# FREE ACBN Nutritionist MCQ Questions and Answers

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#### What weight should a patient with chronic renal disease who is obese use when performing calculations?

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Explanation:
A crucial component in treating individuals with chronic renal disease is anthropometric evaluation. Numerous calculations, such as those for calorie and protein needs, medications, and other treatments, are based on weight. It's crucial to record both current weight and weight fluctuations in the past. The dry weight should be utilized for estimates for non-obese patients because it represents metabolically active lean body weight. A patient's adjusted dry body weight should be determined to determine if they are obese or overweight. The adjusted dry weight can be calculated using the following formula, following the National Kidney Foundation KDOQI recommendations: adjusted dry weight = dry weight + [(standard body weight - dry weight) x 0.25], where the standard body weight can be determined using information from NHANES II. To avoid overfeeding, the modified dry body weight will help precisely adapt the energy and protein requirements depending on the dry lean body mass.

#### 2280 cc of a D15%, 4% amino acid, and 3% intralipid 3-in-1 TNA solution has how many calories in it?

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Explanation:
A 3-in-1 parenteral nutrition solution, commonly known as TNA or total nutritional admixtures, is utilized by many hospitals. Instead of being piggybacked onto the IV line, the intravenous fat emulsion is added to the solution. Dextrose, amino acids, lipids, electrolytes, vitamins, minerals, and other additives are all included in TNA. The total volume in this instance was 2280 cc. Three hundred forty-two grams of dextrose would be produced using a 15% dextrose solution. A gram of dextrose has 3.4 kcal. Hence, its caloric contribution is 1163 kcal. Ninety-one grams of protein, or 4% of the fluid, were amino acids (364 kcal). At 3% of the solution's lipids, 68 grams of fat are produced. Glycerol is present in lipids. Hence the caloric value is 10 kcal per gram rather than 9 kcal per gram because glycerol only provides a modest number of calories. The lipids have a caloric value of 680 kcal. The TNA has a calorie composition of about 2207 kcal overall.

#### Which of the following clinical characteristics is LEAST likely to be a sign of a patient in an acute care hospital who is nutritionally at risk?

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Explanation:
Nutrition screening must be conducted within 24 hours of admission, according to the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations). Risk variables are identified to ascertain each patient's level of nutritional risk. Risk factors commonly include body weight. A dietary risk factor would be defined as an unanticipated weight shift of more than 10% over six months or a change of 5% over one month. Even if the patient ate an appropriate diet, an obese patient who has purposefully reduced 15% of their body weight would not necessarily be in nutritional danger. Other risk factors would be prolonged periods of poor nutrition and GI function changes like nausea, vomiting, stool problems, or severe GI surgery. Several chronic conditions would also impact nutritional status. A person's nutritional status may also be impacted by specific medications, changes in their ability to chew or swallow, and social variables.

#### Which of the following clinical characteristics is least likely to be a sign that medication on this list is most likely to result in weight gain? patient in an acute care hospital who is nutritionally at risk?

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Explanation:
It's critical to identify any drugs a patient could be taking for depression because most antidepressant prescriptions can lead to weight gain. This could be the result of various mechanisms. There could be a metabolic impact, like slowing the metabolic rate. An increase in hunger brought on by medicine may also increase calorie consumption. It might also be the outcome of a general improvement in well-being brought on by a decline in depression and an increase in food consumption. The drugs least likely to increase weight are antidepressants like Serzone, Effexor, and Wellbutrin. Weight gain is more likely to result from SSRI medications and selective serotonin reuptake inhibitors. Paxil, Lexapro, Prozac, and Zoloft are a few of these. Tricyclics like Elavil and MAO inhibitors like Nardil and Parnate are more likely to contribute to weight gain.

#### Which of the following is the best method for evaluating a patient with chronic liver disease and ascites?

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Explanation:
Determining nutrition in a patient with advanced chronic liver disease and ascites is challenging since many common markers are unreliable. The fluid state has an impact on anthropometric metrics like weight for height, BMI, and triceps skinfold measurements, which do not adequately reflect muscle mass or actual weight. Because serum albumin and prealbumin are created by the liver and do not represent protein levels in liver disease, even in a well-nourished patient, they are ineffective indicators of plasma protein status. Studies on nitrogen balance may need to be more precise because of protein retention in ammonia and the possibility of hepato-renal problems that alter nitrogen excretion. The finest instrument is a personal evaluation of the world (SGA). This kind of instrument includes a physical and functional evaluation. Previous intake, weight history, the obvious loss of muscle mass, and the capacity to carry out daily activities are all things that can be assessed. Along with GI symptoms, other chronic diseases can also be detected and assessed.

#### Which of the following best summarizes when an enteral feeding protocol should be started for a patient with a traumatic brain injury?

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Explanation:
For severely ill patients, enteral feeding is always the preferred nutrition method. Feeding intolerance and gastrointestinal reflux are common traumatic brain injury (TBI) symptoms. Nasogastric tubes may usually be inserted without issue; however, early feeding is not advised due to the possibility of aspiration pneumonia and feeding intolerance. The insertion of a gastroenteric tube into the duodenum or jejunum is acceptable for some people. Early enteral feeding, which should start within the first 24 hours, has been demonstrated to help treat TBI. The patient's protein and energy needs should be at a minimum. Early enteral feedings are started with the hope that this will lessen the patient's inflammatory response, which normally peaks during the second week. It has also been demonstrated that early feeding lowers mortality. Early feeding increases blood flow to the gut and lessens bacterial translocation.

#### Immediately after admission, a patient with a history of persistent alcohol misuse and potential Wernicke encephalopathy needs to be supplemented with.

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Explanation:
Numerous nutrients can become deficient as a result of chronic alcohol usage. Alcohol consumption, poor thiamine intake, and impaired thiamine thiamine thiamine thiamine absorption can lead to Wernicke encephalopathy. Memory loss, decreased appetite, nausea and vomiting, trouble sleeping, weakness, and anxiety are all symptoms of thiamine deficiency. Confusion, disorientation, hallucinations, and coma may develop as the deficit worsens—a thiamine shortage known as beriberi causes heart failure and neurological problems. If Wernicke encephalopathy is suspected, urgent IV thiamine therapy should start, followed by a gradual switch to oral thiamine throughout one to two weeks. Due to its role as a cofactor in numerous thiamine processes, magnesium must also be supplemented. Numerous other nutrients, such as folate, fat-soluble vitamins, zinc, selenium, potassium, and phosphate, may also be insufficient.