. What is the glomerular filtration rate (GFR) of a patient with end-stage renal disease?


    (A) >90 mL/min/1.73 m2
    (B) 30-59 mL/min/1.73 m2
    (C) 15-29 mL/min/1.73 m2
    (D) <15 mL/min/1.73 m2
    (D) <15 mL/min/1.73 m2
  12. Increased mortality in maintenance hemodialysis (MHD) patients has been associated with


    (A) low baseline body fat percentage and fat loss.
    (B) elevated albumin and decreased C-reactive protein values.
    (C) increased body mass index.
    (D) decreased serum cholesterol.
    (A) low baseline body fat percentage and fat loss.
  13. Which of the following has NOT been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving enteral nutrition?


    (A) Refeeding syndrome
    (B) Tube feeding syndrome
    (C) Underfeeding
    (D) Overfeeding
    (B) Tube feeding syndrome
  14. What is the recommended dietary protein intake in acutely ill patients receiving continuous renal replacement therapy (CRRT)?


    (A) 0.5-0.8 g/kg per day
    (B) 1.2-1.5 g/kg per day
    (C) 1.5-2 g/kg per day
    (D) 2.5-3 g/kg per day

    (C) 1.5-2 g/kg per day
  15. What are the protein requirements for a patient receiving peritoneal dialysis (PD)?


    (A) 0.6-0.8 grams per kilogram per day
    (B) 1.2-1.3 grams per kilogram per day
    (C) 1.5-1.8 grams per kilogram per day
    (D) 2.0-2.2 grams per kilogram per day
    • (B) 1.2-1.3 grams per kilogram per day
  16. Which of the following is NOT a cause of malnutrition in a patient with liver disease?


    (A) Malabsorption
    (B) Decreased caloric intake
    (C) Abnormal fuel metabolism
    (D) Reduced energy expenditure
    (D) Reduced energy expenditure
  17. Protein-calorie malnutrition is most common in which of the following types of liver disease?


    (A) Viral hepatitis
    (B) Cirrhosis
    (C) Hepatic steatosis
    (D) Nonalcoholic steatohepatitis (NASH)

    (B) Cirrhosis
  18. Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for


    (A) hyperkalemia.
    (B) azotemia.
    (C) hypermagnesium.
    (D) hypoglycemia.
    (B) azotemia.
  19. Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in which type of liver disease?


    (A) Hepatic steatosis
    (B) Well-compensated cirrhosis
    (C) Decompensated cirrhosis
    (D) Fulminant hepatic failure
    (D) Fulminant hepatic failure
  20. In patients with cirrhosis, which of the following should be implemented to avoid starvation during the night?


    (A) Late evening snack
    (B) Tube feeding at night
    (C) Branched-chain amino acids
    (D) Parenteral nutrition at night
    (A) Late evening snack
  21. Which of the following is an important indicator of protein-calorie malnutrition in chronic liver disease?


    (A) Jaundice
    (B) Muscle wasting
    (C) Elevated liver function tests
    (D) Hepatic encephalopathy
    (B) Muscle wasting
  22. In patients with liver disease a low protein restriction may be recommended for patients with which of the following conditions?


    (A) Acute hepatic encephalopathy until cause is diagnosed and eliminated
    (B) Chronic alcoholic liver disease with cirrhosis
    (C) Hepatocellular carcinoma preparing for hepatectomy
    (D) Primary sclerosing cholangitis awaiting transplantation
    (A) Acute hepatic encephalopathy until cause is diagnosed and eliminated
  23. The highest prevalence and severity of weight loss is found in patients with which of the following types of cancer?


    (A) Lung and colon
    (B) Breast and ovarian
    (C) Prostate and testicular
    (D) Pancreatic and gastric
    (D) Pancreatic and gastric
  24. Which of the following best describes the use of megestrol acetate in patients receiving radiation therapy?


    (A) Should only be used in cachectic patients
    (B) Promotes weight loss in patients receiving radiation therapy
    (C) Should not be used in patients receiving radiation therapy
    (D) Is used prophylactically for appetite stimulation and to promote weight gain
    (D) Is used prophylactically for appetite stimulation and to promote weight gain
  25. The nutritional needs of a patient with a bone marrow transplant without acute graft versus host disease are best met with


    (A) 20-25 kcal/kg daily with >= 1.5 g protein per kg body weight.
    (B) 20-25 kcal/kg daily with 80% of total calories from carbohydrate.
    (C) 30-35 kcal/kg daily with >= 1.5 g protein per kg body weight.
    (D) 30-35 kcal/kg daily with 80% of total calories from carbohydrate.

    (C) 30-35 kcal/kg daily with >= 1.5 g protein per kg body weight.
  26. Supplementation with which of the following nutrients is routinely restricted during the early stages following hematopoietic stem cell transplantation?


    (A) Sodium
    (B) Folate
    (C) Iron
    (D) Vitamin B12
    (C) Iron
  27. Which of the following acute changes in serum chemistries would be expected in a patient who is experiencing tumor lysis syndrome?


    (A) Hypercalcemia and hypomagnesemia
    (B) Hyperkalemia and hyperphosphatemia
    (C) Hypernatremia and hypermagnesemia
    (D) Hypoalbuminemia and hyperphosphatemia
    (B) Hyperkalemia and hyperphosphatemia
  28. Which of the following best describes the treatment of diarrhea in inflammatory bowel disease?


    (A) Cholestyramine is effective treatment for steatorrhea
    (B) Patients with diarrhea should be treated with prebiotics
    (C) Antidiarrheal agents can contribute to toxic megacolon
    (D) Pharmacological therapy is withheld until diarrhea exceeds 1 L/day

    (C) Antidiarrheal agents can contribute to toxic megacolon
  29. A patient with Crohn's disease that involves the distal ileum should be closely monitored for malabsorption of


    (A) iron.
    (B) calcium.
    (C) vitamin B12.
    (D) folic acid.
    (C) vitamin B12.
  30. Which of the following is a major contributing factor in the development of metabolic bone disease in patients with inflammatory bowel disease?


    (A) Corticosteroids
    (B) Aluminum toxicity
    (C) Blood transfusions
    (D) Oxalic acid deficiency
    (A) Corticosteroids
  31. In patients with severe acute pancreatitis, the use of enteral nutrition via nasojejunal feeding tube rather than parenteral nutrition is associated with


    (A) an increased incidence of hyperglycemia.
    (B) a lower risk of developing septic complications.
    (C) a greater incidence of negative nitrogen balance.
    (D) a decreased frequency of pancreatic stimulation.
    • (B) a lower risk of developing septic complications.
  32. A patient with chronic heart failure on high-dose furosemide is started on enteral nutrition for an inability to consume adequate oral nutrition. Despite a slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected in the cause of his symptoms?


    (A) Thiamin
    (B) Vitamin B12
    (C) Folate
    (D) Riboflavin
    (A) Thiamin
  33. Gastric hypersecretions following significant small bowel resection (especially the jejunum) can become problematic. Which of the following medications have shown to be the most successful in suppressing gastric hypersecretions?


    (A) Cholestyramine
    (B) Loperamide
    (C) Histamine2 receptor antagonists (H2-blockers)
    (D) Proton pump inhibitors (PPIs)
    (D) Proton pump inhibitors (PPIs)
  34. Which of the following metabolic complications is most likely to occur in patients with short bowel syndrome with small bowel bacterial overgrowth?


    (A) D-lactic acidosis
    (B) D-lactic alkalosis
    (C) Metabolic alkalosis
    (D) Respiratory acidosis
    • (A) D-lactic acidosis
  35. Patients with short bowel syndrome would benefit most from octreotide injections in the presence of


    (A) an intact colon.
    (B) short bowel secondary to mesenteric ischemia.
    (C) short bowel secondary to inflammatory bowel disease.
    (D) refractory diarrhea not controlled with standard antidiarrheal agents.
    (D) refractory diarrhea not controlled with standard antidiarrheal agents.

  36. Which of the following diets should be recommended to patients with a short bowel and part of their colon remaining?



    (A) High fat
    (B) High oxalate
    (C) High simple carbohydrate
    (D) High complex carbohydrate
    (D) High complex carbohydrate
  37. Nephrolithiasis, caused by calcium oxalate stones, can occur in patients with short bowel syndrome (SBS) who


    (A) have no remaining colon.
    (B) do not maintain adequate hydration.
    (C) have no remaining ileum.
    (D) take < 500 mg calcium 2-3 times per day.
    (B) do not maintain adequate hydration.
  38. Which of the following types of fistulas will result in the greatest degree of nutritional loss?


    (A) Distal low output
    (B) Distal high output
    (C) Proximal low output
    (D) Proximal high output
    (D) Proximal high output
  39. Malnourished women with hyperemesis gravidarum who require specialized nutrition support are likely to require supplementation of


    (A) chloride.
    (B) thiamin.
    (C) vitamin E.
    (D) manganese
    (B) thiamin.
  40. (A) Postpyloric placement of feeding tubes requires radiation exposure, which is an unacceptable risk during pregnancy
    (B) Concentrated, hypertonic enteral formulas are indicated to maximize delivery of nutrients needed during pregnancy in a smaller volume
    (C) Successful use has been reported and a trial of enteral nutrition prior to initiation of parenteral nutrition is appropriate
    (D) Prospective, randomized clinical trials have demonstrated the superiority of enteral nutrition over parenteral nutrition in regard to infectious complications and successful delivery of goal protein and calories
    • (C) Successful use has been reported and a trial of enteral nutrition prior to initiation of parenteral nutrition is appropriate
  41. A 14-year-old girl with a 4-month history of intentional weight loss of 10% of her usual weight and a BMI less than the 5th percentile is diagnosed with anorexia nervosa. She is admitted to an eating disorder clinic and states she wants to gain weight but cannot consume the quantities of food she knows she needs. A 24-hour calorie count reveals the patient is consuming 850 kcal of mostly starchy foods and soft drinks. Which of the following is the most appropriate nutrition intervention at this time?


    (A) Peripheral parenteral nutrition
    (B) High calorie diet with a calorie count
    (C) Ad lib diet and nighttime tube feedings
    (D) Ad lib diet with 72 hour calorie count
    (C) Ad lib diet and nighttime tube feedings
  42. Persistent hyperglycemia in patients with type 2 diabetes can result in the development of


    (A) cholestasis.
    (B) lipotoxicity.
    (C) hepatic steatosis.
    (D) macorcytic anemia.
    (B) lipotoxicity.
  43. Human immunodeficiency virus (HIV) associated lipodystrophy syndrome is


    (A) visceral fat loss.
    (B) not observed in patients on highly active antiretroviral therapy (HAART).
    (C) observed in patients with a greater than 7 year history of HIV.
    (D) seen mostly in patients younger than 40 years old.
    (C) observed in patients with a greater than 7 year history of HIV.
  44. What is the most appropriate feeding strategy for a morbidly obese trauma patient receiving mechanical ventilation?


    (A) High protein, hypocaloric feeding
    (B) High protein, hypercaloric feeding
    (C) Low protein, hypocaloric feeding
    (D) Low protein, hypercaloric feeding
    (A) High protein, hypocaloric feeding
  45. Zinc supplementation should be provided to patients with wounds


    (A) of any and all types.
    (B) who are suspected to have a zinc deficiency.
    (C) who are elderly.
    (D) who have below normal zinc levels.
    (B) who are suspected to have a zinc deficiency.
  46. Nutrition support for solid-organ transplant patients receiving cyclosporine may need to be modified due to the presence of


    (A) hyperkalemia.
    (B) hypoglycemia.
    (C) hypermagnesemia.
    (D) hypocholesterolemia.
    (A) hyperkalemia.
  47. A patient with acute renal failure who requires specialized nutrition support would most likely benefit from a solution containing which of the following?


    (A) Essential amino acids only
    (B) Essential amino acids with arginine only
    (C) Essential amino acids and nonessential amino acids
    (D) Essential amino acids and branched-chain amino acids

    • (C) Essential amino acids and nonessential amino acids
  48. A 51-year-old female who is 10 years post gastric bypass surgery for obesity presented with numbness and tingling in her distal lower extremities that had progressively worsened. She was on an oral multivitamin supplement. She was significantly anemic and neutropenic. Her vitamin B12 level was normal as were her serum iron, ferritin, and transferrin levels. What nutritional deficiency is the most likely cause of all of these symptoms?


    (A) Thiamin
    (B) Zinc
    (C) Folate
    (D) Copper
    (D) Copper

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