Krause Food Nutrition Care Process 13th Edition Mahan Test Bank

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Krause Food Nutrition Care Process 13th Edition Mahan Test Bank

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Krause Food Nutrition Care Process 13th Edition Mahan Test Bank

Mahan: Krauses Food and the Nutrition Care Process, 13th Edition

 

Test Bank

 

Chapter 2: Energy

 

 

MULTIPLE CHOICE

 

  1. A particular food provides 100 kilocalories. How many kilojoules does this equal?
a. 420
b. 480
c. 4,200
d. 4,800

 

 

ANS:  A

One kilocalorie is equal to 4.184 kilojoules (100 kcal 4.2 kJ/kcal = 420 kJ).

 

REF:   p. 26

 

  1. Which of the following conditions is necessary to obtain an accurate measure of a patients basal metabolic rate (BMR)?
a. Test at the end of the day when the patient is ready to go to sleep.
b. Test 4 to 6 hours after the last meal.
c. Test in the morning after the patient has awakened.
d. Test in environmental conditions equal to body temperature.

 

 

ANS:  C

For an accurate measurement of BMR, the test should be performed when the body is using its minimum amount of energy, usually in the morning after waking, and at least 10 to 12 hours after the last meal so as to not include the thermic effect of food. Climates above 86F increase metabolism because of sweat gland activity.

 

REF:   pp. 24, 26

 

  1. If a patients body temperature were 104.6F, what would the BMR be compared with normal?
a. 58% of normal
b. 135% of normal
c. 142% of normal
d. 178% of normal

 

 

ANS:  C

An increase in body temperature increases the BMR by 7% for every degree Fahrenheit above the normal 98.6F (104.6 98.6 = 6F; 6F 7% F = 42%).

 

REF:   p. 26

 

  1. How does an elevation in body temperature with fever affect the metabolic rate?
a. It does not change the metabolic rate.
b. It increases the metabolic rate by 7% per degree Fahrenheit above normal.
c. It increases the metabolic rate by 14% per degree Fahrenheit above normal.
d. It decreases the metabolic rate by 7% per degree Fahrenheit above normal.

 

 

ANS:  B

A fever causes an increase in body temperature. For every degree Fahrenheit above the normal 98.6F, the BMR increases by 7%.

 

REF:   p. 26

 

  1. Which of the following does NOT increase the thermic effect of food (TEF)?
a. Carbohydrates
b. Fat
c. Regular eating schedule
d. Spicy foods

 

 

ANS:  B

Although dietary fat provides the highest concentration of energy, metabolism of fat is highly efficient, with only 4% of calories wasted. This partly explains the obesigenic aspect of dietary fat. The TEF after intake of carbohydrates and proteins tends to be higher than after fat intake. Following a regular eating schedule results in a higher TEF than irregular eating. The use of spice and mustard increases metabolism more than unspiced meals.

 

REF:   p. 26

 

  1. What is the clinical method for measuring human energy expenditure?
a. Bomb calorimetry
b. Indirect calorimetry
c. Doubly labeled water
d. Direct calorimetry

 

 

ANS:  B

Indirect calorimetry is commonly used in hospital settings. The piece of equipment is known as a metabolic cart or monitor. Other methods of measuring energy expenditure include doubly labeled water and direct calorimetry; however, these are not practical for clinical practice. Bomb calorimetry measures the energy available from food.

 

REF:   pp. 2728

 

  1. When is basal metabolism at its highest rate?
a. During the digestion of a meal
b. During periods of sleep
c. During periods of exercise
d. During periods of rapid growth

 

 

ANS:  D

Because basal metabolism only accounts for the proportion of energy necessary for support of life functions, it does not include energy increase after eating (TEF) or during exercise (AT). During infancy, childhood, adolescence, and pregnancy, basal metabolism increases as FFM increases.

 

REF:   p. 25

 

  1. Which of the following best describes the contribution of physical activity to total energy expenditure?
a. It accounts for 10% of total energy expenditure.
b. Its contribution to total energy expenditure increases with age.
c. Its contribution to total energy expenditure is most consistent during childhood.
d. It is the most variable component of total energy expenditure.

 

 

ANS:  D

Activity thermogenesis is highly variable and dependent on body size and the efficiency of individual habits of motion. Whereas the thermic effect of food tends to be about 10% of TEE, AT can range from 100 kcal/d in sedentary people to 3000 kcal/d in highly active people. AT tends to decrease with age, and it tends to be variable during childhood.

 

REF:   p. 26

 

  1. What does indirect calorimetry measure?
a. The amount of heat produced by the body at rest
b. The energy potential of foods consumed
c. Oxygen consumption and carbon dioxide excretion
d. The resting metabolic rate

 

 

ANS:  C

Indirect calorimetry measures gas exchange that results from metabolism. The oxygen consumption and carbon dioxide excretion can be used to estimate a resting metabolic rate. Direct calorimetry measures heat production, either from humans in a controlled environment, or from food, by incinerating the food and measuring the amount of heat released.

 

REF:   p. 27

 

  1. The respiratory quotient (RQ) is highest after consumption of a diet that is primarily composed of what?
a. Carbohydrate
b. Protein
c. Fat
d. Mixed macronutrients

 

 

ANS:  A

The RQ compares the carbon dioxide produced with the oxygen consumed when energy substrates are metabolized. The RQ for carbohydrate is 1. The RQs for protein, fat, and a mixed diet are, respectively, 0.82, 0.7, and 0.85.

 

REF:   p. 27

 

  1. Studies have shown that which factor(s) is(are) the primary determinant of an individuals resting energy expenditure (RMR)?
a. The amount of lean body mass
b. The amount of adipose tissue
c. A persons age, gender, and health status
d. The individuals body weight

 

 

ANS:  A

The lean body mass, or fat-free mass, accounts for about 80% of the variance in RMR. Although the body weight and composition are affected by a persons age, gender, and health status, the amount of metabolically active tissue that exists within the overall lean body mass contributes to the overall metabolic rate.

 

REF:   p. 24

 

  1. Which of these best describes the change in the metabolic rate during pregnancy?
a. It decreases as a result of a decrease in maternal physical activity.
b. It increases as a result of fetal growth.
c. It increases as a result of fetal growth and maternal cardiac output.
d. It decreases as a result of an increase in maternal adipose tissue.

 

 

ANS:  C

Hormonal changes that occur during pregnancy support the changes in the maternal body to support the growth of the fetus. These changes include the growth of metabolically active tissue in the uterus, placenta, and fetus. Additionally, blood volume is increased, and cardiac workload increases. Because the metabolic rate is dependent on metabolically active tissues, as these increase and the hearts work increases, the overall metabolic rate increases.

 

REF:   pp. 2526

 

  1. A dish has 60 g of carbohydrate, 35 g of protein, and 25 g of fat. How many total kilocalories are in the dish?
a. 480 kcal
b. 555 kcal
c. 605 kcal
d. 655 kcal

 

 

ANS:  C

One gram of carbohydrate provides 4 kcal. One gram of protein provides 4 kcal. One gram of fat provides 9 kcal. Therefore, (60 g carb 4 kcal g carb) + (35 g prot 4 kcal g prot) + (25 g fat 9 kcal g fat) = 240 kcal + 140 kcal + 225 kcal = 605 kcal.

 

REF:   pp. 2930

 

  1. How many kilocalories are in 4 oz of 40-proof schnapps?
a. 28 kcal
b. 64 kcal
c. 128 kcal
d. 240 kcal

 

 

ANS:  C

The kilocalorie equivalent of an alcoholic drink is equal to the volume of drink times the proof 0.8 kcal/proof/fl oz. 4 fl oz 40-proof 0.8 kcal/proof/fl oz = 128 kcal.

 

REF:   pp. 2930

 

 

  1. How is the determination of the physical activity level (PAL) categories beyond sedentary different from the sedentary category?
a. They are based on METs.
b. They are based on the pace of walking.
c. They are based on the total time spent doing physical activity.
d. They are based on types of physical activity.

 

 

ANS:  B

Beyond the sedentary category, the PAL category is determined according to the energy expended by a person walking a set pace of 3 to 4 miles per hour. Low-active, active, and highly active PALs are equivalent to walking 2 miles, 7 miles, and 17 miles per day, respectively, at 3 to 4 mph. Metabolic equivalents (METs) are another means by which to determine energy expenditure during physical activity, but they are not used in the EER estimation. Determination of physical activity energy expenditure using METs does consider the type, or intensity, of physical activity and total time spent doing physical activity.

 

REF:   p. 30

 

  1. In research regarding the measurement of activity-related energy expenditure, what method is used to validate uniaxial and triaxial monitors of human movement?
a. Doubly labeled water
b. Indirect calorimetry
c. Heart rate monitor
d. Physical activity questionnaire

 

 

ANS:  A

As doubly labeled water has become the research method of choice in regard to measurements of total energy expenditure as well as the individual components of energy expenditure, comparisons of other techniques are made to it. Indirect calorimetry can be used for activity energy expenditure but not in free-living situations. The heart rate monitor has not been found to be reliable in measurement of physical activity in individuals. Physical activity questionnaires would be used as a less expensive alternative to movement monitors and are not used for validation of other techniques.

 

REF:   p. 23

 

  1. A respiratory quotient of 0.64 would most likely occur in which of these patients?
a. A pregnant woman
b. A patient with diabetic ketoacidosis
c. A trauma patient in the ICU
d. Someone who had just eaten a high fat meal

 

 

ANS:  B

The respiratory quotient provides information on the time of fuel the body is burning for energy. A mixed fuel meal yields a respiratory quotient of 0.82. Burning fat exclusively is 0.7. Burning ketones results in a respiratory quotient less than or equal to 0.65.

 

REF:   pp. 23

 

 

  1. Only ________has been developed for use in a hospitalized population.
a. Indirect calorimetry
b. The Harris-Benedict equation
c. The Mifflin-St. Jeor equation
d. Doubly labeled water

 

 

ANS:  A

Doubly labeled water is really only used in research settings. Both the Harris-Benedict and Mifflin-St. Jeor energy expenditure equations were developed using healthy individuals. Indirect calorimetry is done using a metabolic cart in clinical situations and is well accepted for REE in hospitalized patients.

 

REF:   pp. 2324

 

Mahan: Krauses Food and the Nutrition Care Process, 13th Edition

 

Test Bank

 

Chapter 16: Nutrition in Pregnancy and Lactation

 

 

MULTIPLE CHOICE

 

  1. Which of these statements is NOT true about colostrum?
a. It is higher in fat than mature milk.
b. It is higher in immunoglobulins than mature milk.
c. It is higher in protein than mature milk.
d. It is lower in lactose than mature milk.

 

 

ANS: A

Colostrum is the thin, yellow, milky fluid that is the first milk available after birth. It is higher in protein and lower in fat and carbohydrates than mature milk. It is also lower in lactose and higher in immunoglobulins than mature milk.

 

REF:  p. 368

 

  1. According to the National Academy of Sciences, women with normal preconception weight should gain how much during pregnancy?
a. 10 to 15 pounds
b. 20 to 25 pounds
c. 25 to 35 pounds
d. 35 to 45 pounds

 

 

ANS: C

Women with BMIs between 18.5 and 24.9 before conception are considered to be of normal weight and are advised to gain between 25 and 35 pounds during the course of the pregnancy. Underweight women who start their pregnancies with a BMI under 18.5 are advised to gain 28 to 40 pounds. Women with a pre-pregnancy BMI of 25 to 29.9 are advised to gain 15 to 25 pounds. No standard is established for women who are obese. Women giving birth to twins should gain from 40 to 45 pounds during pregnancy.

 

REF:  p. 351

 

  1. Which of the following will result from the normal physiologic adaptation during pregnancy?
a. Decreased serum hemoglobin
b. Proteinuria
c. Hypoglycemia
d. Constipation

 

 

ANS: A

As the blood volume expands by 50% during pregnancy, this results in a dilution of blood constituents, such as serum hemoglobin, albumin, and other blood proteins. This also promotes an increase in glomerular filtration rate; however, the kidneys do not increase the volume of urine excretion. Proteinuria occurs when damage occurs to the basement membrane of the glomerulus. Some glucosuria may occur because of decreased efficiency in renal tubule reabsorption during pregnancy but not to the level of promoting hypoglycemia. Constipation is more likely to occur when inadequate water is taken in by the pregnant woman.

 

REF:  p. 342

 

  1. How can the risk of neural tube defects occurring in utero be reduced?
a. Increasing folic acid intake throughout the childbearing years
b. Ensuring adequate niacin intake during the first 6 weeks of pregnancy
c. Providing an adequate protein intake throughout the pregnancy
d. Increasing vitamin C during the first trimester

 

 

ANS: A

The Medical Research Council Vitamin Study in the early 1990s was stopped early because the results overwhelming supported the reduction of risk of neural tube defects with folic acid supplementation. Niacin needs during pregnancy coincide with the increased energy needs during pregnancy. Sufficient protein during pregnancy allows for the growth of tissues in both the mother and the fetus. Vitamin C may be beneficial in reducing the chance of developing preeclampsia.

 

REF:  p. 352

 

  1. What is the most appropriate recommendation to make when counseling a newly pregnant patient about alcohol consumption?
a. Avoid alcohol for the first trimester; then no more than 1 oz of alcohol per day.
b. Avoid alcohol completely throughout the entire pregnancy.
c. Limit consumption to 1 oz of alcohol per day.
d. Limit consumption to 2 oz of alcohol per day.

 

 

ANS: B

The American College of Obstetricians and Gynecologists and the March of Dimes both recommend no alcohol through the entire pregnancy. Fetal alcohol syndrome results from fetal exposure to alcohol. This could be attributable to alcohols effects on cell differentiation, dietary deficiencies associated with alcohol use, and alterations in metabolism.

 

REF:  p. 361

 

  1. For managing leg cramps in pregnancy, which of the following minerals has the most scientific support for its use?
a. Manganese
b. Potassium
c. Calcium
d. Magnesium

 

 

ANS: D

Magnesium lactate or citrate supplementation is suggested to relieve potential magnesium deficiencies that may occur with pregnancy and lactation. Leg cramps are one sign of this deficiency. Calcium has also been investigated; however, supplementation to treat leg cramps has not been demonstrated. Manganese and potassium have not been investigated in this regard.

 

REF:  p. 364

 

  1. How do the dietary recommendations for breastfeeding mothers differ from those fore pregnant women?
a. Intake of all nutrients is the same as preconception intake for lactating women.
b. The intake level during lactation should be severely restricted to promote weight loss.
c. Fluids are forced for pregnant women and limited during lactation.
d. Intake of almost all nutrients is needed at higher levels during lactation.

 

 

ANS: D

Although nutrient needs are increased during both pregnancy and lactation above those of women before conception, lactation needs are greater when women must produce breast milk, the sole source of food for the infant. Women expend 85 kcal for every 100 mL of milk they produce, and the nutritional profile of the milk reflects their nutritional status. Therefore, for the assured health of the infant, breastfeeding mothers have to continue to maintain and replete their nutritional stores.

 

REF:  pp. 366, 367

 

  1. The recommended energy intake in the second and third trimesters is the sum of the energy requirement for a non-pregnant woman and a daily addition of about _____ kcal in the second and _____ kcal in the third trimesters, respectively.
a. 100, 160
b. 250, 350
c. 350, 460
d. 400, 550

 

 

ANS: C

The DRIs for energy needs for pregnancy add 340 to 360 kcal/day during the second trimester and another 112 kcal/day during the third trimester. These increases accommodate not only the growth of both the mother and fetus during the pregnancy but also an increase in the mothers metabolic rate.

 

REF:  p. 356

 

  1. What advice should be given to a pregnant woman about eating fish?
a. They should eat only vegetable sources of omega-3 fat.
b. There is no specific recommendations about fish.
c. They should eat two or three servings of fish per week.
d. They should eat two or three servings of low-mercury fish per week.

 

 

ANS: D

There are specific recommendations for DHA intake during pregnancy. The main food source is fatty, cold-water fish but many of these sources have high levels of mercury. It is recommended that pregnant women eat two or three servings per week of low-mercury fish such as sardines. Vegetable sources of omega-3 fat are not as efficient sources as fish.

 

REF:  p. 357

 

  1. A woman has a BMI indicating overweight before pregnancy. Which of the following guidelines for weight gain during pregnancy is recommended?
a. Weight gain is contraindicated during this pregnancy.
b. Guidelines for weight gain for overweight women are not currently established.
c. Weight gain should be controlled to 15 to 25 pounds.
d. It is not necessary to control weight gain during pregnancy.

 

 

ANS: C

An overweight BMI is defined as 25 to 29.9. Women with BMIs in this range before pregnancy should promote a weight gain of 15 to 25 pounds. Overweight and obese women who are attempting to become pregnant should not promote any weight loss during the pregnancy.

 

REF:  p. 351

 

  1. According to the RDA, how much additional protein above that of a nonpregnant woman should a pregnant woman consume during the second half of her pregnancy?
a. 10 g
b. 15 g
c. 25 g
d. 35 g

 

 

ANS: C

During the first half of pregnancy, the protein requirement is the same as that of a nonpregnant woman; however, during the second half, the requirement increases from an average of 46 g for nonpregnant women to 71 g for pregnant women. This reflects a change of 25 g more per day to promote the protein deposition necessary for both the mother and the fetus.

 

REF:  p. 356

 

  1. What recommendation about sodium should be given for pregnant women?
a. Aggressive restriction is warranted.
b. Sodium intake should be above 2 to 3 g/day.
c. Sodium intake should not exceed 1 g/day.
d. Sodium intake should not exceed 2 g/day.

 

 

ANS: B

Pregnancy does not place any additional demands in regard to sodium restriction. Excessive sodium restriction runs the risk of promoting water intoxication, renal and adrenal necrosis, and neonatal hyponatremia.

 

REF:  p. 360

 

  1. What should a pregnant woman do to relieve nausea and vomiting during the early months of her pregnancy?
a. Drink liquids with meals and have small, frequent feedings.
b. Eat high-fat foods and include liquids with meals.
c. Eat small, frequent meals low in fat.
d. Eat three regular meals per day.

 

 

ANS: C

Eating small, frequent dry meals of either carbohydrate or protein seem to reduce nausea in pregnant women. Although suggestions for taking liquids between meals have been historically advised, no research has validated the suggestion. Meals high in fat tend to stay in the stomach longer, more likely promoting nausea and vomiting. The best recommendation is to eat whatever does not promote nausea and avoid odors that trigger nausea in the individual.

 

REF:  p. 364

 

  1. What are the signs and symptoms of pregnancy-induced hypertension?
a. Hypertension, proteinuria, and edema
b. Hypotension, hyperalbuminemia, and excessive urine output
c. Abdominal cramping and weight loss
d. Weight loss, edema, and hypertension

 

 

ANS: A

Pregnancy-induced hypertension is evident when a pregnant woman has a blood pressure greater than 140/90 mm Hg, protein spilling into the urine, and subsequent edema. The edema results from the increased blood pressure and protein loss. Weight loss is not common; however, impairment of uterine blood flow can result in reduced placental size and fetal intrauterine growth restriction.

 

REF:  p. 365

 

  1. For the first 6 months of lactation, what is the recommended energy intake?
a. 200 kcal less than the amount for pregnant women
b. 330 kcal more than the amount for nonpregnant women
c. 550 kcal more than the amount for pregnant women
d. The same as the amount for the third trimester pregnant women

 

 

ANS: B

During the first six 6 of lactation, breastfeeding women need 330 kcal more than nonpregnant women to promote adequate milk production. This is equal to the kilocalorie needs of a pregnant woman during her second trimester.

 

REF:  p. 367

 

  1. Which hormone promotes letdown?
a. Colostrum
b. Progesterone
c. Oxytocin
d. Prolactin

 

 

ANS: C

Oxytocin stimulates the myoepithelial cells of the mammary gland to contract, causing milk to move toward the nipple for feeding. Progesterone promotes the development of the mammary glands during pregnancy. Prolactin promotes milk production. Colostrum is the first milk that a woman produces around term.

 

REF:  p. 366

 

  1. What nutrient does the American Academy of Pediatricians (AAP) recommend to be supplemented at 2 months of age for breastfed infants, although the DRI for the nutrient in lactating women is at the same level as that in nonpregnant women?
a. Vitamin A
b. Calcium
c. Zinc
d. Vitamin D

 

 

ANS: D

Because of reports of clinical rickets, the AAP recommends an additional 5 mcg of vitamin D daily for infants, starting at 2 months of age. The vitamin A status of the breastfeeding mother may affect the infant, but the DRIs have an increased value for vitamin A intake of lactating women. The DRIs for zinc are also increased for lactation. The calcium content of breast milk is not related to the calcium intake of women, so the DRIs for calcium do not increase during lactation.

 

REF:  p. 367

 

  1. Which of the following can promote failure to thrive in a breastfed infant as a result of poor milk production?
a. Poor latching or suck during the feeding episode
b. Small for gestational age infant
c. Maternal smoking
d. Maternal illness

 

 

ANS: D

Illness in a breastfeeding mother diverts energy stores away from adequate milk production. Smoking is a factor that can interfere with the letdown reflex, impairing milk flow. Failure to thrive because of poor intake is commonly associated with improper breastfeeding technique and poor suck on the part of the infant. An infant who is small for gestational age may develop failure to thrive because of his or her increased energy needs but limited size to handle increased food intake.

 

REF:  p. 369

 

  1. Milk production is most affected by
a. calories consumed by the mother.
b. mothers hydration status.
c. the frequency of suckling.
d. protein consumed by the mother.

 

 

ANS: C

Although the diet of the mother does affect the milk composition, the frequency of suckling has the biggest effect on milk production.

 

REF:  pp. 366367

 

  1. Which of the following is NOT an indication of adequate infant growth from breastfeeding?
a. Infant feeds from both breasts during a feeding.
b. Infant has at least six to eight wet diapers per day.
c. Infant has frequent stools.
d. Infant continues to gain weight and length steadily.

 

 

ANS: A

When an infant feeds from both breasts during a feeding, it is an indication of the volume of milk the mother is producing between feedings. Usual signs for adequate infant growth dependent on the weight and length gain and the wet diaper and stool frequency.

 

REF:  pp. 368369

Mahan: Krauses Food and the Nutrition Care Process, 13th Edition

 

Test Bank

 

Chapter 32: Medical Nutrition Therapy for Thyroid and Related Disorders

 

 

MULTIPLE CHOICE

 

  1. Iodine deficiency is often a culprit in thyroid disorders. However, in which of these thyroid conditions may supplementing with iodine exacerbate the condition?
a. Adrenal fatigue
b. Hashimotos thyroiditis
c. Polycystic ovary syndrome (PCOS)
d. Graves disease

 

 

ANS: B

In autoimmune Hashimotos thyroiditis, supplementing with iodine may exacerbate the condition. Because iodine stimulates production of TPO, this in turn increases the levels of TPO antibodies (TPO Abs) dramatically, indicating an autoimmune flare-up. Some people develop symptoms of an overactive thyroid, but others have no symptoms despite tests showing an elevated level of TPO Abs. Therefore, one must be cautious regarding the use of iodine. Furthermore, although iodine deficiency is the most common cause of hypothyroidism for most of the worlds population, in the United States and other westernized countries, Hashimotos thyroiditis accounts for the majority of cases.

 

REF:  p. 716

 

  1. Selenium deficiency, inadequate protein, excess carbohydrates, chronic illness, and stress (high cortisol levels) can all impact what thyroid metabolic process?
a. Thyroid-stimulating hormone (TSH) production
b. Organification of iodide
c. Thyroid-binding globulin (TBG) T4 transport
d. 5-deiodinase conversion of T4 to T3

 

 

ANS: D

Changes in 5-deiodination occur in a number of situations, such as stress, poor nutrition, illness, selenium deficiency, and drug therapy. Toxic metals such as cadmium, mercury, and lead have been associated with impaired hepatic 5-deiodination in animal models. Free radicals are also involved in inhibition of 5-deiodinase activity.

 

REF:  pp. 711712, Box 32-1

 

  1. Low energy, cold hands and feet, fatigue, hypercholesterolemia, muscle pain, depression, and a positive test result for thyroid peroxidase antibodies could all be indicative of what condition?
a. Diabetes mellitus
b. Graves disease
c. Hashimotos thyroiditis
d. Polycystic ovary syndrome (PCOS)

 

 

ANS: C

Hashimotos thyroiditis is an autoimmune disorder in which the immune system attacks and destroys the thyroid gland. It is the most common form of hypothyroidism. The TPO Abs test is the most important because TPO is the enzyme responsible for the production of thyroid hormones and the most frequent target of attack in Hashimotos thyroiditis.

 

REF:  p. 712

 

  1. Some plant foods (cauliflower, broccoli, cabbage) exert antithyroid activity through what mechanism?
a. Binding iodine species
b. Inhibiting thyroid peroxidase
c. Increasing thyroglobulin antibodies
d. Simulating cortisol

 

 

ANS: B

Cyanogenic plant foods (cauliflower, broccoli, cabbage, Brussels sprouts, mustard seed, turnip, radish, bamboo shoot, and cassava) exert antithyroid activity through inhibition of TPO. The hydrolysis of some glucosinolates found in cruciferous vegetables (e.g., progoitrin) may yield goitrin, a compound known to interfere with thyroid hormone synthesis.

 

REF:  p. 716

 

  1. Before 1960, reports surfaced that soy formulafed infants were developing hypothyroidism. The addition of what supplement to these formulas ameliorated this problem?
a. Iodine
b. Selenium
c. Iron
d. Tyrosine

 

 

ANS: A

Soybean, an important source of protein in many developing countries, has goitrogenic properties when iodine intake is limited. The isoflavones genistein and daidzein inhibit the activity of TPO and can lower thyroid hormone synthesis. Furthermore, soybean interrupts the enterohepatic cycle of thyroid hormone metabolism. Since the addition of iodine to soy-based formulas in the 1960s, there have been no further reports of hypothyroidism developing in soy formulafed infants.

 

REF:  p. 716

 

  1. Graves disease is an autoimmune disease in which the thyroid is diffusely enlarged (goiter) and overactive, producing an excessive amount of thyroid hormones. It is the most common cause of hyperthyroidism (overactive thyroid) in the United States. What is the primary target of circulating autoantibodies in this disease?
a. Insulin receptors
b. Thyroid-stimulating hormone (TSH) receptors
c. Thyrotropin-releasing hormone (TRH) receptors
d. Cortisol receptors

 

 

ANS: C

In Graves disease, the TRH receptor itself is the primary autoantigen and is responsible for the manifestation of hyperthyroidism. The thyroid gland is under continuous stimulation by circulating autoantibodies against the TRH receptor, and pituitary TSH secretion is suppressed because of the increased production of thyroid hormones. These thyroid-stimulating antibodies cause release of thyroid hormone and Tg and stimulate iodine uptake, protein synthesis, and thyroid gland growth.

 

REF:  p. 718

 

  1. Dietary intervention is a key therapeutic tool in managing patients with thyroid disease. In the absence of nutritional deficiencies, what is the main goal of nutritional support?
a. Maintaining vitamin sufficiency
b. Decreasing oxidative stress
c. Increasing iodine concentrations
d. Reducing antithyroidal antibodies

 

 

ANS: D

A variety of food antigens could induce antibodies that cross-react with the thyroid gland. A food elimination diet using gluten-free grains and possible elimination of casein, the predominant milk protein, might be considered for patients with hypothyroidism of unexplained origin.

 

REF:  p. 719

 

  1. Maintaining thyroid hormone function throughout the aging process appears to be an important hallmark of healthy aging. What characteristic is an indicator of thyroid health in centenarians?
a. Decreased free T4 and rT3 levels
b. An increased libido
c. Constant cortisol production
d. The absence of circulating thyroid autoantibodies

 

 

ANS: D

Because unhealthy aging is associated with a progressively increasing prevalence of organ-specific and nonorgan-specific autoantibodies, the absence of these antibodies may represent a significantly reduced risk for cardiovascular disease and other chronic age-related disorders.

 

REF:  p. 715

 

  1. A rare primary adrenal insufficiency in which insufficient levels of steroid hormones are produced despite adequate levels of the hormone ACTH is known as:
a. adrenal fatigue.
b. Addisons disease.
c. Cushings syndrome.
d. euthyroid sick syndrome.

 

 

ANS: B

Addisons Disease is primary adrenal insufficiency and insufficient levels of steroid hormones are produced despite adequate levels of ACTH. In Cushings Syndrome too much cortisol remains in the bloodstream over a long period of time. Adrenal fatigue is a syndrome caused by the decreased ability of the adrenal glands to respond to stress and is almost always secondary to something else. Euthyroid sick syndrome is hypothyroidism associated with a severe systemic illness.

 

REF:  p. 715, 721-723

 

  1. Which of these is NOT a product of the thyroid?
a. Thyroxine (T4)
b. Calcitonin
c. Reverse T3 (rT3)
d. Triiodothyronine (T3)

 

 

ANS: C

Reverse T3 (rT3) is derived from thyroxine (T4) through the action of deiodinase. It is an isomer of triiodothyronine (T3) but is not itself produced by the thyroid.

 

REF:  p. 710

 

  1. A severe systemic illness that causes decreased peripheral conversion of T4 to T3, an increased conversion of T3 to the inactive rT3, and decreased binding of thyroid hormones is known as:
a. Hashimotos thyroiditis.
b. Graves disease.
c. euthyroid sick syndrome.
d. Addisons disease.

 

 

ANS: C

Euthyroid sick syndrome is hypothyroidism associated with protein-calorie malnutrition, surgical trauma, myocardial infarction, chronic renal failure, diabetic ketoacidosis, anorexia nervosa, cirrhosis, thermal injury, or sepsis. After the underlying cause is treated, the condition is usually resolved.

 

REF:  p. 713

 

  1. Characteristics of chronic adrenal stress do NOT include:
a. increased thyroid-binding protein activity.
b. decreased conversion of T4 to active forms of T3.
c. weakened immune barriers of the digestive tract, lungs, and brain.
d. increased sensitivity to thyroid hormones.

 

 

ANS: D

Chronic adrenal stress results in decreased sensitivity to thyroid hormones.

 

REF:  p. 714

 

  1. Polycystic ovary syndrome (PCOS) is characterized by which of the following biochemical and endocrine abnormalities?
a. Elevated testosterone, insulin resistance, and impaired glucose tolerance
b. Thyrotoxicosis, iodine deficiency, and elevated estrogen
c. Impaired glucose tolerance, increased T4 conversion, and hypertension
d. Low blood calcium, thyroid receptor hypersensitivity, and elevated cortisol

 

 

ANS: A

Biochemical and endocrine abnormalities in women with PCOS include elevated levels of androgens (dehydroepiandrosterone, testosterone, and androstenedione), hyperinsulinemia (which results from insulin resistance), impaired glucose tolerance, and hyperlipidemia. Hyperandrogenism is responsible for many of the symptoms of PCOS, such as reproductive and menstrual abnormalities, hirsutism, and acne.

 

REF:  p. 717

 

  1. Botanical preparations have been found in animal studies to influence thyroid activity. Commiphora mukul (guggulsterones from guggul extract) has strong thyroid stimulatory action, demonstrated by:
a. increasing cortisol production.
b. decreasing iodine uptake by the thyroid.
c. increasing TPO activity.
d. decreasing serum T4 concentrations.

 

 

ANS: C

Administration of 1 mg of Commiphora mukul/100 g body weight increases iodine uptake by the thyroid, increases TPO activity, and decreases lipid peroxidation, suggesting that increased peripheral generation of T3 might be mediated by this plants antioxidant effects.

 

REF:  p. 720

 

  1. Although some T3 is produced in the thyroid, approximately 80% to 85% is generated outside the thyroid in which organs?
a. Nervous system and adrenal glands
b. Liver and kidneys
c. Pancreas and gastrointestinal tract
d. Hypothalamus and pituitary gland

 

 

ANS: B

T3 is primarily produced by conversion of T4 in the liver and kidneys. The pituitary and nervous system are capable of converting T4 to T3, so they are not reliant on T3 produced in the liver or kidney.

 

REF:  p. 710

 

  1. Thyroid health has been shown to be impacted by the elimination of which foods?
a. Seafood
b. Gluten
c. Mushrooms
d. Barley

 

 

ANS: B

A variety of food antigens could induce antibodies that cross react with the thyroid gland. Eliminating gluten-containing grains has been suggested for treatment of hypothyroidism of unknown origin. Selenium has been shown to enhance thyroid function; mushrooms, barley and seafood are good sources of selenium.

 

REF:  pp. 721-722

 

  1. More than 90% of people with autoimmune thyroid disease have a genetic defect affecting their ability to metabolize what?
a. Vitamin D
b. Flavonoids
c. Selenium
d. Tyrosine

 

 

ANS: A

Vitamin D is considered a prohormone with antiproliferative, differentiating, and immunosuppressive activities. Vitamin D also appears to work with other nutritional factors to help regulate immune sensitivity and may protect against development of autoantibodies.

 

REF:  p. 720

 

  1. Which of these is NOT required for the production of thyroxine (T4) and triiodothyronine (T3)?
a. Thyroid peroxidase (TPO)
b. Tyrosine
c. Thyroid-binding globulin (TBG)
d. Iodide

 

 

ANS: C

The synthesis of T3 and T4 requires tyrosine, a key amino acid involved in the production of thyroid hormone, and the trace mineral iodine. Two additional molecules of iodine bind to the tyrosyl ring in a reaction that involves thyroid peroxidase (TPO), an enzyme. When T4 is released from the thyroid, it is primarily in a bound form with thyroid-binding globulin (TBG), a protein that transports thyroid hormones through the bloodstream but is not required for production.

 

REF:  p. 710

 

  1. Thyroid heath in some adults can be improved by increasing the conversion of T4 to T3. This can be accomplished by:
a. supplementing with tyrosine.
b. correcting zinc deficiencies with zinc glycinate or zinc citrate.
c. increasing naturally occurring flavonoids in the diet.
d. cautiously supplementing with lipoic acid.

 

 

ANS: B

Nutritional agents that help support proper deiodination by the type 1 5-deiodinase enzyme include selenomethionine (as L-selenomethionine) and zinc (as zinc glycinate or zinc citrate). Human studies have repeatedly demonstrated consequent reduced concentrations of thyroid hormones when a zinc deficiency is present. Supplementation with tyrosine does not appear to have a beneficial effect on elevating thyroid hormones. Synthetic flavonoid derivatives can decrease serum T4 concentrations and inhibit both the conversion of T4 to T3 and the metabolic clearance of rT3 by the selenium-dependent 5-deiodinase. Naturally occurring flavonoids appear to have a similar inhibitory effect. Lipoic acid reduces the conversion of T4 to T3.

 

REF:  p. 720

 

  1. Cushings syndrome is characterized by weight gain, easy bruising, depression, muscle loss, and weakness. It is caused by:
a. an increased concentration of endocrine autoantibodies.
b. thiocyanate ions, which can compete with iodine for uptake by the thyroid gland.
c. too much cortisol remaining in the bloodstream over a long period.
d. thyroid hormone deficiency during pregnancy.

 

 

ANS: C

In Cushings syndrome, too much cortisol remains in the bloodstream over a long period. The exogenous form occurs when individuals take steroids or other similar medications and ceases when the medication is stopped. Endogenous Cushings syndrome is rare and occurs as the result of a tumor on the adrenal or pituitary gland.

 

REF:  p. 721

 

Mahan: Krauses Food and the Nutrition Care Process, 13th Edition

 

Test Bank

 

Chapter 44: Medical and Nutrition Therapy for Genetic Metabolic Disorders

 

 

MULTIPLE CHOICE

 

  1. An appropriate description of a metabolic disorder is an autosomal recessive disorder that
a. involves amino acids.
b. results in the reduced activity or absence of a specific enzyme.
c. occurs because the body cannot use dietary amino acids, fatty acids, or monosaccharides.
d. results in the buildup of metabolites in the blood, urine, or both.

 

 

ANS: B

Genetic metabolic disorders are mostly autosomal recessive inherited disorders that affect metabolic processes in the body through the absence or reduced activity of specific enzymes. In these metabolic disorders, body functions may become impaired by buildup of certain proteins that did not undergo conversion because of deficiency of the enzyme or lack of the end product of metabolism because of the missing enzyme.

 

REF:  p. 992

 

  1. Which of the following is NOT one of the nutritional treatments that would be provided to patients with metabolic disorders?
a. Restrict the amount of a specific substrate (nutrient) in the diet.
b. Supplement the diet with a greater amount of a safe product of metabolism.
c. Replace the defective enzyme through the diet.
d. Supplement the defective enzyme cofactor.

 

 

ANS: C

Nutritional treatment of metabolic disorders focuses on trying to make up for the missing or inactive enzyme. Ways that this could be done include restricting the dietary intake of the specific substrate that would normally be altered by the missing enzyme, supplementing the diet with the underproduced end product of the enzymes metabolism, and supplementing the patient with the enzyme. Combinations of these approaches could also be used. Provision of the defective enzyme through the diet may not be effective because the digestive process will affect the enzyme as it would any other protein.

 

REF:  p. 992

 

  1. Which of the following will NOT result in the development of phenylketonuria?
a. Deficiency in phenylalanine hydroxylase
b. Deficiency in dihydropteridine reductase
c. Insufficient synthesis of biopterin
d. Insufficiency of dietary tyrosine

 

 

ANS: D

Phenylketonuria (PKU) is characterized by phenylalanine not being converted to tyrosine. As tyrosine is an end product of the metabolic process, insufficiency of tyrosine does not lead to PKU development. PKU may develop through the lack of three different enzymes. The classic PKU involves a deficiency of phenylalanine hydroxylase and prevents the conversion of phenylalanine to tyrosine. A deficiency of dihydropteridine reductase prevents the conversion of quinonoid (qBH4) to tetrahydrobiopterin (BH4), which is the cofactor in the phe to tyr conversion. BH4 is produced from biopterin precursor. Biopterin may be limited because of deficiency of a biopterin synthetase.

 

REF:  pp. 997999

 

  1. Which of the following metabolic disorders is NOT classified as an organic acidemia?
a. Methylmalonic metabolic disorder
b. Propionic metabolic disorder
c. Isovaleric metabolic disorder
d. Arginosuccinic aciduria

 

 

ANS: D

Arginosuccinic aciduria is a urea cycle disorder that results in arginine deficiency. Methylmalonic metabolic disorder and propionic disorder promote the development of metabolic acidosis through the accumulation of organic acids. Isovaleric disorder is also an organic acidemia; however, this disorder can produce metabolic ketoacidosis.

 

REF:  pp. 993994

 

  1. Which of the following metabolic disorders is NOT a disorder of carbohydrate metabolism?
a. Hereditary glucose intolerance
b. Glycogen storage disease
c. Galactosemia
d. Fructose 1,6-diphosphatase deficiency

 

 

ANS: A

Hereditary glucose intolerance is not a known metabolic disorder. Carbohydrate metabolism disorders include hereditary fructose intolerance, galactosemia, fructose 1,6-disphosphatase deficiency, and the various glycogen storage diseases.

 

REF:  p. 994

 

  1. Which of the following is reduced in the diet in the treatment of maple syrup urine disease (MSUD)?
a. Fructose
b. Aromatic amino acids
c. Branched-chain amino acids
d. Sulfur-containing amino acids

 

 

ANS: C

MSUD is also known as branched-chain ketoaciduria, and this results from a defect in the branched-chain alpha-ketoacid dehydrogenase complex. The branched-chain amino acidsleucine, isoleucine, and valinecannot be metabolized; therefore, affected persons require the use of specialty formulas that lack BCAAs. The BCAAs are slowly introduced into the diet when plasma leucine levels are decreased as they are necessary for growth to occur. However, dietary manipulation must occur so that enough BCAAs are available to support growth but not too high to increase plasma levels of the BCAAs.

 

REF:  p. 995

 

  1. Which of the following is NOT one of the enzyme deficiencies associated with urea cycle disorders?
a. Ornithine transcarbamylase
b. HMG-CoA reductase
c. Carbamyl-phosphate synthetase
d. Arginas

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