RD EXAM #3: CDR Study Guide (10th edition)

RD EXAM #3: CDR Study Guide (10th edition) Which action would be most effective in conserving utility resources? - Correct answer properly using and maintaining equipment" "Which of the following is an example of a secondary prevention program? - Correct answer osteoporosis education classes for postmenopausal women" "After iron-fortified cereal, which of the following foods would be the best to introduce to an infant next? - Correct answer pureed carrots" "The relationship among positions and functions within a food service department are indicated primarily by the: - Correct answer organizational chart" "A dietitian planning a health promotion program for state employees collaborates with other health professionals to assess employee needs. The best way to gain health information from the employee is: - Correct answer health risk appraisal" "A female client with newly diagnosed diabetes is 5'5" and weighs 212 pounds. Exam and laboratory values reveal the following: blood pressure level of 145/95 mm Hg, average fasting blood glucose of 150 mg/dl, average 2-hour postprandial glucose 200 mg/dl, and cholesterol of 250 mg/dl. What is the dietitian's most appropriate first intervention? - Correct answer educate the client about carbohydrate counting" "Individual training of a new employee is sometimes delegated to a more experienced employee. The primary disadvantage of this one-to-one teaching method is that it: - Correct answer results in inconsistent training and may perpetuate poor work habits" "During a nutrition assessment before elective surgery, a client reports regularly taking a multiple vitamin, a mineral supplement, and several natural herbal supplements. The dietitian should: - Correct answer investigate the supplements and discuss supplement use with a physician" "A patient with chronic kidney disease on hemodialysis has the following laboratory test results: BUN, 50 mg/dl, albumin, 2.8 g/dl; and calcium, 8 mg/dl. What recommendation should the dietitian make to improve these laboratory values? - Correct answer increase protein intake" "Using the 5-week, simple moving average method of forecasting and the data below, the dietitian will need how many servings for October 7th? Roast beef special--Number of servings consumed September 5 -- 125 September 12 -- 115 September 19 -- 119 September 26 -- 123 October 2 -- 120 October 10 -- 121 - Correct answer 120" "The statement "to increase diabetes awareness in the community, the dietitian will present diabetes classes six times each year" is which of the following types of objectives? - Correct answer process" "A customer who has eaten lunch in the cafeteria informs the dietitian that she became ill 1 hour after a chicken sandwich. Which of the following responses should be first? - Correct answer listen carefully, take the complain seriously, and conduct an investigation" "Patients who have chronic obstructive pulmonary disease may better tolerate diets in which fat, rather than carbohydrate, is the primary energy source, because oxidation of fat: - Correct answer consumes less oxygen Response Feedback: The Respiratory quotient, or RQ is the ratio of moles of CO2 produced to moles of 02 consumed: RQ = moles C02 produced / moles 02 consumed RQ for carbohydrates is 1, while that for fat and protein are 0.7 and 0.82, respectively. A mixed diet has an RQ of 0.85. Beta-oxidation of one fatty acid molecule produces fewer C02 molecules per 02 molecules used (16:23) as compared to metabolism of one molecule of glucose (6:6). A higher fat diet lowers the RQ and the respiratory burden on the patient. A patient with COPD would benefit from a higher proportion of energy from fat, as his or her overall C02 production would be lower, requiring less respiratory effort to eliminate it." "A primary use of Dietary Reference Intakes is to: - Correct answer plan menus for healthy people" "How many FTE employees would be required to staff ten 8-hour positions that require coverage 7 days a week? - Correct answer 14" "After participating in a program to increase intake of low fat milk, study results showed participants were more likely to choose milk than soda. This is an example of which type of evaluation? - Correct answer summative" "A nurse reports that a tube feeding is causing a patient to have diarrhea The first step the dietitian should take is to: - Correct answer evaluate the client's medications" "What diet is typically recommended for a patient who has undergone a gastrectomy? - Correct answer carbohydrate, protein and fat at each meal, and restriction of fluids with meals" "A dietitan can best evaluate a client's knowledge and ability to apply dietary modifications by asking the client to: - Correct answer select an appropriate dinner meal from a menu" "High doses of which supplement is contraindicated for a client who takes Warfarin? - Correct answer ginkgo biloba" "The most important critical control point to monitor in the preparation and service of canned cream soup is the temperature: - Correct answer during service holding" "Carrots rank in the middle of the glycemic index scale, but the glycemic load of carrots is low. Which of the following explanations for this fact is best? - Correct answer a small amount of absorbable carbohydrate is present in carrots" "An interdisciplinary healthcare team has been formed to improve care for in-patients with diabetes. An appropriate outcome indicator would be: - Correct answer readmission rates for patients with diabetes" "An adolescent's BMI is plotted at the 90th percentile on the Centers for Disease Control and Prevention growth chart. The adolescent is: - Correct answer overweight" "A dietitian suspects that a partially breastfed 1-month-old infant has cow's milk allergy. The dietitian should recommend: - Correct answer breastfeeding supplemented with an extensively hydrolyzed casein-based formula" "A patient has a pre-surgery serum albumin level of 3.7 mg/dl and a post-surgery level of 3.1 mg/dl. The dietitian should recognize that: - Correct answer a decreased serum albumin level is normal after surgery" "According to the Exchange Lists for Meal Planning, the menu below includes how many carbohydrate servings? 3 oz of baked chicken, 1 cup of cooked noodles, 1/2 cup of carrots, lettuce wedge, 1 tbsp of low-calorie dressing, 1/2 cup of sugar-free gelatin, 1 cup of black coffee - Correct answer 3 A carbohydrate is equal to 15 grams of carbohydrate. According to the Exchange Lists for Meal Planning, 1/3 cup of noodles has 15 grams of carbohydrates or 1 carbohydrate serving. Since this meal contains 1 cup of cooked noodles, this meal provides 3 carbohydrate servings. The 1/2 cup of carrots only contains 2 grams of carbohydrates and would not count as a carbohydrate serving. The other items are considered carbohydrate free, while the chicken is a protein and the dressing is a fat." "A 75-year old man is to undergo a partial colectomy for treatment of adenocarcinoma of the colon. He is 167.6 cm tall, and has weighed 65 kg for several years. His diet consists primarily of convenience foods. Nutritional assessment reveals a serum albumin level of 3.5 g/dl and a total lymphocyte count of 2,000/mm^3. The most likely assessment of the nutritional status of this patient is: - Correct answer Adequate nutritional status, increased risk" "Which of the following factors contribute to an acceptable turnover rate? outdated equipment hiring based on referrals excessive span of control hiring based on job descriptions - Correct answer hiring based on job descriptions" "The temperature log for a commercial dish machine indicates the following information: Pre-rinse: 121 degrees F Wash: 145 degrees F Final rinse: 205 degrees F The dietitian should: - Correct answer decrease the temperature of the final rinse cycle" "A client explains to the dietitian, "I realize I am overweight, but this is not the time for me to change my diet."The dietitian should respond by asking: - Correct answer "What are the advantages and disadvantages of focusing on change now?"" "A client who has a seizure disorder takes phenytoin, ginkgo biloba, St. John's wort, saw palmetto, and glucosamine daily. The dietitian should counsel the client to stop taking the: - Correct answer ginkgo biloba" "A dining facility uses loss-leader pricing to increase sales. Therefore, the manager will: - Correct answer lower the price below purchasing price" "A community dietitian wants to investigate how many residents in each of two counties had myocardial infarction (MI) and determine which county has the highest incidence of MI. Which study would be best? - Correct answer correlational study" "Using a No. 8 disher to serve 1/2 gallons of ice cream will yield how many portions? - Correct answer 16" "A client is 5'3" tall and weighs 189 pounds. What is the client's BMI? - Correct answer 32" "A dietitian is counseling parents of a child with attention-deficit/hyperactivity disorder and who is being treated with methylphenidate (Ritalin). The dietitian's interview for this child should be based on an understanding that: - Correct answer anorexia can be an adverse effect that may affect growth" "An infant with a phenylketonuria requires which of the following dietary alterations? - Correct answer low-phenylalanine, high-tyrosine" "Which of the following advantages is the primary benefit of a closed system for tube feedings? - Correct answer decreased risk of bacterial contamination Bacterial contamination is a primary concern with open-system tube feedings; closed-system tube feedings can be used to decrease the risk of microbial infection. No separation occurs with enteral formula like it can with parenteral formulation. Ready-to-feed formulas do not require dilution. When additional water is necessary to meet fluid requirements, it is administered intermittently as flushes throughout the day. Closed systems have a longer hang time of 24 hours versus open systems with a hang time of 8-12 hours." "A background check reveals that an employee failed to disclose an arrest from five years ago for domestic violence on the employment application. The employee explains that the charges were dropped, so it was not necessary to provide the information. The foodservice manager wants to terminate the employee. The nutrition director should: - Correct answer make a decision in consultation with human resources" "An important element of a food specification for purchasing fruits and vegetables is the: - Correct answer market form" "Which of the following nutrition outcome indicators is most appropriate for a patient with the assessment parameters as shown below? BMI: 28 Total cholesterol: 263 mg/dl HDL: 41 mg/dl LDL: 139 mg/dl fasting blood glucose: 129 mg/dl blood pressure level: 136/89 mm Hg - Correct answer weight loss" "The effectiveness of nutrition screening at a senior citizen's center is best measured by: - Correct answer identifying older adults at nutritional risk" ""the patient will list three foods high in calcium" is a statement that represents an: - Correct answer outcome objective" "Which of the following foods is most appropriate as an alternative to dairy products for a vegan? - Correct answer fortified soy milk" "A dietitian is asked to prepare a breakfast promotion for a school nutrition program. What is the most important information the dietitian needs before beginning the campaign? - Correct answer students' attitudes about eating breakfast" "An individual states post Roux-en-Y surgery for weight loss, is craving ice and reports chewing large quantities daily. What condition is likely responsible for this behavior? - Correct answer iron deficiency" "An athlete has recently changes his diet to include a large amount of protein in order to increase muscle mass. Since this change, he reports decreased energy during the day and poor performance at practice. What is the most likely cause of these symptoms/? - Correct answer inadequate CHO intake" "Which of the following menu items would most adversely affect the absoprtion of iron? tea milk club soda orange juice - Correct answer tea" "Standard deviation is a ___ statistic. - Correct answer descriptive Descriptive statistics intend to describe data and summarize the current dataset ( e.g., measures of central tendency - mean, median, mode; measures of spread - standard deviation and standard error of mean). Inferential statistics, intend to draw conclusions about the population, based on the sample (e.g., ANOVA, two-tailed test, chi-square, confidence interval, regression, odds ratio, etc)" "A group of individuals in a weight loss class appear to have a good understanding of what they need to do to lose weight. However, they have difficulty taking the necessary steps. The dietitian's next step should be to: - Correct answer help the participants to set realistic goals" "A gastrojejunostomy is most likely to affect a patient's absorption of: - Correct answer calcium and iron" "Which of the following sanitizers is most quickly inactivated by the presence of organic contaminants? - Correct answer chlorine" "A 72-year-old patient who experienced a cerebrovascular accident demonstrated normal laboratory values when an enteral feeding was initiated five days ago. Current laboratory values are: Serum sodium: 146 mEq/L Serum potassium: 3.9 mEq/L Serum creatinine: 1.2 mEq/L Serum glucose: 132 mEq/L Blood urea nitrogen: 43 mEq/L The appropriate intervention would be to: - Correct answer increase fluid intake" "A dietitian conducting a nutrition analysis of a recipe that uses 10 lb of 80/20 raw ground beef can best ensure analysis accuracy by: - Correct answer using data for the "edible portion" weight of the cooked ground beef" "A morbidly obese, ventilator dependent ICU patient has end-stage renal disease, diabetes and sacral decubiti. The primary concern for recommending a tube feeding regimen should be: - Correct answer adequate calories" "A simple, targeted health-promotion message might ask consumers to eat: - Correct answer five servings of fruits and vegetables daily" "A patient with dry, scaly skin and Bitot's spots has the classical signs of a deficiency in: - Correct answer vitamin A" "Which of the following laboratory values would most likely indicate that dialysis is necessary to maintain homeostasis? - Correct answer serum creatinine 6.0 mg/dl; BUN 50 mg/dl BUN: Cr ratio of 20:1 indicates a "pre-renal" state, in which BUN reabsorption is increased due to acute kidney damage. This condition may be reversible and often does not require dialysis therapy. Options A, B, and C are not correct because they fall into this "pre-renal" category with ratios of 40:1, 30:1 and 25:1. A BUN:Cr ratio of 10:1 suggests reduced BUN reabsorption due to renal damage, and often suggests the need for dialysis therapy. Option D falls into this category, with a ratio of 8.3 (50/6). Many factors contribute to the decision about the best time to start dialysis. Normal range for serum creatinine (which may vary somewhat with the individual laboratory) is 0.6-1.5 mg/dl. Creatinine is increased in renal disease, and in catabolic states, and decreased in very malnourished individuals and those with minimal muscle mass. Normal range for BUN is 6-23 mg/dl. BUN is increased in renal disease, and in cases of excessive protein catabolism, gastro-intestinal bleed, and severe dehydration. It is increased in individuals with liver failure. BUN is affected by intake of dietary protein." "he most accurate method of evaluating an in-service training session is to: - Correct answer measure the performance of employees before and after training" "Skinfold thickness measurements are best for assessing which of the following individuals? - Correct answer a 36-year-old athlete" "The management functions in which performance is measured and corrective action is taken to ensure the accomplishment of an organization goal is known as: - Correct answer controlling (note: corrective-controlling)" "Transferring a staff member who is rumored to have chronic obstructive pulmonary disease violates which of the following acts? - Correct answer Americans with disabilities act" "A study is being conducted to evaluate and compare the effectiveness of two different interventions for reducing serum cholesterol levels. Changes in serum cholesterol levels, nutrition knowledge, and attitudes and behaviors regarding the two interventions will be assessed at the beginning and end of the study. What is the independent variable of this study? - Correct answer type of intervention" "A patient receiving hospice care eats poorly. The patient's spouse is upset by this and attends all meals to encourage the patient. The dietitian's best intervention is to ask the spouse to: - Correct answer bring the patient's favorite foods" "A dietitian is developing a pamphlet about breastfeeding for distribution by public health nurses. The first step is to: - Correct answer determine the needs of the target population" "A nutritional assessment of a man who has HIV disease reveals the laboratory results shown below: Height: 5'10", Weight: 115 lb, Hematocrit: 35%, Mean corpuscular volume: 102: um, BUN: 11 mg/dl, Serum Albumin: 2.8 g/dl, CD4: 280, total lymphocytes: 1200/mm^3 The primary concern of the dietitian should be the: - Correct answer weight" "One month ago, a patient began receiving parenteral nutrition that delivers 2,300 kcal/day. Since then, the patient has experience undesirable weight gain. Which of the following formulations would be appropriate? - Correct answer 1800 ml of 20% dextrose and 5% amino acids plus 250 ml of 20% lipid emulsion The patient in question has experienced undesirable weight gain on the current parenteral nutrition regimen, which is providing 2,300 kcal/day. In order to prevent further weight gain, the dietitian should alter the regimen in order to reduce the total number of kcal the patient is receiving. As outlined in the calculations below, the other options are not correct because each total kcal level is higher than the original 2,300 kcal/day. All of these options would result in increased weight gain for the patient. Only the correct option provides a daily kcal level below 2,300 kcal/day." "A patient with diabetic gastroparesis diet should avoid foods that are: - Correct answer high in fat" "A resident in an extended-care facility is experiencing elevated levels of BUN and serum sodium, poor skin turgor, and decreased urinary output. The most likely cause is: - Correct answer voluntary restriction of fluid intake" "A food service operation has 18 FTEs that produce 7,000 meals in a 40-hour workweek. How many meals per labor hour are being produced? - Correct answer 9.7" "A 70-year-old woman who is ambulatory and has low income is referred to a dietitian. When discussing her 24-dietary recall, the woman states that she doesn't like to eat by herself. The most appropriate referral would be to which of the following programs? - Correct answer Elderly Nutrition Program" "A study finds that people who drink at least two coups of green tea daily have a relative risk of 0.85 of developing heart disease compared to those who do not drink green tea. This finding indicates that, compared to people who do not drink green tea, the people in the study who drink two cups of green tea daily are: - Correct answer 15% less likely to develop heart disease" "An employee becomes loud and disruptive and refuses to comply with the dietitian's request concerning a tray with errors. What should the dietitian do? - Correct answer designate a replacement and remove the employee from the line for further discussions" "The process of comparing a program's advances to net savings is called: - Correct answer cost benefit analysis" "Given the following financial expenses, what would be the direct cost? Cost of goods sold: $6,000 Salary: $5,200 Employee benefits: $1,300 Direct operating: $3,250 Administrative: $500 Depreciation: $565 - Correct answer $14,450" "The best way to evaluate whether clients in a community nutrition education class view the class as informative and necessary would be to: - Correct answer have participants complete a course evaluation" "A client's laboratory tests indicate a glomerular filtration rate of 14 mL/min/1.73m^2, BUN level of 70 mg/dl, serum potassium 5.9 mEq/L, serum phosphorus 9.6 mg/dl. These values are associated with which of the following conditions? - Correct answer end-stage renal disease" "A patient reports decreased oral intake, persistent nausea and vomiting, and decreased functional capacity. To complete a subjective global assessment, the dietitian needs to evaluate: - Correct answer the presence of edema and wasting or dehydration" "When a manager updates the director about activities occurring on the patient trayline, he is demonstrating which of the following managerial roles? - Correct answer interpersonal" "Which is the best way to ensure compliance when a client is counseled about a meal plan for diabetes management? - Correct answer recommend healthy food choices consistent with food preferences" "A dietitian in a small rural community is conducting research to explore barriers to healthy eating. The dietitian will use a focus group. An advantage of using this methodology instead of others for this study is that focus groups: - Correct answer involve more interactions with informants" "A 42-year-old woman who is 5'10" needs how many grams of protein per day? - Correct answer 60" "At birth, an infant was at the 75th percentile for weigh -for-age. At six months, the baby is at the 60th percentile for weight-for-age. The growth chart data most likely indicates: - Correct answer normal growth rate" "A dietitian should consider a client's absorption of which of the following nutrients during peritoneal dialysis before modifying his or her diet? - Correct answer carbohydrate" "A primary benefit to using physical inventory versus perpetual inventory is: - Correct answer less time and supervision are needed" "Standards that specify the amount of pesticide residue allowed on raw and processed foods are established by the: - Correct answer Environmental Protection Agency" "A cook who was injured in a mother vehicle accident is still not able to perform a majority of the job duties after a period of recuperation. To comply with the Americans with Disabilities Act, the manager should: - Correct answer obtain written recommendations from the employee's physician" "A dietitian who wishes to delegate work to a subordinate should first: - Correct answer evaluate employee skills and task difficulty" "The best choice of a food-production system in an area where labor costs for skilled employees are extremely high is: - Correct answer assembly/serve" "Which management function involves the development of policies and procedures? - Correct answer planning" "Which of the following actions most likely will reduce the average food cost percentage? - Correct answer implement forecasting into the production process" "Which of the following actions would reduce direct expenses in a foodservice facility? - Correct answer reduce food costs" "When seeing a client for an initial outpatient appointment, the dietitian should begin the session by: - Correct answer identifying what the client wants to learn" "Which of the following lunch menus would be most appropriate for an 18-month-old infant? - Correct answer beef patty, whole wheat bread, cooked carrots, banana chunks and whole milk Self-feeding skills on an 18-month-old infant include good pincer control. Finger Feedback: foods allow for independent eating. Whole milk is recommended until age 2. Utensils are not well handled at this age and foods that require use of utensils should be avoided for independent eating." "A patient needs a diet for dysphagia. Which of the following foods must be avoided to meet the nectar consistency requirement? - Correct answer flavored gelatin" "A clinical manager has created a marketing strategy for a new pediatric weight-loss program to be competitively priced and held at a local school. Another factor required for a successful marking mix is: - Correct answer advertising to parents" "A 49-year-old overweight woman smokes one pack of cigarettes daily, has a blood pressure level of 140/85 mm Hg, and medical history reveals hypertension and hyperlipidemia. What is the best nutrition intervention for the client? - Correct answer a complex CHO, low saturated fat diet The most effective dietary changes to address both hypertension and hyperlipidemia of those listed are to increase dietary fiber and to reduce saturated fat intake. To increase dietary fiber, a patient should include more high-fiber carbohydrates such as whole grains, and increase their intake of fruits and vegetables. In addition to decreasing saturated fat, additional strategies would include using monounsaturated fats and omega-3 fatty acids. Options B, C and D are not correct because they contain nutrition recommendations that would either be contraindicated (refined carbs) or lacking specific evidence (high protein diet) when looking specifically at an individual with both hypertension and hyperlipidemia." "A client who has diabetes, uses an insulin pump and has a carbohydrate to insulin ration of 16:1. The client plans to eat the following meal: 1 1/3 cups cooked spaghetti noodles 1 cup marinara sauce 1 cup green beans 1 slice Italian bread 1 tsp garlic butter 1/2 cup ice cream What amount of insulin should the client take? - Correct answer 8 units" "Harriett is an 84 yoF resident of the long-term care and rehab facility where you are currently the registered dietitian. She has severe CAD and has been prescribed a 2 gm sodium, low fat diet. She recently has been complaining of lack of taste and her weight has declined 1% in one month. What are your intervention suggestions? - Correct answer liberalize Harriett's diet to regular" "