Nutrition Final Review

Created by mspharmd 

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quiz + midterm

Calcium should be taken in which of the following doses for greatest absorption?

500 mg TWICE daily

Supplements can claim to treat, diagnose, and prevent any medical condition

FALSE!

supplements CANT claim to treat, diagnose, or prevent any medical conditions. they CAN claim to affect structure/function in body and/or advertise ntutrient content

Which of the following resources would be best to use to assess the effectiveness of a Devil's Claw supplement?

Natural Medicines Comprehensive Database

Which of the following is not required to be shown by the manufacturer of a dietary supplement?

Safety & effectiveness

Which of the following vitamins is more likely to cause toxicity?

Vitamin A

Vitamin A= fat soluble. often stored in body while excess water-soluble vitamins are usually excreted in urine; therefore more like to cause toxicity

The human body needs which vitamin in order to absorb calcium?

Vitamin D

Vitamin D promotes calcium absorption in gut & helps maintain adequate serum calcium

Dietary supplements are approved by the FDA prior to marketing

FALSE!

A macronutrient is defined as..

A nutrient required in large amounts by the human body. it provides calories as well as performing other vital function within the body

protein: key in building, maintaining, and repairing body tissues

A product that is USP verified, indicates which of the following?:

It was submitted by the manufacturer to undergo additional testing and has met the stringent criteria set by USP, regarding product safety, potency, and free of harmful contaminants

Deficiency in Vitamin _______ is known as Pellagra

Vitamin B3 (Niacin)

Pellagra is classically described by "the four D's": diarrhea, dermatitis, dementia and death.

Saw Palmetto is commonly used for which indication?

Benign prostatic hyperplasia

BPH = noncancerous enlargement of the prostate gland

Which of the following is a major source of trans fatty acid in the diet?

Baked pastry products


*trans fat is created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid; generally found in commercially baked products and fried foods

Which one of the following risk factors for cardiovascular disease is not accounted for in the framingham risk scoring system?

Family history of heart disease

Listed below are data from four different patients. Which patient has metabolic syndrome?

A patient with hypertension, smoking female with HDL: 35mg/dL, triglyceride: 165mg/dL, fasting glucose 90mg/dL and waist circumference: 39inches

MR is a morbidly obese female with pre-diabetes. A reasonable weight loss goal would be..

Lose 5-10% of her current weight

*5lbs per week is too rapid of a weight loss. just a 5-10% decrease in current weight can reduce risk factors for chronic disease and/or improve chronic conditions like diabetes

Cranberry supplements or juice has been known to moderately interact with which of the following medications?

Warfarin

cranberry can increase INR and risk of bleeding when taken in large doses with warfarin

List 4 modifiable risk factors for cardiovascular disease

cigarette smoking, alcohol intake, physical inactivity, poor diet


others: unhealthy diet, lack of physical activity, smoking, high BP, diabetes, alcohol, high cholesterol, overweight or obesity

Which of the following is the recommended salt intake from the American Heart Association?

Less than 1500mg per day

The American Heart Association recommendation for physical activity is to engage in a minimum of 60 minutes of moderate exercise daily most days of the week

FALSE

*moderate intensity of 30 min/day for most days of the week

Which of the following is true regarding the DASH diet?

Can lower blood pressure by 8 - 14 points


focuses on increasing the number of fruits & vegetables (calcium, potassium, and fiber) and decreasing the amount of salt and saturated fat and decreasing alcohol intake. advocated by JNC 7 guidelines

Vitamin C can claim to treat, diagnose, and prevent any medical condition

FALSE

The DASH diet focuses on increasing the number of fruits and vegetables and decreasing the number of salt and saturated fat

TRUE

Which of the following statements is an appropriate claim a green tea extract supplement can make?

"A green tea extract can aid in management of weight"

JK is a regular at your pharmacy. He has just been started on simvastatin. His current LDL level is 210 mg/dL. What is JK's target goal for LDL cholesterol?

Less than 100mg/dL

Which of the following is the correct statement?

Breast fed infants require iron supplementation at 4 months as iron stores are depleted at 4 months

*formula fed infants do not require supplementation as formula contains iron

Which of the following is correct regarding the TLC diet?

1. One of its main features include daily intake of saturated fat to be less than 7%
2. A dietary plan and nutrition change targeted at lowering LDL cholesterol levels to prevent the development of atherosclerosis


trans fat <1% cholesterol <200mg/day increase soluble fiber (10-25g/day) and plant sterols (2g/day)

Calcium Citrate

To be taken with or without food
*more expensive

Calcium Carbonate

To be taken with food as it requires an acidic environment for best absorption
*inexpensive

Which one of the following is considered a CHD risk equivalent?

Diabetes

*diabetes = CHD risk equivalent (condition that places an individual at high risk for experiencing a cardiac event, such as a heart attack)

The dairy group of "My Plate" provides

protein in the form of casein and whey
*carbohydrates in the form of lactose, and an excellent source of calcium

Cyanocobalamin is also known as which vitamin?

Vitamin B12

What symptoms can occur if an infant is given too much vitamin D?

Muscle weakness, loss of appetite, and abdominal pain. Can cause toxicity due to incorrect dosing.

Which of the following indications is Omega-3 fatty acids thought to be beneficial for?

Decrease inflammation in blood vessels, lower triglyceride levels (high cholesterol), blood thinner, reduce risk of death from heart disease, decrease risk of second MI (decrease arrythmias)

Which of the following is not a water soluble vitamin?

Vitamin K (fat soluble)

Mrs. Rose has been experiencing hot flashes for the past two months, her best friend has been taking a natural product over the counter, which has "cured" her hot flashes. Mrs. Rose cannot remember the name of this product, which of the following products is Mrs. Rose referring to?

Black Cohosh

*shown to be moderately effective in reducing symptoms of hot flashes in menopausal women

Reference Daily Intake (RDI or RDA)

The daily intake level of a nutrient that is considered to be sufficient to meet the requirements of 97-98% of healthy individuals in every demographic in the United States

Saturated fats

known to increase LDL cholesterol

Monounsaturated fats

known to lower LDL cholesterol

Trans fat

daily intake should be >1% according to the TLC diet

Which of the following is Echinacea commonly used for?

common cold

which of the following is a source of dietary vitamin K?

Kale

LDL Cholesterol

<100mg/dl

Triglycerides

<150mg/dl

HDL cholesterol

>60mg/dl

Total cholesterol

<200mg/dl

Vegans are at risk for what type of deficiency?

Animal products (source of iron) and dairy (source of calcium)

Goals of nutrition support therapy:

1. provide energy intake for normal growth and development in neonates
2. provide energy and preserve fat calories in adults
3. provide positive energy balance to malnourished patients and re-plete fat stores

Indications for parenteral nutrition:

Patients with non-functioning GIT (blocked; leakage)
Cancer patients receiving antineoplastic therapy, radiation therapy, or HSCT
Pancreatitis
Critical care patients
Perioperative
Hyperemesis gravidarum
Eating disorders

Macronutrients:

carbohydrates (dextrose), protein (crystalline amino acids), and fats (IV fat emulsion)

Factors contributing to nutrient deficicencies:

Economical, disease states, education, health status

In order to be removed from the market, FDA must prove the product is _________

unsafe



*manufacturers dont need to register product with FDA nor get FDA approval before producing/selling

__________ is the treatment of disease using methods other than recognized/conventional medicine

CAM: Complementary and Alternative Medicine

Cranberry

UTI prevention

Soy

High cholesterol

Garlic

reduce cholesterol, overall heart health
CVD: hyperlipidemia, hypertension, type II diabetes

Ginko

memory improvement
mild-to-moderate vasoactive agent
potential drug-herb interaction with anticoagulants, antiplatelets, and insulin

Milk Thistle

liver disorders such as cirrhosis

St. John's Wort

depression/anxiety

Ginseng

boost immune system/diabetes

Improves abstract thinking, selective memory, and mental arithmetic skills (more effective in conjunction with ginko biloba leaf extract)

Modifiable risk factors for CVD:

high cholesterol
high blood pressure
diabetes
cigarette smoking
overweight/obesity
alcohol use

Non-modifiable risk factors for CVD:

sex
age
family history of CHD
race

Risk factors for metabolic syndrome

abdominal obesity
triglyceride level of >150 mg/dl
HDL <40 mg/dl (men) <50mg/dl (women)
systolic BP >130mmHg
diastolic BP >85 mmHg
fasting glucose >100mg/dl
insulin resistance or glucose intolerance
waist circum is >35 women, >40 men

*>3 risk factors = metabolic syndrome

Coenzyme Q

general heart health, antioxidant
great for CVD

Fish oil supplements

prevention of heart disease, lower triglyceride.


*pick USP verified fish oil. assess label for EPA and DHA content. AMA recommends EPA +DHA = 1000mg (heart health)

In Prader-Willi syndrome, Ghrelin (which controls hunger) is____________, while LEptin (controls satiety) is _____________.

In prader-willi syndrome, ghrelin is HIGH and leptin is LOW

Which organization declared obesity a disease on June 18, 2013 and what is the DSM-IV code for such disease?

AMA (american medical association), 278.00

True or False: High-glycemic foods cause the release of the neurotransmitters: dopamine, serotonin, and endorphins

TRUE

True or False: With some controversy, the CDC has declared obesity as a disease as of June 18, 2013

FALSE; It was the American Medical Association

What factors contribute to weight gain?

A. stress
B. birth control pills
C. Alcohol
D. All of the above

D. All of the above

True or False: The recommended portion size for an average adult is the size of a kid's meal

TRUE

True or False: In 2010, 35.9% of adults 20 years and older were obese in the United States

TRUE

Medical conditions associated with obesity include all of the following EXCEPT:

A. diabetes mellitus
B. Hypothyroidism
C. Hyperthyroidism
D. Hyperlipidemia

C. Hyperthyroidism

What is the active ingredient in alli?

Orlistat

True or False: Alli is the only FDA approved over the counter weight loss aid.

TRUE

Which of the following is the only FDA approved weight loss aid?

a. green tea
b. alli (orlistat)
c. hydroxycut
d. raspberry ketones

alli (orlistat)

True or False: alli needs to be taken with a high fat diet

FALSE

Of the total fats consumed, Alli only removed _____% of the fats absorbed.

25%

What is the generic name for Alli?

Orlistat

What is the recommended fat intake when taking Alli? no more than ________

15g per meal

How does Alli work? What enzyme does it inhibit?

Lipase

Which population has the highest rate of obesity?

African American Women

How much salt is involved in a subway sandwich in the United States?

1200 mg

What is the least obese state in America?

Colorado

What has a higher calorie count at McDonalds?
Southwest Crispy Chicken Salad
McDouble

Southwest Crispy Chicken Salad

Which of the following genes has been found to be related to obesity?

a. BRCA2
b. BDNF
c. CFTR
d. A & C

B. BDNF

True or False: States with more inactive people are less obese

False

According to the US COC, Americans are:

a. more sedentary than in past years
b. snack twice as often between meals as they did two decades ago
c. consume about 200 calories more than they did in the 1970's
d. all of the above

d. All of the above

True or False: 1/4 of US adults are obese

FALSE 1/3 of adults are obese

What is the primary source of carbohydrates from parenteral and enteral nutrition?

Dextrose
*1g of dextrose = 3.4 kcal

What is the primary source of protein from parenteral nutrition?

Crystalline amino acids (CAA)
*1g of protein = 4kcal

What is the major source of calories and essential fatty acids in parenteral nutrition?

from IV fat emulsion (lipids)
*1g of fat = 9kcal
10% IVFE = 1.1 kcal/mL
20% IVFE = 2 kcal/mL
30% IVFE = 3kcal/mL

What is contained in 3-in-1 TPN formulations?

contains dextrose, crystalline amino acids, and IV fat emulsions
*referred to as TNA (total nutrient admixture)
*opaque

What is contained in 2-in-1 TPN formulations?

contains dextrose and crystalline amino acids
*IV fat emulsion administered as a separate bag
*more stable than 3-in-1 formulations

What is/are the advantages of Peripheral Parenteral Nutrition? (PPN)

Lower risk of infection and good for short term use

*disadvantages: lower conc of amino acids, dextrose, and micronutrients required compared to central route
*larger volume required for PT to receive their nutrient requirement due to the lower concentration
*limited use due to poor peripheral vein tolerance to hypertonic solutions

*PREFERRED WHEN: central IV access unavailable
GI tract function expected to return in 10 to 14 days
*NOT PREFERRED: PTs who are fluid restricted, who require large nutrient amounts/concentrations

What is the route of delivery of Enteral Nutrition?

Enteral Nutrition is the delivery of nutrients by tube or by mouth into the GI tract

What is the purpose of enteral nutrition?

purpose of enteral feeding (tube feeding) is to provide calories, micronutrients, and macronutrients to patients who are unable to achieve their nutritional goals on an oral diet

What are the indications for enteral nutrition?

*indicated for patients who cant/wont eat sufficient amount to meet their nutritional requirements
*PATIENTS WITH FUNCTIONING GI TRACT!!!!
*difficulty swallowing
*facial, neck, esophageal, or jaw injuries

*Absolute CONTRAINDICATIONS: mechanical intestinal obstruction, necrotizing enterocolitis

List some of the factors that leads to obesity

Excess calorie intake
Physical inactivity
Environmental factors
Hypothalamic disorder
Endocrine disorder
Genetic disorder

What is the initial guideline for weight-loss for patients with obesity?

Starting weight loss goal of 10% of body weight
*recommended time frame: 6 months
*follow-up assessment and further goals defined

*3500 calories = 1 lb of body fat; to lose 1-2 lbs per week, decrease calorie intake by 500 to 1000 calories/day

What is the ideal duration of physical activity for weight-loss?

duration: 5 to 10 min (initially), 20 to 60 min (2-3 sessions/day or 10 to 30 min each)
frequency: 2 to 4 times per week (first 2 to 8 weeks) then increase to most days of the week (after initial 8 weeks)

Being overweight impairs body's ability to maintain proper ________ levels

glucose

*cause resistance to insulin
treatment: nutrition -> medications -> PHYSICAL ACTIVITY

What is the general recommended amount of carbohydrates per meal for diabetic men and women?

Total 3 meals per day:
Men: 60-75g CHO/meal
Women: 45-60g CHO/meal

snacks (optionals) 0-30 g CHO/snack
SUGAR FREE ≠ CARBOHYDRATE FREE

What are the short term access sites for Enteral Nutrition?

Nasogastric
Orogastric
Nasoduogenal
Nasojejunal
*used for patients requiring EN <4-6 weeks
*not preferred in post-op PTs (delayed gastric emptying)

What are the long-term access sites for enteral nutrition?

Gastrostomy (g-tube) - children &ambulatory adults
Jejunostomy (j-tube) - GERD, high risk for aspiration, unable to tolerate gastric feeding

*for PTs requiring tube feeding longer than 4-6 weeks

What is the most common administration methods for enteral nutrition?

Continuous

*over 8 to 24 hours per day
*better tolerated when initiating feeding
*best method when EN is delivered tot he small intestine

Cyclic administration method for enteral nutrition is usually given __________

Nocturnally

*Pt has enhanced mobility
*rehabilitation

How is clogged tubes prevented?

To prevent clogged tubes, the tube should be flushed with at least 30 mL before and after the administration of any medication

*pediatric: <30 mL
*flushing should occur every 8 hours for pts on continuous cycle
*should not occur before/after intermittent feeding
*clogged tube: flushing with warm water (pancreatic enzymes + sodium bicarb)

Which medications CANNOT be crushed prior to administration of feeding tubes?

enteric coated and extended release

*crushed medications should be mixed with 15 to 30 mL of water prior to administration

Calculate how many calories are present in a TPN containing 300 mL of 20% IVFE, 360g of dextrose, and 150g of protein.

(3002) + (3603.4) +(150*4) = 1826 kcal

A nurse calls the pharmacy and inquires whether she is able to administer her patient's levetiracetam 500 mg PO BID and metoprolol succinate 100 mg PO daily via his NG-tube.

Is he/she able to crush these medications? Why or why not?

Crush levetiracetam but cannot crush metoprolol b/c it is an extended release

*nurse should crush metoprolol tartrate instead of succinate

What general instruction would you give the nurse on administering medication through a NG-tube?

Administer medication with water so that it does not obstruct the tube.

What is the Rule of 15?

Rule for treating hypoglycemia (>70) with 15 g of glucose/carbs
-glucose tabs (3 5g tab or 4g tab)
-glucose gel
-glucose shot
-4 oz fruit juice
-1/3 can of soda
*self monitoring of blood glucose 15 min after treatment
*repeat if necessary

*GLUCAGON-> for indiv at risk of severe hypoglycemia

IBW
Estimated ideal body weight in (kg)

Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.

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