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An 85 year old nursing home resident was transferred to the hospital with anorexia, malnutrition, and probable aspiration pneumonia. On admission, his WBC was 14K, creatinine 1.3. Which of the following nutrition plans would be most appropriate for this patient?
(A) Start the patient on a regular oral diet with supplements
(B) Establish central access with a PICC line and initiate parenteral feedings
(C) Establish peripheral access and initiate peripheral parenteral nutrition until enteral feedings can be established
(D) Determine the most appropriate enteral feeding route and establish tube feeding
(D) Determine the most appropriate enteral feeding route and establish tube feeding
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Which of the following medications is LEAST likely to cause diarrhea in a tube-fed patient?
(A) Clindamycin
(B) Kayexalate
(C) Codeine
(D) Magnesium oxide
(C) Codeine
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Which of the following is NOT appropriate to tell a family regarding nutrition at the end of life?
(A) Dying patients rarely feel hungry or thirsty
(B) Fewer calories are needed at the end of life
(C) The experience of eating remains unchanged at the end of life
(D) Patients should not be made to feel guilty if they do not wish to eat
(C) The experience of eating remains unchanged at the end of life
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The decision to terminate enteral feeding in a patient in a persistent vegetative state whose wishes have been made known through an advance directive is based on the ethical principle of
(A) justice.
(B) autonomy.
(C) beneficence.
(D) nonmalfeasance.
(B) autonomy.
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Which of the following best reflects the use of specialized nutrition support (SNS) in patients with a Do Not Resuscitate (DNR) status?
(A) The DNR status is a contraindication to the provision of SNS
(B) The DNR status should not preclude the initiation of SNS if the indications exist
(C) The provision of SNS to a patient with a DNR status is based on individual state laws
(D) SNS cannot be withheld or withdrawn in a patient with a DNR order, even if all agree that SNS is no longer meeting the desired goal
- (B) The DNR status should not preclude the initiation of SNS if the indications exist
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Which of the following best describes the use of artificial nutrition and hydration (ANH) in terminally ill patients?
(A) Those who receive ANH have a more comfortable death
(B) Those who have dysphagia survive longer with ANH
(C) Those who receive ANH have a decrease in abnormal electrolytes
(D) Those who receive no ANH survive as long or longer than those who do
(D) Those who receive no ANH survive as long or longer than those who do
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A patient has an advanced directive stating a desire to forego medical technology, including nutrition and hydration, in order to prolong life. The patient is now incompetent and in an irreversible vegetative state. In deciding whether to continue nutrition and hydration by medical means, the patient's surrogate decision-maker must
(A) consult with a lawyer.
(B) have a psychiatric evaluation to be declared competent to make any decisions in the patient's care.
(C) honor the patient's expressed wish to withdraw nutrition and hydration by medical means.
(D) decide, based upon own values, to make a decision to withdraw the patient's nutrition and hydration by medical means.
(C) honor the patient's expressed wish to withdraw nutrition and hydration by medical means.
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In an older adult who requires long term EN, which of the following complications is most often overlooked?
(A) Tube leaking
(B) Tube clogging
(C) Decreased urination
(D) Skin problems at tube site
(C) Decreased urination
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Vitamin D (25, hydroxyvitamin D) deficiency is defined as a serum level of less than
(A) 100 ng/mL.
(B) 20 ng/mL.
(C) 50 ng/mL.
(D) 120 ng/mL.
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Vitamin D (25, hydroxyvitamin D) deficiency can manifest as
(A) Muscle weakness.
(B) Decreased production and excretion of parathyroid hormone (PTH) levels.
(C) Hypotension.
(D) Less than normal serum lipid levels.
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Which of the following complications of EN is the most potentially dangerous in the elderly?
(A) Diarrhea
(B) Abdominal distension
(C) Leaking around the insertion site
(D) Aspiration
(D) Aspiration
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A 75 year old male admitted to the hospital for aspiration pneumonia. He was previously on a feeding devilered via NG tube. Which of the following long-term feeding options would be the most appropriate?
(A) Withdraw support
(B) PEG feeding
(C) PEJ feeding
(D) Parenteral Nutrition (PN)
(C) PEJ feeding
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An elderly patient requires bowel rest for 6 weeks. Which of the following feeding delivery methods should be employed?
(A) PN through a port
(B) PN through a PICC line
(C) Peripheral PN
(D) PN through a short-term central venous catheter
(B) PN through a PICC line
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According to the Administration on Aging, what percentage of older adults in hospitals or nursing homes are malnourished and may be discharged malnourished back into the community?
(A) 10%
(B) 25%
(C) 50%
(D) 90%
(C) 50%
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The Omnibus Budget Reconciliation Act (OBRA) of 1987 provides the total assessment and process for facilities certified to participate in Medicare or Medicaid programs. Which of the following represents the core set of clinical and functional status elements which form the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid?
(A) Minimum Data Set (MDS)
(B) Resident Assessment Protocols (RAP)
(C) Utilization Guidelines
(D) Trigger Legend
- (A) Minimum Data Set (MDS)
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The threshold for initiating PN support in the elderly as compared with a younger adult would be
(A) lower because age-related decreases in muscle mass and organ function render the elderly population with diminished reserves and impaired compensatory mechanisms.
(B) about the same because the patient either has an indication or not.
(C) higher because of the increased risks associated with PN.
(D) significantly higher because PN should generally be avoided in the elderly.
- (A) lower because age-related decreases in muscle mass and organ function render the elderly population with diminished reserves and impaired compensatory mechanisms.
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Which one of the following vitamin deficiencies is most likely to occur in an older adult who consumes alcohol on a regular basis?
(A) Vitamin K
(B) Vitamin A
(C) Vitamin D
(D) Thiamine
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Which of the following medications is most likely to contribute to hyponatremia in an elderly patient?
(A) furosemide
(B) digoxin
(C) omeprazole
(D) ciprofloxacin
(A) furosemide
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An elderly nursing home resident with a history of constipation has a newly placed PEG tube. Which of the following formulas would most likely be the best choice?
(A) Concentrated 2 kcal/mL formula
(B) Standard 1 kcal/mL formula with fiber
(C) High nitrogen formula
(D) Predigested formula
(B) Standard 1 kcal/mL formula with fiber
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An assessment of functional status may aid in determining nutrition risk. Which of the following provides an assessment of functional status?
(A) IQ exam
(B) Handgrip strength assessment
(C) Measurement of fat mass
(D) Visual exam
- (B) Handgrip strength assessment
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In an older adult receiving parenteral nutrition as well as anticoagulation therapy, which of the following vitamin considerations is most important?
(A) Vitamin D should be removed with metabolic bone disease
(B) Vitamin A losses increase with kidney impairment
(C) Vitamin K is a component of multivitamin preparations and intravenous lipid solutions
(D) Vitamin E increases the risk of kidney stones
(C) Vitamin K is a component of multivitamin preparations and intravenous lipid solutions
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Enteral nutrition products supplemented with fiber are often used in the elderly to prevent constipation. Which of the following considerations is most important if this type of formula is chosen?
(A) Addition of a prokinetic agent
(B) Avoidance of lactose
(C) Lowering feeding rate to prevent bloating
(D) Provision of adequate water
(D) Provision of adequate water
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Which of the following is most likely to be observed first if a non-diabetic older patient is overfed?
(A) Hepatobiliary effects
(B) Hyperglycemia
(C) Weight gain
(D) Accumulation of CO2
(B) Hyperglycemia
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Which of the following is most likely to occur as the result of an age-related functional change in the gastrointestinal tract?
(A) Increased anorectal tone
(B) Enhanced IgA responsiveness
(C) Increased calcium absorption
(D) Decreased gastric emptying
(D) Decreased gastric emptying
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The Plan/Do/Study/Act (PDSA) cycle is employed as a
(A) quality improvement problem-solving model.
(B) medical nutrition protocol.
(C) tool for measuring trends in older Americans.
(D) benchmarking tool used to compare institutions
(A) quality improvement problem-solving model.
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Levodopa is often used in the treatment of Parkinson Disease. Which of the following vitamins has been demonstrated to reverse the effects of levodopa?
(A) Vitamin B-6
(B) Vitamin B-12
(C) Vitamin C
(D) Vitamin K
(A) Vitamin B-6
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Which of the following medication classes used in the older population will least likely contribute to anorexia?
(A) Narcotic analgesics
(B) Antihistamines
(C) H-2 receptor antagonists
(D) Antihypertensive agents
(B) Antihistamines
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A patient receiving digoxin and parenteral nutrition who is experiencing signs of digoxin toxicity should be assessed for
(A) hyperkalemia.
(B) hypercalcemia.
(C) hypermagnesemia.
(D) hyperphosphatemia.
(B) hypercalcemia.
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An older adult with poor oral intake over a two month period requires specialized nutrition support. Which of the following electrolyte abnormalities is associated with aggressive refeeding?
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypermagnesemia
(D) Hypophosphatemia
(D) Hypophosphatemia
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In which of the following patient populations is toxicity with fat soluble drugs most likely?
(A) Obese elderly
(B) Sedentary elderly
(C) Malnourished elderly
(D) Physically active elderly
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The Short-Form Mini-Nutritional Assessment (MNA-SF) was derived from the Mini-Nutritional Assessment (MNA) in order to
(A) adapt the MNA for use in pediatric patients.
(B) eliminate the need to obtain height and weight data for nutrition assessment.
(C) allow patients to generate their own nutrition assessment with a questionnaire method.
(D) obtain high diagnostic accuracy for detecting nutritional problems in geriatric patients with a brief screening tool.
(D) obtain high diagnostic accuracy for detecting nutritional problems in geriatric patients with a brief screening tool.
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Which of the following is NOT a component of geriatric nutritional assessment?
(A) Exercise level
(B) Anthropometry
(C) Quality of life
(D) Biochemical markers
(A) Exercise level
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JD is an 85 year old male whose height is 63 inches and who weighs 45kg. His weight 10 years ago was 55kg. His weight loss has been non-volitional and gradual, and he has no major health problems. Which of the following statements most appropriately describe JD's weight loss?
(A) JD demonstrates a decrease in lean body mass known as sarcopenia, which occurs during the aging process.
(B) JD's weight loss is not a normal phenomenon. He should be evaluated for an underlying disease process.
(C) JD demonstrates a decrease in fat mass, which occurs with the aging process.
(D) JD should be placed on a specialized nutrition support regimen to replace the weight he has lost
(A) JD demonstrates a decrease in lean body mass known as sarcopenia, which occurs during the aging process.
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What is the most widely used tool to measure generic health status?
(A) Katz's ADL
(B) Lawton & Brody's IADL
(C) FIM
(D) SF-36
(D) SF-36
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Which of the following is not a common change in the body composition of healthy older adults?
(A) Increased body water
(B) Decreased bone mineral mass
(C) Decreased lean body mass
(D) Redistributed fatty tissue
(A) Increased body water
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Which of the following is evidenced by a gradual wasting of body fat and somatic muscle with preservation of visceral proteins?
(A) Marasmus
(B) Mixed state
(C) Kwashiorkor
(D) Hypoalbuminemia
(A) Marasmus
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Sarcopenia, a loss of lean body mass that occurs with aging, is also associated with
(A) excess growth hormone.
(B) decreased cytokine activity.
(C) decreased bone density.
(D) decreased total body fat.
(C) decreased bone density.
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Which of the following best describes typical changes in body composition with age that contribute to a decrease in energy requirements?
(A) Decreased fat mass and increased lean body mass
(B) Increased fat mass and decreased lean body mass
(C) Increased fat mass and increased lean body mass
(D) Decreased fat mass and decreased lean body mass
(B) Increased fat mass and decreased lean body mass
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When using cyclic parenteral nutrition solutions for nonstressed, nondiabetic patients, age should be taken into account because compared to the middle-aged, the elderly have
(A) lower fat oxidation and lower glucose oxidation.
(B) lower fat oxidation and higher glucose oxidation.
(C) higher fat oxidation and lower glucose oxidation.
(D) higher fat oxidation and higher glucose oxidation.
(C) higher fat oxidation and lower glucose oxidation.
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What is the recommended daily energy intake for patients over 65 who are receiving hemodialysis or peritoneal dialysis?
(A) 25 kcal/kg on nondialysis days and 35 kcal/kg on dialysis days
(B) 30-35 kcal/kg
(C) 35 kcal/kg on nondialysis days and 25 kcal/kg on dialysis days
(D) 40-45 kcal/kg
(B) 30-35 kcal/kg
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A 65 year old female had complications associated with GI surgery, and was admitted to the intensive care unit with pneumonia and septic shock. After she became hemodynamically stable, she was started on parenteral nutrition secondary to a prolonged ileus. Prior to surgery, she was at her ideal weight. Currently her labs include albumin 2.0 mg/dL and creatinine 1.0 mg/dL. Her urine output is adequate. Which of the following best estimates her protein needs for initiation of parenteral nutrition therapy?
(A) 0.6 grams/kg
(B) 0.8 grams/kg
(C) 1.5 grams/kg
(D) 2.5 grams/kg
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In an afebrile person with intact skin, insensible fluid loss is approximately
(A) 10 mL/kg/d.
(B) 20 mL/kg/d.
(C) 30 mL/kg/d.
(D) 40 mL/kg/d.
(A) 10 mL/kg/d.
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An 87-year-old woman underwent a total abdominal colectomy. Her ileostomy output is 1.5-2.0 liters per day. Supplementation of which of the following micronutrients should be considered?
(A) Zinc
(B) Copper
(C) Vitamin E
(D) Chromium
(A) Zinc
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A decrease in food intake in older adults is most likely attributable to
(A) changes in taste and flavor sensations.
(B) delayed satiety.
(C) fear of incontinence.
(D) enhanced olfaction.
(A) changes in taste and flavor sensations.
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If a 68-year-old woman with encephalopathy is receiving a tube feeding due to recent gastrointestinal surgery and develops elevated ammonia levels, which of the following should be tried first?
(A) Decrease in amount of protein given to 0.6 g/kg of body weight
(B) Medium-chain triglyceride added to tube feeding
(C) Formula enriched with branched-chain amino acids
(D) Lactulose and neomycin therapy
(D) Lactulose and neomycin therapy
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An 80 year old, living alone at home, has experienced a weight loss of 15 pounds over a year and a half. The clinician assessing his nutrition status finds that he has inadequate intake. Which of the following risk factors for diminished intake most likely contributed most significantly to his weight loss?
(A) Poor oral health
(B) Mental health issues.
(C) Alcohol use
(D) Functional limitations.
(A) Poor oral health
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