ANATOMY BSC2086C Day 2 Pre-Acute Care Exam GRADED A

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3/17/2020 Pre-Acute Care Exam Pre-Acute Care Exam Page 1/1 2. A 67 year old female was admitted to the hospital with a past medical history significant for ESRD on HD. In this scenario, w... hat does "HD" stand for? Huntington's Disease Hemodialysis Heart Disease High Definition 3. A 81 year old man was admitted with an un-intentional 15 lb weight gain within 1 month. While reviewing his medical chart you noted that the patient has a history of heart failure and has admitted that he has not been taking his diuretic medication as prescribed. What is the BEST explanation for his 15 lb weight gain? He has been consuming more calories than usual He has not been exercising He is experiencing fluid retention due to being noncompliant with his medication He is probably eating foods very high in sodium and requires dietary education 4. Overweight is defined as a BMI of: 19 to 24 25 to 29 27 to 32 31 to 36 5. When preparing a PES statement in situations where there are diagnoses from multiple domains, the dietetics professional should give preference to the diagnosis related to: Intake Physical conditions Knowledge Food safety 6. Which of the following disease states may require a fluid restriction? Liver disease with ascites Chronic renal failure Congestive heart failure All of the above 1/1 point 7. If a person with type 1 diabetes experiences dramatically low blood glucose and becomes unconscious, the most appropriate action would be to give three hard candies and administer insulin give 4 oz fruit juice and administer insulin give 4 oz fruit juice and administer glucagon administer glucagon and call 9-1-1 1/1 point 8. Diagnosis is the second step in the Academy's Nutrition Care Process and Model. Part of the Diagnosis step is to document PES, which stands for which of the following? Problem, Etiology, Signs and Symptoms Plan, Education, Significant Results Proposal, Efficacy, Strategies Policy, Establish, Skills 1/1 point 9. A patient is admitted with increased confusion, liver failure, and a high ammonia level. Which of these medications will likely be utilized in the care of this patient? Metformin Lactulose Furosemide Folic acid 1/1 point 10. A patient with Chronic Kidney Disease is admitted with hyperkalemia. Which of the following foods should you educate the patient to avoid? Spinach, Lima beans, Celery Chicken, Fish, Turkey Bananas, Orange juice, Tomato soup Cantaloupe, Strawberries, Apples 1/1 point 11. A patient is admitted with acute pancreatitis. The physician wants you to provide diet education prior to their discharge home. Which handout would be best to send the patient home with? "National Dysphagia Diet Pureed Nutrition Therapy" "Hypoglycemia (Not Caused By Diabetes) Nutrition Therapy" "Low-Sodium Nutrition Therapy" "Low-Fat Nutrition Therapy" 12. A patient was just admitted with a stroke and is experiencing neurological deficits. From a nutrition-standpoint, what is the first thing you might be concerned about? Has the patient been experiencing any irregular bowel movements? What is the patient's Hemoglobin A1c? Is this patient following a Heart Healthy Diet at home? Is this patient able to chew and swallow properly? Has nursing initiated a bedside swallow evaluation? 1/1 point 13. You are asked to see Mr. Smith due to a positive nursing screen for recent weight loss. Which of the following is the best way to start a conversation with this patient? "Hi Mr. Smith! My Name is _____. I am a dietetic intern here. I noticed your blood sugar has been high recently, what are you eating at home?" "I'm here to see you for weight loss. What's been going on? Why aren't you eating?" "Hi Mr. Smith! My name is _____. I am a dietetic intern here. How are you enjoying the food here? How is your appetite? What is your usual body weight? What have you been eating at home?" "Hi Mr. Smith! I need to perform a nutrition-focused physical exam on you immediately. Can you please sit up in bed?" 1/1 point 14. Which lab values would you be most concerned with when evaluating a patient with end-stage renal disease? Glucose, Chloride, Sodium Phosphorus, Potassium, Calcium Hemoglobin, Hematocrit, White Blood Cell Count Hemoglobin A1c 1/1 point 15. What does ARF stand for? Acute Renal Failure Acute Renal Focus Acute Respiratory Failure Acute Rheumatoid Flare 16. What does VFSS stand for? Video Fluoroscopic Swallow Study Vital Fluenza Scan Study Virtual Focus Sodium Study Video For Students Studying 1/1 point 17. A patient has a below the knee amputation. What percentage of the body does the amputation account for? 16% 5.9% 7% 22% 1/1 point 18. You are calculating an adjusted IBW on a patient who is female, 66" tall, and has a below the knee amputation. What is her adjusted IBW? 130 122 117 127 19. A patient is admitted with a Stage IV pressure injury. Their BMI indicates that they have a normal body weight. Which equation would you use to calculate their estimated calorie needs? 25-30 kcals/kg 35-40 kcals/kg using their IBW 11-14 kcals/kg using their IBW 25-30 kcals/kg using their adjusted body weight 30-40 kcals/kg 20. What is a PEG tube? A small-bore tube inserted through the nose which is used for temporary (usually less than 2 weeks) enteral nutrition. A tube which is inserted directly into the stomach through the abdominal wall which is used to provide long-term nutrition support. A tube inserted through the mouth ending in the stomach. A tube used to drain and prevent fluid accumulation from around a surgical site. 1/1 point 21. Which patient below meets malnutrition criteria? Patient A who has an albumin level of 2.6 g/dL Patient B who has lost 7% body weight in 1 month, has severe fat loss in the orbital region, and severe muscle loss in the clavicle region Patient C who has lost 4% body weight in 1 month, has no signs of muscle or fat loss Patient D who's weight has been stable within the last 10 years, reports a great appetite, but appears thin 22. You are trying to prioritize your patient caseload for the day. Which patient below should you see first? Patient A: Admitted for UTI, Nursing screen reveals no weight loss or loss of appetite. Patient has a stage 1 pressure injury Patient B: Admitted for an asthma exacerbation, nursing screen is negative for weight loss or loss of appetite Patient C: Admitted with a primary diagnosis of Malnutrition/Failure to thrive, nursing screen is positive for both weight loss and loss of appetite Patient D: Admitted for CHF exacerbation with fluid overload. Nursing screen negative for both weight loss and loss of appetite. Per nursing documentation, the patient is eating 100% of his 2 gm Sodium diet 23. Mr. B is a 94 year old patient with dementia who is admitted for a work-up for increased confusion. While reviewing Mr. B's chart you see that he was un-able to provide any meaningful information to the physician during an initial evaluation and that he was combative with staff this morning. You learn that Mr. B is currently residing in a local nursing home and his family has not visited him in many years. You are asked to see Mr.B due to a physician consult for question of malnutrition and poor appetite. Who should you talk to in order to obtain the most accurate information about the patient's weight and eating habits? The nurse who just started her shift and has not worked with Mr. B before Mr. B The staff at Mr. B's nursing home The family 24. You chose to call Mr. B's nursing home to obtain more information. You are able to talk to Mr. B's primary nurse. What are some questions you should ask? How was Mr. B eating at the nursing home? What diet was Mr. B on? What was Mr. B's most recent weight? What was Mr. B's weight a month ago? 6 months ago? Were there any recent bowel irregularities? Any noted chewing or swallowing difficulties? What was Mr. B's most recent albumin level? What was Mr. B's most recent Sodium level? A1c? Have you noticed if Mr. B has had any recent chewing or swallowing difficulties? Then hang up the phone because you're busy and that's all the information you really need. What medications was Mr. B taking at the nursing home? Then proceed to tell the nurse how you think they should discontinue some of his medications because you feel that they are the cause of his increased confusion. 1/1 point 25. You are reviewing a patient's medication list and you see that they are ordered for Lispro three times a day prior to meals. What disease state would you expect to see if you were reviewing their past medical history? Hypertension Heart Disease Type 2 Diabetes Mellitus Congestive Heart Failure 26. You are reviewing labs on one of your patients and notice that they were admitted with an A1c of 10.5%. They are currently eating 100% on a Regular diet. What would be the best nutrition intervention based on the options below? You don't need to see this patient. They are eating 100% and their diet is appropriate. Recommend adding Glucerna to meet their estimated needs. Educate them on a sodium-restricted diet since you noticed their blood pressure was 150/95 this morning Provide verbal education on a Carbohydrate-Controlled diet with handouts and recommend that the physician change their diet to the facility equivalent of a Diabetic diet. 27. You see that a previous dietitian has ordered Ensure "TID" for a patient. In this case, what does TID mean? Three times a day Once a day Four times a day Twice a day 1/1 point 28. Mrs. G has a past medical history of CHF. She has been admitted to the hospital due to shortness of breath and fluid overload. She is started on diuretic therapy. After being in the hospital for a week, you notice that Mrs. G has lost 12 lbs. You interview Mrs. G and the nursing staff and determine that she has been eating well and is meeting her estimated needs. What is likely the reason why Mrs. G has lost 12 lbs? Mrs. G is not eating enough and needs an oral nutrition supplement immediately. Mrs. G likely has some form of aggressive cancer and should have a work-up done immediately. Mrs. G's diuretic therapy is working properly. The 12 lbs was most likely fluid. Mrs. G is probably exercising too much with Physicial Therapy and burning too many calories. 29. You are reviewing a patient's chart and notice that the physician wrote that the patient has "Lung Cancer with mets to the liver" what does this mean? The patient only has cancer in their lungs. The patient has cancer which started in their lungs and has spread to their liver. The patient has cancer which started in their liver and spread to their lungs. The patient's lung and liver cancer was discovered at the same time. 1/1 point 30. A patient was admitted with hypoglycemia. What does this mean? The patient was admitted with a low sodium level The patient was admitted with a low white blood cell count The patient was admitted with a high blood sugar The patient was admitted with a low blood sugar 31. Mr. M is a 70 year old male with a past medical history of COPD. Mr. M has been admitted for hypoxemia and respiratory failure. In this scenario what does hypoxemia mean? Low levels of oxygen in the blood High levels of oxygen in the blood Low blood sugar Low cholesterol 32. What is considered a normal sodium level? 135-145 mEq/L 125-135 mEq/L 145-155 mEq/L 130-140 mEq/L 33. What is considered a normal potassium level? 3-6 mEq/L 2-4 mEq/L 3.5-5 mEq/L >5 mEq/L 34. You are reviewing a patient's chart and you see that the physician wrote that the patient had a "partial gastrectomy". You have never heard the terminology "partial gastrectomy" before. What should you do? Call the physician and ask him what a partial gastrectomy is. Ask the patient. Just ignore it since you're busy and need to see your patient's as soon as possible. Research the terminology via text book or computer and if you cannot find it, or your sources are unclear, then ask you preceptor. 35. You walk into a patient's room and introduce yourself as a dietetic intern. The patient immediately starts yelling at you to leave. What should you do in this situation? Stay in the patient's room and start arguing with them about why you need to talk to them right now. Leave the patient's room, wait five minutes and then walk back into the patient's room since they've probably cooled off by now. Apologize to the patient and leave the room immediately. Gather as much information as you can from the medical chart, nursing staff, family etc. and document in your note that you attempted to see the patient, but they were un-agreeable to the meeting. Discuss this encounter with your preceptor. Document how rude the patient was so that every other clinician knows to stay away. 36. You are going to educate a patient on a carbohydrate-controlled diet to help manage their diabetes. The patient abruptly stops you and states that they don't need to hear your education because they already know what they're doing. What do you do? Tell them that they clearly do not know what they are doing because their A1c is very high. Attempt to give them a handout with the nutrition department's contact information attached. If they don't want the handout then document that the patient was not ready for nutrition education. Ignore what they are saying and continue to try to educate them. Ask the preceptor to do the education for you. 1/1 point 37. A patient tells you that their usual body weight is 140 lbs and that they have likely lost about 10 lbs in the past month. They have not been able to eat due to nausea and vomiting from their chemotherapy treatment. You confirm that they have lost 10 lbs (7% body weight) by cross-referencing the medical chart. Their weight is 130 lbs today. What is the best PES statement for this patient. Inadequate oral intake related to chemotherapy as evidenced by patient reports that they are not eating enough Inadequate oral intake related to nausea and vomiting s/p chemotherapy as evidenced by un-intentional weight loss of 7% weight loss in 1 month Altered GI function related to chemotherapy as evidenced by vomiting No nutrition diagnosis at this time 38. You just spoke with a patient with type 2 diabetes mellitus (HbA1c 10.2%). The medical chart indicates that the patient's spouse states the patient has been non-compliant with his oral medications for a few months. What is the best PES statement to use for this patient? Inadequate oral intake related to poor appetite as evidenced by patient consumed less than 25% of all meals over 4 days while admitted No nutrition diagnosis at this time. Altered nutrition-related lab values related to un-controlled type 2 diabetes mellitus as evidenced by HbA1c 10.2% and non-compliance with oral medications per spouse Food and nutrition knowledge deficit related to type 2 diabetes mellitus as evidenced by HbA1c 10.2% 39. A patient has just had a stroke. The nursing staff reports they have noted that the patient has been repetitively swallowing, clearing his throat and drooling only at times of eating/drinking. They keep him nothing by mouth and consult the speech-language pathologist. What is the best PES statement for this patient? Altered GI function related to swallowing difficulty as evidenced by drooling No nutrition diagnosis at this time Inadequate oral intake related to poor appetite as evidenced by low by mouth intake at meals Swallowing difficulty related to Cerebrovascular Accident (stroke) as evidenced by repetitive swallowing, clearing his throat and drooling while eating/drinking 40. You are asked to educate a patient on hemodialysis. During your education it is apparent that the patient has never spoken to a dietitian before. What is the best PES statement for this scenario? Food/Nutrition related knowledge deficit related to no prior nutrition-related renal diet education as evidenced by questions raised regarding protein serving size and high potassium foods Altered nutrition-related lab values related to end-stage renal disease as evidenced by high potassium level No nutrition diagnosis at this time Inadequate oral intake related to poor quality hospital food as evidenced by patient reports not liking the food 41. You are asked to evaluate a patient that has a stage 3 pressure ulcer. After researching pressure ulcers, you realize that the protein/calorie and vitamin/mineral needs are higher than the normal patient. You recommend a protein supplement, a multi-vitamin with minerals as well as extra zinc and vitamin c. What is the best PES statement for this patient? Increased nutrient needs-protein/vitamin/minerals related to wound healing, maintenance of skin integrity as evidenced by stage 3 pressure ulcer Inadequate oral intake as evidenced by poor wound healing as evidenced by stage 3 pressure ulcer No nutrition diagnosis at this time Altered nutrition-related lab values related to low zinc level as evidenced by stage 3 pressure ulcer 1/1 point 42. Mrs. T was admitted with a congestive heart failure exacerbation. You forgot to look-up her diet before talking to her, but while you were in her room she was complaining that the kitchen would not allow her to order a pastrami sandwich with potato chips for lunch and that they didn't put a salt packet on her breakfast tray. What diet is Mrs. T likely receiving? A Low Residue diet A 2 gm Sodium diet A Puree diet A Hemodialysis Diet 1/1 point 43. What does BUN stand for and what does it measure? Blood urea nitrogen. It measures the amount of urea nitrogen found in your blood and is a good indication of how efficient your kidneys are working. Blood urine nicotine. It measures the amount of nicotine in a patients blood to determine if they have recently smoked a cigarette. Basal urine nitrogen. It measures the amount of nitrogen present in the body at rest. Blood urine niacin. It measures the niacin level in the body. It is an important lab test to help dietitians better diagnose a niacin deficiency 44. Your patient is NPO. What does this mean? Not Providing Oxygen. The patient is not providing enough oxygen to their brain. Nothing by mouth. The patient is un-able to eat likely because they are awaiting a procedure or they are un-safe to eat. No Pulmonary Oxygen. The patient is not getting enough oxygen to their lungs. None of the above. 45. A patient has a dx of CKD 3. They are a normal body weight and their skin is intact. How would you calculate their protein needs? 1 gm/kg body weight 0.6-0.8 gm/kg body weight 1 gm/kg adjusted body 0.6-0.8 gm/kg ideal body weight weight 1.5-2 gm/kg body weight 1/1 point 46. A patient has a diagnosis of CKD stage 3. They also were admitted with a stage IV pressure injury. You are trying to calculate their estimated protein needs, but you are confused. You look in your text book and search journal articles online, but you can not find the answer you are looking for. What do you do? Nothing. Just leave the protein requirements blank. Tell your preceptor you have a question about a patient and determine if it is a good time to discuss. Tell your preceptor you looked in your textbook and in online journal articles and you are still unsure. Call the physician and ask. Calculate a random number and hope for the best. Don't tell your preceptor. 47. Which patient below should be your top priority? Patient A who the physician wants you to educate on a heart healthy diet. You see that Patient A has heart surgery scheduled for tomorrow. Patient B who has head and neck cancer, a PEG tube and has reported 10 lb weight loss in the past month Patient C who has a stage 2 pressure injury Patient D who was admitted with a COPD exacerbation 1/1 point 48. You want to provide a supplement for a patient on a puree honey thickened liquids diet. What is the most appropriate supplement for them? Ensure Plus Glucerna Ensure Pudding Nepro 49. What is hypokalemia? Low phosphorus level Low potassium level High potassium level Low sodium level 1/1 point 50. What is hypernatremia? High potassium level High sodium level High magnesium level Low sodium level 1/1 point 51. Which patient would you recommend starting a Low Fiber diet for? Patient A who was admitted with a heart attack Patient B who has a bowel obstruction Patient C who was admitted with a diverticulitis flare Patient C who has a past medical history of diverticulosis 1/1 point [Show More]

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